Welsh Renal Clinical Network (WRCN) Board Meeting

Transcription

1 Welsh Renal Clinical Network (WRCN) Board Meeting Minutes of the meeting held on Friday, at Bowel Screening Wales, Llantrisant (VC links from North Wales & Morriston) Present Dr Kieron Donovan Dr Stuart Robertson Ms Elizabeth Baker Ms Janet Williams In attendance Mr Argiris Asderakis Mr Bill Morgan Mr David Heyburn Mr Gareth Davies Mr Jonathan Matthews Mr Nick Wilson Ms Helen Harris Ms Kate May Ms Lynne Callow Ms Tersa Humphries Ms Toni Hamlett Renal Network All Wales Clinical Lead and Clinical Information Lead (Chair) Lead Clinician in the North (BCU) Renal Network Lead Nurse (South Wales) Representative of WKPA Clinical Director, Nephrology and Transplantation, Cardiff and Vale Patient Representative Transport Project Renal Network Manager Patient Representative Transport Project Renal Network Coordinator Deputy Renal Network Manager Financial Accountant Renal Network Transport Manager National Kidney Federation DGM Regional Services Directorate Unit Manager (BCU) Apologies Dr Ashraf Mikhail Dr Khesh Sidhu Mr Berwyn Owen Mr Bob Evans Mr Brent Roberts Mr Edward Rees Mr John Reever Mr Stuart Davies Ms Kim Williams Ms Melanie Wager Ms Nell Brown Ms Pam Wenger Professor Jean White Renal Network Lead for Clinical Governance / Clinical Director (ABMU) Deputy Medical Director, WHSSC National Renal Pharmacy Advisor Director of Finance, BCUHB Chairman, WKPA Welsh Government WKPA Director of Finance, WHSSC Renal Network Performance Analyst Kidney Wales Foundation Directorate Unit Manager (ABMU) Committee Secretary, WHSSC Welsh Government Chief Nursing Officer Welsh Renal Clinical Network Board Minutes Page 1

2 Professor John Williams Professor Paul Dummer Renal Network Chair Non-office member LHB Representative Agenda Item Action log WRCN14/14 Welcome, Introductions and Apologies for Absence The Chair welcomed attendees to the meeting. Apologies of those members unable to attend were noted. WRCN14/15 Declarations of Interest The Chair INVITED members to declare any personal or pecuniary interests, direct or indirect, in any contract, proposed contract or other matter that is the subject of consideration on any item on the agenda for the meeting. None were noted. Jonathan Matthews advised that there were some remaining declaration forms to collect from members. Action: Jonathan Matthews to chase individuals via . WRCN14/16 Minutes of the previous meeting Members RECEIVED the minutes from the Board meeting in June Members RESOLVED to RATIFY the minutes as a true and accurate record with exception to amendments within the attendee list which will be corrected. WRCN14/17 Matters Arising Renal Social Worker The Chair REPORTED that the Renal Social Worker post holder in Cardiff and Vale will be returning to work in September WRCN14/18 Action Log See Appendix 1. WRCN14/19 Report of Chair The Chair INFORMED members that the report would be compiled from the agenda and discussions of the current meeting. The report will then be submitted to the next Joint Committee. The Chair suggested it may be useful for the report to be submitted to Network Board meetings. The Board AGREED. Welsh Renal Clinical Network Board Minutes Page 2

