111/14 APOLOGIES FOR ABSENCE Apologies were received from Alexandra Howells, Chief Operating Officer and Ceri Phillips, Non Officer Member.

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1 UNCONFIRMED Minutes of the ABMU Health Board Meeting held on 31 st July 2014 in the Waterton Technology Centre Present: In Attendance: Andrew Davies, Chairman (in the Chair) Paul Roberts, Chief Executive Alan Stevenson, Associate Board Member Paul Newman, Non Officer Member Ed Roberts, Non Officer Member Eifion Williams, Director of Finance Paul Stauber, Director of Princess of Wales Hospital Melvyn Nott, Non Officer Member Gaynor Richards, Non Officer Member Sue Cooper, Associate Board Member Rhian Evans, Non Officer Member Michael Williams, Non Officer Member Darren Griffiths, Acting Director of Planning & Performance Christine Williams, Acting Director of Nursing Hamish Laing, Medical Director, Charles Janczewski, Non Officer Member Chantal Patel, Non Officer Member Barry Goldberg, Non Officer Member Sara Hayes, Director of Public Health Rory Farrelly, Director of Nursing & Patient Experience Sandra Miller, Non Officer Member Andrew Phillips, Director of Therapies & Health Science Geraint Evans, Acting Director of Workforce & Organisational Development Emrys Davies, Welsh Ambulance Services Trust (WAST) Non Officer Member Steve Combe, Board Secretary Wendy Penrhyn-Jones, Head of Corporate Administration Roger Smith, Chair, ABM Community Health Council (until 129/14) Dorothy Edwards, Assistant Director, Primary Care & Partnerships (for 121/14) 111/14 APOLOGIES FOR ABSENCE Apologies were received from Alexandra Howells, Chief Operating Officer and Ceri Phillips, Non Officer Member. Andrew Davies welcomed Rory Farrelly and Roger Smith to their first Board Meeting and congratulated Emrys Davies on his appointment to the WAST Board. 1

2 112/14 DECLARATIONS OF INTEREST 113/14 MINUTES Sandra Miller declared an interest in any matters relating to Neath Port Talbot County Borough Council, Ed Roberts declared an interest in any matters relating to Carers and Gaynor Richards declared an interest in any matters relating to Neath Port Talbot Council for Voluntary Services. The minutes of the meetings held on 22 nd May and 3 rd June were received and confirmed as a correct record. 114/14 ACTION LOG ARISING FROM ABOVE MEETING With reference to local authority representation on the Stakeholder Reference Group (SRG), Rhian Evans stated that a member had consistently sat on the group from Bridgend, a representative had been on the group from Neath Port Talbot until the autumn of 2013 although Swansea s representative had yet to join the group. 115/14 MATTERS ARISING There were none. 116/14 PATIENT STORY An oral report from Rory Farrelly was received. In introducing the report, the following points were raised: An opportunity to reflect on the way in which the patient story was gathered and presented to the Board needed to be taken; The Board s session with patients and voluntary sector representatives on 30 th June 2014 which presented the opportunity to hear directly from service users who needed to be at the centre of service delivery decisions patient centred care; The ways in which successes and good practice were celebrated and lessons learned and shared across the organisation needed to flow from the patient story. In discussing the report, the following points were raised: Paul Newman concurred that services needed to be patient-focussed and advised that following each meeting of the Quality & Safety (Q & S) Committee its members visited a clinical area to conduct a quality spot check which allowed staff to feedback things that were going well and challenges. He added the ABM Community Health Council (CHC) was also a source of patient feedback and he hoped that it would be possible to derive patient stories from the CHC for future Q & S meetings which were now taking place 2

