Fallside Road Bothwell G71 8BB Telephone:

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1 Lanarkshire NHS Board Kirklands Hospital Fallside Road Bothwell G71 8BB Telephone: Meeting of Lanarkshire NHS Board, held on Wednesday 30 th April 2014 at 9.30am in the Board Room, NHS Lanarkshire Headquarters, Kirklands Hospital, Bothwell CHAIR: Mrs N Mahal, Non-Executive Director PRESENT: Mrs L Ace, Director of Finance Councillor J Burns, Non Executive Director Mr P Campbell, Non Executive Director Dr A Docherty, Chair, Area Clinical Forum Mr M Fuller, Non Executive Director Dr H S Kohli, Director of Public Health and Health Policy Professor R Lyness, Director for Nurses, Midwives and the Allied Health Professions Mrs L Macer, Employee Director Miss M Morris, Non Executive Director Dr A Osborne, Non Executive Director Mr I A Ross, Chief Executive Mr C Sloey, Director, North Lanarkshire Community Health Partnership Mrs S Smith, Non-Executive Director Mr T Steele, Non Executive Director Dr. I. Wallace, Medical Director IN ATTENDANCE: Mr N J Agnew, Board Secretary Mr C Cunningham, Interim Head, South Lanarkshire Community Health Partnership Mrs K Hamilton, Head of Communications Mr A Lawrie, Director of Acute Services Mr K A Small, Director of Human Resources Mr H Stevenson, Chief Officer, South Lanarkshire Health and Social Care Partnership Mr T Gaskin, Chief Internal Auditor (for item 2014/80) Mr C Lauder, Head of Planning and Development (for item2014/80) Mrs S Dunne, Deputy Director of Human Resources (Organisational Development) (for item 2014/80) APOLOGIES: Councillor J McCabe, Non Executive Director 2014/66 WELCOME ACTION Mrs. Mahal welcomed colleagues to the meeting. 2014/67 DECLARATION OF INTERESTS 1 No interests were declared.

2 2014/68 CHAIR S REPORT a) NHS Chairs Private Meeting 14 th April 2014 A briefing on the principal issues considered at the meeting had been issued to Board Members. Mrs. Mahal invited any member who wished clarification of any issues to contact her. Board Members b) Director of Strategic Planning and Performance Mrs. Mahal advised Board Members of the appointment of Colin Sloey as Director of Strategic Planning and Performance. She extended her congratulations to Mr. Sloey on his appointment. Mr. Ross reported that, indicatively, the formal start date for Mr. Sloey in his new role would be 1 st June In the meantime, consideration would be given to interim management arrangements for leading the North Lanarkshire Community Health Partnership. c) North Lanarkshire Transition Integration Board Mrs. Mahal reported that Dr. Osborne had been appointed as Vice-Chair of the North Lanarkshire Health and Social Care Partnership Transition Integration Board. She extended her best wishes to Dr. Osborne. d) Dr. Memo Langa Mrs. Mahal reported that Dr. Langa, Consultant Psychiatrist, had been appointed Honorary Professor by the University of the Highlands. She would write to Dr. Langa congratulating him on this appointment. Mrs Mahal e) Acute Hospital Medical Staff Association Mrs. Mahal reported that the Director General, Health and Wellbeing/Chief Executive, NHS in Scotland, had had a positive discussion with representatives of the Acute Hospital Medical Staff Associations on Friday 25 th April At this meeting, there had been a reaffirmation of the Board s commitment to patient safety, linked to clinical change. 2014/69 CHIEF EXECUTIVE S REPORT a) West of Scotland Satellite Radiotherapy Hub Mr. Ross reported confirmation on 29 th April 2014 of Scottish Government approval for the Full Business Case, approved by the Board on 26 th March b) Inspection of Services for Children and Young People in South Lanarkshire Mr. Ross reported that the Inspection had now commenced. It was envisaged that the Inspection Report would be available around October 2014, and would be the subject of a report to the NHS Board. Mr. Ross c) Neonatology Unit 2 Mr. Ross referred to the SBAR Report circulated to all Board Members. He reported that the Cabinet Secretary for Health and Wellbeing had, during the course of a planned visit to Lanarkshire on 8 th April 2014, met with the Director for Nurses, Midwives and the Allied Health Professions and colleagues, and was fully briefed on the issues which had been the subject of media coverage.