3 Action: Inclusion of the Chairs report to be discussed with Professor John Williams at the next meeting. WRCN14/20 Risk Register The Chair INFORMED members that the format was due to be revised to comply with the new WHSSC register guidelines. Specific issues discussed: Vascular Access Nick Wilson INFORMED members that the Vascular Access service in Shrewsbury has agreed to complete a quarterly report in line with units in Wales. This will provide an opportunity to measure any risk that may exist within that unit related to vascular access. Stuart Robertson reminded the Board that the Network had taken over the commissioning of pre-dialysis service as part of a collaborative commissioning agreement with Powys Health Board. Delayed Transfers of Care The Chair advised that Cardiff and Vale had been visited by an external team as part of a review around the mortality rates identified within the UK Renal Registry returns. Whilst the issue was recognised by the network it was not by the Health Board and that one of the reflections by the external team was that the Health Board risk register didn t function as well as it could. David Heyburn felt that both the Renal and Critical Care Networks should redirect their energies and challenge the Health Boards about capacity management. Tersa Humphries advised there had also been problems within Cardiology at ABM but corrective steps have helped to ease the pressure. A live database of all patients waiting to come in has been implemented. This is circulated daily and executives have sight of it. A 6 day wait has been reduced to 2.5 days. Tersa offered to send a copy of the database metrics to David Heyburn as potential helpful information. Action: Schedule meeting with the Critical Care Network to discuss further. WRCN14/21 Dialysis Expansion Programme The Board RECEIVED the expansion programme. Noted comments included: Haverfordwest & Padarn A significant amount of work has been undertaken to bring the tender to conclusion. The work has been extremely complex; David Heyburn expressed his gratitude for the team s hard work. The tender will close on the 21 st July 2014 and the Evaluation will take Welsh Renal Clinical Network Board Minutes Page 3

4 place on the 22 nd July The Water Treatment plant in Withybush has been tested and is functioning correctly. The earliest opening date is likely to be mid- September 2013 and the latest date is likely to be November 2014 and this will depend upon the winning bidder as the mobilisation timelines differs between them (this reflects the issue of staff transfer, etc). The Padarn surgery will take 26 weeks to be refurbished. Completion date is anticipated to be by March Bangor Completion is expected in March/April North Gwent This is linked to the South East Tender and the network will be looking for an off site option following confirmation from Aneurin Bevan Health Board that there is no space at any of its sites in North Gwent which could be redeveloped. East of Swansea The Network has been asked to undertake a prioritisation exercise which will include consideration of the east of Swansea area. Both capacity and logistics need to be considered as well as impact on the Morriston renal services and capacity. West Wing Cardiff & Vale University Health Board has agreed with the Directorate of Nephrology & Transplantation s clinical strategy to move the facility off-site (This fits with their intentions to sell the site in the long term). UHW Main Unit The water treatment plant is installed and the final work to test is underway. Morriston Business case has been refined and resubmitted to Welsh Government. Morriston Annexe The completion date has been revised to Spring WRCN14/22 Finance Review 2014 David Heyburn PRESENTED the finance review to the Board. During the last Board meeting, the background and main challenges of the Network were conveyed to members. This included the anticipated risk of a 250,000 deficit. Since that meeting work has been undertaken to consider how to reduce this deficit and balance the books for 14/15. Key risks identified were: Immunosuppressant savings Welsh Renal Clinical Network Board Minutes Page 4

5 Obtaining the 379,000 non recurrent savings from WHSSC Predicted dialysis underperformance at Cardiff and Vale High cost drugs for the transplant programme Procurement Immunosuppressant savings It has been recognised there has been a delay at Cardiff and Vale with the repatriation of Immunosuppressant s but progress is now in motion. Costs associated with this delay will be limited to 600,000. The satellite dispensary should be operational by the end of July. The rate of return of patients being switched should result in completion by November. This is based on repatriation of 72 patients per week. Non Recurrent savings The WHSSC plan has now been agreed in principal and this includes the return of the non-recurrent 379,000. Transplant Programme It has been agreed to revise the SLA to the outturn of 2013/14 with an agreed mechanism for variation. Procurement The West Wales Unit Haemodialysis tender is expected to make savings of circa 80,000 FYE. The Network now anticipates breaking even with the possibility of a minor surplus. There will be no further developments/investments without a business case that is authorised by the Network Board and Joint Committee. WRCN14/23 Patient Transport David Heyburn REPORTED that the critical factor to improve dialysis transport is clear commissioning responsibility which includes Agreed performance standards; Agreed financial framework Performance Management mechanism Historically, the WRCN had an agreement with WAST to try to deliver against the standard but this has never been fulfilled or delivered. KPI s are still in use but these are flawed when it comes to applying them to dialysis transport patients. There have been repeated attempts by the WRCN to engage with Health Boards to develop momentum and ownership in improving dialysis transport but this has failed each time due to a lack of senior commitment from the Health Boards. Dialysis patients and their requirements remained on the periphery of the Griffiths Review which has recently concluded. The WRCN has requested financial information from WAST which Welsh Renal Clinical Network Board Minutes Page 5

