Direct Health Services

Direct Health Services Specialist Services Unit Management Team Minutes of the formal meeting held on Wednesday 12 January 2005, 3.30pm, Rooms 1 & 2, 4 th Floor, Raigmore Hospital PRESENT: Miss J (Chairperson) Dr J Cormack Dr D Lees Ms S Eddie Dr C Lush Mrs E Gray Mrs L McClurg Mr N Hobson Mr K Oliver Mrs M Brown Mr A Ward Dr S Cross Mr R Ward Mr J Huband Ms I McGauran Mr D McRonald Ms H Sheerin Mr M Lister Mr D Seago Mr Q Cox Mr C Stewart Ms D Forsyth Mrs R Soplantila Mr D Leslie Mr D MacRae IN ATTENDANCE Ms Ruth Cleland Minute Secretary APOLOGIES: Dr L A Smith Ms G McVicar Dr A Graham Mr N Small Mr B Devlin Mr R Wells 1. APOLOGIES AND WELCOME ACTION Apologies were noted. 2. MINUTES OF MEETING HELD ON 26 NOVEMBER 2004 The minutes of the meeting held on 26 November 2004 were approved subject to the following amendment: Page 4, item 5b change Liz Maitland to Lynn Marsland. Agenda for 12 January 2005 The date of next meeting should read 9 February 2005 instead of 9 March 2005. 3. MATTERS/ACTIONS ARISING a) Scheme of Delegation Development Plan Scheme of Delegation Following the dissolution of the 3 Trusts, Malcolm Iredale, Director of Finance, is responsible for Standing Orders and is preparing a draft Scheme of Delegation for SSU. This will be circulated to the SSU then to the Audit committee in March. J Development Plan A meeting with Anne Gent on the Development Plan will be held next week and nominations were asked for a designated SSU Medical Practitioner, to be a member of the CHP Committees. Mr Derek Leslie confirmed the general integration of Medical Services was critical to ensure greater understanding between the SSU and CHPs. Discussion followed on the Statutory Requirements and options for resourcing. The issue of whether one or 3 reps will be required from SSU to sit on CHP Committees was raised. Mr Cox 1

pointed out that as the contractual issues relating to payment of Clinical Directors and Heads of Service was still to be resolved in the SSU, it was unlikely that Clinicians would come forward to be members of CHP Committees meantime. The issue is to be discussed further at an Informal SSU meeting. Ms Heather Sheerin suggested the possibility of having a nominated Clinician from SSU as a contact for CHPs for specific problems, but it was pointed out that this may not satisfy the Statutory Requirements. Dr Cormack suggested that he might act as SSU rep on CHP Committees pending a resolution of the above matters and the appointment of Clinicians to these positions. b) Service Continuity Dr Lesley Anne Smith circulated a paper. The first meeting of the Service Continuity Care Working Group was held on 17/12/04 and the membership noted. The group s remit is to produce a draft Project Initiation Document/Business Case for it s next meeting on 21/01/05 with wider exposure at a seminar scheduled for 15/02/05 followed by presentation to the Corporate Team. c) Communications Strategy Outcomes Well Informed Staff Further discussion was asked for following presentation at the DHS Management Team meeting on 17/11.04. Ms Cleland had undertaken an audit, which identified Secretarial staff achieved good access but some groups, ie domestics were unaware of its availability. Ms Cleland proposed the introduction of regular staff open days but concern was expressed around resources for this. Discussion followed on the best mechanism for cascading the right information to the right people and the following was agreed: Directorates to use the audit and improve deficits; Report to be prepared for Formal SSU in May identifying what happens within departments; Ms Cleland to re-audit and bring back to May Formal SSU; Clarification to be given on Team Updates and Team Briefs; Brief of Formal SSU to be incorporated in Team Update; Formal distribution to be discussed; and Operational issues from CHPs to be provided. J Cormack DGM s/ds Joy / Ruth Cleland 4 PLANNING 4.1 MODERNISATION PLAN Ms Joy tabled an Action Plan on the Modernisation Plan. a) Theatre Services Review Ms Susan Eddie confirmed the draft of this report on improving efficiency of service had been circulated with comments requested by 14 January 05. The paper would be part of P&PP with implementation likely to be undertaken as a year s programme. b) Radiology Services Mr R Ward advised that the procurement process to replace the Radiology Management System had commenced. The national procurement of PACS was progressing, and NHS Highland had indicated its desire to become an early adopter. SEHD wished to see a Business Case developed to support PACS, but this was proving difficult as the contribution from SEHD was unknown at this stage. A Project Manager was currently being appointed. Susan Eddie Ron Ward c) Ambulatory Care 2

