Fallside Road Bothwell G71 8BB Telephone:

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1 Lanarkshire NHS Board Kirklands Hospital Fallside Road Bothwell G71 8BB Telephone: Meeting of Lanarkshire NHS Board, held on Wednesday 25 th September 2013 at 9.30 in the Board Room, NHS Lanarkshire Headquarters, Kirklands Hospital, Bothwell CHAIR: PRESENT: Mrs N Mahal, Non-Executive Director Mrs L Ace, Director of Finance Mr J A Anning, Non-Executive Director Councillor J Burns, Non Executive Director Mr P Campbell, Non-Executive Director Mr D Clark, Non Executive Director (up to and including item 2013/156) Dr A Docherty, Chair, Area Clinical Forum Mr M Fuller, Non-Executive Director (up to and including item 2013/163) Dr H S Kohli, Director of Public Health and Health Policy Mrs R Lyness, Director for Nurses, Midwives and the Allied Health Professions (up to and including item 2013/161a) Mrs L Macer, Employee Director Miss M Morris, Non-Executive Director Mr I A Ross, Chief Executive Mr C Sloey, Director, North Lanarkshire Community Health Partnership Mrs S Smith, Non-Executive Director IN ATTENDANCE: Mr N J Agnew, Board Secretary Mrs K Hamilton, Head of Communications Mr A Lawrie, Director of Acute Services Mr K A Small, Director of Human Resources Mr C Cunningham, Interim Head of South Lanarkshire Community Health Partnership Mrs J M Stobie, Occupational Therapy Service Manager (up to and including item2013/154) Mr A Yeung, Consultant in Dental Public Health (for item 2013/157) Mrs G Forsyth, Primary Care Administration Manager (for item 2013/157) Mr M Kennedy, Manager, SALUS, Lanarkshire Occupational Health and Safety Service (for items 2013/162 & 164) APOLOGIES: Councillor J McCabe, Non-Executive Director 2013/146 WELCOME ACTION Mrs Mahal welcomed colleagues to the meeting. She extended a particular welcome to Mrs. Stobie, and to observers.. 1

2 2013/147 DECLARATION OF INTERESTS Mr Fuller declared an interest in item 2013/153 Clinical Governance, which involved Healthcare Improvement Scotland, where he served as a Board Member. Mr Fuller highlighted the section of the Clinical Governance Report which focussed on Hospital Standardised Mortality Ratio (HSMR) and the current Healthcare Improvement Scotland Rapid Review which was underway in Lanarkshire. He reported on a decision taken within Healthcare Improvement Scotland that, given his position as a Non-Executive Director on the Lanarkshire NHS Board, he should be excluded from any discussions within Healthcare Improvement Scotland, either about the progress of the Rapid Review, or its conclusions. Mrs Mahal acknowledged this declaration. She indicated that since the issues to be considered by the Board were not contentious, Mr. Fuller could contribute fully to their consideration. Members endorsed this view. No other interests were declared. 2013/148 CHAIR S REPORT Mrs. Mahal reported on key issues as follows: a) Meeting of Cabinet Secretary for Health and Wellbeing with NHS Chairs: Monday 9 th September 2013 Mrs. Mahal reported that the principal issues considered were: A presentation on Health Informatics, specifically focussed on data analysis to better inform the management of Long Term Conditions. A presentation from Ros Moore, Chief Nursing Officer, on Learning from complaints and using feedback. This included discussion about the Patient Opinion website. Mrs. Mahal reported that the Acute Operating Management Committee meeting on 23 rd September 2013 had had a focussed discussion on complaints. She invited Mrs. Lyness to comment further. Mrs. Lyness reported that learning from feedback, comments, concerns and complaints was an increasing focus for the service. She referred to the Scottish Government Press Release the previous day about the numbers of complaints which the NHS in Scotland had dealt with. She advised that the volume of complaints, at approximately 900 formal complaints per annum, with an additional number of informal complaints, was lower than for Boards of comparable size. She advised that learning from feedback, comments, concerns and complaints, along