6 would allow a better understanding of activity, give context in terms of spend and value. Information that was received recently raises a number of concerns that will be taken back to WHSSC: Commissioning responsibility is split between health boards and the WRCN based on activity pre and post 1 April 2008 (net growth from this date being the WRCNs responsibility). Since this date there has been a growth of 72 patients; far lower than expected. The amount of money invested by the Network is circa 1.2million. It's understood that this represents 37% of the total funding but pays for only 7% of the patients. Performance Management data has started to come through but requires further refinement to improve its usefulness. Patient representatives expressed significant frustration at the perceived lack of engagement by some health boards and WAST in working with them and the WRCN to improve dialysis transport. There was concern that the reasons why effective transport is important are lost on WAST, its planners and other staff and this contributes to the poor performance. There was agreement that the perfect solution would be a dedicated service but patient representatives recognised this was not likely to be financially viable. Bill Morgan expressed his belief that there was still room to extend and implement the lessons learnt from the St. Woolos pilot without the need for huge sums of money it just required greater collaboration, buy-in and engagement across NHS Wales. Action: It was AGREED that the WRCN management team raises this issue with the new Director of Specialised and Tertiary Services at WHSSC (who in previous role had been the Strategic lead for the Griffith Review) and seek advice on escalation and engagement. WRCN14/24 Any Other Business None. WRCN14/25 Date of the Next Meeting The next meeting will take place on 28 October WRCN14/16 Signed Professor John Williams (Chair) Welsh Renal Clinical Network Board Minutes Page 6

7 Date Welsh Renal Clinical Network Board Minutes Page 7

8 Appendix 1 Action Log following the previous Network Board Meeting: 6 th June 2014 Action Page Background: Action: Update: Ref. Act. 1 2 The Chair asked that all members ensure they complete the 2014/15 declaration form. Jonathan Matthews to issue the form via to those members who have not yet submitted. Act. 2 3 A meeting has been scheduled with A prioritisation exercise is to be Aneurin Bevan Health Board to receive completed and submitted to the next formal confirmation that there is no Board meeting. opportunity within existing sites for expansion or onsite development in Gwent. It is likely an offsite option will be pursued. Act. 3 4 Elizabeth Baker advised that HealthVision Swansea were reportedly behind schedule and that completion had shifted to February David Heyburn to discuss the delays with the Director of Planning at ABMu. Act. 4 Act It was noted that there had been significant delays in progressing the work at Cardiff and Vale. For every month of delay there is a further cost of 100,000 to NHS Wales. This financial risk will be reflected within the paper submitted to Joint Committee. A plan will need to be presented at the Act. 6 6 David Heyburn presented a briefing paper to the board on dialysis transport related matters. next Board meeting to show how we will reduce the budget and break even by the end of the year. David Heyburn to refine the briefing with greater focus on any performance details and financial flow information. Act. 7 6 Provide cost of reimbursement by dialysis unit across Health Boards. JM to chase remaining individuals via . Still awaiting confirmation from Richard Bowen in respect to the on/off site options. South East Wales plan will shortly be published. Satellite pharmacy is being constructed. Repatriation is due to start. The Health Board are aware of the cost and accelerating as quickly as possible. To be discussed in Transport paper. Welsh Renal Clinical Network Board Minutes Page 8

9 Act. 8 7 Kieron Donovan felt the Network should discuss other unfilled vacancies within Cardiff and Vale which are impacting on Home Therapies, Clinical Psychology and social work support. Workforce to be included within the Agenda of the September Board. The Network has written to Cardiff and Vale and this is ongoing. Welsh Renal Clinical Network Board Minutes Page 9

10 Action Ref. Appendix 2 Action Log concluding the current Network Board Meeting: Page Background: Action: 3 Dr Kieron Donovan and Nick Wilson felt it would be useful to have a copy of the last Chair s Report at the Board meeting. 3 Delayed patient transfers are an ongoing issue which cause harm. Inclusion of the Chairs report to be discussed with Professor John Williams at the next meeting. A meeting is to be scheduled with the Critical Care Network to discuss further. Welsh Renal Clinical Network Board Minutes Page 10