3 Mrs. Lyness confirmed that a Review of the Neonatology Service, against the National Neonatology Standards and the British Association of Perinatal Mortality Standards, was being set up. The review would be led by Dr. Ian Laing, a retired Consultant Neonatologist and former Chair of the East of Scotland Neonatology Network. The review team would include a representative from the Royal College of Midwives, the Lead Supervisor of Midwives and the Lead Neonatology Nurse from NHS Greater Glasgow and Clyde. The Review Team would be supplemented by a parent of surviving twins. Invitations to participate in the review had been extended to families who had featured in the media coverage. The review would commence on 16 th May 2014, and would conclude at the end of May. The Review Report would be brought to the NHS Board, and would be made public. Mrs. Lyness confirmed that senior Neonatology Medical and Nursing personnel had fully briefed staff of the Neonatology Unit on developments, including the arrangements for the review. d) Meeting with Acute Hospitals Medical Staff Associations Mr. Ross endorsed the previous report from Mrs. Mahal about the positive nature of the meeting which the Director General Health and Wellbeing/Chief Executive NHS in Scotland had had with representatives of the Medical Staff Associations on 25 th April He reported on the key issues raised by MSA representatives, in relation to: clinical change; additional nursing staff; flexible visiting; the Consultant Contract and the recruitment of medical staff; and bed capacity. The Director General had indicated that he was willing to visit Lanarkshire again to meet with a wider representation of clinical staff, with any such meeting being arranged in discussion with the Area Clinical Forum. e) Briefing Meeting with MSPs and MPs 2014/70 MINUTES Mr. Ross confirmed that a Briefing Meeting with MSPs and MPs was scheduled for Friday 9 th May He would arrange for the Agenda for the meeting to be shared with Board Members. Mr. Ross Mrs. Hamilton responded to questions from Mr. Fuller about dialogue with media representatives in relation to coverage of the Neonatal Unit. She reported on the nature of the communication with the media. She reported on the receipt of a Freedom of Information request in relation to correspondence and communications with neonatal staff, which was due for release on 15 th May She also confirmed that MSPs had been briefed on the issues in relation to the Neonatology Unit, with confirmation to MSPs that further briefing would be available to any individual MSP who wished to avail themselves of this offer. The minute of the meeting held on 26 th March 2014 was submitted for approval. 1. Approved the minute. 2014/71 MATTERS ARISING AND ACTION UPDATE The NHS Board considered an Action Log update. The NHS Board considered the progress of actions set out within the updated Action Log. Mrs. Mahal drew Members attention, in particular, to action reference 2014/02/30 relating to discharge summaries and data for coding. She invited Dr. Kohli to update the Board. 3 Dr. Kohli explained that the National Target was that 95% of discharges would be coded within six weeks of the end of each quarter. He reported that for the quarter to 31 st December 2013, NHS Lanarkshire performance was approximately 92%. He highlighted the ambitious target for discharge summaries to be dictated within 10 working days, and explained that a realistic target for

4 achievement would be September In pursuit of achievement of this target, a number of additional measures had been put in place, including: an endeavour to improve links with medical staff; the contribution of medical records staff; the issuing of an information pack to medical staff; and the issuing of a discharge summary flow chart. In addition, consideration had been given to the means of providing meaningful information for management purposes. The Information Quality Review workstream would monitor progress towards achievement of the target, and would report regularly to the Hospital Standardised Mortality Ratio (HSMR) Programme Board. Dr. Kohli responded to a question from Mr. Campbell about the performance for each hospital for the completion of Discharge Summaries. He explained that performance for all three hospitals was improving, with Wishaw General at 91%, Monklands Hospital at 87% and Hairmyres Hospital at 86%. Consideration was being given to applying the learning from Wishaw General Hospital to the other two sites. Mr. Lawrie assured Board Members about the extent to which performance around Discharge Summaries was monitored, with particular regard to performance in typing, verification and coding, and managing any backlog. He confirmed that the Head of Health Records was currently working with Monklands and Hairmyres Hospitals towards raising their performance to at least the level being achieved by Wishaw General Hospital. Mrs. Macer suggested that it would be appropriate to consider benchmarking Lanarkshire performance against the National Target with the performance of other NHS systems. She highlighted the importance of sustainability given the additional effort and resource that improving performance had required. Dr Kohli Mrs. Mahal endorsed this view. She asked that a detailed report on the issues highlighted in discussion be presented to the NHS Board for consideration. 1. Noted the Action Log update. 2. Asked to receive a further Action Log update. 3. Agreed to consider a detailed report on performance in relation to Discharge Summaries and Data for Coding. Dr. Kohli Mr. Lawrie 2014/72 PATIENT SAFETY AND QUALITY OF CARE a) Patient Safety and Quality of Care The NHS Board considered an update report on Patient Safety and Quality of Care. Dr. Wallace explained that the paper aimed to provide assurance to the NHS Board on the arrangements that were in place, and would be put in place, to oversee progress in the continuing endeavour to transform patient safety and quality of care in NHS Lanarkshire. 4 Dr. Wallace reported that a draft Health Care Quality Assurance and Improvement Strategy was currently out for consultation, having been given initial consideration by the Healthcare Quality Assurance and Improvement Committee on 10 th April The amended Strategy, based on revision to take account of material issues raised during the consultation, would be signed off by the Healthcare Quality Assurance Committee in June, and brought to the NHS Board thereafter. A Prioritised Plan for Patient Safety would also shortly be the subject of consultation, and would be presented to the NHS Board in June. On Monday 9 th June 2014, NHS Lanarkshire would be launching a local Patient Safety Reducing Harm Collaborative. The Healthcare Improvement Scotland Review of Adverse Event Management Arrangements had been held on 22 nd April The report was awaited, and would be the subject of reports to various groups, including the