Dr Cormack tabled a paper and confirmed the draft agreement was almost complete, feedback was requested, and following approval by the Board the paper will be presented to the Capital Investment Group at NHSScotland by March 2005. Following which the Outline Business Case could be prepared. John Cormack d) OP Programme Mr Kenny Oliver gave the following update: Orthopaedic Referral Facilitator Appointment made Helen Robertson starts 10/01/05. Options for Orthopaedic OP Services was being explored. Consultant Neurologist post Advert to BMJ on Saturday, 15/01/05 Dental Specialties work is ongoing with Primary Care to develop Community Dental Practitioners with Special Interests. Targets The Minister, in his announcement before Xmas, advised OP Waiting Lists to be down to 18 weeks by December 2007. e) Clinical Planning Group (CPG) 6 December 2004 - Update Mr Quentin Cox confirmed discussions had been undertaken with the P&PP. Dr Chris Lush confirmed Mr Paul Leak had produced an update on the Cost Cube. Mr Leak is to be invited to the next Formal SSU meeting. The Minutes of the CPG Meeting are to be circulated. f) Progress on Redesign Projects From Board meeting 7 December 2004 and DHS Management Team The Executive Report from the DHS Committee meeting held on 11 January was tabled and Ms asked for feedback for the Formal SSU meeting on 9 February 2005. g) Laboratory Services Additional Item Dr Chris Lush confirmed a group had been set up to look at various initiatives, which was progressing and had been included in the P&PP. The Microbiology review had been completed, and a series of projects were running with the structured major re-design programme, which was working well. 4.2 PLANNING AND PRIORITISATION PROCESS UPDATE Ms Margaret Brown confirmed useful feedback had been given following the Special DHS meeting held in December. Following the Clinical Planning Group last Monday, all bids with scores are to be fed into the P&PP. Revised scoring is being done across NHS Highland. Weekly meetings are to be held with the 4 Acting COOs and feedback will be given. This item is to be kept on the Agenda. Joy All Ron Ward Margaret Brown 4.3 ASSET MANAGEMENT PLANNING UPDATE a) Revenue Equipment Update Mr MacRae tabled a paper, which had been requested by the Capital Management Board, on the recurring shortfall in allocation of revenue equipment resource. The paper was initially for discussion at the Formal SSU then for presentation to the Asset Management Group, on Capital and Revenue equipment issues. Mr MacRae confirmed the need for additional funding to the existing 200k budget as the spend amounted to twice the budget. Discussion followed on why with Mr MacRae identifying the need for: A 10 year rolling programme to replace equipment; 3

More equipment needed, the paper confirmed we have less equipment per bed than other Boards; A need for replacing basic Non-Medical Equipment; The 20% capital to revenue allocated drops next year; and A quick resolution is needed in order place a bid with the Planning & Prioritisation Process this year. This is to be discussed in detail at the Informal SSU meeting to be held on 21 January. The group asked that the Minute of the Asset Management Group be circulated routinely for info to members of the Formal SSU meeting. 4.4 SERVICE LEVEL AGREEMENTS UPDATE Western Isles Health Board Ms Brown confirmed that Western Isles had verbally offered reducing the gap from 600k to 203k for the current year, followed by instalments of 70k/year. We asked for a bigger contribution to reduce the gap combined with reduced services but Dr Graham has since said this was not acceptable. Ms Eddie added that Clinicians were under increasing pressure from the Western Isles to provide more services. Grampian Health Board Mr Leslie advised a meeting was scheduled with Grampian this week and he would provide an update on the outcome. Margt Brown Derek Leslie 5. SERVICE DELIVERY 5.1 Key Service Delivery Issues a) Bed Review and Recommendations Update Ms Eddie confirmed the Bed Review had received the support from SSU and is being prepared for a Building Warrant for internal restructuring which is expected to start at the beginning of April 2005. b) Hospital at Night Update Ms Soplantila advised an inaugural meeting is to be held on 24 January 05 to obtain an all round perspective, a complete understanding of difficulties and how other projects will impact on Hospital at Night. Ms Soplantila and Mr N Hobson are due to attend the North of Scotland planning group on the 26 January to gain perspectives from other areas and to canvass for funding for a Project Manager. 3 c) Out of Hours Impact on A&E Update Ms McGauran confirmed additional resources had been used over Christmas and that OOHs had worked well during this period. Ms McClurg asked for a debrief of the Xmas and New Year period and give consideration for plans over this period for the next 3 years. This will be added to the Informal SSU Agenda. d) Renal Services Update Ms McGauran confirmed the service at Raigmore was extremely pressured nearly reaching its capacity of 74 patients. The Belford Satellite Unit is on track for completion at the end of April. Interviews are planned within the next couple of weeks for the 2 nd Renal Consultant post and the Project Manager post has been advertised with a closing date of next week. 4

