FLINTSHIRE LOCAL HEALTH BOARD

FLINTSHIRE LOCAL HEALTH BOARD Appendix A Minutes of the meeting of the Flintshire Local Health Board held on at 1.30pm in the Boardroom, Preswylfa PRESENT: Mr Barry Harrison Chair Mr Andrew Gunnion Chief Executive Dr Eric Beckett General Practitioner Member Mr Ian Bellingham Executive Director of Operations, Conwy and Denbighshire NHS Trust Mr Neil Bradshaw Director of Planning, North East Wales NHS Trust Mrs Val Coleman Nurse Member Mr Harry Crook Pharmacist Member Mr Gareth Davies Acting Director of Development and Performance Management Mrs Margaret Dennis Carer Member Mr Gareth Evans Therapies Member Dr Janette Fells Medical Director Cllr Mrs Ros Griffiths Local Authority Representative Mr Trevor Hinstridge Mrs Lynne Hughes Voluntary Sector Member Mr Colin Jenn Director of Finance Ms Sue Lewis Director of Adult Social Care Cllr Mrs Hilary McGuill Local Authority Representative Dr Dan Muckle-Jones GP Member Dr Richard Neal Associate Member Mrs Eileen Prestidge Associate Member Mrs Barbara Roberts Voluntary Sector Member Mr Ivor Roberts Local Authority Representative Mr John Smith Optometrist Member Mrs Angela Tinkler Associate Director of Public Health IN ATTENDANCE: Mr Paul Bowker Head of Primary Care Services Ms Caroline Bartley North East Wales Learning Disabilities Critical Placement Breakdown Nurse (for agenda item 5.4) Mrs Amanda Casey Senior Nurse Manager Mr Trevor Hinstridge Head of Medicines Management Mr Andrew MacGlashan Joint Planning Manager (for agenda items 5.3 and 5.4) Ms Mary Popplewell Head of Clinical and Corporate Governance Mr Simon Pyke Directorate General Manager (Mental Health (NEWT)) (for agenda item 5.3) Mrs Llinos Roberts Corporate Services Manager OBSERVERS: Mrs Penny Rothwell Flintshire Local Voluntary Council Mr Peter Roberts Novartis Mr John Williams Novartis Ms Sarah Pierce Student, NEWT Flintshire Local Health Board 1

(06)155 APOLOGIES Apologies were received from Mr Mick Horton, Mrs Debbie Smith and Mrs Nesta Rees. (06)156 PERSONALIA The Chair welcomed Councillor Mrs Ros Griffiths, Local Authority Representative, to her first meeting of the LHB. (06)157 DECLARATIONS OF INTEREST Declarations of interest were received from the: Chair and Pharmacy Member in respect of agenda item 5.1 Corporate Report 3.3 Pharmaceutical Services. Executive Director of Operations, CaDT in respect of agenda item 5.2 Strategic Outline Case: Replacement Linear Accelerators and Simulator, North Wales Cancer Treatment Centre. Director of Planning, NEWT, in respect of agenda item 5.3 Strategic Outline Case for Adult Mental Health In-Patient Facility. (06)158 MINUTES OF THE MEETING HELD ON 26 JULY 2006 The minutes of the meeting held on 25 October 2006 were agreed as a true record. (06)159 MATTERS ARISING (06)147 Matters Arising, (06)130 Chair and Chief Executive s Briefing Chief Executive s Report Designed For North Wales: The Chief Executive reported that formal notification had been received that the Clwyd Community Health Council would not be contesting the proposals, and that all CHCs across North Wales were now supporting the proposals. The LHBs across North Wales would continue to liaise with the CHCs and discuss any concerns as the work progressed. (06)149 Chair and Chief Executive s Briefing Chief Executive s Report (vi) Designed For Flint It was reported that the Clwyd Community Health Council had declined the invitation to chair the public consultation meetings. (06)150 LHB Corporate Report 2.1(f) Referrals: The Acting Director of Development and Performance Management reported that the waiting list at CaDT remained closed, with the exception of emergency referrals, however, the waiting list at NEWT remained open. Flintshire Local Health Board 2