5 Healthcare Quality Assurance and Improvement Committee and the NHS Board. Mrs. Lyness reminded members that she would bring to the NHS Board in June a report on the Review of Complaints Management. She advised that a Scottish Health Council Report Listening and Learning How Feedback, Comments, Concerns and Complaints, can improve NHS Services in Scotland, would be published that day, and would be issued to Board Members. Mr Agnew Mr. Ross assured Board Members that work was underway to draw together the remaining strands of work around the Healthcare Improvement Scotland Rapid Review and the Hospital Standardised Mortality Ratio (HSMR) improvement endeavour, with the aim of ensuring that the focus on actions was maintained, with progress reported accordingly in a number of forums, including the Healthcare Quality Assurance and Improvement Committee and the NHS Board. He confirmed that further progress meetings with the Scottish Government and the Governance and Improvement Support Team would be held in June and September Councillor Burns referred to the element of the report about the Review of Complaints Management, and the Review of 15 randomly selected complaints. He expressed a concern that this review had identified issues in relation to the tone of some responses, and apparent staff attitudinal issues. He questioned whether this suggested a need for external validation. He also enquired whether there were issues around training and courtesy to be addressed to equip staff better to deal with patients with dignity. Miss. Morris noted and welcomed the appointment of Improvement Advisers, reporting to the Head of Patient Safety and Improvement, and she questioned the rationale for a decision about the number appointed. Mr. Campbell highlighted the need for further information in relation to Adverse Events and the associated timelines for reviews. He stressed the importance of feedback from Patient Safety Walkrounds, including clarity about the timely escalation of relevant issues to the NHS Board. Mrs. Lyness reminded members that Healthcare Improvement Scotland had commented on the need to ensure that, increasingly, responses to complaints should be person-centred. She explained that the process of randomly selecting complaints for review was now established, and had demonstrated that with the benefit of hindsight, some responses could have been more person-centred. She stressed that this endeavour was part of an overall improvement exercise. She confirmed that this involved review of complaints and complaints responses with the authors of the responses and the individuals who had led the investigation of the complaints. This initiative would continue during the year. Mrs. Lyness reported that there was a company of former NHS professionals which undertook work in this area, and she was considering the potential for the company to contribute to the initiative, enabling a significant increase to the sample size. She stressed the aspiration to move to 100% of responses demonstrably being person-centred. Mrs. Lyness noted the issues raised by Councillor Burns about the essential requirement to deal with individuals with dignity. She confirmed that this issue had featured in the Complaints Masterclass held on 4 th April She reported that there was in use an online learning programme for staff, to compliment face to face learning. She acknowledged the power of apology, and the consequent need for staff to be appropriately trained to recognise the circumstances under which an early apology would be appropriate. Mrs. Lyness noted the need highlighted by Mr. Ross to focus the endeavour on communication and attitude given the extent to which these issues continued to feature significantly in complaints. She advised that, on 1 st May 2014, 120 Senior Charge Nurses and Team Leaders from Mental Health, Long Term Conditions and Acute, would attend an event at the University of the West of Scotland on person-centred care, with the content for the event being based on individual cases, linked to patient safety. 5 Dr. Wallace explained that the additional Improvement Advisers would be allocated accordingly by the Head of Patient Safety and Improvement to support the endeavour to implement the Patient Safety Prioritised Plan. He also reported that three new categories were being introduced for the NHS in Scotland for the investigation of adverse events. Category 1, being serious adverse events,