with other patient experience information, was considered by the Care Assurance Board. She reminded colleagues that a national Corporate Responsibility Masterclass on Feedback and Complaints was being held later in the year, and would be attended by Operating Management Committee Chairs and relevant Executive Directors and Senior Officers. She advised that a local event would be held in Lanarkshire early in 2014, to engage with service users who had been involved in complaints. She reported on work being taken forward with personnel involved in complaints management within the Acute Division and the Community Health Partnerships, in order that they would better understand their role, and to identify training and learning needs. Mrs. Lyness confirmed that the work being taken forward in Lanarkshire would link, for comparability, with the endeavour within other Board areas. She acknowledged that compliance with the target reporting timescale for responding to complaints was important, but suggested that the over-riding consideration should be ensuring thorough and sensitive investigation of complaint. She advised that the intention, increasingly, would be to invite complainants to a meeting to discuss their complaint, which may, on occasions, impact on the timescale for written responses. 2

3 Mrs. Mahal welcomed the breadth of the endeavour to develop organisational management and learning from feedback, comments, concerns and complaints. b) NHS Chairs Away Day Mrs. Mahal reported that a key focus for the day had been the consideration of the implications of reports on patient safety, viz: The Francis Report; The Keogh Report; and The Berwick Report. c) Non Executive Director Appointments Mrs. Mahal confirmed that adverts for two Non-Executive Director positions had recently appeared in the media. This included a series of public meetings in venues across Lanarkshire, to afford an opportunity for interested individuals to hear more about the role. d) Awards and Events Mrs. Mahal reported that she had participated in a number of Awards as follows: 1. A Nurses, Midwives and Allied Health Professionals Awards Ceremony for staff who had undergone further training. 2. A Celebration of one year for Motherwell as a Dementia Friendly town. Notably, a Norwegian contingency had recently visited to learn about the initiative. 3. UNICEF Accreditation Awards for Breastfeeding on 24 th September 2013 Certificates were presented to community mothers who had supported the breastfeeding endeavour. 4. Undertaking the draw on 24 th September 2013 for the Lanarkshire Cup under 17s football tournament, involving Airdrie, Clyde, Hamilton and Motherwell Football Clubs, which would be held in December /149 CHIEF EXECUTIVE S REPORT a) Industrial Action - Fire and Rescue Service Mr. Ross referred to the recent four hour industrial action by the Fire and Rescue Service Trades Unions in England. He advised that discussions about potential industrial action in Scotland were ongoing. He confirmed that, in anticipation of industrial action in Scotland, contingency planning was underway, and he undertook to report further in this regard. Mr. Ross 2013/150 MINUTES 3 Mr. Sloey reported that the Fire and Rescue Service was undertaking a series of Fire Safety Audits of areas with inpatient beds, and would undertake audit visits in Lanarkshire at Lockhart Hospital on 10 th October 2013, and Monklands Hospital on 31 st October He confirmed that preparations for these audit visits were underway, informed by the contingency planning that was underway for any industrial action by the Fire and Rescue Service Trades Unions. The minute of the meeting held on 28 th August 2013 was submitted for approval. 1. Approved the minute, subject to a correction at item 2013/137 Healthcare Contracts with Independent Sector providers. In the final paragraph the question was from Mrs. Macer and not from Councillor McCabe. Also the Option Appraisal exercise had not involved Four Seasons, as stated. 2013/151 MATTERS ARISING NOT INCLUDED ON THE AGENDA No matters were raised.