(06)160 CHAIR AND CHIEF EXECUTIVE S BRIEFING Appendix A 1. CHAIR S REPORT The Chair tabled his report which highlighted meetings and events he had attended since the last Board meeting. In particular, the Chair reported on the following issues: (i) (iii) Meeting with Minister for Health and Social Services Met with the Minister and Chief Executive of NHS Wales on 9 November 2006 to discuss Designed For Flint. It was noted that WAG were due to produce a paper during the early part of the New Year on community services. This would be reported to the Board in due course. Board Appointments In preparation of the Board appointments in April 2007 an advertisement would be circulated week commencing 4 December 2006, and interviews would be held at the end of January/early February 2007. This would allow time for induction and training. Health Overview and Scrutiny Committee A positive meeting held on 7 November 2006 to discuss the LHB s Annual Report and other issues. 2. CHIEF EXECUTIVE S REPORT The Chief Executive reported on the following issues: (i) SCEPs Meetings had been held between the Regional Office and both Health Economy areas to discuss the SCEP process. Both meetings had been positive and a course of action had been agreed by which both SCEPs would be submitted by the end of November 2006. North East Wales NHS Trust It was reported that Ms Hilary Pepler, Chief Executive, had resigned as from 31 March 2007. That the reports be noted. (06)161 LHB CORPORATE REPORT The following key issues were highlighted: 1. FINANCE REPORT The Director of Finance reported that the overall financial forecast had improved, with an anticipated underspend of 1m at year end. A significant element of this surplus was due to Category M savings, which, based on current data, was estimated to be in the region of 600,000. Flintshire Local Health Board 3

Members were informed that there was an increased non recurring underspend forecasted on the new Pharmacy Contract and further slippage on the LHB reserves and that this would be used to reduce SCEP deficits. 2. COMMISSIONING, SERVICE DEVELOPMENT AND PERFORMANCE MANAGEMENT The Acting Director of Development and Performance Management reported that: (i) (iii) Balanced Scorecard Quarter 2: The Balanced Scorecard had been submitted to Regional Office and feedback was awaited, and this would be reported to the Board at its meeting on 20 December 2006. Local Delivery Plans: The LHB were working within the Health Economy areas on developing the Local Delivery Plans and the LDP for the North East Wales, Conwy and Denbighshire areas, Countess of Chester and the Robert Jones and Agnes Hunt Trusts had been submitted to WAG. Review meetings had been held with Regional Office with regard to the North East Wales and Countess of Chester submissions, and a meeting was scheduled for 23 November 2006 to discuss the Conwy and Denbighshire submission. Feedback would be reported back to the Board in due course. Cancer Waiting Times: The waiting times target for cancers was 100% compliance by December 2006, with 2% tolerance in the 31 day target and 5% tolerance in the 62 day target. Trusts had not yet achieved the 100% targets due in part to the differing clinical conditions. WAG had reported that a breach report would be required for each individual patient who had breached the target. It was noted that, across the Health Economy areas, due to the numbers of patients on the waiting lists, the numbers being breached were very low. (iv) Designed For Flint: Members were informed that concern had been expressed at patients not being discharged from acute hospitals to Flint Hospital. These issues had been investigated with the Trusts and it had been confirmed that discharges to other Community Hospitals had been made based on individual clinical need. As part of the consultation process the Chief Executive reported that two public meetings would be held on 27 and 29 November 2006 and that the LHB had contacted a wide range of groups in Flint and the surrounding area to offer the opportunity for the LHB to attend to discuss the proposals and to answer any concerns. The Chair reported that his regret at the Community Health Council declining the invitation to Chair the public meetings. Flintshire Local Health Board 4

Members were informed that WAG would be issuing guidance early in the New Year on development of a Community Services Plan. Mr Geraint Martin, who had undertaken the work on behalf of WAG, had attended meetings with the North East Wales Health Economy to look at the work undertaken to-date, and positive feedback had been received on the Hospice from Home Scheme and work around the development of the Integrated Health Teams. 3 PROVISION OF PRIMARY CARE SERVICES The Head of Primary Care Services reported that: (i) GP Workforce - Following the resignation of Dr McHugh, the LHB had taken over management of the practice and this will continue until future arrangements had been put in place. Guidance had been received from WAG on GP practice vacancies a Panel would be held on 28 November to consider this guidance as part of the option appraisal on the future provision of services for patients registered with the practice. Implementing the Primary Care Estate Strategy: Through the Flintshire Local Voluntary Council, a workshop has been arranged for the 7 December 2006, to highlight and discuss the opportunities the estate projects may present for the Voluntary Sector. The Chief Executive reported that, following the ratification of Project Group minutes, updates would be provided to the relevant Town/Community Council for information. Mr Ivor Roberts, Local Authority representative/lhb Estates Champion reported his satisfaction on how the LHB were progressing with the schemes. Following requests for separate meetings with the Developers, it was agreed that the Chair, Chief Executive and Mr Roberts would meet with the other Local Authority representatives on the Board to discuss how to progress these issues. (iii) Pharmacy Contract: The Head of Medicines Management reported that, following the recent visits to all pharmacies in Flintshire the LHB were looking to integrate existing pharmacy services (palliative care, emergency hormonal contraception and care home advice) into the new Pharmacy Contract as enhanced services. It was reported that, unlike the GMS contract, no funding had been identified for this work and this would need to be funded directly by the LHB, and work was progressing on this issue. 4 NATIONAL PUBLIC HEALTH SERVICE The Associate Director of Public Health reported that: (i) Proposed Ban on Smoking in Public Places Update: A Smoke Free Partnership Workshop had been scheduled for 12 December 2006 and all Members were welcome to attend. Flintshire Local Health Board 5