6 would involve a maximum of 90 days, with Category 2 involving a maximum of 30 days and others being 10 days. Dr. Wallace noted a question from Mr. Campbell about the timescale for the completion of the review for category 1 events. He explained that the timescale of 90 days was the maximum, and advised that, in a recent case, the review had been completed within 60 days. Dr. Wallace noted issues raised by Non Executive Directors in discussion about reporting on issues raised through Patient Safety Walkrounds, including reporting to the NHS Board. He acknowledged that any serious issues identified through Walkrounds should be raised and escalated on the day of the Walkround, if appropriate. He confirmed that key findings and emerging themes from Patient Safety Walkrounds would be reported to the Healthcare Quality Assurance and Improvement Committee. He advised that the Head of Patient Safety and Improvement had set out the process for pursuing issues and themes arising from Walkrounds. He undertook to ensure that this documented process was shared with Board members. Dr. Wallace Mr. Lawrie endorsed the need for key issues identified through Walkrounds to be fed back to site Directors and, as appropriate, to Chiefs of Medicine and Nursing, in order that addressing the issues could be taken forward with senior personnel, including Service Managers. Mr. Small explained that the response to patient safety issues was multi-layered, and included rollout of the Organisational Values at all levels. He confirmed that the values had been launched, and that the process around the means by which teams locally would engage in dialogue, was at an advanced stage of implementation. Mr. Steele referred to the awareness of Hospital Standardised Mortality Ratio Performance since He acknowledged that work had been undertaken since then in an attempt to understand the contributory factors and bring about an improvement. He also acknowledged the substantial endeavour to implement the Healthcare Improvement Scotland Rapid Review recommendations. He stressed the need for the Board to have continued confidence in the ongoing delivery of improvement actions going forward. He instanced the Board s approval in March of additional investment in Acute nursing staff, and suggested that this was an area where there was a need for the Board to be aware of progress on implementation. Mr. Ross noted these observations. He assured Board Members about the substantial volume of actions being taken forward across the system, and acknowledged the need for further clarity about the reporting at Board level to provide Board members with confidence about the focus and intensity of the endeavour, matched with demonstrable evidence of improvement. He reminded Board Members that a number of significant improvement actions were already at an advanced stage prior to the Healthcare Improvement Scotland Rapid Review. Mrs. Mahal noted the observations, questions and concerns raised by Members in discussion. She explained that she had asked for a forward Action Plan to be developed and made available to the Board, and she stressed the absolute requirement to maintain an intense focus on the measurements and delivery of the actions. Mrs. Lyness reminded colleagues of the Board s agreement about the reporting on the implementation of the Board s approval on 26 th March 2014 of the investment of 3.15m for the appointment of an additional whole time equivalent nursing staff for acute services. Mr. Sloey explained that he viewed as a critical task in his new role as Director of Strategic Planning and Performance, the need to ensure that the Board has clarity about its critical success factors, and the means by which their delivery will be monitored and reported, including at Board level. 6 Mr. Fuller noted that regular reports on patient safety and the quality of care would be considered by the Healthcare Quality Assurance and Improvement Committee, and that the Action Plan which the Chair had referred to would compliment the Healthcare Quality Assurance and Improvement Strategy. He highlighted the need to reflect on the Committee s capacity to fulfil its remit in relation to oversight of patient safety and quality of care, and the provision of the required assurances to the NHS Board.

7 Mrs. Macer highlighted the fact that today was International Workers Memorial Day. She explained that during the course of the week, she had undertaken a Health and Safety Walkround at Beckford Lodge. This experience had reinforced for her the crucial link between patient safety and staff governance, in pursuit of staff safety and a safe working environment. She explained that Walkrounds had delivered substantial positive results for Beckford Lodge. She also stressed the need to further enhance the focus on organisational learning. Dr. Osborne acknowledged that the report before the Board brought together a number of strands of work which would require to be the focus for the organisation and the NHS Board, at an early date, to have a genuine sense of the outputs and outcomes from the individual elements and the totality of the endeavour. Mrs. Mahal stressed the priority of maintaining an intense focus on delivery, in pursuit of the Board s aim to transform patient safety and the quality of care. She welcomed the confirmation from Mr. Sloey of his intention to take forward work on identifying the critical success factors for the Board, with progress in their delivery being robustly performance managed. She highlighted the need for the Board to have a clear vision of the direction and the milestones in relation to patient safety and quality of care, including clarity about the arrangements and locus for the monitoring and reporting on delivery of actions. She acknowledged that there was a need to consider the capacity of Non Executive Directors, and confirmed that this would be an important consideration going forward. She also endorsed the need for assurance for the Board about the impact of the actions aimed at transforming patient safety and the quality of care. 1. Noted the further report on Patient Safety and Quality of Care. 2. Confirmed that the report provided adequate assurance about the arrangements that were in place and would be put in place to oversee progress in the continuing endeavour to transform patient safety and quality of care in NHS Lanarkshire. 3. Agreed to consider further reports on Patient Safety and Quality of Care, including an Action Plan which confirmed the timescales and milestones, and the key outputs and outcomes. Dr. Wallace b) Clinical Governance Corporate Report The NHS Board considered a Clinical Governance Corporate Report. Dr. Wallace highlighted the principal elements of the report in relation to the Quality Ambitions, viz: safe; effective; and person centred. He noted observations from Non Executive Directors about the timeliness of some elements of the data, and explained that this was a consequence of the need for the data, which was generated nationally, to be subject to data verification. Dr. Wallace noted an observation from Miss Morris about the disparity in falls rates across the system. He explained the contributory factors, and confirmed the intention to move to introduce the Falls Safety bundle at Hairmyres Hospital as a new measure. Mrs. Lyness reminded members that falls was one of the recognised four harms. She assured members that embedding Falls Safe across all three sites was a key component of the Patient Safety Collaborative. 7 Dr. Wallace noted questions from Mr. Fuller about the comparison between the Hospital Standardised Mortality Ratio adjusted and unadjusted rates, and the ability to correlate improved performance in this area with the HSMR improvement endeavour and the implementation of the Healthcare Improvement Scotland Rapid Review recommendations. He explained that, theoretically, the delivery of actions should improve HSMR performance, but explained that this would only be confirmed when quarterly HSMR performance information was published. He highlighted performance in Lanarkshire in relation to deaths within 30 days of discharge, and