3 at sites around ABMU. Chantal Patel stated that the sharing of information gathered from patient stories was only one aspect of patient experience and whilst she acknowledged that changes were being made to the means by which such feedback was collected she did not feel the Health Board yet held a complete picture. Gaynor Richards said that as part of the actions being taken in response to the Andrews Report the voluntary sector had been invited to make a contribution to this important area. Paul Roberts said that he had always taken time to speak with patients but since the publication of the Andrews Report had spent a lot more time doing this. Andrew Davies referenced that improvement was everyone s responsibility and that to be a true learning organisation both the positives and negatives needed to be taken from patient feedback. Rory Farrelly concurred underlining the important of such learning being shared across the organisation. Rhian Evans extended an invitation to Rory Farrelly to attend the next meeting of the SRG which had representation from more than 20 agencies. Resolved: The Board supported the proposed way forward 117/14 UPDATE ON TRUSTED TO CARE ANDREWS REPORT A report setting out progress with the implementation of the actions arising from the Andrews Report was received. In presenting the report, Paul Roberts highlighted the following points:- The report captured achievements eight weeks post-publication and the further progress made in the intervening three weeks; Phase One had been focussed on communicating with staff and stakeholders whereas the recent focus had moved onto checking ; The concept of the ideal ward was to be rolled as a template and this would involve multi-disciplinary training; Unannounced spot-checks had taken place by Welsh Government representatives at Swansea Hospitals. Formal feedback would be provided once received. In discussing the report the following points were raised: Hamish Laing stated that clarity around patient medication issues had been provided to staff and guidelines and policies had been re-issued. Electronic (e) prescribing systems would also help address medication issues. Hamish Laing added that there were some patient environment issues to resolve and work was also underway under the 1000 Lives programme to help improve systems and processes. 3

4 Rory Farrelly referenced the issue of nursing documentation which due to its voluminous nature was taking a significant amount of time to complete. A review was therefore underway with a view to reducing this whilst still capturing important information. Rory Farrelly added that he was also involved in a review of nursing numbers which would consider issues such as skill-mix as well as patient acuity. Andrew Davies stated that this work was a key priority for the organisation and urged Non Officer/Associate Board Members to visit the Renal Ward at Morriston Hospital where, amongst other significant service changes, e prescribing was already in use and bringing demonstrable benefits for patients and staff. Ed Roberts said that e prescribing was already in use within primary care. Whilst acknowledging the benefits of e prescribing, the Director of Public Health said that it remained a tool rather than a solution. Sandra Miller noted that the services of a Consultant Nurse and Royal College of Nursing (RCN) leads had been secured to help the Andrews Task Force take forward the actions and said that there was expertise across all of the unions. Paul Roberts advised that the RCN had been relevant in this case due to their dual role but that he was content to consider what other expertise may also be available. Sandra Miller also raised the issue of a lack of storage facilities at ward level which was being exacerbated by the continued downsizing of the estates staff and suggested there was a need to reflect on this. Paul Roberts said that he acknowledged the importance of having a responsive estates team and that the new Director of Human Resources would soon be appointed who would be best placed to look at such workforce issues. The Chief Executive acknowledged the issues relating to storage facilities and said this related in part to the level of disposable items being used. Sandra Miller added that the locking of ward doors could have an impact with regard to deprivation of liberties. Sue Cooper said that Bridgend County Borough Council was working with the Health Board to look at this issue. Paul Stauber highlighted the need for consistent application of solutions across the organisation. Sara Hayes stated that there were two other challenges that needed to be considered, these being actions to avoid hospital admissions and where this was necessary, actions to ensure speedy discharge. Barry Goldberg stated that it would be important to consider how well the organisation was performing in terms of discharge and follow-up care and such matters could not be assessed from spot-checks and could only come from gathering more patient experience information. Alan Stevenson said that as a GP he experienced instances where patients had not had robust discharge arrangements and suggested that valuable information could therefore be gained by listening to GPs. 4