4 2013/152 HEALTHCARE ASSOCIATED INFECTION The NHS Board considered a Healthcare Associated Infection Exception Update. Dr. Wallace explained that the report was provided to update Board members on the current status of Healthcare Associated Infections, and any exceptions that needed to be highlighted outwith the bimonthly mandatory HAI reporting template. He reported that Monklands Hospital was subject to an unannounced inspection by the Healthcare Environment Inspectorate on 12 th September He explained that the draft report of that inspection would be available on 9 th October 2013 to check for factual accuracy, for return to the Healthcare Environment Inspectorate by 17 th October 2013, with the final report being published on 5 th November He reported that a meeting had been arranged to review the accuracy of the report, and to devise an Action Plan relating to any requirements reported. He confirmed that a full update on the findings would be incorporated into the October HAI reporting template to the NHS Board. Dr. Wallace highlighted performance against the National Target for staphylococcus aureus bacteraemias, and he confirmed that the target for 2014/2015 required all Boards to reduce their rate of SABs by a further 8% from the previous target. He outlined the implications for Lanarkshire. He explained that this would equate to just under an average of 10 SABs in each calendar month, and advised that from April 2013 until August 2013 there had been a total of 58 SABs. He further advised that, analysis of the SAB enhanced data for this timeline demonstrated that of the 58 SABs in total, 14 were deemed to be preventable. Dr. Wallace noted a question from Mr. Fuller about the report that only one of the 13 SABs identified in August was preventable, and the implications for achievement of the target. He explained the factors that impacted on this performance, and advised that elimination of preventable cases was based on measurement over time, rather than within the monthly reporting period. He also noted an issue raised by Mr. Anning about the percentage of cases for which no source was identified. He reminded members that there was a level of background staphylococcus aureus bacteraemias within the community, which was a likely contributory factor in this performance. Mrs. Lyness highlighted the key element of the Scottish Patient Safety Programme around avoidable harm, and highlighted the need to consider further the situation of patients who had a cannula or a catheter in situ. Mr. Sloey highlighted for members the reported improvements in practise, including within Primary Care, including ongoing work with GP practices to reduce the rate of antibiotic prescribing. Members noted and welcomed the reported improvements in several key areas, including the reported improved performance in relation to the labelling and segregation of laundry. 1. Noted the Healthcare Associated Infection Exception Update, including the revised national targets for staphylococcus aureus bacteraemias, and the improved performance in several key areas. 2. Asked to receive a further report in October based on the mandatory Healthcare Associated Infection reporting template. Dr. Wallace. 2013/153 CLINICAL GOVERNANCE The NHS Board considered a report on Clinical Governance. 4 Dr. Wallace explained that the report was provided to outline progress on Quality Assurance, with a focus on risk management. He explained that, at its meeting on 26 th August 2013, the Clinical Governance Committee had proposed that, in future, the Quality Dashboard should be considered in detail by the Clinical Governance Committee, with issues highlighted as appropriate to the Board for consideration. Dr. Wallace drew members attention to the summary of issues considered by the Clinical Governance Committee on 26 th August 2013.

5 Dr. Wallace drew members attention to the element of the Clinical Governance report relating to Hospital Standardised Mortality Ratio (HSMR). He reported that the HSMR Programme Board had met on 13 th September 2013 and had ratified a revised Programme Plan. He explained that, in light of the Rapid Review being undertaken by Healthcare Improvement Scotland, HIS had deferred the review of the management of serious adverse events. He confirmed that the National Framework document for managing adverse events had now been issued to the Service, and assured members that the document would be used to further review and revise the approach in Lanarkshire accordingly. Dr. Wallace highlighted the principal elements of progress in relation to the four HSMRworkstream areas, viz: the deteriorating patient/sepsis; end of life care; information and quality reviews; and clinical leadership. He highlighted, in particular, the consideration given to the experience at the front door, where often the stay before moving to a ward was short, with consequent implications for the clarity of diagnosis and coding. He confirmed that further work to better understand this issue was underway. Dr. Wallace confirmed that the Healthcare Improvement Scotland Rapid Review of Hospital Standardised Mortality Ratio had commenced, and that this was being taken forward in partnership with NHS Lanarkshire. He reported that the review process would include visits to Wishaw General, Monklands and Hairmyres Hospitals over the period from 9 th 11 th October The review process would include engagement with key staff across the system, and with the public, including through dialogue with the Public Partnership Forums. Currently, Healthcare Improvement Scotland was conducting an analysis of relevant data, and had undertaken to highlight relevant issues that merited early attention as they arose. Dr. Wallace advised that the timescale to which the Review Group was working would involve the availability of the draft report to NHS Lanarkshire in early November to check for factual accuracy. Following this, a meeting between NHS Lanarkshire representatives and the Healthcare Improvement Scotland Review Team would be held on 18 th