8 explained that whilst performance had improved, the improvement was behind the improvement figures nationally. He assured members that delivering further improvement in this area would remain a priority. Mrs. Mahal asked that further information and clarification of the actions being taken in response to the Emergency Medical Readmissions within seven days be presented to the Healthcare Quality Assurance and Improvement Committee at its next meeting. 1. Noted the Clinical Governance Corporate Report. 2. Asked to receive a further report. Dr. Wallace c) Healthcare Quality Assurance and Improvement Committee The NHS Board considered a summary report on the key issues considered by the Committee on 10 th April Mr. Fuller, Committee Chair, spoke to the summary report. He also referred to recent correspondence from Healthcare Improvement Scotland about establishing a network of Non Executive Directors with an involvement in Clinical Governance. He welcomed this development, and the opportunity that it would provide for him and other Non Executive Director colleagues to participate. 1. Noted the summary report on the key issues considered by the Healthcare Quality Assurance and Improvement Committee on 10 th April Agreed to receive the minute of the meeting in May. Mr. Agnew d) The Deteriorating Patient and Sepsis Mrs. Lyness reminded Board Members that the Deteriorating Patient and Sepsis was one of the key Workstreams established as part of the Hospital Standardised Mortality Ratio improvement endeavour. She presented a video featuring a number of staff and patients, who spoke positively about their direct experience of the changes that had been put in place through the implementation and roll-out of the workstream. She emphasised the extent to which staff had embraced the workstream concepts, and had contributed materially to their implementation. She also stressed the aim of further embedding and sustaining this work, and to continue to gather staff and patient stories for learning purposes. 2014/73 MEDICAL STAFFING 1. Noted and welcomed the positive feedback from staff and patients about the implementation of the Deteriorating Patient/Sepsis workstream. 8 Dr. Wallace updated Board Members on the medical staffing position. He described, in detail, the areas of pressure, and outlined the recruitment actions, both current and planned, to improve the position. He also reported on the position with regard to dialogue with the Postgraduate Dean about the allocation of Trainees. He reported on the position with regard to doctor staffing within the GP Out of Hours Services. He confirmed that the Business Continuity Plan for the Service had been updated, and outlined the approach to filling doctor rotas for the three main Primary Care Out of Hours Centres and the Satellite Centres, and the priority being accorded to home visits. He confirmed that these measures and, where appropriate, the payment of enhanced rates, had

9 contributed materially to stabilising the position. However, he explained that challenges remained, and were being considered within the overall context of the current comprehensive review of the service, the product of which would be reported further to the NHS Board. Dr. Wallace noticed emphasis placed by Mrs. Mahal on the need to ensure that robust contingency plans were in place within acute services, to mitigate the impacts of medical staff shortages on patient care. He confirmed that a full report on the position, including the outcome of a comprehensive risk assessment exercise being led by Dr. Burns, would be presented to the NHS Board in May. Mr. Lawrie confirmed that Contingency Plans were in place for 48 hours. He highlighted the need for an interim Business Continuity Plan covering a minimum of six months, and confirmed that work in this regard was being taken forward. Mr. Ross confirmed that the Director General, Health and Wellbeing/Chief Executive of the NHS in Scotland, and senior colleagues at Scottish Government level were aware of the medical staffing challenges which Lanarkshire faced. Mr. Lawrie noted the need highlighted by Mr. Campbell for clarity about crisis, and the consequent need to move to introduce different operating models and service redesign, supported by robust communications. He confirmed that these issues were a feature of the consideration currently being given to the management of the medical staffing pressures. Mr. Fuller expressed a concern about the short timescales for planning mentioned in discussion, which suggested that the point might soon be reached where services were dictated by the staff and other resources available. Dr. Wallace reminded Board Members of the view expressed by Healthcare Improvement Scotland in their Rapid Review report about the need to configure services for safety around available staff. Mr. Ross assured Board Members that work to consider the issues, including the future configuration of services, was underway, and that the Board would be updated on progress. Mrs. Smith noted the reported staffing position within the Primary Care Out of Hours Service, and she sought clarification on the extent to which the options to bolster the service had been exhausted, with a consequent impact on the level of unplanned presentations at Accident and Emergency. She sought clarification on whether the sustainability issues for Accident and Emergency across the three acute sites applied also to other specialties. Dr. Osborne endorsed these views. She enquired about the extent to which risk arose in relation to the treatment of individuals in ambulances, and she stressed the requirement for a robust report on the position in Lanarkshire as a precursor to meaningful engagement at Scottish Government level. Mr. Lawrie noted confirmation from Dr. Wallace that General Medicine was the key specialty where immediate pressures applied to operating across the three acute sites. He highlighted the need for the consideration of two site working to recognise the impact on admissions, and he confirmed that work had been undertaken on planning for the resource requirements in this eventuality. Mr. Campbell noted confirmation from Mr. Ross about the strategic timeframe for clinical change within the overall context of the development of a Clinical Strategy for Lanarkshire. He expressed a concern about some of the timelines, given the extent of the medical staffing pressures reported to the Board. Mrs. Lyness reported that key individuals from the NHS in England with specialist knowledge about unscheduled care had visited Wishaw General Hospital on 29 th April This visit had highlighted the significance of the conversion rate from attendance to admission as a key factor contributing to the challenges in managing activity. Mrs. Lyness explained that where medical staffing gaps persisted, there was a need to consider other roles for appropriately qualified, experienced nurses, building on work already undertaken in this area. 9