Although additional resources had been made available to the National Public Health Service to support the smoking in public places ban as from 1 April 2007 it was hoped that further funding would be made available in the future. 5 ORGANISATIONAL DEVELOPMENT AND MANAGEMENT The Head of Clinical and Corporate Governance informed Members that: (i) Healthcare Standards For Wales: The standards were now out for consultation. Disappointment had been expressed that the standards were generic across Trusts and LHBs and that it may be difficult for LHB s to present the required evidence. The Healthcare Standards for Wales were separate to the Welsh Risk Pool Standards and at present it was unclear as to how both assessment processes would work together. That the reports be received. (06)162 STRATEGIC OUTLINE CASE: REPLACEMENT LINEAR ACCELERATORS AND SIMULATOR, NORTH WALES CANCER CENTRE The Chair welcomed James Roach and Adrian Thomas from CaDT to the meeting. The Acting Director of Development and Performance Management informed the Board that the Linear Accelerators at the North Wales Cancer Centre would need replacing in 2009 and 2010 and that the Strategic Outline Case had been developed to seek approval in principle to the submission of the Strategic Outline Case to WAG. It was also reported that a further Linear Accelerator would be required in 2016 and this had been included as part of this Strategic Outline Case. It was anticipated that the commissioning period for this work would take approximately 25 months. Members were informed that, in order to provide a seamless service, it would be necessary to construct a decant bunker and additional bunker to install the replacement linear accelerators and that an investment of 14.1m would be required to undertake these works. It was reported that WAG were considering providing on-going strategic support for capital charges revenue relating to radiotherapy investment programmes and that the Strategic Outline Case would be subject to a capital bid to WAG as part of the All Wales capital scheme relating to radiotherapy. The financial impact on North Wales LHBs would be related to additional related costs and would be split across LHBs, dependent on usage. Flintshire Local Health Board 6

Members were informed that the Strategic Outline Case had been approved by the North Wales Cancer Network. The Director of Finance reported that there was no funding currently identified for this work and that this would be built into the SCEP. (i) That the Strategic Outline Case be approved in principle, subject to confirmation from WAG of capital investment and on-going strategic support for capital charges revenue. (iii) That the LHB provide additional revenue funding on a shared cost basis across North Wales LHBs, dependent on usage. That the Board approve in principle the submission of the Strategic Outline Case to WAG. (06)163 STRATEGIC OUTLINE CASE FOR ADULT MENTAL HEALTH IN- PATIENT FACILITY The Director of Planning, NEWT, supported by Mr Simon Pyke, Directorate General Manger, NEWT, and Mr Andrew MacGlashan, Joint Planning Manager, Flintshire LHB, presented to the Board on the background to the development of the Strategic Outline Case (SOC) for the adult mental health in-patient facility. Members were informed that, an external review of mental health services identified the current in-patient facility at Wrexham Maelor Hospital were condemned as unfit for purpose, and in addition to resolving the identified shortcomings of the existing inpatient unit, the proposed new facility and service arrangements would incorporate crisis resolution and home treatment services, which should enable reduced lengths of stay, although the number of admissions may rise under the new service model. Following the review, and the Local Health Boards review of mental health services, an agreed vision was developed and the Trust developed a SOC for the redevelopment of adult mental health in-patient services. The SOC identified a preferred way forward and, subject to securing capital charges from WAG, this proposal would fully implement the vision through the development of a Crisis Resolution Service through North East Wales. It was noted that mental health was a priority area for WAG and it was likely that capital charges would be secured. The Director of Planning, NEWT, reported that, if approved, the SOC would be submitted to WAG in December 2006. The Director of Adult Social Care supported the proposed development as part of the agreed strategy for managing services for delivering, which would also cater for 16 18 year olds. In answer to a question by Councillor McGuill regarding as to whether the unit would cater for adolescents, Mr Simon Pyke confirmed that issues of transition between children and adults Flintshire Local Health Board 7

