NHS Board Meeting 14 January 2009 Paper 8 NHS BOARD MEETING 14 January 2009 Subject Purpose Recommendation Draft Minutes of Health & Performance Governance Committee To report to the Board To receive the Health & Performance Governance Committee Draft Minutes and raise any issues of interest or matters for clarification. 1. Background 1.1 Committees of the Board should submit approved minutes to the Board. Committees of the Board should also submit draft minutes to speed up information flow 2. Current situation 2.1 Attached are the draft minutes of 10 December 2008. 3. Conclusion 3.1 The Board is asked to receive and note the content of the draft minutes. Martin Cheyne Chairman, Health & Performance Governance Committee December 2008 [Allan Gunning] 1
Draft Minutes for approval by Committee Eglinton House Ailsa Hospital Dalmellington Road AYR KA6 6AB Tel: 01292 513651 Fax: 01292 513655 www.nhsayrshireandarran.com Minutes of a meeting of the NHS Ayrshire & Arran Health and Performance Governance Committee 10.00 am Wednesday 10 December 2008 Board Room, Biggart Hospital 1. ATTENDANCE AND WELCOME 1.1 Present Members In Attendance Ms Kirsty Darwent Mr John Callaghan Mr Colin Duncan Councillor Drew Filson Dr Carol Davidson Dr Allan Gunning Dr Elspeth Lindsay Dr Bob Masterton Mrs Grace Moore Dr Jim McHardy Dr Femi Oshin Ms Pauline Sharp Vice Chair (Chair of meeting) Employee Director Non-Executive Member East Ayrshire Council Director of Public Health Executive Director - Policy, Planning & Performance Consultant Radiologist/Director of SW Scotland Breast Feeding Unit Executive Medical Director Associate Director of Health Promotion & Equalities Consultant in Public Health Medicine Specialist Registrar in Public Health Medicine Board Secretary - Minutes 1.2 Apologies Mr Martin Cheyne Councillor Robin Reid Chair South Ayrshire Council 2. Minutes of the Previous Meeting Action 2.1 Accuracy The minutes of 13 August and 10 October 2008 were both approved by the Committee as accurate recordings of proceedings. 2
2.2 Matters Arising 2.2.1 The Committee were advised the Cabinet Secretary for Health and Wellbeing had responded to the Annual Review held on 8 October. This had been discussed by the NHS Board and a lead Director identified for each action. 2.2.2 The H&PGC homologated all actions taken at the 10 October meeting. 2.2.3 Non Executive members had visited NHS Tayside to view their committee structure. The current model of NHS Ayrshire & Arran s H&PGC was considered to be providing assurance to NHS Board on their remit and that there was no need to change. 2.2.4 All other matters arising were covered in the agenda. 3. OPERATIONAL PLAN UPDATE REDUCTION IN SMOKING IN PREGNANCY 3.1 Mrs Moore was in attendance to provide the H&PGC with information on the costs and successes of initiatives in connection with Reducing Smoking in Pregnancy requested by the Committee. Members were advised this was not a campaign, as had been noted in the H&PGC minutes, but part of an overall programme aiming to reduce smoking rates in a number of target groups. 3.2 A breakdown was given on numbers plus cost for the Community Pharmacy Smoking Cessation Service and the Specialist Smoking Cessation Service. Also included was a cost for a social marketing project undertaken and a resulting brief intervention programme within maternity services, currently being planned. 3.3 The Committee supported the pro-active approach and initiatives discussed but wished to see encouragement and support to ensure a cultural change within Maternity Services, embedding health promotion as part of each practitioner s core business. 4. FORWARD WORK PLAN SINGLE OUTCOME AGREEMENTS 4.1 Mrs Mandy Yule, Health Care Director Integrated Care & Partner Services had provided the paper which gave an update on the development of Single Outcome Agreements (SOA) in each Local Authority. 3
4.2 Dr Gunning advised the SOAs will be submitted to the Scottish Government at the end of February 2009, an interim report on current SOAs for April 2009 and following this a period of discussion, with the Scottish Government looking to sign them off over the summer of 2009. The final Performance Reports for targets for 2009/10 is due September 2010. 4.3 NHS Ayrshire & Arran have identified a set of core health indicators which are recommended in order to measure progress in achieving the outcomes within the three SOAs. With SOAs being a central role for the CHP Committee the Strategic Alliance had discussed the Officer Locality Groups (made up of key stakeholders) as an appropriate mechanism in supporting the link between Community Planning and SOAs, this view had yet to be confirmed. 