5 Paul Newman sought clarity around the organisational response to Never Events. Rory Farrelly said that firstly it was important to learn from the instance as the organisation needed to provide a supportive learning environment but that where staff did not learn from this the matter would be considered as a professional practice issue and managed accordingly. Charles Janczewski said that he had been involved in the development of the Ward Assurance Framework following the publication of the Andrews Report and from this he recognised the challenges posed in caring for the frail elderly. He added that as part of his Non Officer Member role he spoke with patients who had offered positive feedback in terms of care delivery. Sandra Miller sought clarity around the timing of patient medication rounds as these appeared to be taking place when the ward was already at its most busy. Michael Williams said that spot-checks and the Friends & Family Test had limitations and sought clarity around when it was anticipated that there would be a comprehensive system in place to measure patient outcomes and how this linked to the Integrated Medium Term Plan (IMTP). Michael Williams added that he was keen to look at clinical workload and patient outcomes rather than just patient throughput. Paul Roberts acknowledged that whilst spot-checks provided valuable information other mechanisms were also needed. He added that considerable work was being undertaken in partnership with staff through the In Your Shoes programme and that this was highlighting well motivated leaders that could make a difference. In concluding discussions, Andrew Davies confirmed that the Board would receive a progress report at each of its meetings. Resolved: The report be noted. 118/14 REPORT FROM CHAIRMAN A report on significant policy issues was received. In introducing the report, Andrew Davies highlighted the following issues: The In Your Shoes event which enabled Board members to participate in a structured approach to listen to patients; A Future Generations Bill which had recently been placed before the National Assembly which had significant implications for the Health Service; The Social Services and Wellbeing (Wales) Act which would come into force from 2016 reforming and integrating social services law which had clear linkages with the Future Generations Bill; The Welsh Government s response to the Williams Commission which the Board would need to consider; 5

6 Resolved: The request for approval of the appointment of Alan Stevenson as Associate Board Member on the basis that this would need to be referred to the Minister for ratification. In discussing the report the following points were raised: Melvyn Nott referenced a paper being produced by the Welsh Local Government Association in relation to the recommendations of the Williams Commission. Sue Cooper said that the Social Services and Wellbeing Act was not solely a matter for social services and would require closer working arrangements between health & social services and also the need to encourage greater involvement from third sector partners. The issue was being considered through the Western Bay Project. Andrew Davies stated that the legislation had profound implications for the health service as well as providing opportunities for social enterprises. Gaynor Richards referenced an event being planned in relation to the Act which would take place on 30 th September the invitations for which would soon be issued. The report be noted The appointment of Alan Stevenson for a further year be approved subject to Ministerial approval. 119/14 CHIEF EXECUTIVE S REPORT A report on various issues impacting on the Health Board was received. In introducing the report, Paul Roberts highlighted the following points: The IMTP which had been approved by Welsh Government; The implementation arrangements that were being put in place to take forward the agreed service models arising out of the South Wales Programme (SWP) which would be reported in further detail to the next meeting; An update on actions in response to the report into Betsi Cadwaladr University Health Board (BCUHB); The appointment of Sian Harrop-Griffiths to the position of Director of Strategy and the pending appointment of the Director of Human Resources; The Ministerial Statement on Pay Awards and Contracts; The award of MBE s in the Queen s Birthday Honours to two members of staff; The NHS Health at Work Award. In discussing the report, the following points were raised: Paul Roberts congratulated Darren Griffiths and his team for their hard work in ensuring the IMTP was approved. 6

7 Sandra Miller said that the pay award settlement had not been well received by union members and that English colleagues were balloting. Barry Goldberg said that one of the critical success factors in relation to SWP would be integrating information systems. Paul Roberts confirmed that this had been raised. Hamish Laing added that the South Central Alliance was arranging for records and IT leads to scope out the challenge and the possible solutions. It was acknowledged that the creation of systems to facilitate the movement of records was likely to take longer to resolve. Ed Roberts referenced page thirteen of the position statement in response to the review of BCUHB and sought clarity around the meaning of supervisory time. Rory Farrelly advised that this related to a member of staff being available in the clinical area rather than in an office environment. He added that he was clear that he would be very visible to staff in his role as Director of Nursing & Patient Experience as would Lead Nurses. Resolved: The report be noted. 120/14 PERFORMANCE MANAGEMENT ARRANGEMENTS EMERGENCY AMBULANCE SERVICES ABMU A report regarding formal performance management arrangements for emergency ambulance services was received. In introducing the report, Paul Stauber highlighted the following points: Health Boards were now accountable for the planning and provision emergency ambulance services for their local population; ABMU was now accountable for the performance of emergency ambulance services including response times as well as handover times; An improvement plan had been developed in conjunction with WAST to ensure that the agreed trajectory of performance was achieved; Recent performance indicates an improving trend despite increases in demand. In discussing the report the following points were raised: Paul Stauber advised that handover times were linked to patient flow, the size of the Accident & Emergency Department as well as the number of ambulances that arrived in close succession. Andrew Davies stated that Emrys Davies had been appointed to the WAST Board as a Non Executive and was ABMU s designated link member. Emrys Davies said that improvements had been achieved through joint-working. He added that he was a conduit to the WAST Board and was available to help with any local issues in ABMU. Sandra Miller said that the Health Board needed a coherent transport plan and made reference to the availability of the Neath to Morriston bus service that 7