10 Mrs. Mahal highlighted the need to update the Board, in early course, about the work being undertaken on clinical change, within the overall context of the emerging Clinical Strategy for Lanarkshire. This update would encompass: the process; the stakeholders; prioritisation of work, and the key timelines and milestones. The update to the Board should also describe the risks, to inform a need to accelerate the process in particular areas. Mr. Ross 1. Noted the update on medical staffing. 2. Agreed to consider a further update accompanied by a risk assessment in May. 3. Agreed to consider an update on progress with the development of the Clinical Strategy. Dr. Wallace Mr. Ross 2014/74 PUBLIC BODIES (JOINT WORKING) (SCOTLAND) BILL a) Integration of Adult Health and Social Care The NHS Board considered a report which provided an update on the work undertaken in establishing Health and Social Care Partnerships, as set out in the Public Bodies Joint Working (Scotland) Bill. The issues which featured in the update had been considered by the Corporate Management Team and at meetings between Health and Local Authority Chief Executives, Social Work and Community Health Partnership Directors. Mr. Cunningham emphasised that under the Health and Social Care Partnerships, services and standards would be unchanged, albeit the Partnerships and Localities would be different from the current arrangements. Mr. Sloey explained that these changes dictated the need for Strategic Commissioning Plans informed by information from Public Health about the Health and Healthcare needs of Communities. The Strategic Commissioning Plans would be underpinned by a performance framework with a built in level of tolerance. 1. Noted the continuing progress to develop Integrated Health and Social Care Partnerships in North and South Lanarkshire. 2. Noted that the appropriate communication and engagement process would be undertaken in agreeing future models of service provision and wider change issues. 3. Agreed to continue to receive update reports at future meetings on the progress being made in the establishment of Health and Social Care Partnerships. Mr. Cunningham Mr. Sloey b) South Lanarkshire Health and Social Care Partnership Transition Integration Board 10 The NHS Board received the minute of the meeting of the South Lanarkshire Health and Social Care Partnership Transition Integration Board held on 11 th March 2014, having received a summary of the key issues considered by the Transition Integration Board at the previous meeting of the NHS Board. Councillor Burns, Chair of the Transition Integration Board, reported that the TIB had held a further meeting on 29 th April 2014, when the principal issue considered was the need to establish the key priorities for the Transition Integration Board. Mr. Stevenson endorsed this view. He explained that this presented opportunities for redesign to maximise the benefits of existing services and resources. He reported that an Integration Plan would be out to consultation in June. He also reported that there was a need to set and agree a Vesting Date. c) North Lanarkshire Health and Social Care Partnership Transition Integration Board

11 The NHS Board received a summary report on the key issues considered by the Transition Integration Board at its inaugural meeting on 15 th April Dr. Osborne, Vice Chair of the Transition Integration Board, highlighted the discussion about the need to review the Draft Programme Plan, the appointment of a Chief Officer, and the scoping of services. She confirmed that a further meeting of the Transition Integration Board had been set for 10 th June Mr. Small reported that a meeting of interests was scheduled for this afternoon to progress the arrangements for the recruitment of a Chief Officer, with appointment envisaged around mid-june Mr. Sloey highlighted the need for the Organisational Development Plan to be in place, and to take forward joint work between the North and South Transition Integration Boards in this important area. Mr. Small Mr. Sloey Mr. Stevenson 1. Noted the Summary Report on the key issues considered by the Transition Integration Board at its meeting on 15 th April Noted that the minute of the meeting would be presented to the NHS Board on 20 th May Mr. Sloey 2014/75 BOUNDARY CHANGE Mr. Sloey updated Board members on discussions with NHS Greater Glasgow and Clyde colleagues on 24 th April 2014, the outcome of which was that further work would be taken forward in early course to clarify the position. He explained that he had taken the opportunity at the meeting to remind colleagues of the Ministerial criteria for boundary change, and he stressed that Lanarkshire had applied these principles and had made significant progress. He outlined, for Board members, the elements of the financial position which remained to be confirmed and agreed with Glasgow, and explained that further meetings were scheduled with the aim of concluding matters to the satisfaction of both NHS systems. Mr. Sloey would update the NHS Board further in May. Mrs. Mahal thanked Mr. Sloey for his update report. She stressed the imperative of ensuring that Lanarkshire received the appropriate transfer of resources to sustain the provision of services for the transferred population. 1. Noted the update on boundary change. 2014/76 PERFORMANCE REPORTS a) Finance 2. Asked to receive a further report. Mr Sloey The NHS Board considered a Finance Report for the period ended 31 st March Mrs. Ace highlighted the principal elements of financial performance for the year end, in relation to delivery of the revenue plan, cash savings from budgets, productivity gains and the capital programme. She stressed that all three financial targets had been met in 2013/14. 11