units were managed on an individual patient bases dependent on circumstances. It was agreed that in supporting the SOC the Board would wish to ensure that the service issues between Conwy and Denbigh and NEWT around the provision of mental health services for West Flintshire should be addressed and agreed prior to the formal provision as part of the next stage of the planning process. That the Strategic Outline Case be approved for submission to WAG. (06)164 LEARNING DISABILTIES: REPATRIATION AND CRISIS PREVENTION SERVICE DEVELOPMENT Mr Andrew MacGlashan, Joint Planning Manager, and Ms Caroline Bartley, North East Wales Learning Disabilities Critical Placement Breakdown Nurse, presented a proposal to establish a Service Level Agreement with a local provider to enable six beds to be made available for repatriation purposes, and to establish two crisis prevention assessment and treatment beds (one for Flintshire and one for Wrexham). This proposal has been discussed at officer level with both Flintshire and Wrexham Local Authorities and NEWT and the proposal had been fully supported by WLHB. In considering the proposal the Board were informed that it was proposed to undertake a Single Tender Action in line with Standing financial instruction (9.4) to enter into a contract with Mental Health UK. Subject to approval by the Board discussions would be concluded with Hill Dickinson to ensure that the contract documentation was agreed and would enable the LHB to sign the contract in due course. (i) That the Board support the service development in the Learning Disabilities services. That the Board agreed the single tender action in line with the LHB s Standing Financial Instructions (9.4). (06)165 COMMISSIONING NHS DENTAL SERVICES As part of the Board Briefing session on 25 October 2006, to consider the new Dental Contract, a paper was presented to the Board on commissioning GDS/PDS contracts; a revised paper which takes account of the Boards required changes was presented - this would form the basis of the LHB s commissioning approach and would be reviewed in January 2008. The Board was requested to approve the document. That the report be approved. Flintshire Local Health Board 8

(06)166 EMERGENCY PREPAREDNESS Appendix A The Acting Director of Development and Performance Management up-dated the Board on work undertaken to date to support Emergency Preparedness, actions to be completed and areas of concern. Following a recent Capability Survey, two key areas had been identified for the LHB to address by Spring 2007, ie, the identification of a Board Level Champion, and the development of a Business Continuity Plan (currently being developed). The Chair requested that, as part of the Risk Management agenda, Councillor Mrs Hilary McGuill take on the role of Board Level Champion. Councillor Mrs Hilary McGuill accepted the request and this nomination was supported by the Board. Members were informed that the LHB s Management Team were part of the North Wales Emergency On-Call Rota. (i) That the report be approved. That Councillor Mrs Hilary McGuill be nominated as the Board Level Champion for Emergency Planning. (06)167 NORTH EAST WALES SCEP 2 ND QUARTER REPORT The Director of Finance presented the second quarterly SCEP monitoring report to the Board for information, together with a summary of planned savings for the remainder of 2006/07. It was reported that the implementation of schemes had been phased throughout the year and that the summary position as at the end of September 2006 identified savings of 1.297m, representing an overperformance of 19,000 against the agreed profile. A detailed review of the implementation plans for each of the schemes had taken place to ensure that actions were being taken to release savings. The review had resulted in the savings projections again the plan shown for the months of October to March and the projections had indicated an estimated shortfall in savings of 471,000 at year end. 300,000 further savings had been identified in prescribing and plans were in place for the remaining 170,000 in order to deliver the financial forecast for the Health Economy for 2006/07. Members were informed that, whilst WAG had recognised the 1.8m deficit at year end, formal confirmation of this was awaited. The Chief Executive reported that positive discussions had been held with WAG regarding the detail of the documentation and, it was anticipated that, following resubmission of the document, approval would be given. Flintshire Local Health Board 9