8 operated between 6:15am - 4:45pm which needed publicising to staff in the relevant areas. Andrew Davies advised that this issue had been explored as part of the SWP work but accepted that it may need further consideration. Charles Janczewski said that whilst recognising the challenges involved, there remained more to do to improve emergency ambulance response times. Resolved: The report be noted. 121/14 ABMU PRIMARY CARE ANNUAL REPORT An Annual Report providing a summary of progress against the priorities and actions identified for Primary Care and across the four independent contractor professions was received. In introducing the report, Dorothy Edwards highlighted the following points: Progress against the strategic priorities set in 2013/14; Priorities for development in 2014/15 that would need to be reflected in the IMTP such as consideration of different service models; Key challenges in taking forward the delivery of primary care services; The Summit taking place later that day between Health Boards and the Welsh Government which represented a major strategic discussion forum. In discussing the Annual Report, the following points were raised: The Welsh Government s recent announcement of financial support around the development of new workforce models which would require the submission of bids. Andrew Davies referenced the valuable discussions that had taken place around primary care issues at the June Board Development Session. He added that the Deanery was currently looking at primary care training issues to assist in the response to the issue of sustainability of practices. Barry Goldberg cited the issue of improving communication and noted that electronic referrals had not been referenced and suggested that this be incorporated into the Annual Report. Barry Goldberg added that on a recent visit to GP surgeries he had not felt there was evidence of ownership of Locally Enhanced Services (LES). Alan Stevenson stated that it remained a challenge to develop a LES within the available resources. Paul Roberts said that this was linked ongoing work around Community Networks which he felt would bring increased levels of commitment. Dorothy Edwards acknowledged that it could take time to implement LES but that moving to a two/ three year process would allow time for staff to become suitably skilled to deliver new services. 8

9 Sandra Miller sought clarity around the new surgeries due to open in Neath Port Talbot. Darren Griffiths advised that a lease date had been agreed for Briton Ferry but the plans around the Vale of Neath Surgery had been delayed. Andrew Davies said that it would be necessary for the Health Board to be innovative in sourcing capital to support such primary care projects as traditional capital resources were scarce. Consideration needed to be given to exploring joint development opportunities with local authority and other partners. Sara Hayes stressed the importance of the development of Community Networks as these formed the basis for public health intervention and commissioning. Gaynor Richards referenced the additional money that had been made available in relation to health inequalities and said this would need dialogue with partners. Dorothy Edwards responded that consideration would need to be given to the bidding criteria. Ed Roberts welcomed the document adding that there was a need for further integration between primary and secondary care services. Resolved: The report be approved 122/14 DEVELOPMENT OF INTEGRATED HEALTH & SOCIAL CARE SERVICES, WESTERN BAY STATEMENT OF INTENT A report seeking approval of a Statement of Intent to develop integrated health & social care services across the Western Bay was received. In introducing the report, Hamish Laing highlighted the following points: Welsh Government required the Health Board and its partners to agree the Statement of Intent to integrate health and social care services for older people with complex needs; The Statement had been endorsed by the Western Bay Programme Board; The intention was to develop integrated community services in each of the three local authority areas and to work towards a pooled budget for services in line with the approved business case. In discussing the report the following points were raised: Paul Newman sought clarity around when a further report would be received on the arrangements for pooling resources and governance arrangements. Andrew Davies concurred that this was an important issue and said that there had been discussions regarding governance and the debate would continue at the meeting the following day. 9