12 1. Noted the contents of the paper and, in particular, the forecast that all three financial targets covered in the paper had been met. 2. Noted the 4.857m overspend in the Acute Division. 3. Asked to receive further reports for the new financial year commencing on 1 st April Mrs Ace b) Waiting Times The NHS Board considered a Scheduled Care Waiting Times report, and an Unscheduled Care Performance Update. Mr. Lawrie highlighted the principal issues from the reports. He explained that the scheduled care waiting times report was provided to update Board members on: waiting time access guarantees and targets set by the Scottish Government as at the end of March 2014; progress against national waiting time guarantees as they impacted on access to mental health services; the recent audit of patient records that had taken place as part of the requirements from the Audit Scotland Review of Waiting Lists. He advised that during 2013/14 there had been only one Treatment Time Guarantee breach, the circumstances of which had previously been reported to the NHS Board. He outlined the measures in place to ensure ongoing compliance with the Treatment Time Guarantee. He also outlined the arrangements for a sampling audit of case records in response to the Scottish Parliament Public Audit Committee report into the management of NHS waiting lists, and he confirmed that consideration was being given to the means of reporting to the NHS Board on performance in this area. He confirmed that work was underway on the production of a Capacity Plan for 2014/15, which would be brought to the Board in the coming months. 1. Noted the ongoing positive performance on the Treatment Time Guarantee and Referral To Treatment targets. 2. Noted the results of the recent casenote audit. 3. Noted the improvements in Allied Health Professions Waiting Times Mr. Lawrie explained that the update report on unscheduled care performance was provided to brief the Board on performance against the four hour emergency department standard, to identify issues that were affecting achievement of the standard, and to outline the measures that had been taken and continued to be pursued by the hospital teams and across the Acute Division. He outlined the principal contributory factors to the unscheduled care performance, and he drew members attention to the section of the report setting out the analysis of the performance and the key actions required. He confirmed that Scottish Government support continued to be in place, with regular meetings between Scottish Government Support Team personnel and NHS Lanarkshire. Mrs. Lyness highlighted from the unscheduled care performance update the number of bed days lost in South Lanarkshire relevant to the position in North Lanarkshire. Dr. Osborne highlighted the contribution of access to care homes and availability of home care to the position in South Lanarkshire, and the need to consider the impacts of clinical change occasioned by the medical staffing and activity pressures considered earlier in the meeting. 12 Mr. Lawrie noted an issue raised by Mr. Fuller about the Scottish Government s position with

13 regards to the Lanarkshire performance. He assured Board Members that within Lanarkshire there was clarity about the issues to be pursued across the three acute sites, and about the issues which required to be the subject of dialogue with the Scottish Government Support Team. Mrs. Mahal indicated that the Acute Operating Management Committee should focus its attention on the identification and delivery of the actions required to deliver sustainable improvements in performance. She noted the need highlighted by Mr. Ross for the Transition Integration Boards to also consider the position, particularly with regard to the issues around access to care homes and the delivery of home care. 1. Noted the ongoing challenges and action being taken in relation to unscheduled care, and the prioritised actions being implemented to address the performance gap. 2. Noted the work being undertaken by the Acute Division, the Community Health Partnership and South Lanarkshire Council to improve the delayed discharge position. 3. Agreed to receive, in June, a report on Boarding, along with the second Lanarkshire Unscheduled Care Action Plan submission. Mr. Lawrie c) Primary Care Out of Hours Service The NHS Board considered a Primary Care Out of Hours Service Report. Mr. Cunningham highlighted the principal elements of the report. He updated Members on the progress of the review of the service, which was moving to the development of options, and confirmed that the outcome of the review would be presented to the NHS Board later in the year. Mr. Cunningham updated Board Members on the position with regard to populating doctor rotas. He reported on revisions to the rota management system, and advised that the staffing position had shown some improvement during April, but remained fragile, with upcoming challenges in populating the rotas for the holiday weekends during May. He reported on work undertaken in relation to evaluating the cost for treating patients comparing the satellite centres with the main centres. Mr. Cunningham advised Board Members of recent work undertaken by a secondary care clinician on patient redirection for patients considered appropriate to be seen by their General Medical Practitioner, in hours. He also highlighted work undertaken by the Chief Pharmacist for Primary Care, in relation to the redirection of appropriate patients to their Community Pharmacy. Mr. Cunningham noted requests from Non-Executive Directors for further information within the next report, on context, with the aim of providing confidence about continuity in the delivery of services across Lanarkshire. This enhanced description would include information about access to primary care services, principally General Medical Practitioners and Community Pharmacists, during normal daytime hours. Mr. Cunningham 1. Noted the update report on the Primary Care Out of Hours Service. 2. Asked to receive a further report to address the issues highlighted in discussion. Mr Cunningham 2014/77 GOVERNANCE COMMITTEE REPORTS 13