The Executive Director of Operations, CaDT, informed Members that it had been widely recognized that the SCEPS across North Wales were broader in their range of schemes and had potential for long term sustainability, and that this had been acknowledged in the feedback from PricewaterhouseCoopers. That the report be received. (06)168 DISABILITY EQUALITY SCHEME 2006 2009 The Head of Clinical and Corporate Governance stated that the draft scheme requested that the Board approved by the Board in September 2006. Following this approval the draft Scheme had been sent out for consultation and the comments received had been incorporated into the final document. It was anticipated that the Scheme would be published within the 4 December 2006 deadline and had received endorsement by the Flintshire Disability Forum. An Action Plan had been included and this would be further developed over time. Progress against the Action Plan would be monitored by the Remuneration and Human Resources Committee and PPI Working Group and progress reports would be made to the Board on a six monthly basis. The Head of Clinical and Corporate Governance reported that the LHB had worked jointly with Flintshire County Council, Wrexham LHB and Wrexham County Borough Council in developing the scheme and undertaking a joint consultation process. This had worked well and the LHB would continue to work with partners on the Gender Equality Scheme, which was due to be developed in April 2007. It was noted that the LHB is currently undertaken in a disability audit of all practices and had provided funding to primary care through its Estates Improvement Grant to undertaken DDA works. That the Disability Equality Scheme 2006-2009 be approved. (06)169 RISK MANAGEMENT ANNUAL REPORT 2005/06 The Director of Finance reported that the Risk Management Annual Report had been presented to the Risk Management Committee on 8 November 2006 and identified key areas addressed as part of the risk management agenda. It was noted that further risk management training would be arranged for Board Members and staff. That the Risk Management Annual Report 2005/06 be received. Flintshire Local Health Board 10

(06)170 COMPLAINTS ANNUAL REPORT 2005/06 Appendix A The Chair of the Complaints Panel presented the Complaints Annual Report 2005/06 to the Board, and thanked Members, officers and partner organizations for their support to the Panel over the course of the year. Members were informed that, following the amendment to the Terms of Reference, the Panel now met on a six monthly basis and that the Chair of the Panel and Corporate Services Manager met on a monthly basis to review trends and monitor targets. That the Complaints Annual Report 2005/06 be received. (06)171 ALL WALES HUMAN RESOURCES POLICIES The following policies were presented to the Board: (a) Alcohol and Drug Misuse Policy and Procedure (b) Procedure for Dealing with Staff Who Are Victims of Domestic Abuse (c) Grievance Policy and Procedure (d) Well-Being in the Workplace Policy The Director of Finance informed the Board that the Policies had been developed by the All Wales LHB Staff Forum, and that, following consultation with the BSC and LHBs, were presented to the Board for formal adoption. The policies had been approved by the LHB s Staff Forum and Remuneration and Human Resources Committee. That the Board formally adopt the policies for implementation. (06)172 MINUTES OF STANDING COMMITTEES AND WORKING GROUPS (i) Clinical Governance Committee 13 September 2006 There were no issues to report. Remuneration and Human Resources Committee 4 October 2006 The Committee had discussed Agenda For Change and resultant implications for the LHB. (iii) Audit Committee 4 October 2006 There were no issues to report. (iv) Primary Care Committee 11 October 2006 A review of the GMS capacity in Flint had been undertaken and a copy of the report would be made available to Members on request. Flintshire Local Health Board 11

(06)173 FULFILLED LIVES, SUPPORTIVE COMMUNITIES: A STRATEGY FOR SOCIAL SERVICES OVER THE NEXT DECADE The Adult Director of Social Services informed Members that the draft 10 year Strategy had published by WAG and had been out to consultation which ended on 15 November 2006. The Local Authority had responded to the consultation and a copy of the response was tabled for information. The Carer Member reported to Members that, following attendance at a consultation event, the document appeared to be weak on service user involvement and that concern had been expressed as to lack of detail within the strategy of how and when. It was noted that the strategy would present challenges for the delivery of joint health and social care. No announcement had been made regarding the availability of resources to implement the strategy and WAG had indicated that Local Authorities would be required to look at innovative ways of change. The Adult Director of Social Services informed the Board that the Minister of Health and Social Services had recently visited the county to look at work being carried out on service remodeling. It was noted that a Regional Collaborative Co-ordinator had been appointed to look at areas of collaborative work. That the report be noted. (06)174 DATE OF NEXT MEETING 20 DECEMBER 2006 Signed as a True Record The date of the next meeting of the LHB will be held on Wednesday 20 December 2006 at 1.30pm in the Boardroom, Preswylfa, and would include a Board Briefing Session on Risk Management and the new Pharmacy Contract.. (Chairman) (Date) Flintshire Local Health Board 12