Minute of the above meeting held at 09:00am on Thursday 7 December 2017 in the Board Room, Ninewells Hospital, Dundee

Item 4 Minute NHS Tayside TAYSIDE NHS BOARD Minute of the above meeting held at 09:00am on Thursday 7 December 2017 in the Board Room, Ninewells Hospital, Dundee Present Non Executive Member Professor J Connell Chairman, Tayside NHS Board Mr D Cross, OBE Non Executive Member, Tayside NHS Board(from item 7) Dr A Cowie Non Executive Member, Tayside NHS Board Mrs L Dunion Non Executive Member, Tayside NHS Board Mrs J Golden Employee Director, Tayside NHS Board Mr S Hay Vice Chair, Tayside NHS Board (from item 10) Councillor K Lynn Non Executive Member, Tayside NHS Board (from item 7) Dr R Peat Non Executive Member, Tayside NHS Board Councillor C Reid Non Executive Member, Tayside NHS Board Mr H Robertson Non Executive Member, Tayside NHS Board Mrs A Rogers Non Executive Member, Tayside NHS Board Professor M Smith, OBE Non Executive Member, Tayside NHS Board Mrs S Tunstall-James Non Executive Member, Tayside NHS Board Councillor D Wann Non Executive Member, Tayside NHS Board (to item 13) Executive Members Mr L Bedford Mrs G Costello Ms L McLay Professor A Russell Dr D Walker Apologies Mr M Hussain In Attendance Mrs J Alexander Dr A Cook Mr G Doherty Ms M Dunning Mr T Gaskin Miss D Howey By Invitation Director of Finance Nurse Director Chief Executive Medical Director Director of Public Health Non Executive Member, Tayside NHS Board Partnership Representative Medical Director, Operational Unit Director of Human Resources and OD Board Secretary Chief Internal Auditor Head of Committee Administration Ms K Anderson Director of Allied Health Professions (for item 13) Dr A Clement Clinical Director, Angus Health and Social Care Partnership ( for item 13 ) Dr J Cotton Consultant, Medicine and Cardiovascular ( for item 13) Mrs S Dickie Associate Nurse Director ( for item 13 ) Dr S Doig Consultant, Forensic Psychiatry (for item 14) 90

Mr S Dunn Head of Leadership & Management Development ( for item 15) Mr G James Transformation Programme Director ( for item 9) Ms L Hamilton Mental Health Programme Director & Finance Manager ( for item 14 ) Ms J Jones Associate Director Development (for item 15) Dr A Karcher Lead Infection Control Doctor (for item 16) Ms S Muir Service Manager ( for item 13 ) Mr W Nicoll Director of Strategic Change ( for item 14 ) Ms K Paterson Organisational Development Consultant ( for item 15 ) Professor Sir L Ritchie Chair, Assurance and Advisory Group Mrs S Slane OD Lead (for item 15) Ms L Wiggin Chief Operating Officer ( for items 10 and 12 ) Prof J Connell in the Chair 1. PRESENTATIONS Investing in Volunteers Award Ms Anne Hislop, Investing in Volunteers Manager was in attendance and presented NHS Tayside with the Investing in Volunteers Award. Carer Positive Award Established Employer Ms Sue McLintock, Manager, Carer Positive Awards was in attendance to presented NHS Tayside with the Carers Positive Award Established Employer. The Chairman noted that it was important to recognise all of the excellent work that staff undertook in NHS Tayside. Highlighted was the recent Queen s Nurse Award given to Lesley Paterson, a community mental health nurse in Dundee, the COSLA silver award for excellence given to the Corner s Support U+ project and the NHS Tayside Audiology Department had achieved the British Academy of Audiology Team of the Year of Award. This was amongst many other awards and achievements received by multi disciplinary teams across health and social care in Tayside. 2. APOLOGIES The apologies were as noted above. 3. CHAIRMAN S WELCOME AND INTRODUCTION The Chairman welcomed all to the Board meeting. He welcomed Councillor Derek Wann to his first Board meeting as the newly elected Angus Council stakeholder Non Executive Board Member. ACTION 91

The Chairman and the Board paid tribute to Dr Alan Cook who was retiring from NHS Tayside that month. The Chairman thanked Dr Cook for his outstanding service to NHS Tayside in his role as Medical Director, Operational Unit. The Chairman advised that there had been a positive visit by the General Medical Council (GMC) recently. There had been no training concerns raised in respect of paediatrics or surgery training. The Chairman expressed his thanks to all who had been involved with this. The two Board development sessions on leadership and culture were highlighted and an update paper was on the agenda as was the Integrated Clinical Strategy and a successful development session had been held on 30 November 2017. It was also noted there had been a successful national Non Executive NHS Board Member meeting held in November. The Chairman highlighted the excellent work undertaken by staff in NHS Tayside to eradicate Hepatitis C. This had the potential to make Scotland a world leader in this area. He also outlined the bid put forward for funding from the Taycities deal. This was a joint approach by NHS Tayside and the University of Dundee and had the aim of enhancing surgical skills training in Tayside. The Chairman advised that the Christmas carol concert was being held that evening in the Caird Hall, Dundee. The Ninewells Christmas Tree lights were being switched on that morning at 11:00am and if the opportunity arose the Board could join in the celebration. The Board noted the Chairman s update 4. CHIEF EXECUTIVE S UPDATE The Chief Executive highlighted the revised Partnership Agreement had been signed by her and the Employee Director on 22 November 2017. There had been a series of Ministerial visits to Tayside including the First Minister to the Family Nurse partnership on 30 October 2017 and the Cabinet Secretary for Health to Macmillan services and the national Bowel Screening Service. A Section 22 Report on NHS Tayside finances had been published by the Auditor General on 16 November 2017 and discussed at a recent meeting of the Public Audit and Post Legislative Scrutiny Committee. It was noted that NHS Tayside did not have to present to this Committee at this stage. The Chief Executive advised of the appointment of Mr Mark Wilde as interim senior strategic planning support. It was noted that Mr Wilde was currently supporting NHS 24 and would be full time with NHS Tayside in the new year for a six month period. The Board noted the Chief Executive s update 92

5. MINUTES Minute of meeting of 26 October 2017 The Minute of the Board meeting of 26 October 2017 was approved on the motion of Mrs S Tunstall-James and seconded by Mrs A Rogers. 6. ACTION POINTS UPDATE The action points update was noted and discussed. The Board noted the action points update 7. OTHER MATTERS ARISING There were no other matters arising. 8. COMMITTEE CHAIRS ASSURANCE REPORTS Clinical and Care Governance Committee (BOARD150/2017) Mrs A Rogers spoke to her report. It was noted that since this meeting the General Medical Council (GMC) had visited NHS Tayside. No concerns had been raised but surgical training was in enhanced monitoring. It was noted that the action plan associated with this monitoring would be reported and monitored through the Clinical and Care Governance Committee. In respect of the National Education Scotland (NES) visit to mental health services; there had been a positive follow up visit. It was highlighted that the risks that exceed risk appetite; capacity and flow, mental health services and Managed/2c practices were for consideration at this Board meeting. Noted the update provided by Mrs A Rogers, Chair, Clinical and Care Governance Committee Staff Governance Committee (BOARD149/2017) The Employee Director highlighted an update that had been given on apprenticeships and their implementation; there had been good discussion on culture and leadership (this was on the Board agenda for discussion); and there was currently a national review on the Staff Governance Standard and the information returns provided to the Scottish Government with comments being sought. Noted the updated provided by Mrs J Golden, Co Chair, Staff Governance Committee Councillor Lynn and Mr Cross arrived. 93

Finance and Resources Committee Mr Cross gave an update. He advised that the Committee had: Considered the Work Plan Reviewed the Capital Report to 30 September 2017 Reviewed the Corporate Financial Report to 30 September 2017 Received a report on the Sustainability and Environmental Strategy and noted the good work ongoing to reduce energy consumption and the Carbon Footprint Considered the Corporate Workforce Dashboard and also the development of Finance KPIs as part of a wider consideration of performance issues Received assurance reports on the strategic risks aligned to the Committee Financial Plan; Capital Resources; Information Governance; and Implementation of TrakCare Noted the Additional Cost of Teaching (ACT) Report and the requirement to ensure there was clarity within the delegated IJB budgets of amounts designated for ACT and the requirement to ensure these monies were used for this purpose Received an update on Property Disposals and also the NHS Pharmaceutical Specials Service Project The main items related to Forecast Outturn and Further Actions being taken to reduce the overspend and also the Transformation Programme Board Update. The key issues from these were for consideration at this Board meeting. The Finance and Resources Committee had: noted a flattening of the overspend trajectory received updates and presentations from the executive leads for each of the programmes and also updates on the actions being taken to bring the outturn in line with our LDP position including further actions to close the gaps noted good progress in workforce and the collaboration with IJBs to reduce the use of non-contract agency and to reduce delayed discharges noted the extensive work in trying to reduce medicines costs but highlighted concern that NHS Tayside continued to spend above the Scottish average, and as yet, there was no explained rationale for the spend in Angus being above the Tayside average and therefore well above the Scottish average Noted the verbal report provided by Mr D Cross, Chair, Finance and Resources Committee 94

Transformation Programme Board (BOARD151/2017) The Chairman outlined the suite of actions being undertaken to decrease the financial outturn including the minimisation of use of non contract agency nurses across Tayside, the cancellation of the remaining Vanguard theatre, the step down of activity for non urgent elective surgery and the presentation of workstream targets in dashboard format. Noted the update provided by Professor J Connell, Chair, Transformation Programme Board PART A Matters on which discussion is expected 9. Assurance Advisory Group Recommendations and Transformation Support Team Progress Report (BOARD171/2017) The Chief Executive introduced this report. She advised that this was a progress report on the Assurance and Advisory Group s recommendations and gave the Board sight of the ongoing self assessment. It was noted the Executive Review Group including all of the Directors, the four Chief Officers, the Employee Director and the Area Partnership Forum Secretariat met every morning to talk through issues and escalate any risks. There was also a weekly meeting with programme support. Mr James gave an overview of the main points of the report. He advised there had been focussed and detailed discussion of the self assessment at last week s meeting of the Transformation Programme Board. Each Director/Lead had provided a status update as at 13 November 2017. The progress in each recommendation was outlined in the table on page 2 of the report. The gaps against outcomes were reported in Table 1 and included further actions. The Finance and Resources Committee had required additional actions and a number of these were now completed. The reporting timetable and structure was outlined. It was noted that the Assurance and Advisory Group s report would cover the period from 27 June to 31 December 2017, would focus on the 10 recommendations and was likely to be published in January 2018. The self assessment would be submitted to the Transformation Support Team, they would report to Professor Sir Lewis Ritchie and the Assurance and Advisory Group would produce an overarching report. It was noted that the Transformation Support Team had undertaken a detailed review of the Integrated Clinical Strategy and workforce. They had highlighted areas where progress had been shown and areas for further improvement. Mr James outlined the Key Performance Indicators and the monitoring of the performance of these metrics. It was noted that these were discussed at a number of foras including in depth at the weekly huddle. It was noted that good progress had been made with non contract agency staff and vacancy management. 95

It was noted that the additional metrics included in the report were helpful. The high level of delayed discharges in Perth and Kinross and the higher than average use of medicines in Angus were highlighted. There was discussion on what was to happen next. It was noted that these new operational models would be embedded in the organisation. This was a critical period for the Board; to demonstrate learning and working differently. It was noted that the Assurance and Advisory Group would submit their report to the Director-General Health and Social Care/ Chief Executive NHS Scotland for evaluation and then submitted to the Public Audit and Post Legislative Scrutiny Committee. Noted the overall progress to date against the 10 Recommendations Would ensure continued organisational commitment to each of the recommendations and delivery of the further actions Noted the timeline for the final report Mr Hay arrived. PERFORMANCE 10. Forecast Outturn and Further Actions (BOARD164/2017) The Director of Finance introduced a presentation that had been given to the Finance and Resources Committee on 16 November 2017. He outlined the month 7 current position and forecast. It was noted that the October 2017 position was likely to be confirmed as the same as the end of September 2017; an overspend of 6.5 million. The key actions taken since July were noted with the continued focus on further improving the position. There had been significant discussion at the Finance and Resources Committee on a range of actions to close the gap. At this stage, the yearend forecast was a 5.0 million overspend. It was noted that the Financial Framework presented to the Board in March required 49.8 million in order to breakeven. Due to additional medicines pressures of 2.0 million, there was now a requirement to deliver 47.8 million of efficiencies to maintain the 4.0 million unbalanced Local Delivery Plan target. It was noted that 47 million of savings were close to being indentified. The current financial position was outlined. The projected deficit based on the June position was 13.3 million. Recognising the national pressure on medicines through the lower level of benefit deriving from medicines coming off patent and certain medicines whose price had inflated through being in short supply, the impact of which within NHS Tayside was 2 million, lead to a projected shortfall at that stage of 15.3 million. 96

The Director of Finance reported that agreed service actions were standing at 310.3 million. The risk assessment of these service actions was outlined with the majority being risk assessed as green. It was noted that with regard to the actions taken to further contain spend, the Finance and Resources Committee had taken the decision to defer the capital programme as well as the further review of in year allocations. The Director of Human Resources and OD outlined the position in respect of workforce controls. He outlined service planning and redesign, workforce management, national and regional working and creating the conditions for change. He gave an overview of the ongoing work including the payroll analysis toolkit to track and analyse budgeting and payroll systems, the workforce plan, the vacancy management process and the corporate workforce review and supporting business model. Regional and national initiatives were also highlighted. The Nurse Director outlined the range of measures that had been put in place during September to November 2017 to mitigate the use of non contract agency staff across NHS Tayside. It was noted that a position of ceasing use of non contract agency personnel from 1 November 2017 had been agreed for NHS Tayside with the exception of eight identified clinical ward areas; critical care and emergency department areas where enhanced or advanced practice may be required. It was noted additional assistance would be required at times for patients who require unique support (people experiencing mental ill health; patients who were critically and acutely unwell). These additional staffing requests had to be authorised by the relevant Chief Officers and Chief Operating Officer. A graph that outlined the use of agency staff was discussed. In response to a query the Director of Finance advised that between now and the end of the financial year, it was expected that these measures introduced would reduce costs by about 1 million. This contributed to the overall 5 million forecast outturn position. The Medical Director outlined the prescribing initiatives covering reduction in prescribed items, formulary compliance and those in development. He advised that there was no one factor that had contributed to the reduction in prescribed items; however, public messaging about medicines waste and polypharmacy reviews in care homes had contributed. In respect of formulary compliance, this was currently 90% in primary care and 98.4% in the acute sector. The changes in prescribing over the period April to September 2016 to April to September 2017 were discussed. The Director of Finance highlighted that none of the Tayside localities were above the Scottish average for growth in prescribed items. In respect of cost per item and overall cost; there were improved positions in Dundee and Perth and Kinross. The Angus position was discussed and it was noted and an assurance was given that progress was being made with further prescribing efficiencies. 97

It was highlighted that guideline driven prescribing should also be reviewed by Managed Clinical Networks. There was discussion in respect of a whole system prescribing approach to be taken by the Prescribing Management Group and the need for an analysis of the impact of prescribing. It was noted that approaches to be taken to address polypharmacy were discussed at the Directors meeting on 11 December 2017. This had highlighted the alternative of social prescribing and it s potential. It was agreed that it would be useful for the Finance and Resources Committee to receive an update report in January or February 2018. It would be useful for this to focus on the most expensive items. The Chief Operating Officer outlined the service redesign work including pathway redesign to remove unnecessary visits to and the length of stay in hospital, the bed and staffing model aligned to demand, the theatre improvement programme and the management of unscheduled care. Areas of note were changes in testing in primary care, review in the community setting and medicine for the elderly pathways. Work on the Angus Care Model was outlined by the Chief Officer of the Angus Health and Social Care Partnership. The theatre improvement programme was outlined by the Chief Operating Officer. Highlighted, was the review of the day surgery theatre admission suite, the balance of emergency and planned theatre work and the removal of the Vanguard units. In respect of the Integration Joint Boards, it was noted there had been good discussions and work was ongoing to contain costs in the last months of the financial year. The Director of Finance advised that discussions on the forecast position were regularly reviewed by Service Managers and the Executive Review Team. There was also detailed discussion at the Transformation Programme Board as well as to this Board. The governance and scrutiny was acknowledged. The Chairman noted that it was critically important to deliver on the financial position as per the Assurance and Advisory Group s recommendations. Reviewed and challenged the progress made in implementing the actions agreed to address the financial gap between available resources and projected year end outturn 11. Corporate Financial Report for period ended October 2017 (BOARD167/2017) The Director of Finance spoke to this paper and the October position was noted. The update given earlier by Mr Cross, Chair of the Finance and Resources Committee was also noted. 98

It was highlighted that monthly meetings of the Finance and Resources Committee were to be held between January and March 2018 to continue the focus on meeting the Local Delivery Plan target. During discussion, a query was raised on the ability to achieve recurring savings and the fundamental requirement for recurring savings to be in place. It was noted that any shortfall against this planning assumption would increase the financial challenge for 2018/19. It was noted that the most recent meeting of the Transformation Programme Board had discussed that next year s savings target was likely to be in the region of 54 million recognising the current position on recurring savings delivery. The two challenges to be addressed were the unbalanced Local Delivery Plan and the requirement to increase recurring savings. Metrics for these had been discussed at the last meeting of the Finance and Resources Committee. The Committee would track the performance of recurring and non recurring efficiencies. The Chief Executive noted the ongoing areas of work such as Shaping Surgical Services and the business and service planning processes that would assist with recurring savings. Noted the current position and supported the actions being taken by management to contain spend, wherever practical, and to minimise the over commitment against available resource 12. NHS Tayside Key Metrics Report (BOARD169/2017) The Chief Operating Officer and the Medical Director, Operational Unit presented this report. During discussion the following points were noted: Treatment Time Guarantee (TTG) was discussed in detail and it was noted that patients who were urgent were prioritised and an assurance was given this was not compromised due to capacity issues The Emergency Department performance remained positive and a recent review had been undertaken and an assurance was given that TTG measurement was being done per Scottish Government guidance Performance was discussed and the actions being taken to improve the position were outlined The performance of the percentage of drug and alcohol patients treated had decreased. It was noted that there were currently staffing issues in this small team. It was noted that the service had advised that it would be some months before performance was back to the previous level 99

It was suggested that this changes to the complaints and feedback system including the five working days response should be included in the performance report. It was noted that a meeting was to be held in January with the Chief Operating Officer, Mr Cross and Mr Hay to discuss what information should be included in the performance /metrics report Readmission rates at Perth Royal Infirmary were highlighted. Dr Cook explained that an extensive retrospective review of case notes had been undertaken by Perth senior clinicians on patients readmitted at 7 and 28 days. He advised that one third of patients that had been readmitted at 7 days; one third were frail, elderly patients with an average age of 85 years old. It was noted that Perth and Kinross had above the Scottish average in this demographic. For 28 day readmission rates, a quarter of the patients were discharged the same day or after one day. In moving to assess to admit in Perth and Kinross, it was likely that this category of readmission would reduce Did Not Attend (DNA) rates were again highlighted due to recent media coverage. It was noted that work was ongoing to improve performance in the areas including text reminders, the potential for virtual clinics and the reinstatement of patient focussed booking following the move to Trakcare. It was noted that the cost of an outpatient appointment was approximately 120 and this resource could be used in different way The impact on TTG/outpatients with the transfer to the Trakcare system was outlined. It was noted that work was ongoing with Intersystem to address the issues, however a number of work had required to be put in place which were person dependant Noted the NHS Tayside Key Metrics Report STRATEGY 13. Integrated Clinical Strategy : Staging Report (BOARD170/2017) The Medical Director introduced this report. He thanked all the members of the Programme Team for their support and work in bringing this forward. He also expressed his thanks to Mr Alex McMahon and Mrs Barbara-Anne Nelson from the Transformation Support Team for their advice and support. A presentation was then given on the Integrated Clinical Strategy. Ms Sue Muir gave the background to the start of the process, the engagement that had taken place across the clinical community, the feedback received and the development of the principles. Drs Alison Clement and James Cotton gave an overview of the Integrated Clinical Strategy Principles following discussion with over 80 groups as well as the strategic events. 100

The 5 key strategic principles were noted as: Why do we care? How we care? Where we care? Who we are? How we organise care? Ms Karen Anderson outlined the Tayside Health and Social Care system that would assist with the implementation of the Integrated Clinical Strategy. Ms Sue Muir outlined the timeline of the four phased approach. This covered outlining the strategic direction between November and December 2017( the strategic vision), phase 2 and 3, the individual service plans and public engagement and evidence base and impact between January and March 2018 (clear service proposals and keeping the Tayside community informed and a clear evidence base approach to underpin the Strategy) and phase 4, the design of the Integrated Clinical Strategy and an implementation road map in April 2018 (a realistic Strategy with sustainable core services and an implementation plan). The Medical Director concluded by noting that nobody felt that the status quo should remain. He highlighted that all needed to understand that the changes to the acute hospital footprint would be significant. During discussion the following points were highlighted: External resource from Involve was in place to support the engagement exercise for the Integrated Clinical Strategy. There would be a detailed action plan with co ordinate actions between now and March 2018. There was a query on the timeline beyond April 2018 and what detailed planning would be in place from there. It was noted that this was linked with the Shaping Surgical Services Business Case, the implementation of the Mental Health and Learning Disabilities review and the One Year Plan for 2018/19. The pace of the implementation of this Strategy and the ability to achieve what was described was queried. It was noted that there was additional expertise in the system to assist with the implementation. The regionalisation agenda would also be important and more information would be available for the next regular Board meeting in February 2018. It was noted that NHS Tayside was required to undertake the Scottish Government requirements in respect of service change and this had an impact on timescales for change. The timeline and sequence of reporting was highlighted. NHS Tayside was facing increasing financial challenges against the need for transformational change. A query was raised if the testing of the Integrated Clinical Strategy principles would influence the service plans and budgets for 2018/19; with a difference being made to recurring and non-recurring savings. It was noted that service redesign proposals would be benchmarked against these principles. The Integrated Clinical Strategy 101

Principles underpinned the Shaping Surgical Services Business Case coming forward to the Board in January 2018. The need to recognise prevention, health equity, communities leading care and non-clinical staff in title of the Strategy was suggested. It was felt that there needed to be a clear statement on the interdependencies between acute and health and social care to assist with the engagement of all in the Integrated Clinical Strategy. The Medical Director advised that different care pathways would be described as work moved forward. The Shaping Surgical Services Business Case would require other services to change due to inter and co dependencies and more detail would be available in February 2018. Noted progress against the project plan Noted the level of engagement across the clinical community Endorsed the principles for change identified by the clinical community and partners Noted the collaboration with Health and Social Care Partnerships and the five main areas identified as our joint areas for development Noted the co-dependencies and interdependencies required for hospital based services Supported the requirement for a different site based configuration of hospital services to support sustainable models of care Agreed to a period of public informing and awareness raising whilst a plan for long term, ongoing engagement with our stakeholders is developed. Supported the action plan for December 2017- March 2018 Councillor Wann left the meeting 14. Mental Health Services and Learning Disability Service Redesign Timeline (BOARD160/2017) Ms Hamilton, Dr Doig and Mr Nicoll were in attendance for this item. Ms Hamilton outlined the timetable for the presentation of the consultation feedback report and approval. It was noted that the report was to be presented to the Clinical and Care Governance Committee on 14 December 2017, to provide clinical and professional overview of proposals and comment to the Boards; to the Angus and Dundee Integration Joint Boards, Tayside NHS Board and the Area Partnership Forum for noting and comment and then finally to the Perth and Kinross Integration Joint Board for approval on 26 January 2018. In response to a query on the expectation of the various roles of the committees and Boards when considering the report, the Director of Strategic Change advised that the Clinical and Care Governance Committee was to provide assurance that the proposal was clinically viable and sustainable and supported by the Care Governance 102

Framework (noting this was an NHS Tayside responsibility). The Area Partnership Forum was being asked to give consideration to the potential impact of relocation of services on staff and the other Integration Joint Boards were being asked consider to the consultation feedback received and make comment to inform the final decision to be made by the Perth and Kinross Integration Joint Board. It was noted that each cover report to each Committee/Board would reflect the different role and responsibilities of that Committee/Board, while the main report and feedback report would remain the same. The final report presented to the Perth and Kinross Integration Joint Board would include all feedback from these Committees and Boards. The Chairman asked the Chairs of the Integration Joint Boards for their comment. Mr Robertson, Chair, Angus Integration Joint Board advised that Mr Nicoll had covered the relevant points and he was clear on what was required of the Angus Integration Joint Board. Councillor Lynn, Chair, Dundee Integration Joint Board noted that he was clear on what was required of the Dundee Integration Joint Board at their meeting on 19 December 2017. Mrs Dunion, Chair, Perth and Kinross Integration Joint Board advised that she had arranged a meeting the previous week to consider any issues. It was noted that the main concern had been the potential adverse media reaction and how that would be handled. It was also noted that a meeting was being arranged with all members of the three Integration Joint Boards to ensure there was sufficient assurance that clinical safety and sustainability issues were addressed as well as affordability. Mrs Dunion advised that all members of the Perth and Kinross Integration Joint Board who had attended a briefing session held on 4 December 2017 had clearly understood the process. She highlighted that the scheduling of the meetings allowed time for comments back from the Committees and Boards to be included in the final report. It was noted that these comments and feedback would be sent in advance to the Perth and Kinross Integration Joint Board in writing. Mrs Dunion advised that agreement had been made on when the report and its supporting materials would go live on the respective websites starting with the Dundee Integration Joint Board. Once a decision was taken at the end of January 2018, the communications strategy being prepared would be put in place. Noted the consultation plan timetable and endorsed the proposal to move forward 103

15. Design Phase: Compassionate and Inclusive Leadership Setting Out our Strategic Priorities (BOARD168/2017) The Director of Human Resources and OD and Mrs J Jones spoke to this paper. The Director of Human Resources and OD noted there was a strong relationship between this piece of work and the Integrated Clinical Strategy, with the culture and style of leadership. He gave the background to the work that had been undertaken since the presentation given to the Board in June 2016. It was noted there had been a build of the knowledge base following on from Phase 1, the diagnostic phase and the work undertaken in conjunction with the Kings Fund, NHS Improvement and Professor Michael West. It was noted that 5 principles and 12 strategic priorities needed to be adopted. These would continue to be revised and refined and be embedded as business as usual. Ms Jones advised that Mrs Slane Ms Paterson and Mr Dunn were in attendance at the Board meeting, to hear this report being discussed as they were involved in the design phase. Ms Jones outlined the work that had been undertaken since the development session held in May 2017. She stressed the importance of culture and leadership in transforming care. It was noted that two interactive workshops had been held in September and November and a design engagement team had been formed. The next steps were to realign the Integrated Clinical Strategy with the 12 strategic priorities. The Employee Director that this was a long term strategic commitments and she suggested there should be regular progress reports back to the Board. It was agreed that an update report should come back to the Board in June 2018. During discussion it was noted that this work needed to be explicitly linked with the Five Year Plan and there needed to be measures for improvement included in the 2018/19 Plan. It was noted that Professor Smith would discuss innovation and quality and links with the Academic Health Science Partnership with the Director of Human Resources and OD. Noted the progress and journey described through the Design Phase to date, and gave their continuing commitment to delivery of onward key actions Agreed that a progress report should come to the Board in June 2018 Director of Human Resources and OD The Board agreed to take Item 16, HAI control in Tayside for September and October 2017 next for discussion. 104

16. HAI control in Tayside for September and October 2017 (BOARD155/2017) Dr A Karcher was in attendance and spoke to this report. She highlighted the NHS Tayside performance against the Health Protection Scotland report published in October 2017. It was noted there were a number of areas that were below target. Dr Karcher outlined how these could be addressed; highlighting the need for a culture change and building on the strong Infection Control Team that was in place. She highlighted that the Team was to now be known as the Infection Prevention and Control Team. During discussion in respect of the Staphylococcus aureus bacteraemia (SAB) rates, Dr Karcher explained the actions that were being taken to reduce these. This included the reinforcement of vascular catheter bundles, increased engagement with clinicians with re-introduction of a letter requesting feedback from clinicians on all SABs to raise awareness and identify and reduce any avoidable risk factors and revisiting the relevant agencies to identify interventions to reduce the incidence of SABs in Persons Who Inject Drugs (PWID). The Caesarean infection rates were discussed and Dr Karcher advised that a step by step checking process was being undertaken looking at all areas including ventilation. She highlighted that as the numbers were low; less than 10 would make a difference. The Board : Noted Report BOARD155/2017 The Board meeting stopped for lunch at 1:00pm and restarted at 1:25pm Assurance and Advisory Group Professor Sir Lewis Ritchie thanked the Board for the opportunity to attend and observe this Board meeting, as well as the ongoing support for the assurance and Advisory Group and the Transformation Support Team. He outlined the process that had been in place since he spoke to the Board on 4 May 2017. He advised that as previously discussed the Assurance and Advisory Group report would be submitted to the Director General, Health and Social Care, and Chief Executive of the NHS in Scotland and then to the Public Audit and Post Legislative Scrutiny Committee. Professor Sir Lewis advised the Board that he was happy to answer questions on the process or to meet with individual Board Members before the report was published. The Board thanked Professor Sir Lewis for his update. The Board agreed to move into reserved business at 1:30pm and take item 25, Option Paper Service Configuration next on the agenda 105

Option Paper Service Configuration (BOARD172/2017) The Board approved the recommendations in Report BOARD 172/2017 The Board returned to open business at 1:45pm. RISK 17. Strategic Risks exceeding risk appetite Infection Management (BOARD159/2017) The Nurse Director advised that a report was awaited of a recent themed inspection. The Board noted the assurance report on the Infection Management strategic risk Capacity and Flow (BOARD158/2017) Dr Cook advised that discussion had taken place on the data that was being used. He confirmed that the most up to date data was included in this report and he highlighted the assurance on the current controls given to mitigate the risk in section 3 of the report. There was discussion in respect of the lack of improvement over the past year in the number of delayed discharges at Perth Royal Infirmary. It was noted that there were recruitment and retention issues with Care at Home services, as well as a recent change in the contracted provider. The occupancy rates were discussed and it was noted that bed occupancy was around the 90% plus mark. It was noted that with the prediction of a cold winter and a potential increase in flu; it was indicated there was likely to be cancellations of elective surgery. The Board noted the assurance report on the Capacity and Flow strategic risk Strategic Financial Plan (BOARD162/2017) The Director of Finance spoke to Report BOARD162/2017. The Board noted the assurance report on the Strategic Financial Plan strategic risk Medical Workforce (BOARD157/2017) It was noted that there were rota compliance issues with junior doctor rotas over a few areas; and work was ongoing with the Chief Operating Officer and the Associate Medical Director Team. There was to be a meeting to discuss the New Deal and how it affected junior doctors, between the British Medical Association, the Scottish 106

Government Health Directorate and clinicians. An update on this would be provided when there was more information available. The Board noted the assurance report on the Medical Workforce strategic risk Nursing and Midwifery Workforce (BOARD156/2017) The Nurse Director spoke to Report BOARD 156/2017. The Board noted the assurance report on the Nursing and Midwifery Workforce strategic risk Mental Health Services Sustainability of Safe and Effective Services (BOARD163/2017) The Medical Director advised that this risk was being reviewed and would be recalibrated. The Board noted the assurance report on the Mental Health Services Sustainability of Safe and Effective Services strategic risk Managed/2c Practices The Medical Director gave an update. He advised that a Professor of GP practice had been established for Lochee Health Centre. There was the ability to create posts with academic colleagues and other proposals would be coming forward. In response to a query from Mr Robertson, there was discussion on the management of preparing and moving GP practices back to the GMS model. It was noted that Phase 2 of the new GMS contract would be better placed to allow this. It was noted that as a principle, consideration should be govern to an exit strategy back to the GMS model before changes were made. The Board noted the assurance report on the Managed/2c Practices strategic risk GOVERNANCE 18. Changes to NHS Tayside Committee Structure (BOARD165/2017) The Board Secretary spoke to this report. She advised that the changes to the committee structure were outlined in the tracked appendices. It was noted that the biggest change was to the remit of the Finance and Resources Committee which was to be changed to the Performance and Resources Committee. This Committee would scrutinise performance to the Board and this would also include the public reporting of performance. The Board Secretary advised that the Lead Officer for the Performance and Resources Committee at the moment was the Director of Finance. 107

The Chairman noted that the establishment of the Performance and Resources Committee would allow the Transformation Programme Board to focus on strategy and the implementation of the transformation work. He asked the Chief Internal Auditor to comment. The Chief Internal Auditor advised that he was in accord with these changes, which in his view were needed to allow the areas of governance; challenge, holding to account and leading and directing the organisation to be strengthened. He added that there needed to be a focus on key priorities and moving the business forward without unnecessary delay and to achieve this reports should not be duplicated and presented to a number of foras, giving the recent Mental Health redesign as an example. Noted the update Approved the proposed changes to the NHS Tayside Committee Structure and agreed they should come forward to the Board in February 2018 as part of a paper on Updates to the NHS Tayside Code of Corporate Governance 19. A Healthier Future Action and Ambitions on Diet, Activity and Healthy Weight Consultation (BOARD154/2017) The Director of Public Health spoke to this report. He advised that the consultation document, A Healthier Future, proposed a range of fundamental actions to improve diet and weight in Scotland. He highlighted that obesity was the single biggest public health threat and one of the main threats was the link between obesity and the onset of Type 2 diabetes. The Director of Public Health advised that NHS Tayside published the first healthy Weight Strategy in the UK and NHS Tayside was well placed to implement the recommendations from the consultation. It was noted that the consultation was to run until the end of January 2018 and a draft response had been prepared and had been circulated with this paper. The Director of Public Health advised that the draft response was also to be considered by the Community Planning Partnerships and the health and social care partnerships, with the aim of submitting a Taysidewide response to the consultation. It was noted that individual responses could also be submitted on the consultation. It was noted that a series of interactive road shows were to be held across Scotland during December 2017 and January 2018 and Board Members were encouraged to take part in these road shows. The Director of Public Health advised that he wished to come back to the Board with the response back from the Scottish Government on the consultation. During discussion, there was general support for the approach taken and there was the evidence base that significant weight loss impacted on other 108

conditions and pathologies as well as the potential impact on the increasing cost of medicines. It was noted that the nursing profession had a challenge with the new standards for the nursing profession and in particular the requirement to be a role model and take responsibility for their actions. It was noted that the Chief Nursing Officer was working with NHS Tayside on the ways to support student and trained nurses to maintain a healthy weight. There was discussion about the unhealthy products that were on sale on the concourse at Ninewells Hospital. It was noted that work was ongoing to promote healthy eating and provide more fruit and vegetables. It was acknowledged that there was a staff welfare issue in certain areas of NHS Tayside, one being the dining room at Perth Royal Infirmary, that closed at 1:30pm and thereby staff did not have access there to healthy eating. Recognised that the Scottish Government has firmly identified obesity as a priority for action Noted the draft response to the consultation document and that comments could be provided to enable a partnership response from NHS Tayside Noted the four interactive national road shows PART B Other matters for note, information, reading 20. Non Executive Appointment and Membership of Committees (BOARD166/2017) Noted the appointment of Councillor Derek Wann as the Angus Council Stakeholder member of Tayside NHS Board from 14 November 2017 to 30 April 2022 Noted that Mrs Linda Dunion is no longer a member of the Clinical and Care Governance Committee Approved that the refresh of the membership of the NHS Tayside Standing Committees be deferred to August 2018 21. Record of Attendance The Record of Attendance was noted for information. 22. Minutes The following Minutes were noted: Finance and Resources Committee 12 September 2017 Transformation Programme Board 5 October 2017 Finance and Resources Committee 19 October 2017 Awaiting Committee Approval Staff Governance Committee 26 September 2017 Clinical and Care Governance Committee 5 October 2017 Transformation Programme Board 1 November 2017 109

RESERVED BUSINESS 23. Reserved Minute of meeting of 26 October 2017 The reserved minute of the Board meeting on 26 October 2017 was approved. 24. Reserved action points update The reserved action points update was noted. 25. Committee Chairs Assurance Reports Remuneration (BOARD153/2017) The Board noted Report BOARD153/2017. PART B Other matters for note, information, reading 26. Property Disposal Land and Building at 5 Buchanan Place, Kinloch Rannoch (BOARD152/2017) The Board agreed the recommendation in report BOARD152/2017. 27. Reserved Minutes The following minutes were noted by the Board: Area Clinical Forum 7 September 2017 East of Scotland Research Ethics Services REC 1 20 October 2017 Awaiting Committee Approval Remuneration Committee 26 September 2017 Clinical and Care Governance Committee 5 October 2017 28. Date of next meeting Tuesday 16 January 2018 at 9:00am in the Board Room, Kings Cross Hospital, Dundee 110