5.2 WAITING TIMES a) Update on 6-month Surgical Plan Ms Eddie tabled a paper for information showing and highlighted: Increased activity in November with December going in the right direction. Orthopaedics - are well on the way to meeting the 6-month target mainly as a result of evening operating. Ophthalmology increased activity has begun reducing the number of patients waiting over 6 months but issues such as accommodation availability at Kyle Court need to addressing. Pre-op assessments by staff outwith Raigmore or nurses travelling outwith to undertake these are to be looked again Orthopaedic Outpatients 6-month target will be a big challenge to meet without some radical solution, which might include patients being referred outwith Highland for appointments. Gynaecology Waiting Times are coming down and should meet target in December. Hysteroscopy equipment has been ordered resulting in some in-patients having their treatment on an Out-patient basis. Susan Eddie 5.3 UPDATE FROM BOARD MEETING HELD ON 7 DECEMBER 2004 Caithness General Hospital (CGH) Dr Lees expressed his concern that the emerging model for CGH could further delay resolution to the locum-based service, which he considered to be an unsafe service. The Board are aware of Dr Lees s concern and a letter expressing concerns of Obstetricians had been produced. Joy Non Hospital Patient Family Accommodation A major review is to be undertaken at the Raigmore site. Community Hospitals Dr Ken Proctor undertook a review of Community Hospitals, which had been identified as a critical issue, and a Managed Clinical Network is to be set up. Integration of Pharmacy Services Ms tabled a paper, from the DHS Committee meeting, showing the structure for the proposed Integration of Pharmacy Services. Discussion took place and as this is a whole area structure this item is to be further discussed at the DHS Management Team meeting. Joy 5

6. FINANCIAL GOVERNANCE a) Performance Report Mr David McRonald circulated a paper confirming the underspend position for the first 8 months of 310k, the forecast deficit of 52k at the end of the financial year, the forecast surplus of 515k arising from slippage on SSU reserves with the current drugs underspend of 852k. CRS Expect to achieve 1.42m from vacancy management. Mr McRonald will organise a meeting in January to understand area-wide position, where we are, where are pressures, where we need to go and discuss how to take forward. David McRonald Discussion took place on the knock-on effect of the vacancy factor and Mr McRonald confirmed the budget needs underpinning as this is underfunded and has set a 1m savings target from SSU, which will be challenging. 7. CLINICAL GOVERNANCE RISK MANAGEMENT a) Critical Incident Reports Paper circulated. b) Patient Focus. Paper circulated. c) Review Visits Paper circulated. QIS Visits An interim review on HAI issue confirmed process was better than first anticipated. d) Major Incident Exercise 19/09/04 - Feedback Paper circulated. e) Update on Complaints Responses to MPs MSPs Ms Joy confirmed the Corporate Team had advised responses to MPs and MSPs were to be undertaken within 20 working days and that any response containing patient information must first have the patient s written consent. Any other responses to be undertaken within 20 days. Ms is to check again on inequity of responses. Joy f) Update on Integration Project Job descriptions have been drafted for the Head and Deputy Head of Clinical Governance and it is hoped that these posts can be progressed early in the New Year. g) Clinical Effectiveness Strategy, Implementation and Review Nursing Quality Standards are part of a pilot site with and a review of the strategy of NHS Highland to be undertaken. Dr Smith is to prepare an Action Plan. Lesley Anne Smith 8. STAFF GOVERNANCE Mr Huband tabled a paper. 6

8.1 Agenda For Change: Implementation Issues Mr Huband confirmed the importance of job descriptions being submitted timeously when matching panels are established. Nursing and ancillary posts are to be matched by 31/03/05. Annual Leave Discussion took place on the knock-on effect of additional Annual Leave with concern being noted over funding. Mr McRonald confirmed figures on backfill costs will be firmed up by the first week of February, after which P&PP will agree how much goes back into department budgets but this issue has been covered financially. Mr Ron Ward asked that the impact to services around this issue was to be clearly Minuted with the need for people for backfill purposes To be kept on Agenda. John Huband 8.2 Pay Modernisation Mr Donald Shiach has been appointed as Pay Modernisation Manager, with effect from 12/02/05. 8.3 Workforce Planning Mr Huband s paper contained a briefing on Workforce Planning with SEHD requesting all Boards to produce a Baseline Report by 31/03/05, with Hamish Johnston and Anne Gent producing a 2-part Skeleton Report, which will be issued for comment as appropriate, with a series of meetings to follow. 8.4 Health and Safety and Occupational Health Mr Huband s paper contained a briefing on outcomes, which are progressing. 8.5 OTHER ISSUES SSU General Manager Interviews to be held on 14/01/05. DGM Medical Directorate Job Description to be evaluated prior to advertising. Director of Public Health To be advertised in Health service Journal on 20/01/05. Dental Director To be advertised in British Dental Journal on 22/01/05. Consultant Appointments Respiratory Medicine interviews on 13/01/05 Renal Medicine interviews 27/01/05 A&E interviews 28/01/05 9. AOCB 9.1 Involvement of the Public Health Team in SSU Letter circulated. To be added to February s Formal SSU Agenda. Ms Susan Eddie confirmed she is the SSU rep. 10. DATE OF NEXT MEETING Wednesday 9 February 2005 at 3.30am, Rooms 1 & 2, 4 th Floor, Raigmore Hospital 7

PLEASE NOTE FORMAL MEETINGS NOW BEING HELD ON THE 2 ND WEDNESDAY OF THE MONTH FROM 3.30 PM, IE 12 January 2005 13 July 2005 9 February 2005 10 August 2005 9 March 2005 14 September 2005 13 April 2005 12 October 2005 11 May 2005 9 November 2005 8 June 2005 14 December 2005 8