10 Sandra Miller sought clarity around whether there was an intention to reduce beds at Gorseinon Hospital which was operating as a step-down facility. Hamish Laing said that he was not aware of a proposal to change bed numbers. Andrew Davies and Paul Roberts concurred. Gaynor Richards said that the Third Sector was delighted to have been invited to participate in the work of the Western Bay Programme Board. She added that while the document referenced over 2000 organisations being involved there were actually 4,000 in this sector alone that could potentially play a role in the preventative agenda. Barry Goldberg sought clarity around the linkages with Health Board governance arrangements. Paul Roberts responded that it was helpful that two Non Officer Members had raised this issue in addition to Executives. He acknowledged that if ABMU was to be ambitious around what could be achieved by the project then robust governance arrangements were essential. Michael Williams stated that he sat on the Scrutiny Committee where the issue of reporting arrangements for Local Service Boards (LSBs) had been raised. Eifion Williams stated that the work of the Western Bay did not feature prominently in LSB agendas. Andrew Davies stated that the reporting arrangements needed to be clarified. Resolved: The Statement of Intent be approved. 123/14 PUBLIC SERVICE OMBUDSMAN (PSO) REPORT SECTION 16 A report published by the PSO on 27 th May 2014 was received. In introducing the report, Rory Farrelly highlighted the following: The matter related to a failure to diagnose the patient s condition and undertake appropriate investigations; The complainant was dissatisfied with the Health Board s investigation and the PSO s investigation upheld a number of failings; The Health Board fully accepted the recommendations contained within the report and all of these had now been acted upon. In discussing the report, the following points were raised: Barry Goldberg sought clarity around the processes that Health Board had in place to investigate complaints as there had been serious issues raised by the Ombudsman on a number of occasions. Rory Farrelly responded that the department that co-ordinated such matters had been restructured and there had been a change in focus to ensure that the response was of appropriate quality even if this resulted in the target 30 day response time not being achieved. He added that more meetings were also now being offered to complainants with a view to focussing on the root of their concerns. It was acknowledged that there were a number of existing cases currently with the Ombudsman that had yet to reach a conclusion. 10

11 Rory Farrelly added that a significant amount of staff training had been put in place to address culture and staff behaviour issues. Hamish Laing stated that the National Q & S Forum had been discussing the need to encourage Welsh Government to move towards measuring outcomes which would look at the number of responses that satisfied complainants rather than the number processed within the thirty day target. Paul Roberts stated that where care had not been of the required standard it was important to acknowledge this. He added that nothing was more powerful than speaking directly with patients and relatives as health records could only provide part of the picture. Ed Roberts advocated early resolution of complaints where this was possible. Hamish Laing advised that he had recently met the PSO and was confident that the changes put into place would have the desired positive impact. Resolved: The report be noted. 124/14 MANAGING COMPLAINTS & CONCERNS A report summarising various changes being implemented around how complaints were investigated, responded to and learned from was received. In introducing the report, Rory Farrelly highlighted the following: Since February 2014 changes had been made to the way in which formal complaints were managed; Findings of the Review of Complaint Handling in the NHS; Work to reduce the back-log of complaints; Departmental structural changes; Staff Training & Education. In discussing the report the following points were raised: Andrew Davies thanked Rory Farrelly and his team for all the work to improve systems and processes in this important area. Michael Williams emphasised the importance of sharing learning across the organisation. Chantal Patel concurred adding that patient stories were very important tools. Sue Cooper said that it was helpful to recognise the level of compliments received and that both positive and negative feedback were valuable. Paul Newman stated that he had repeatedly been embarrassed following instances of poor complaint handling within the organisation. He added that whether responses were generated at service level or corporately it was important that the staff concerned were appropriately resourced. Emrys Davies said that the complaints policy needed to be linked to education, training and professional development. Andrew Davies suggested 11