4.4 Although the newly formed CHP Committees report directly to the NHS Board the H&PGC considered the Committee still have a responsibility to monitor the performance of SOAs to ensure a pan Ayrshire aspect. Unease was expressed about some outcomes being difficult to measure clearly. Members were advised the CHP facilitators would be taking up their posts on 5 January 2009. 4.5 The Committee noted the progress made by East, North and South Ayrshire Community Planning Partnerships and supported the move to a more outcome based focus. 5. HEAT BALANCED SCORECARD 5.1 Dr Gunning provided the H&PGC an update on current performance against the 2008/09 HEAT targets and indicators and informed the proposed process with respect to areas of potential concern. This had been discussed at the Director s Team meeting on 2 December 2008. 5.2 The Committee discussed three main areas where detailed position reports and recovery plans were supplied: o H7 Breastfeeding at 6-8 weeks Mrs Darwent declared an interest being a member of the Breastfeeding Network. The Committee noted this as a challenging target requiring cultural change with rates decreasing nationally. Locally the revised Infant Feeding Strategy consultation is nearly complete with a suite of actions resulting from this already starting to be implemented eg Public Health Nurse recruited and additional support being provided for new mothers including a Breastfeeding DVD. 4
o E2 Sickness Absence The Committee were informed there is a consistent high sickness pattern for NHS Boards in Scotland. There has been a great focus by NHS Ayrshire & Arran and long discussions at the Area Partnership Forum to try and address issues. Despite these vast endeavours trends are not decreasing. The H&PGC discussed issues impacting on these figures and considered this concern also came under the locus of the Staff Governance Committee. o T3 - Prescribing of anti-depressants noted work being progressed through the Mental Health Collaborative. 5.3 The Committee discussed a number of the other targets including Multiple Emergency Admissions (aged 65+) with concern expressed regarding the number of admissions and number of bed days although work undertaken was beginning to show dividends around bed utilisation. Members noted that some targets have no national data but considered it important to measure these locally in order to monitor performance. More detailed information on the at a glance scorecard will be available through the AthenA sharepoint for H&PGC members. 5.4 The H&PGC commended the wide range of highly performing areas and considered adequate the processes being pursued in areas of underperformance. 5.5 Delayed Discharges - Although no longer included within HEAT targets Dr Gunning updated the H&PGC on the current position. East and South Ayrshire continue to maintain the 0 standard for Delayed Discharges although there exists ongoing challenges for North Ayrshire. This area of concern was being discussed at Chief Executive / Chairman / Council Leader level. 6. PREGNANCY AND NEWBORN SCREENING PROGRAMMES 2007/08 6.1 The paper advised members on the performance of pregnancy and newborn screening programmes and reported on forthcoming changes to pregnancy and newborn screening programmes. 6.2 Dr McHardy spoke to the paper in Dr Carswell s absence. Areas highlighted included: o Use of CHI on newborn bloodspot test. o Page 6 Concern was expressed about information regarding insufficient samples. The Committee were assured proposals are being drawn up for the purchase of new more efficient equipment. o The introduction of first trimester combined ultrasound and biochemical (CUB) screening for Downs syndrome. 5
o Universal newborn hearing screening to detect permanent congenital hearing impairment and offer early treatment and intervention. o Uptake of HIV screening was analysed by postcode district The Committee enquired why the areas with the lowest uptake had the highest proportion of missing data? Dr McHardy to enquire from Dr Carsewell and e-mail the H&PGC with the information. JMcH 6.3 The Committee raised their concern about funding for new tests and affordability issues in the future if these are not funded recurringly. The H&PGC supported the comprehensive and straightforward report. 7. BREAST SCREENING PROGRAMME ANNUAL REPORT 2007 7.1 This paper informed the H&PGC on the processes and outcomes of the Breast Screening programme for 2007. 7.2 Dr Lindsay gave a brief summary advising there had been a 74% uptake within NHS Ayrshire & Arran compared against a national target of 70% with 114 women being referred for breast surgery. 99.5% received their result letter within the standard time and the satisfaction survey showed the majority would recommend the Breast Screening Service to a friend. 