Strategy, Planning & Partnerships (SPP) Sub Committee Minutes of the meeting held on 27 th July 2015 in Preswylfa, Mold Present: Mrs Margaret Hanson Ms Bernie Cuthel Mr Andrew Jones Mr Geoff Lang Mr Keith McDonogh Mrs Lyn Meadows Ms Morag Olsen Mrs Bethan Russell-Williams Mr Chris Wright Independent Member (Sub Committee Chair) Interim Director of Primary, Community & Mental Health Services Executive Director of Public Health Executive Director of Strategy Independent Member Independent Member Chief Operating Officer (part meeting) Independent Member Director of Contractor Services In Attendance: Mr Russ Favager Ms Ellen Greer Mrs Angela Hopkins Mr Douglas Leech Mrs Ann Lloyd Mr Trefor Jones Ms Kate Parry Mr Mark Sykes Mrs Mandy Townsend Mr Dylan Williams Mr Keith Williams Agenda Item Executive Director of Finance (part meeting) Observer Executive Director of Nursing & Midwifery (part meeting) Committee Adviser Observing, Welsh Government (via video conference) Committee Adviser Corporate Governance Manager Assistant Director Workforce & Organisational Development (for Mr Martin Jones) Observer, Wales Audit Office Assistant Director Informatics (part meeting) Head of Joint Resilience Unit (part meeting) Action SP15/55 APOLOGIES FOR ABSENCE SP15/55.1 Apologies had been received on behalf of Professor Matt Makin, Mr Martin Jones and Mr Tom Brookes. The Chair welcomed Mr Mark Sykes to the meeting deputising for Mr Martin Jones, and asked that deputies are provided for other Executive Directors if they were unable to attend. Execs SP15/55.2 At this point the Chair invited any declarations of interest and Mrs Bethan Russell-Williams declared an interest relating to in committee item 15/73 Third Sector Strategy. SP15/56 MINUTES OF MEETING HELD ON 4.6.15 SP15/56.1 Accuracy Minutes SPP Sub Committee Public 27.7.15 V1.0 Page 1
The minutes were agreed as accurate pending following amendments: SP15/41.3 to read Mrs Hanson, as Board Champion for Carers SP15/42.2 to read outlined Local Authority spending rather than WG spending SP15/48 to read Health Board not LSBs. SP15/56.2 Review of Summary Action Plan and Matters Arising Updates were provided and recorded against the summary action plan. [Mrs Angela Hopkins, Ms Morag Olsen and Mr Russ Favager joined the meeting during this item] SP15/56.2.1 Mr Geoff Lang provided a progress update against capital developments, noting that the Board had been asked by Welsh Government to do some further work on overall costs. He also reported on the Blaenau and Flint primary care resource centre projects. Mr Keith McDonogh added that aspects of the management arrangements for the Sub Regional Neonatal Intensive Care Centre had been discussed and noted at a recent Finance & Performance Sub-Committee meeting. SP15/56.2.2 Mr Chris Wright indicated that he would provide a briefing paper to sub-committee members regarding the 100 day plan and changes to the IMTP engagement plan since the last meeting. CW SP15/56.2.3 Mrs Margaret Hanson reported she had had discussions as to where workforce issues should sit within the governance and committee structures, and felt this needed addressing as part of the committees review. Mr Trefor Jones indicated that workforce indicators showed that there was a skew in the age profile to the older employees with work to be done re training and young people and felt this was an issue for the Board. SP15/57 ALL WALES WORKFORCE POLICY PAY PROGRESSION SP15/57.1 Mr Mark Sykes presented the paper, noting that this all Wales policy had been developed through the Welsh Partnership Forum to support the application of amendments to the Career and Pay Progression sections of Agenda for Change terms and conditions. He indicated that a set of FAQs had also been developed in partnership which would be used to support local training for managers. He indicated that the implementation of this policy would be highly dependent on the effective delivery of the PADR (appraisal) process which members were aware was an existing challenge within BCUHB. In response to a point made by Mr Trefor Jones, it was confirmed that PADR compliance was reported to the Finance & Performance Sub-committee SP15/57.2 Mrs Lyn Meadows was supportive of the policy, although she did raise a query as to why workforce policies were coming to this sub-committee as she could not see this within the terms of reference, and she noted that the other sub-committees also had some workforce elements. Mr Keith McDonogh felt the situation was attributable to the loss of the former Workforce & Organisational Development Committee, and felt that the review Minutes SPP Sub Committee Public 27.7.15 V1.0 Page 2
of Committees should pick this issue up. Mrs Margaret Hanson undertook to raise this matter as an issue of significance at the Integrated Governance Committee. SP15/57.3 The Sub-committee endorsed the policy for submission to the Integrated Governance Committee in September. SP15/58 NORTH WALES PRISON HEALTHCARE DEVELOPMENT UPDATE SP15/58.1 Mr Andrew Jones presented the paper. He highlighted that it was vital to ensure that the right services were developed and delivered to meet the prison population need, and that assurances were being provided through these update reports to the sub-committee, but also through the reports into the National Programme Board, the Health Board itself and other regional stakeholder forums. It was noted that a Governor designate had now been appointed and Mr Simon Dean (Interim Chief Executive) had had a constructive meeting with him together with Mr Geoff Lang and Mr Andrew Jones. SP15/58.2 Mr Andrew Jones reminded members that the Health Board would in the near future be required to consider options and make a decision on the delivery of prison health care. He indicated that as part of preparing for this requirement, a robust needs assessment had been undertaken which had been subject to peer review in advance of being considered by the National Programme Board. SP15/58.3 Mr Andrew Jones felt that the sub-committee should be aware of two key matters firstly that there was a significant focus on the prison development, within which health and well-being was featured largely and would bring both opportunities and challenges. Secondly that there was an absolute commitment to providing healthcare services within the prison. SP15/58.4 Mr Douglas Leech made reference to a letter that had been provided to the Chair from Mr Tom Brookes, indicating that he continued to see the prison development as a high risk area with a potential and substantial negative impact on the Health Board. Mr Brookes had also indicated he would wish to see an assurance statement from the Chair of the National Programme Board. Mr Trefor Jones outlined his own concerns regarding challenges with a relationship with the Home Office. Mrs Margaret Hanson felt that the points were well made, and she agreed that some of the governance arrangements around the development could be clearer. She undertook to circulate a summary of Mr Brooke s letter. She also felt that the financial settlement necessary to deliver appropriate health and social care to the prison population was an extremely significant matter. Mr Russ Favager felt that the key would be to manage expectations and to ensure there was a reality check about what sort of health service could be provided. He also noted that funding would need to be extracted from the English system, as these were not new prisoners. There would also need to be early and robust discussions around whether health services were directly provided by BCUHB or commissioned. Mrs Margaret Hanson enquired when it was anticipated that the financial position would be clarified, and Mr Andrew Jones expected this to be by the Minutes SPP Sub Committee Public 27.7.15 V1.0 Page 3
autumn. SP15/58.5 Mr Andrew Jones fed back that Mr Simon Dean s stance was that the model for service delivery would need to be agreed from the health needs assessment. Mr Geoff Lang indicated that ownership by the Health Board, the National Project Board and the Ministry of Justice was essential. SP15/58.6 In response to a question from Mrs Lyn Meadows, Mr Andrew Jones confirmed that a recommendation was being made to the Corporate Directors Group (CDG) that prison health be included on the corporate risk register. AJ SP15/58.7 Mr Keith McDonogh supported the principle of ownership as he felt delivery would be compromised otherwise. He referred to the key dates within the paper and felt that these needed to be clearer and more measurable. He also enquired whether the indicative figure would be ring fenced. Mr Geoff Lang responded that this was not known long term, however, Welsh Government would be looking to have an ongoing dialogue to review this with the Ministry of Justice. SP15/58.8 Mrs Margaret Hanson noted that the paper made reference to the small project team, and enquired whether it was felt there were adequate resources given the level of associated risk to the development. Mr Andrew Jones indicated that it was felt that resources were insufficient and he intended to flag this at CDG. SP15/58.9 A discussion took place around the provision of a specialist secure facility for mental health and well-being treatment, as outlined in the paper. It was understood that there would be phased approach to filling the prison and that each prisoner would be assessed individually to determine the category of prison they needed to be in, and if their mental health deteriorated whilst in prison, they would be further assessed to ensure they were located appropriately. Mrs Bethan Russell-Williams noted that with a widespread shortage of prison space in the UK, she felt it was unlikely that the promised gradual phased intake would happen. Mr Andrew Jones indicated this was only a verbal assurance at present, but that partnership arrangements and responsibilities would be clarified more formally through the service specification. SP15/58.10 Mr Keith McDonogh enquired at what point, having established the service model, would there be a discussion around the nature of delivery and impact on core services including addressing any implications for workforce planning. Mr Andrew Jones indicated that a paper being developed for the CDG further elaborated on this and the need for a detailed assessment of opportunities and risks. The impact on BCUHB services would need to be assessed whether services were delivered or commissioned. SP15/58.11 Mr Douglas Leech enquired whether the construction plans had been shared and Mr Andrew Jones reported that he had been advised that a phased construction would be undertaken which would develop the support services first. Minutes SPP Sub Committee Public 27.7.15 V1.0 Page 4
SP15/58.12 The sub-committee noted the report. Mrs Margaret Hanson requested a further paper in September which addressed Mr Brooke s concerns, clarified timescales within a RAG rated project plan approach with key deliverables, set out initial recommendations for either delivering or commissioning health care. She also requested that the information video be available at the meeting. SP15/59 THE PUBLIC HEALTH (WALES) BILL AJ SP15/59.1 Mr Andrew Jones presented the paper which provided an update on the background and provisions of the Public Health (Wales) Bill and confirmed the opportunity for the Board to respond to this piece of legislation. SP15/59.2 Mrs Lyn Meadows thanked Mr Jones for the clear and concise paper. She noted the proposal to change the way pharmaceutical services are planned by Health Boards, indicating that she would appreciate clarity on how they are currently planned. SP15/59.3 Mrs Margaret Hanson noted that Directors of Public Health had already submitted a response to the Bill and enquired whether there had been any attempt to undertake a costed impact assessment, as the Board would need to be fully sighted in terms of the costs of implementing the Bill. Mr Russ Favager indicated that a caveated response had been submitted. SP15/59.4 Mrs Margaret Hanson noted with disappointment that Welsh Government had chosen not to look at the nutritional content of meals in nursing and residential homes. Mrs Angela Hopkins felt it was clear that the Board had a responsibility to work with colleagues within the independent sector including care homes, on areas such as nutritional standards. SP15/59.5 The sub-committee noted the paper, endorsing the response provided by the Directors of Public Health. SP15/60 WORKING WITH OTHERS IN A PARTNERSHIP MODEL OF PREVENTION SP15/60.1 Mr Andrew Jones presented the paper which had been developed for the sub-committee in response to an action agreed at Board to outline a planned approach to working in partnership. He noted it was a strategic paper and described areas where the Board could aspire to improve on partnership working. SP15/60.2 Mrs Lyn Meadows supported the principles of the paper but felt that it would be difficult to measure and determine whether it had been successful. Mr Andrew Jones suggested that evaluation is core and he undertook to build in a baseline and evaluation measures to the next iteration of the paper. Mr Chris Wright indicated there would need to be an associated communications plan and there was an opportunity to do so collectively with partners. SP15/60.3 Mr Geoff Lang suggested that the connection be made between this work and that of framing priorities within the Thee Year Plan, to determine which inequalities the Board wished to address. Mrs Bethan Russell-Williams suggested there should be evidence of social return and investment on every Minutes SPP Sub Committee Public 27.7.15 V1.0 Page 5
aspect of the work as it progresses. Mrs Margaret Hanson felt there would already be a large evidence base of interventions that could be utilised. She requested a further update in September, taking into account earlier comments regarding baseline and evaluation. AJ SP15/60.4 The sub-committee noted and endorsed the paper. SP15/61 IMPROVING THE HEALTH AND WELL-BEING OF HOMELESS PEOPLE AND SPECIFIC VULNERABLE GROUPS SP15/61.1 Mr Andrew Jones presented the paper which updated members on progress with developing systems and processed to work towards the achievement of national standards for homeless and vulnerable people. He highlighted the small BCU resource to deliver on this piece of work and that whilst some progress had been made, officers were finding it challenging to getting people to engage. Mrs Margaret Hanson expressed concern at this and undertook to raise as an issue of significance to the IGC. She also referred to a recent paper regarding standards for gypsy travellers which she would circulate. SP15/61.2 In response to a question from Mrs Lyn Meadows, Mr Andrew Jones confirmed that the associated population was relatively small but had specific and extended needs. SP15/61.3 A discussion took place regarding a range of challenges relating to engaging with these vulnerable groups and ensuring that services could be appropriately provided. The role of the Third Sector in supporting hard to reach groups was noted, and the need for a baseline assessment of these and other vulnerable groups, aligned to safeguarding risks. There was also a need to understand any implications on the BCU workforce, for example, the paper referred to completion of e-learning by all staff. Existing challenges and compliance issues around mandatory training were known to members and concern was expressed that this training needed to be aligned to wider training priorities. Mr Mark Sykes undertook to find out more detail about the e- learning package referred to within the standards. SP15/61.4 Mrs Margaret Hanson requested a further paper later in the year setting out how the Board intended to meet the standards and an associated timeline. MS AJ SP15/61.5 The sub-committee noted the report. SP15/62 BCU RESILIENCE WORK PROGRAMME 2015/16 [Mr Keith Williams joined the meeting] SP15/62.1 Mr Geoff Lang introduced the paper and welcomed Mr Williams to the meeting. He confirmed that the Health Board worked jointly with the Welsh Ambulance Service on areas of emergency preparedness, and a recent annual report to Board had recommended that details of the work programme be shared with the sub-committee. Mr Lang confirmed that he was the executive lead for civil contingencies, with the Director of Secondary Care being a key operational link. It was noted that the working structure for resilience work would need to be amended to reflect changes in the Board s operational Minutes SPP Sub Committee Public 27.7.15 V1.0 Page 6
management structures. Mr Lang assured the sub-committee that there was a forward work programme to address key areas of risk, and Mr Keith Williams confirmed there was an associated local risk register. SP15/62.2 In response to a question from Mr Trefor Jones regarding cross border issues, Mr Keith Williams confirmed that the Joint Resilience Unit was heavily engaged with North West England and there were reciprocal arrangements across civil contingency boards to ensure that separate organisations could be responsive. SP15/62.3 Mr Andrew Jones noted that the paper identified limited compliance relating to programme 4 (governance and assurance). Mr Geoff Lang indicated there were some known weaknesses in systems and this programme had therefore been identified as a key workstream. SP15/62.4 Mr Douglas Leech enquired regarding major incident exercises and Mr Keith Williams confirmed that live exercises were still planned in conjunction with local partners. SP15/62.5 Mr Keith McDonogh raised the point regarding transition between structures and the related uncertainties and inherent vulnerability. Mrs Margaret Hanson had a similar concern and suggested that civil contingency / resilience should be on the corporate risk register. Mr Geoff Lang undertook to discuss at CDG. Ms Morag Olsen felt that the new structures would be an improvement and would better support the on-call arrangements which were being reviewed by Mr Nigel Lee. Mrs Margaret Hanson indicated she would raise resilience as an issue of significance at IGC, along with a broader concern regarding the potential impact on services in general during the migration to new structures. GL SP15/62.6 The sub-committee noted and endorsed the paper. [Mrs Ann Lloyd left the meeting and Mr Dylan Williams joined the meeting] SP15/66 UPDATE REPORT OF THE PROGRESS MADE AGAINST THE RECOMMENDATIONS OF THE WALES AUDIT OFFICE REVIEW OF DISTRICT NURSING SERVICE [Item taken out of order at Chair s discretion] SP15/66.1 Mrs Angela Hopkins began with an apology that the paper was not of the desired quality for the sub-committee and did not reflect the amount of work that had been undertaken to address the Wales Audit Office recommendations such as the district nursing establishment tool, metrics, service specification, operational delivery plan and collaborative work with Universities to influence the curriculum. She suggested that she develop a more appropriate paper for the September meeting. Mrs Margaret Hanson agreed this was the best approach in the circumstances, but she did express concern at the quality of a range of sub-committee papers. She indicated she had asked to review all sub-committee papers prior to their circulation in future. She would take this principle as an issue of significance to IGC. AH SP15/66.2 Mrs Angela Hopkins added that some of the proposals that will be Minutes SPP Sub Committee Public 27.7.15 V1.0 Page 7
made for this service were not likely to be popular. Mr Andrew Jones reiterated the need to provide services based on population need and the importance of mapping services to community and primary care. Ms Bernie Cuthel reminded members of the current consultation regarding the primary care workforce in Wales. [Mrs Angela Hopkins left the meeting] SP15/63 INFORMATICS STRATEGIC PRIORITIES SP15/63.1 Mr Dylan Williams delivered a presentation which covered: BCU status of national implementation Strategic outline plan areas (community and mobile working, digital records, ICT infrastructure, information, transactional) Year 1 Proposals (reduction of transactional overheads, stabilisation of underlying technical infrastructure, wider integration between solutions, information potential) Strategic systems profile current and future Summary of key priorities Data warehouse starting to include Referral to Treatment and Welsh Ambulance Services Trust data IRIS self service reporting portal Successes, innovation Real time reporting Patient contact notification Appointment reminders Opportunities (resources, culture, live data, appointment reminders) Challenges (change, new structures, complex stakeholder environment, replacement of core networks and telephony systems, the ageing computing estate, cost improvement target on Informatics Long term thinking design, procurement and rollout Comparison for informatics capital Service models SP15/63.2 Mr Russ Favager reflected that the biggest challenge was actually enabling and encouraging staff to use IT systems to their full potential. Mr Dylan Williams gave an example relating to the Patient Administration System (PAS) which offered huge efficiency opportunities, however, the investment from managers and staff was essential. He indicated that proper implementation of PAS would free up people to actually do their jobs and will improve patient flow. He indicated that digital record elements would alter how the organisation managed paper, and the first role for the newly appointed Head of Digital Records would be to source benefits. Mr Trefor Jones and Mr Douglas Leech raised issues around redeployment and resistance to change, and Mr Williams acknowledged that new systems could initially be seen as a barrier and additional work, however these needed to be overcome to realise the benefits. SP15/63.3 Mrs Mandy Townsend suggested that methodology from national projects would be beneficial, and Mr Williams indicated he hoped the Informatics Management Board would identify and share as appropriate. SP15/63.4 Ms Bernie Cuthel felt that the strategic intention to care for people Minutes SPP Sub Committee Public 27.7.15 V1.0 Page 8
outside of a hospital setting, relied heavily on integrated systems and the biggest challenge was pace. SP15/63.5 Mrs Margaret Hanson felt that the sub-committee did need to be sighted on associated risks, one of which was around finance and resourcing. She also expressed concerns around the geography of North Wales, and national infrastructure. Mr Williams confirmed there were several related risks on the corporate risk register and it was noted that the Finance & Performance Sub-Committee oversaw progress against finance. Mrs Hanson would raise key points from the discussion as an issue of significance at IGC. SP15/67 MENTAL HEALTH STRATEGY [Item taken out of order at Chair s discretion] SP15/67.1 Ms Bernie Cuthel delivered a presentation which included A population-based approach to development of a strategy; Integration and the delivery of seamless and personalised care; Access; Models of excellence; Changing the workforce; Progress to date on development of the strategy; Emerging themes from workshops; Next steps. SP15/67.2 Mr Geoff Lang referred to a capacity issue and the need to identify additional resources to allow for early and robust engagement as part of an overview of all mental health services. Ms Bernie Cuthel confirmed that the Local Authorities had nominated someone to work with the Board on this matter which would help. Mr Andrew Jones felt the Board needed to be very clear in its communications to allow for proper engagement. SP15/67.3 Mrs Margaret Hanson suggested there was a need to have an open and honest conversation with Third Sector colleagues about how mental health services would look in the future and how this impacted upon them. Ms Morag Olsen noted that there was inconsistency across the patch with regards to the workforce delivering mental health services, and the ability to start with a blank sheet would not be helped by the existing pay protection arrangements. SP15/67.4 Mrs Margaret Hanson requested a further update in October. SP15/64 SUB COMMITTEE ANNUAL REPORT 1.1.15-31.3.15 MO GL BC SP15/64.1 Mr Geoff Lang presented the annual report, noting it was for one quarter only as the sub-committee was newly established. He also indicated that an assessment of whether the sub-committee had met its terms of reference was not applicable for a part year. SP15/64.2 With regards to the terms of reference, Mrs Lyn Meadows queried the accuracy of section 4.1 which stated the sub-committee had 4 members, and section 5.2 regarding the frequency of meetings. She also reiterated her earlier point regarding consideration of workforce policies. Mr Geoff Lang would further review the terms of reference with the Chair. GL Minutes SPP Sub Committee Public 27.7.15 V1.0 Page 9
SP15/64.3 The sub-committee approved the annual report. SP15/65 CORPORATE RISK REGISTER REVIEW OF ALLOCATED RISKS SP15/65.1 CRR25 Clinical Services - noted that score had not altered since last review. Mr Geoff Lang suggested the need to reflect and further review over the next month or so as corporate objectives were signed off. There was a discussion around the current risk rating and it was agreed to move to a 4x5 which would be comparable to CRR1 regarding financial risks, and to add a timeframe of milestones to achieve the target risk score. Mrs Margaret Hanson would raise as an issue of significance to IGC. KP SP15/65.2 CRR23 GP Recruitment Ms Bernie Cuthel suggested that the risk be refocused around wider issues of sustainability within primary care. The current risk rating of 5x5 was still felt appropriate, however, it was suggested the date to achieve target score should be extended to March 2016. Also noted that the target risk score of 4x4 should show as red not amber. SP15/65.3 Mr Chris Wright indicated that a risk appetite workshop was being arranged for the near future. Mrs Hanson asked that where possible current controls against all risks include relevant dates or timeframes. SP15/68 REPORTS AND PUBLICATIONS FOR NOTING Noted that the following had been circulated: Mental Health Care Crisis Concordat 111 Project Briefing SP15/69 ISSUES OF SIGNIFICANCE TO INFORM REPORT TO INTEGRATED GOVERNANCE COMMITTEE Inconsistencies in CoBs and terms of references of sub committees regarding workforce policies since the stepping down of the W&ODC in particular. Challenges in engagement relating to homeless and vulnerable groups. Associated risks to resilience and civil contingencies, and wider issue around impact on services during migration to new structures Concerns over quality of sub-committee papers. Challenges and risks associated with informatics priorities, including resourcing. Increase to current risk rating for CRR25 Clinical Services and the need for milestones to achieve the target risk score. SP15/70 ANY OTHER BUSINESS None raised SP15/71 DATE OF NEXT MEETING Thursday 3.9.15 10.00am at Carlton Court, St Asaph. Public Session Meeting Closed @ 5.30pm Minutes SPP Sub Committee Public 27.7.15 V1.0 Page 10