12 that given Emrys Davies quality management experience staff could learn from his skills in this area and asked Rory Farrelly to make links in this respect. Rhian Evans suggested that there may be opportunities when working with service users to create records together. Sandra Miller said that there was a need to improve communication and that events similar to the In Your Shoes Board Development Day should be held for Ward Managers, Staff Nurses and Healthcare Support Workers who would be better placed to cascade the learning than Board Members. Rory Farrelly stated it was important to create time to learn from complaints and for staff to recognise they were accountable. Andrew Davies referenced the recent presentation by ABMU staff to the National Assembly s Health & Social Services Committee which had received positive feedback. Resolve: The report be noted. 125/14 INTEGRATED PERFORMANCE REPORT A report providing trend-based analysis of the Health Board s performance against key measures together with an assessment of their relative level of delivery against national and local targets was received. In introducing the report, the following points were highlighted: Work to map performance and align this to outputs and quality was being incorporated into the assurance framework along with comparative benchmarking; Actions in place to improve the monitoring of the 62 day delivery Cancer Services target which stood at 82% at the end of June 2014 and the 98% target had been achieved for non-urgent cases. Referral to Treatment rates at the end of May 2014; Home vaccinations which were being offered to those who failed to present at clinic to increase take-up; The significant under-performance in relation to smoking cessation; Pathways which were being designed for bariatric surgery; The robust action plan in relation to infection prevention. In discussing the report the following points were raised: Paul Roberts said that Welsh Government were clear in relation to the 62 day Cancer Services target in that it needed to improve in line with timescales set out in the IMTP. Charles Janczewski asked if ABMU was in touch with patients so that they were aware of how long they could expect to wait for treatment. Darren Griffiths advised that any communication would take place at the clinical 12

13 interface level. Hamish Laing advised that there were key worker specialist nurses that would provide such an interface but that the treatment pathway could be affected by the individual patient s clinical condition. It was acknowledged that it was important to provide patients with a clear description of what they could expect at the start of their patient journey. Alan Stevenson stated that any delays in patient care impacted on GPs. Hamish Laing acknowledged this point adding that in such instances patients should be encouraged to contact their key worker at hospital level. Alan Stevenson clarified that his point was not specific to cancer care. Paul Roberts accepted that patient information needed to be improved. Rhian Evans suggested that if patients could access their own records then it would be possible for them to identify where they were in the pathway. Hamish Laing concurred but advised that it could take years to progress to this point. Michael Williams sought clarity around the influence of e cigarettes. Sara Hayes advised that their availability appeared to be reducing the urgency by which the public sought to give-up smoking. She added that it was her intention to propose that the existing ABMU no smoking policy be extended to include e cigarettes. Resolved: The report be noted. 126/14 MORTALITY REVIEWS PROCESS A report setting out the importance of the mortality review process, current compliance levels and an outline of future action improvements was received. In introducing the report, Hamish Laing highlighted the following: The Palmer Report regarding measures of mortality in Wales which strongly supported clinical review of all in-hospital deaths and recommended extending such reviews in primary care; The two-stage mortality review process in use within ABMU and the common and recurring themes emerging from completed reviews; The higher Risk Adjusted Mortality Index (RAMI) ratios at Neath Port Talbot and Singleton Hospitals were due to statistical factors rather than poor care; In discussing the report the following points were raised: Hamish Laing stated that RAMI did not provide adequate assurance. He added that bearing in mind Professor Palmer s view of RAMI, further guidance was awaited from Welsh Government as to the way forward. Stage One Mortality Review compliance was in excess of 95%, however where a more detailed review was required less than a third were complete for the period March April

14 Paul Newman asked how hot spots would be identified and where would this be reported. Hamish Laing responded that death certificate information and learning will be accessible from a new information system which will bring significant benefits. Barry Goldberg sought clarity around clinical coding and the RAMI. Hamish Laing advised that clinical coding was not the sole source of information used in calculating RAMI and that as patient outcome measures were reported clinical coding would be important although it may be necessary to use this information differently. The need for timely accurate coding would remain essential. Andrew Davies said that he was encouraged by the level of discussion around patient outcomes. Resolved: The report be noted. 127/14 FINANCIAL POSITION MONTH 3 A report setting out the overall financial position to 30 th received. In introducing the report, Eifion Williams highlighted the following: 14 June 2014 was The IMTP identified inflationary costs of some 27.5m, service investment requirements of 17m and an underlying deficit of 15m carried forward from previous years which resulted in a total additional cost of 59.5m for the Health Board in 2014/15; Against these costs, savings of 33.4m were planned leaving a shortfall of 26.1m which was being reported as a forecast year-end deficit pending the receipt of further financial support from the Welsh Government in-line with the approved IMTP; An over-spend of 9.487m to the end of June 2014, mainly due to budgetary overspends and slippage against delivering the required savings targets; Budget holders had been reminded of their responsibility to ensure services were delivered within agreed budgets; The Capital Investment Plan was currently awaiting approval by the Capital Investment Committee with the majority of schemes progressing to plan; Cumulative Public Sector Payment Policy (PSPP) compliance levels to the end of June 2014 stood at 90.19% of supplier invoices paid within 30 days and in-month compliance of 91.02% against a target of 95%. In discussing the report, the following points were raised: Andrew Davies referenced a previous request for spending profiles for the last four/five years. Eifion Williams undertook to provide this. Paul Newman sought clarity around whether there was any concern regarding

15 the ability to recover non-nhs debts over 91 days. Eifion Williams advised that processes were in place to recover such debts. Charles Janczewski referenced the debts owed to ABMU by other Health Boards. Paul Roberts advised that this was being taken up with his colleague Chief Executives. Resolved: The report be noted. 128/14 RESEARCH & DEVELOPMENT (R&D) REPORT A report setting out details of R & D activity was received. In introducing the report, Hamish Laing highlighted the following points: Large numbers of patients were being recruited to clinical trials; Bids going forward to build bigger research groups the outcome of which was anticipated in the autumn; The next report would include work ongoing with the other Universities. In discussing the report the following points were raised: Barry Goldberg sought clarity around the level of engagement with the pharmaceutical industry. Hamish Laing advised that ABMU R&D performed well in this respect with very successful bidding rounds in relation to work with commercial sponsors. Paul Roberts suggested that the next report provided a forward look with clarity around how R & D linked-in with the IMTP. Paul Newman concurred advising that it would be useful to see the future vision for R&D. Resolved: The report be noted. 129/14 FUNDED NURSING CARE (FNC) A report setting out the current position since the previous report in November 2013 and including the Chief Executive Group recommendations was received. In discussing the report and the potential equality impact issues, the following points were raised: Eifion Williams advised the pay award had recently been announced and its impact needed to be worked through. The labour inflation mechanism was an attempt to create an equitable solution for dealing with annual inflationary pressures on the pay elements of the FNC fee. An uplift of 1 had been suggested in relation to continence products in recognition of inflationary pressures. Paul Stauber referenced the two nursing homes that were closing in the Bridgend area which would bring additional pressures during the winter. 15

16 Eifion Williams advised that there was greater room for flexibility over Continuing Heath Care fees. Paul Newman proposed that the recommendations in the report be approved on a without prejudice basis. Andrew Davies concurred. Resolved: The report be approved on a without prejudice basis. 130/14 CHILDREN & YOUNG PEOPLE S SERVICES UPDATE A report setting out the challenges faced by the service in delivering safe and effective model of care for Children & Young People was received. In introducing the report, Rory Farrelly highlighted the following: The plan to review the terms of reference and work plan for the Children & Young People s Strategy Group with progress reports to the Board; A review of the current framework for service delivery across the organisation. In discussing the report, the following points were raised: Gaynor Richards as Champion for this service said that she was committed to putting children at the heart of the service and work had begun on a Charter which children and young people were contributing to. A Children s Conference was planned for 17 th November 2014 and the draft charter would be launched at that event. Gaynor Richards added that Children & Young People s Services needed to be a key issue on the Board s agenda. Andrew Davies said that the plans showed practical action which underlined the IMTP commitment for ABMU to be a rights respecting organisation and mainstreaming this issue. Ed Roberts referenced Child & Adolescent Mental Health Services (CAMHS) which were provided on ABMU s behalf by Cwm Taf Health Board. Darren Griffiths advised that a multi-disciplinary group were putting forward a planning framework around CAMHS. Operational issues were being taken up with Cwm Taf Health Board in the meantime. A report was being prepared for the September Health Board meeting on CAMHS. Resolved: The report be noted. A report on the development of a Children s Charter be prepared for the September Health Board. A report on CAMHS be submitted to the September Health Board. 16