14 The NHS Board received reports from Governance Committees on the principal issues considered by the Governance Committees as follows: a) Audit Committee: 4 th March 2014 The Board noted the minute of the meeting, having considered a summary of the key issues on 26 th March b) Acute Operating Management Committee: 25 th March 2014 The Board noted the minute of the meeting, and a summary report on the key issues considered bv the Committee. c) North Lanarkshire Community Health Partnership Operating Management Committee: 26 th March 2014 The Board noted the minute of the meeting, and a summary report on the key issues considered by the Committee. Miss Morris, Committee Chair, drew Members attention to the consideration given by the Committee to the issue of the discontinuation of Keep Well funding. d) South Lanarkshire Operating Management Committee /Health and Care Partnership: 24 th March 2014 The Board noted the minute of the meeting, and a summary report on the key issues considered by the Committee. e) Staff Governance Committee: 27 th March 2014 The Board noted the minute of the meeting, and a summary report on the key issues considered by the Committee. Mrs. Macer, Committee Chair, highlighted for Members, the consideration given by the Committee to the new Electronic Employee Support System, and reported that work was underway locally and nationally to mitigate any risks associated with the implementation of the system. f) Area Clinical Forum: 24 th April 2014 Dr. Docherty, Chair of the Area Clinical Forum, outlined for Members the key issues considered by the Area Clinical Forum. The minute of the meeting would be presented to the NHS Board on 28 th May /78 DATE OF NEXT MEETING: Wednesday 28 th May /79 MOTION TO MOVE INTO PRIVATE SESSION The NHS Board approved a Motion to move into Private Session for the remaining item of business. 2014/80 GOVERNANCE REVIEW Mrs. Mahal welcomed Mr. Gaskin, Mr. Lauder and Mrs. Dunne to the meeting. She explained that the Private Session had been arranged to enable the Board to give initial consideration to the conclusions and recommendations from the Review of Governance Arrangements. 14 Mr. Gaskin and Mr. Lauder, in turn, presented the key issues from the Internal Audit Review of Committee Effectiveness, and the Review of Board Committees and Supporting Groups. The latter

15 piece of work had been commissioned specifically in response to recommendation 17 from the Healthcare Improvement Scotland Rapid Review Report, that NHS Lanarkshire should review the number of internal groups and bodies, with a view to ensuring a sharper and clearer line of accountability through the Corporate Management Team, and to the Board for delivery. Members were generally supportive of the conclusions and recommendations from both the Internal Audit Review of Committee Effectiveness, and the review of Board Committees and Supporting Groups. The Board noted the Internal Audit view that there were no fundamental issues of governance but areas where good practice could be strengthened. However, the need was highlighted, in moving forward to implement the recommendations, particularly with regard to the establishment of a Planning and Performance Governance Committee and the rationalisation of Board supporting groups, to develop absolute clarity about the level of reporting to the NHS Board, and to the principal Governance Committees, having regard to the outputs from the work which Mr. Sloey had reported earlier in the meeting in relation to the development of critical success factors for the NHS Board. Further information about the Terms of Reference and Membership of the Planning and Performance Committee would be produced, in order that Board Members could have clarity about the Committee s role, and confidence in the coverage of performance monitoring and reporting at Governance Committee and NHS Board level. It would be essential to consider carefully the implications of the establishment of a Planning and Performance Committee for the remits of other Governance Committees, in order to ensure that there would be an appropriate fit between the Committees and between the Committees and the NHS Board. The revised Governance Committee arrangements would require to be supported by a structured cycle of planning, aligned as far as possible to the scheduling of meetings of the NHS Board and the consideration of matters at NHS Board level as previously agreed, adopting the Golden thread principle of reporting and monitoring. Mrs. Mahal stressed the need to consider the reports conclusions and recommendations as part of the overall endeavour to further strengthen future Board assurance whilst taking into account the changing landscape of Governance. She suggested that it would be appropriate to move forward towards the development of a Framework for implementation from April 2015, aligned to the introduction of Health and Social Care Partnerships in their final form at that point. She endorsed the need for the work of a Planning and Performance Committee to be carefully and closely aligned with the work of the NHS Board and the other Governance Committees. She highlighted, as a fundamental and overriding consideration, the importance of Board Member trust in the reporting arrangements, clarity about escalation of issues to Board Members and the NHS Board, and robust management of risk. In his position as Director of Strategic Planning and Performance Designate, Mr. Sloey would meet at an early date with Mr. Gaskin and Mr. Lauder and other relevant colleagues, to reflect further on these reports, the conclusions from the Board Self -Assessment discussed at the Board Development Event, and to begin to shape the conclusions and recommendations into an overarching Action Plan for consideration by the NHS Board. Mr. Sloey 15

16 16.

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