7.3 The Committee discussed: o Uptake in General Practices - Two public health nurses have been appointed by NHS Ayrshire & Arran with a remit to enhance screening uptake. Other work to increase uptake was also highlighted. o Risk rises with age Screening now been extended to 70 year olds. o Test Results - 99.6% of routine normal results were sent out within 15 working days, which is a great improvement and due mainly to more film readers enabling faster processing of work. o New Screening Procedure To comply with Scottish Government standards (2 views per breast) to be introduced by 2010 an extension is planned to the breast screening building starting in April proposed to be finished in August 2009 with an extra radiologist being actively recruited. o Statistical Monitoring Statistics across NHS Ayrshire & Arran are actively monitored to highlight any trends. o Mobile Units Issues regarding AfC were highlighted and resulting clinical services issues and slippages. NHS Ayrshire & Arran are looking to resolve with a submission for a recruitment and retention premium from the Scottish Terms and Conditions Committee having been submitted. 7.4 The Committee thanked Dr Lindsay for attending and providing information on the report which they approved. 6
8. CERVICAL SCREENING PROGRAMME ANNUAL REPORT 2007 8.1 The paper provided background on processes and outcomes of the Cervical Screening Programme for 2007. 8.2 The Committee were advised the programme is continuing well and meets all the standards laid down by NHS Quality Improvement Scotland. The main areas discussed included: o High-grade pre-invasive cervical disease continues to be most frequently detected in young women aged 20-29 - The Committee discussed the importance of continuing to screen women from the age of 20 rather than 25 and referred to Table 4 on page 9 highlighting the results of cervical biopsies in ages 20-24 which would argue this case. The uptake for this age group was noted as being lower than other groups, although this is a national problem. o Decline in uptake of cervical screening in NHS Ayrshire & Arran (1995-2007) Members expressed concern at the decline in uptake and the consequent expectation of an increase in the number of patients presenting in the future with cancer. Discussion was held on the likely factors contributing and initiatives in place to reverse this with the evidence base for the service being person orientated being highlighted. Again it was noted this was a national trend. o SCCRS - Members noted the current positive impact nationally but also the disadvantages for NHS Ayrshire & Arran in light of their previous robust system. 8.3 The Committee approved the report and considered it contained many positive messages. Mrs Darwent thanked Drs Oshin and McHardy for attending the H&PGC and providing the background to the report. 9. WAITING TIME POSITION STATEMENT 9.1 The paper provided the H&PGC with a revised at a glance Scorecard format for Waiting Times. Behind the at a glance scorecard are pages with detailed background information eg performance, diagnostics and trajectories. The Committee were asked to consider and approve the revised format and reporting process. 7
9.2 Dr Masterton advised the Committee for both second and third quarters the 95% target cancer waits had not been met, although this involved very small numbers. He assured the Committee there was significant recovery work ongoing to move this forward and that he would keep the H&PGC up to date on progress. Other areas where actions are being taken to ensure targets are met include ophthalmology and general medicine. Successfully NHS Ayrshire & Arran were moving back towards trajectory for the 15 week target for end of March. BM 9.3 The main areas discussed with Dr Masterton by the Committee were: o Radiograpy Currently there is little resilience in the system but work is ongoing to provide a robust local service. o Local Mental Health targets a) Eating disorders Development of a local service and how it will be measured are taking place with appointments in the offing. b) CAMHS Due to investment there has been a significant reduction in the time between assessment and treatment. Dr Masterton to bring back up dates on both these local Mental Health targets for the H&PGC. 9.4 Mrs Darwent thanked Dr Masterton for the paper and members agreed the new format was very helpful in making sense of the figures but suggested another column be added giving the previous months data to inform direction of travel. BM BM 10. ANY OTHER BUSINESS 10.1 There was no further business. 11. DATE AND TIME OF NEXT MEETING 10.00 am Friday 30 January 2009, Board Room, Biggart Hospital 8