17 131/14 PROPOSALS FOR REVISING BOARD COMMITTEES A report setting out proposed Board Committee arrangements following a governance review was received. In introducing the report, Steve Combe highlighted the following: The restructuring provided a means of extending the work of the Board through its committee structure to enable it to focus on its main role; The creation of a Strategy Committee and also a Performance Committee; The merger of the Remuneration & Terms of Service Committee with the Workforce & Organisational Development Committee and the Mental Heath Legislative Committee for Mental Health & Learning Disabilities with the Powers of Discharge Committee; Determination of membership would be a matter considered by the Chairman following agreement of revised arrangements; Board reporting should be in the form of an assurance report as was being piloted by the Q&S Committee; The proposal that review of the arrangements take place in six-months time. In discussing the report, the following points were raised: Chantal Patel raised the issue of the Public and Patient Experience Group and the equal rights of its members which could result in a conflict of interest. Steve Combe advised that this issue had been discussed at the Chairs Advisory Group and with Wales Audit Office. The Board was unitary and so the issue was whether Committees should also be. Hamish Laing suggested that consideration be given to reviewing existing groups so that there was opportunity to re-shape and obtain consistency. Ed Roberts concurred. Rory Farrelly stated there was a need to refocus the Patient Experience Group. Rhian Evans stated that meetings of the SRG had previously been cancelled due to the non-availability of ABMU staff. Resolved: The report be approved. 132/14 KEY ISSUES REPORT FROM BOARD COMMITTEES / ADVISORY FORA / FORUMS SEEKING APPROVAL / RATIFICATION a) Audit Committee A summary of key issues arising from meetings held on 15 th May and 3 rd June was received. In discussing the report, Charles Janczewski advised that the 17

18 Committee had met again on 29 th July. Paul Roberts had attended this meeting to respond members in relation of the conclusions of the Head of Internal Audit s Audit Opinion and Annual Report for 2013/14 when assurances were given that that the issues were receiving the full attention of the Executive Team. b) Charitable Funds Committee A summary of the key issues arising from the meeting held on 12 th June 2014 was received. In discussing the report, Charles Janczewski advised that the Committee had received the final report on the small grants scheme for the voluntary sector. He added that it was agreed that the Health Board s Trustees would need to review the current Charitable Funds Investment Policy at its next meeting when the Investment Manager would respond to issues raised in relation to ethical investment considerations. c) Quality & Safety Committee A summary of key issues arising from the meeting held on 1 st May and 19 th June 2014 was received. In discussing the report Paul Newman advised that the summary had been prepared in a revised format. Andrew Davies commented that he felt the format was helpful adding that many of the issues contained within the summary had been discussed at the Board meeting that day. Sandra Miller noted from the work programme that no future meetings were currently planned at Neath Port Talbot. d) Mental Health Legislative Committee for Mental Health & Learning Disabilities A summary of key issues arising from the meeting held on 20 th May 2014 was received. In discussing the report Sandra Miller referenced the numbers of patients who failed to arrive for their appointments and asked whether there was a reason to explain why this was happening. Ed Roberts advised that this issue was being explored. 133/14 CHANGES TO PRIMARY CARE CONTRACTOR ARRANGEMENTS A report setting out changes to Primary Care Contractor Arrangements for the period May to June 2014 was received and noted 134/14 AFFIXING THE COMMON SEAL A report outlining documents to which the Common Seal had been affixed since the last meeting was received and noted. 18

19 135/14 CHAIRMAN S ACTIONS A report setting out details of two instances of requests for Chairman s Action was ratified. 136/14 BOARD BUSINESS CYCLE The Board Business Cycle was noted. 137/14 ANY OTHER BUSINESS Chantal Patel raised the issue of Non Officer Member Champion Roles and advised that no guidance had been received regarding this. Steve Combe undertook to respond outside the meeting. 138/14 DATE OF NEXT MEETING The Board would next meet on 18 th September 2014 (Annual General Meeting) and 25 th September 2014 (scheduled bi-monthly meeting). Following the meeting the date of the AGM was changed to coincide with the next meeting of the Health Board (25 th September 2014) Andrew Davies (Chairman) Date: 19