MINUTE OF THE MEETING OF FIFE NHS BOARD HELD ON WEDNESDAY 14 MARCH 2018 AT 10

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1 Fife NHS Board 4 MINUTE OF THE MEETING OF FIFE NHS BOARD HELD ON WEDNESDAY 14 MARCH 2018 AT AM IN THE LECTURE HALL, EDUCATION CENTRE, VICTORIA HOSPITAL, KIRKCALDY Present: Ms T Marwick (Chairperson) Mr P Hawkins, Chief Executive Dr L Bisset, Non-Executive Director Mr M Black, Non-Executive Director Mr E Clarke, Non-Executive Director Mrs C Cooper, Non-Executive Director Dr F M Elliot, Medical Director Cllr D Graham, Non-Executive Director Dr M Hannah, Director of Public Health Mr S Little, Non-Executive Director Ms J Owens, Non-Executive Director Mrs C Potter, Director of Finance Mrs M Wells, Non-Executive Director Ms H Wright, Director of Nursing In Attendance: Mr A Fairgrieve, Director of Estates, Facilities & Capital Services Ms J Gardner, Director of Planning & Strategic Partnerships /Interim Chief Operating Officer (Acute) Mr M Kellet, Director of Health & Social Care Ms B A Nelson, Director of Workforce Mrs P King, Corporate Services Manager (Minutes) 18/18 CHAIRPERSON S WELCOME AND OPENING REMARKS The Chair welcomed everyone to the Board meeting and took the opportunity to thank staff sincerely for their efforts during the recent adverse weather to ensure the resilience of services and patient safety. The NHS had again risen to the challenges presented and the Board wished to record its thanks to the many members of staff that had faced difficult journeys, worked longer hours and stayed overnight to maintain vital services for the people of Fife. The Chair reminded Members that the notes are being recorded with the Echo Pen to aid production of the minutes. These recordings are also kept on file for any possible future reference. Thanks were paid to Ms Wright for acting as Interim Chief Operating Officer (Acute) over the past few months. Ms Gardner has assumed the role as of 1 March Reference was made to recent media articles regarding the Acute Services Division. It is the position of the Board that it will maintain its legal responsibility to protect the privacy of its employees and will, therefore, not comment upon matters relating to individual staff members, past or present. 19/18 DECLARATION OF MEMBERS INTERESTS There were no declarations of interests. 20/18 APOLOGIES FOR ABSENCE Originator: Paula King Page 1 of 8 Review Date:

2 Apologies for absence were received from Mrs Brown and Ms Laing. 21/18 MINUTE OF THE PREVIOUS MEETING HELD ON 10 JANUARY 2018 The Minute of the previous meeting was approved as a true record. 22/18 MATTERS ARISING (a) Up-date on Pressures over Winter An up-date will be provided under 23/18 (b). 23/18 CHIEF EXECUTIVE S REPORT (a) Up-date Mr Hawkins reiterated thanks to staff for their support during the recent snow and for the assistance of the Royal Marines, which helped significantly in the community. Also Police vehicles that were put at our disposal and the large number of volunteers that helped transport people making sure access to services. The success of the Flu Fighters campaign was highlighted with a move in the numbers of staff vaccinated from 26% last year to just over 50% this year. This is a fantastic achievement and the aim is to increase further in Work continued with the region to compile the Regional Delivery Plan (RDP), both financial and performance. Significant work is being undertaken on Laboratories in terms of how they procure in order to get better value for money. Once an RDP is available, it will be discussed with the Board. (b) Executive Summary Integrated Performance Report: February 2018 Mr Hawkins introduced the Executive Summary that had been to each of the Governance Committees in its full format. Executive leads and Committee Chairs highlighted areas of significance, in particular: Clinical Governance Staphylococcus Aureus Bacteraemia (SAB) Although the target had not been reached, there had been a vast improvement particularly over the past few months. NHS Fife had achieved two local improvement targets with support from Healthcare Improvement Scotland (HIS) and this was a positive piece of work being taken forward particularly in Acute Services. Vascular Access Device improvement work continued with HIS. Finance, Performance & Resources Ms Gardner provided an up-date on performance related to winter and the significant challenges with the snow and confirmed that over the past Originator: Paula King Page 2 of 8 Review Date:

3 two weeks there had been an increase in acuity and more detail would be provided through the Clinical Governance Committee. Despite that, NHS Fife had managed to maintain A&E performance and elective performance and performed above most other Boards in Scotland. NHS Fife Acute Division - Performance around three key targets of 4- Hour Emergency Access, Cancer 62 day Referral to Treatment and Patient Treatment Times Guarantee (TTG) were set out in the paper. Dr Elliot explained why changes in the Prostate pathway had affected the ability to meet the standard and advised that work was underway with colleagues to try and reduce this. Health & Social Care Partnership (H&SCP) Mr Kellet echoed thanks for the wide range of support received during the snow and commented on how staff worked well together to make sure there was good flow. An update on performance related to Delayed Discharge, in particular those waiting beyond 14 days, Smoking, Child and Adolescent Mental Health Services (CAMHS) and Psychological Therapies was provided. Considerable work was being undertaken in CAMHS to try to reduce the waiting list by ensuring that people were referred appropriately to the higher tier with earlier interventions in schools by members of staff trained to understand and support mental health challenges. Financial Position The revenue position for the ten months to 31 January 2018 showed an overspend of 2.054m. Analysis of that position and taking account of the provisional results for February, indicated that a breakeven position could be achieved by 31 March This is a substantial achievement by staff and managers, particularly noting the challenges over the winter period. Mrs Potter highlighted that financial flexibility of 8.6m had been reflected in the year to date position to mitigate, in part, slippage in savings delivery and the reported position reflected the impact of a risk share with Fife Council of the total Integration Joint Board overspend. Sections 7 and 8 of the full Finance Report provided further details on the year end forecast and the next steps toward securing a balanced position. Staff Governance Ms Nelson up-dated the Board on sickness absence rates, noting that focussed discussion will take place on specific actions to improve this area, and imatters which will be reported to the Area Partnership Forum, Staff Governance Committee and the Board, as appropriate. The Board noted the information contained within the Integrated Performance Executive Summary Report. (c) Draft Annual Operational Plan and Draft Regional Delivery Plan including Financial Plan Ms Gardner presented the Draft Annual Operational Plan , that replaced the Local Delivery Plan, produced in line with guidance received from Scottish Government s (SG) NHS Scotland Director of Performance Originator: Paula King Page 3 of 8 Review Date:

4 and Delivery on 9 February Due to tight timescales, the first draft had been submitted to SG on 6 March 2018 and further iterations would be submitted to the Board following any comment from SG. Mrs Potter made reference to the Financial Planning section (4) that was a summary version of the Draft Financial Plan and Budget Setting paper on the Board s agenda today. A number of questions were asked around TTG that had been under sustained pressure during the current financial year. Full scenario planning was being undertaken with clinical staff in order to feedback to the Board, through the Committees, on the different options and to develop forward plans using the key principles of value and sustainability. Further work was also required to further target sickness absence based on current data. Plans were available to support the information contained within the table on p10 and the detail was available for Members. Members were asked to contact Ms Gardner if they were interested in attending a briefing session. Action: All/J Gardner The Board approved the Annual Operational Plan Draft Financial Plan and Budget Setting The report concluded discussions with the Board, Finance, Performance & Resources Committee and the Area Partnership Forum since Autumn and provided a recap of up-dated figures and both the underpinning assumptions and methodology used to inform the financial planning and budget setting process for , including a Service Review process to support strategic financial planning and longer term sustainability. Attention was drawn to the projected in year budget gap for of 19.6m taking into account the potential pay consequential funding and prior year savings recurring shortfall. It is important to note that a prudent view had been taken in relation to non-recurring flexibility. An early estimate of how the pay consequential funding would sit between the Health Board delegated budget and those devolved to the Integration Joint Board (IJB) had been considered and it was likely to be a 50/50 split but close working continued with the Chief Finance Officer, IJB. The Board: noted the methodology used to allocate income uplifts; noted the up-dated projected financial gap for and the potential favourable impact of pay consequential funding; noted the progress made to date on the service review templates; and approved the opening budgets set out in Appendix 1. Draft Capital Investment Programme Originator: Paula King Page 4 of 8 Review Date:

5 The paper set out the draft expenditure plan for and the future capital investment programme for each year to , noting that this was an estimate as capital funding for had not yet been formally clarified by Scottish Government Health & Social Care Directorate. A risk-based assessment is undertaken with colleagues to prioritise the capital budget and that process was currently being taken forward by the Capital Investment Group. The report also identified a number of pipeline projects that would be taken into account in the forward plan. In response to questions, an up-date was provided in relation to the Kincardine and Lochgelly Health Centres projects and the clinical services reconfiguration pipeline project. Attention was also drawn to the orthopaedic theatres project, supported in principle by the Regional Programme Board. A revised Initial Agreement had been produced that increased theatre capacity and included a 36 bedded ward and ambulatory area. This was one of the three capital investment priorities for the East Region and a report had been submitted through the Clinical Governance and Finance, Performance & Resources Committees. The Board: considered and approved the proposed capital investment plan for ; and considered and approved the proposed draft programme of investment for , recognising the pipeline of projects requires further detailed refinement and supporting business cases. 24/18 CHAIRPERSON S REPORT (a) Board Development Session 14 February 2018 Members were encouraged to contact the Chair if there were any topics that they would like discussed in more depth and these would be considered for future Board Development Sessions. The Board noted the report on the Development Session. 25/18 REVIEW OF CODE OF CORPORATE GOVERNANCE During the review process, Governance Committees had reviewed their Terms of Reference and the Standing Financial Instructions had been up-dated based on current regulations. The Audit & Risk Committee had considered the revised Code of Corporate Governance at its meeting on 14 December An Executive Summary had also been created for quick reference. Mr Hawkins referenced the large amount of work done to revise the Code of Corporate Governance and thanked the Executive Directors and Chairs of the Governance Committees for their work on it. The Chair asked Members to ensure they were familiar with the content of the Code of Corporate Governance. The Board approved the up-dated Code of Corporate Governance. Originator: Paula King Page 5 of 8 Review Date:

6 26/18 NURSING, MIDWIFERY, ALLIED HEALTH PROFESSIONS (AHPs) PROFESSIONAL ASSURANCE FRAMEWORK Ms Wright introduced the Framework that set out how the Executive Director of Nursing provided assurance to the Board on the quality and professionalism of nursing, midwifery and AHPs through the structures and processes in place to provide the right level of scrutiny and assurance across all these professions. The Framework will be reviewed as part of an annual stock-take and will be reported through the Clinical Governance Committee. Action: H Wright The Board adopted the Framework to assure itself, the public and SG on the quality of nursing, midwifery and AHP services. 27/18 NHS FIFE BOARD ASSURANCE FRAMEWORK (BAF) Ms Wright spoke to the report that provided an up-date on the six BAF risks related to Financial Sustainability, Workforce Sustainability, Environmental Sustainability, Quality & Safety, Strategic Planning and integration Joint Board that had each been considered and scrutinised at the respective standing committees. Each BAF was recently reviewed at its respective standing committee as part of the February 2018 meeting cycle and the BAF in its entirety was reported to the Audit & Risk Committee on 22 February Work is currently underway with the IJB about how to integrate these risks as one. Thanks were recorded to the Directors and the Governance Committee Chairs for the enormous amount of work undertaken to produce this document that had been scrutinised in great detail within the organisation. The Board considered and approved the Board Assurance Framework. 28/18 DUTY OF CANDOUR The paper provided the Board with information on the local position in relation to the new requirements under The Health (Tobacco, Nicotine, etc and Care ) (Scotland) Act 2016 that comes into effect on 1 April 2018 and introduces an organisational Duty of Candour to ensure that organisations are open, honest and supportive when there is an unexpected or unintended adverse event resulting in death or harm, as defined in the Act. Considerable work had been taken forward to put the Act requirements in place to be effective from 1 April 2018 and further reports would be submitted through the Clinical Governance Committee. A useful booklet had been produced that would be widely circulated throughout the organisation and the Health & Social Care Partnership and briefing sessions were being arranged to communicate with as many staff as possible. Further guidance on implementation was still awaited and any subsequent changes would be incorporated as necessary and built into the systems and processes to ensure incident reporting is part of the every day process. An up- Originator: Paula King Page 6 of 8 Review Date:

7 date report on implementation would be submitted to the Clinical Governance Committee or Board as appropriate. Action: FME The Board noted the report for information. 29/18 FLU SUCCESS UP-DATE ON STAFF FLU VACCINATION PROGRAMME Dr Hannah spoke to the report that provided a summary of the Staff Influenza Vaccination Programme in Fife, in particular the promotion, delivery and co-ordination activities that contributed to the successful achievement of the 50% staff vaccination uptake target. There are lessons to be learned in order to build on the success of this year s campaign such as the need to target areas with low uptake and reflect in our data staff that attend their own GP for the vaccination. The Board noted the report for information and congratulated all those involved. 30/18 ANNUAL WORKPLAN The Annual Workplan was presented to the Board. It was noted that the June meeting is an additional meeting outwith the normal cycle to allow NHS Fife to deliver the Annual Accounts within the SG deadline. The Board noted the workplan for /18 FIFE NHS BOARD AND COMMITTEE DATES The Board noted the dates for information. 32/18 STATUTORY AND OTHER COMMITTEE MINUTES The Board noted the below-noted Minutes and the issues raised for escalation to the Board. (a) Audit & Risk Committee dated 22 February 2018 (unconfirmed) (b) Clinical Governance Committee dated 21 February 2018 (unconfirmed) Dr Bisset highlighted the actions from the Internal Audit Report on Clinical & Care Governance Strategy and the up-dates received on the various projects about the Clinical Strategy. (c) Finance, Performance & Resources Committee Part 1 dated 27 February 2018 (unconfirmed) (d) Staff Governance Committee dated 23 February 2018 (unconfirmed) It was agreed that imatter/dignity at Work to be a topic at a future Board Development Session. (e) SEAT & East Region Programme Board dated 24 November 2017 Originator: Paula King Page 7 of 8 Review Date:

8 33/18 FOR INFORMATION: The Board noted the items below. (a) Integrated Performance Report January and February 2018 (b) Joint Health Protection Plan /18 ANY OTHER BUSINESS None. 35/18 DATE OF NEXT MEETING: Wednesday 30 May 2018 at am in the Staff Club, Learning Centre, Victoria Hospital, Kirkcaldy Originator: Paula King Page 8 of 8 Review Date: