NHS GRAMPIAN APPROVED Minute of Meeting of GRAMPIAN NHS BOARD held in Open Session at 10.00 am on 5 October 2017 CLAN House, 120 Westburn Road, Aberdeen Present Professor Stephen Logan Chairman Mrs Rhona Atkinson Non-Executive Board Member Dame Anne Begg Non-Executive Board Member Professor Amanda Croft Director of Nursing, Midwifery and Allied Health Professions/Deputy Chief Executive Mrs Sharon Duncan Employee Director/Non-Executive Board Member Dr Nick Fluck Medical Director Mr Alan Gray Director of Finance Mrs Luan Grugeon Non-Executive Board Member Professor Steven Heys Non-Executive Board Member Mrs Christine Lester Non-Executive Board Member/Vice Chair Dr Lynda Lynch Non-Executive Board Member Dr Helen Moffat Non-Executive Board Member Mr Jonathan Passmore Non-Executive Board Member Mr Eric Sinclair Non-Executive Board Member Mrs Susan Webb Director of Public Health Mr Malcolm Wright Chief Executive By invitation Miss Lesley Hall Dr Annie Ingram Mr Gary Mortimer Mr Graeme Smith Assistant Board Secretary Director of Workforce Director of Acute Services Director of Modernisation Attending Mrs Marion Anderson PA/Minute Taker Mrs Jillian Evans Head of Service, Health Intelligence (Item8) Dr Adam Coldwells Chief Officer, Aberdeenshire HSCP (Item 10) Mrs Pam Gowans Chief Officer, Moray HSCP(Item10) Mrs Sally Shaw Head of Strategy and Transformation, Aberdeen HSCP (Item 10) Item Subject 1 Apologies Apologies were received from Mrs Amy Anderson, Councillor Frank Brown, Councillor Isobel Davidson, Mrs Laura Gray and Councillor Douglas Lumsden. 2 Declarations of Interest There were no declarations of interest relating to specific agenda items. 1
3 Chairman s Welcome and Introduction Professor Logan welcomed everyone to the meeting and introduced Professor Steven Heys, Head of the School of Medicine, Medical Science and Nutrition at the University of Aberdeen, as Aberdeen University s representative on the Board, succeeding Professor Mike Greaves. The Chairman thanked Professor Greaves, in his absence, for his tremendous contribution to the Board during his five years as a Board Member. The Chairman advised of some of the meetings and events he had recently attended including; 12 September - the leadership walkround to the Day Case and Surgical Assessment Unit at Dr Gray s Hospital. Although this was a smaller part of the hospital compared to many of the clinical areas he had visited it emphasised the important function in reducing overnight stays and maximising the surgical procedures that can be done on a day case basis. 15 September - celebrations to mark the Intensive Care Unit earning the Centre of Excellence title. This was awarded for the level of care shown to patients using an Extracorporeal Membrane Oxygenation (ECMO). The ECMO team at Aberdeen Royal Infirmary was presented with the award by the Extracorporeal Life Support Organisation and was the first UK centre to receive this award. 29 September The official opening of the Robertson Family Rooftop Garden by the Queen. We welcomed the Queen to Aberdeen Royal Infirmary to undertake the opening of the Robertson Family Roof Garden. This had been a special day of celebration which involved over 80 volunteers, donors, nurses, patients, domestic staff, gardeners and fundraisers. The chairman thanked Mrs Laura Gray and her team for all their hard work in coordinating the visit. The Chairman took the opportunity to congratulate Susan Webb, Director of Public Health who had been invited to be a full member of both NHS Grampian and NHS Shetland Boards with effect from 1 September. Professor Logan went on to congratulate the team from NHS Grampian and Aberdeen University who had been shortlisted for a Health Service Journal award. The collaboration between NHS Grampian and the Filege Hiwot Hospital in Ethiopia had brought tremendous benefits to both organisations. 4 Chief Executive s Report Mr Wright presented his Report which highlighted a range of issues including details of important meetings and events attended. He echoed the thanks given by the Chairman on the tremendous effort from staff and volunteers in welcoming the Queen to open the Rooftop Garden. The annual Unscheduled Care Conference had taken place on the 29 August where there had been a number of presentations from Aberdeen City, Aberdeenshire and Moray which highlighted new ways of working. 2
Mr Wright highlighted the campaign film, Ending PJ Paralysis, which had been produced for the Unscheduled Care Conference and promoted the benefits of staying active and independent in hospital. The video had received over 270,000 views on social media. This highlighted good multi professional leadership and the Chief Executive commended all staff that had been involved. Mr Wright advised that NHS Grampian had made good progress with Health and Safety Executive Improvement notices. He thanked Dr Ingram and all staff involved for all their continued hard work. Other topics highlighted in the report included: Paediatric Inpatient Services at Dr Gray s Hospital Aroma Cairngorm Lady Helen Parking Centre Stonehaven Renal Unit Chief Nursing Officer Strategy for Scotland 5 Minute of Meeting held on 3 August 2017 The minute was approved. 6 Matters Arising Item 7 - Quality Indicators Mrs Webb advised that consideration was being given to a range of sources and key measures to gather patients opinions (in addition to Care Option). Item 10 Performance Report Mr Sinclair reported that the section for comment by the service would be reinstated for next year s stroke audit. Mr Smith advised that a draft Regional Delivery Plan had been submitted to the Scottish Government. This would be sent to Board members who would have an opportunity to discuss this at the Board Seminar in November. 7 Workforce Plan 2017/20 Dr Ingram reported on the Workforce Plan 2017/20. She explained that this year s plan had been developed in a period of significant change, following the introduction of Health and Social Care Partnerships and the Scottish Government s Health and Social Care Delivery Plan, which signalled an intention to transform services. Dr Ingram advised there were ongoing challenges with workforce supply and an ageing workforce. She highlighted that, although service planning would be driven by need, the enduring workforce challenges suggested that the service model may be determined on the basis of the available workforce, either locally or working with partners regionally. She advised that there were some errors in the figures on page 12, item 3.2 of the 3
plan, which would be amended before submission to the Scottish Government. In response to a query about the challenges of delivering the scale of Physicians Associates referred to in item 4.1, Dr Ingram advised of limitations regarding the number of placements and a career framework. Professor Heys advised that there was competition because NHS England funded posts and there were limitations with a career structure, as Physicians Associates cannot prescribe. The Board was advised that NHS Grampian had been successful in recruiting Physicians Associates (PAs) but there were challenges with scaling up the number of PAs and integrating new disciplines/types of workers into the workforce. Following a query about what action had been taken to increase the number of job plans that were submitted, Dr Ingram advised that new guidance on job planning had been issued and that work was underway to introduce an electronic system. There had been a significant improvement since the Report had been written. Dr Ingram advised that the current plan included all staff within the health and social care partnerships, as it was not possible to extract the health staff. Work was underway nationally to develop a single workforce plan for health and social care and revised guidance would be published in the Autumn. Dr Ingram explained that actions in the workforce plan were monitored by a range of groups in the organisation and a report would come to the Board later in the year. Professor Heys advised that the University of Aberdeen was keen to underpin the workforce strategy by developing training programmes, working alongside clinical colleagues. The Chairman highlighted the importance of both the local Universities and North East Scotland College in proving workforce for the future Dr Ingram advised of other initiatives to encourage workers into the NHS in both clinical and non-clinical roles, such as increasing the number of apprentices, through introduction of both Foundation and Graduate schemes and extending the Modern Apprentice Scheme. Mrs Duncan commended the work by HR colleagues to increase the numbers of nurses and the good work being done for and with our staff. She advised that the forthcoming recruitment drive in Australia had staff-side support. Dr Ingram responded that although there were more nurses employed now compared to five years ago, services faced challenges dealing with increased activity. Front-line teams were looking at a range of solutions to workforce challenges. 4
Mr Wright welcomed this report and commended Dr Ingram and her team on their hard work. He highlighted that demand and expectations were rising and stressed the importance of providing services safely. He felt that this was a good local plan, with local solutions. The plan highlighted the attractiveness of working in the Grampian area and the partnership working that was evident between NHS Grampian and the Higher Education establishments. Professor Croft advised that ninety percent of the nursing graduates from the Robert Gordon University in 2017 had been recruited to work in the Grampian area. The Board Approved the NHS Grampian Workforce Plan 2017 2022 subject to corrections being made to the figures; Agreed to its publication and submission to the Scottish Government. The Chairman thanked Dr Ingram and the Workforce team for producing the comprehensive plan. 8 Quality Report Mrs Webb introduced the paper by explaining that it built on the recommendations endorsed by the Board at its August meeting, particularly around the approval of the quality ambitions and the development of a common understanding behind the purpose and rationale for the metrics chosen to measure quality. The paper aimed to provide insight about current processes and explain developments which will influence changes in culture and the way in which quality was viewed. The immediate actions were to: discuss the aims of the project with management teams, communicate these intentions at all levels of the organisation and to begin liaising with front line staff to identify quality metrics that they felt defined quality for their work. Mrs Webb explained the continuous development of NHS Grampian s quality culture and the aim of matching clinical ambition to organisational aims. Work will be undertaken by the Quality Group, a cross-sector expert group that will be responsible for coordinating activities, overseeing education and support for implementation, monitoring progress and communication. The paper outlined the timetable for the next steps in the process. Mrs Webb advised that the Clinical Governance Committee would scrutinise the process and review reports before findings and recommendations are presented to the Board. The process would compare performance and identify areas for action and improvement. Mr Wright highlighted the importance of the availability of real time data and of professionals across the system using data creatively. Ms Evans advised that NHS Grampian was working with the University to develop predictive analytics. Dr Moffat reported that clinicians were enthusiastic for meaningful and useful metrics, recognising there were huge challenges. 5
Dame Anne reflected on the recent visit from Canterbury, New Zealand colleagues which showed that when accuracy increased, staff were more willing to engage when they realised the importance and value of data. Mr Passmore also welcomed the work and suggested that the presentation by New Zealand colleagues had provided helpful examples. He stressed the need for openness and transparency in data. Dr Ingram advised that a Staff Governance Committee role was to scrutinise staff experience. Mrs Duncan highlighted there were no staff side representatives on the Clinical Governance Committee. It was noted that the Clinical Governance Committee was concerned and would complement the role of the Staff Governance Committee. The Board Noted the existing quality assurance structures and processes across the organisation Noted the assessment of quality and system effectiveness based on high level markers Endorsed the proposed process to scrutinise quality by the Clinical Governance Committee Approved the next stage of the quality improvement programme 9 Performance Report Mr Gray provided an update on Performance and Quality as set out in the Report, and the actions that had been taken to address those areas not in line with the plan. He highlighted the main points in the report which included: Unscheduled Care for the year ending June 2017, A&E attendances were 1.3% fewer than the year previously and the percentage of people spending 4 hours or less in A& E was still well below the Scotland-wide rate of 93.9%. Since July 2017 there had been a dip in performance. A daycare audit was planned and would be undertaken quarterly. Elective Care Surgical Elective Classification System has been introduced to ensure that consideration was given to clinical priority in relation to listing patients for surgery. Access times continued to be monitored as number of patients breaching standards continued to increase. Child and Adolescent Mental Health Services a number of staff appointments had been made and it was hoped that this would improve performance. Alcohol and drug services performance in Aberdeen and Moray was regularly above the 90% standard. Maintaining access within the standard was challenging in certain parts of Aberdeenshire, particularly North Aberdeenshire. 6
Financial position NHS Grampian was expected to achieve its three statutory financial targets. Cancer 11.4% colorectal cancers diagnosed at stage 1 compared to 15.1% across Scotland. There was interest and research taking place as uptake of screening had been the highest in Scotland. The Board noted the Performance Report and the actions being taken to address those areas where performance was not in line with plan. 10 Integration Joint Boards (IJBs)- Annual Reports 2016-17 The Chairman welcomed Pam Gowans - Chief Officer Moray, Sally Shaw Head of Strategy and Transformation Aberdeen City and Adam Coldwells - Chief Officer Aberdeenshire, who reported on highlights from their respective IJB Annual Reports. Mrs Gowans gave an overview of the reports and advised that it had been a requirement for each IJB to produce and publish an annual performance report. The highlights from the three reports included: Moray Housing initiatives in Forres and Elgin that would help to prevent hospital admissions. The opening of Jubilee Cottages in Elgin as halfway homes for people ready to leave hospital so they can work to regain independence. Appointment of 6 mental health GP link workers who would signpost patients to alternative community and non medical resources. Aberdeen Reduction of people delayed in hospital Delivered first partnership conference and held first staff partnership awards event Developed Carers Strategy Maintained downward trend in emergency admissions to hospital. Aberdeenshire Reduction in number of people delayed in hospital once ready for discharge Implementation of Virtual Community Ward supporting people stay at home The roll out of participatory budgeting The Board welcomed the achievements of the IJBs in their first year. Mr Gray highlighted that the Grampian IJBs had performed well in Scotland and that this should be celebrated. Dr Moffat advised that the Area Clinical Forum was keen to hear about the unintended consequences of the work that had taken place. The Chief Officers would be attending the Area Clinical Forum meeting in November to discuss this further. Professor Logan thanked the Chief Officers for all their hard work and it was agreed 7
that the approved minutes from the IJB meetings would be included in the papers for future Board meetings. The Board Noted the three Integration Joint Boards (IJBs) for Aberdeen City, Aberdeenshire and Moray had published their Annual Performance Reports for 2016-17. Noted the content of the Annual Performance Reports which had been presented to the respective IJBs. 11 Revised Approach to Risk Dr Ingram gave an update on the Board s revised approach to risk. Board Members had taken part in a workshop on 1 September 2016, where they refreshed and updated the strategic risks and agreed to a programme to transform the approach to risk within the Board. A further two workshops in July and September 2017 had refined the Board s risk appetite and risk tolerance and the paper proposed the revised approach. Dr Ingram advised that this work would be aligned with the new quality metrics approved by the Board, and the strategic risk register would be updated based on the high level risks identified within the paper. She also highlighted that a risk horizon scanning report would be prepared quarterly to facilitate discussion on emerging risks. A risk management implementation plan would be developed to support the rollout of the revised approach across the organisation. She advised that this would be cascaded to services once it was approved by the Board. Professor Logan welcomed the revised approach to risk and thanked all involved for all their hard work. The Board approved the revised approach to risk, including the next steps. 12 Committee and Forum Reports The following reports were presented to the Board for noting, with chairs highlighting important specific points by exception. 12.1 Audit Committee Mrs Atkinson gave a verbal update from the Audit Committee. She advised that the committee had received an annual update on backlog maintenance; this was a hugely complex piece of work which was susceptible to change. This work was on target to be completed in 2020. Mrs Atkinson also advised that NHS Grampian s Performance relating to the present CO2 emissions was good. She highlighted that the internal audit had brought forward the Mental Health review. She explained that the Children s Services audit had been completed but significant work would still need to be done. Mr Garry Kidd, Assistant Director of Finance had advised the committee that NHS Grampian was taking a more proactive approach to fraud and were now using the National Fraud Service framework. 8
12.2 Clinical Governance Committee Dr Lynch referred to the self-explanatory report. 12.3 Endowment Committee Dame Anne advised that the endowment fund was not to be over-exposed to the uncertainties of Brexit but the committee was mindful to consider monies that had already been committed. She also highlighted that funding had been granted for a counselling service for amputees at Aberdeen Royal Infirmary and Woodend Hospitals. 12.4 Performance Governance Professor Logan referred to the self-explanatory report. 12.5 Spiritual Care Committee Mrs Atkinson referred to the self-explanatory report. 12.6 Staff Governance Committee Mr Sinclair advised that representatives from the General Medical Council would be visiting NHS Grampian in October. He also highlighted the successful workshop that had taken place after the last Committee meeting. 12.7 Area Clinical Forum Dr Moffat highlighted the launch of the Grampian Guidance, a new internet system for clinical guidance for health professionals across Grampian. Professor Logan welcomed this project and encouraged the Board to support this. 12.8 Grampian Area Partnership Forum (GAPF) Mrs Duncan gave a verbal update from the Grampian Area Partnership Forum, highlighting that GAPF would like senior management to be mindful that as roles and remits were expanding, staff may have limited capacity. Mrs Duncan also advised that GAPF would like to note its concerns that the Annual Review taking place following the Board meeting that day would be a non-ministerial review for the second year. GAPF had felt that this would be a missed opportunity for face to face engagement with staff side and others. Professor Logan supported these concerns. 13 Approved Minutes The Board noted the following approved minutes 13.1 Audit Committee 27 June 2017 13.2 Clinical Governance Committee 19 May 2017 13.3 Endowment Committee 8 June 2017 9
13.4 Performance Governance Committee 16 Mar 2017 13.5 Spiritual Care Committee 15 May 2017 13.6 Staff Governance Committee 22 May 2017 13.7 Area Clinical Forum 28 June 2017 13.8 Grampian Area Partnership Forum 15 June 2017 & 10 August 2017 15 Any Other Competent Business Professor Heys advised that in the National Student Survey, NHS Grampian and NHS Highland had recorded the highest satisfaction level for final year medical students. 16 Date of Next Meeting Board Meeting on Thursday 7 December at CLAN House, Westburn Road, Aberdeen. Signed.. Date Chairman 10