November 2013, for a focussed discussion on implementation of the Review Team recommendations. Dr. Kohli reported that Healthcare Improvement Scotland would undertake 50 case note reviews at each acute site. He advised that the reviews of mortality and morbidity were progressing well. He confirmed that Lanarkshire would seek to learn any relevant lessons from the approach within other NHS systems, and advised that this involved a visit to Forth Valley. Dr. Wallace noted a question from Mr. Fuller, and confirmed a level of confidence in the mechanisms in place to progress the HSMR Programme Plan, including a defined set of measures for each of the four workstreams. Mr. Clark highlighted discussion at the Acute Operating Management Committee on 23 rd September 2013, when Dr. Burns had highlighted, as a potential contributory factor to HSMR Performance, the way in which patients were fast tracked through admission and assessment. He restated the need to take account of HSMR comparability with adjusted mortality data. He also suggested that consideration might usefully be given to comparative HSMR performance based on coding undertaken later in the patient journey. He sought clarification on the Lanarkshire performance taking account of the HSMR based on discharge coding. Dr. Wallace explained that the Information and Statistics Division had run HSMR based on discharge, which demonstrated that Lanarkshire did not appear as an outlier. He reported that, in England, HSMR as a realistic measure of performance was currently the subject of a major review. He also reported that the Royal College of Physicians had recently published a paper on the future of hospitals, and advised that, in Lanarkshire, consideration was being given to the care model, with particular regard to the organisation of clinical services and clinical teams and their role in the management of acutely ill medical patients. 5 Dr. Docherty reported on discussion at a meeting with representatives from the Information and Statistics Division aimed at better understanding coding and its relationship with HSMR. He

6 highlighted the need to ensure that patients were diagnosed and treated in the appropriate clinical environment, with an accurate diagnosis being made at the earliest opportunity. Dr. Wallace noted a question from Miss. Morris about the relative priority of the outputs from the four workstreams. He explained that the workstreams were mostly at the same stage in progressing their remits. He highlighted the Deteriorating Patient/Sepsis workstream, and advised that the work undertaken to date had confirmed the critical importance of reliable rescue. He also highlighted the linkages between this workstream and the Unscheduled Care Action Plan, and advised that, already, the system was experiencing winter-like pressures. Mrs. Lyness highlighted the important opportunity which the Deteriorating Patient/Sepsis workstream had afforded to focus on ensuring the safety of patients. Whilst acknowledging the need for system capacity to treat patients in a timely, appropriate manner, she stressed the need to ensure that staff had the capacity to maximise their contribution to this endeavour. Mr. Ross acknowledged the substantial contribution of staff across the system to the HSMR improvement endeavour, and to the Healthcare Improvement Scotland Rapid Review. Mrs. Mahal endorsed this view. She reported that arrangements were in place for Non-Executive Directors to engage with Healthcare Improvement Scotland as part of the rapid review process. She also stressed that achieving clarity about the factors contributing to HSMR performance, and improving performance in this area, was the uppermost priority for the NHS Board. Mr. Fuller referred to the proposal at the meeting of the Clinical Governance Committee on 26 th August 2013 that in future the Quality Dashboard should be considered in detail by the Committee, with issues highlighted, as appropriate, to the Board for consideration. He stressed the need for the complex information within the Quality Dashboard, including the information presented in charts, to be intelligible, with support and training being provided to Non-Executive Directors in this regard. Mr. Clark highlighted the elements of the Clinical Governance report relating to Stroke Services, and commended the material improvement in performance against the Stroke Treatment Indicators. 1. Noted and accepted the progress report on Clinical Governance. 2. Agreed to the proposal from the Clinical Governance Committee that the Quality Dashboard should be considered in detail by the Committee with issues highlighted, as appropriate to the Board for consideration. 3. Asked to receive a further report, with a particular focus on the progress of work in relation to Hospital Standardised Mortality Ratio (HSMR). Dr Wallace 2013/154 PATIENT EXPERIENCE: COMMUNITY BRAIN INJURY TEAM The NHS Board considered a report on Patients Experience of the Community Brain Injury Team. Mrs. Lyness explained that the report was provided to give the Board an overview of the service now in place following the introduction of the Community Brain Injury Team. She advised that the service and team had now been in place for one year, and the opportunity had been taken within the paper to highlight the person-centred approach developed for rehabilitation, and to share experiences of patients who had used the service. 6 Mrs. Stobie explained that, prior to the launch of this new service, there was no specialist rehabilitation available within NHS Lanarkshire for people presenting with a head injury, and no practitioner specialising in brain injury rehabilitation. She stressed that the new service was developed following significant discussion with stakeholders, which identified that delivering services in the patient s own home, community or workplace resulted in a better rehabilitation outcome. She outlined the key focus for the team, and the approach based on agreement with the patient about their goals, and the arrangements for monitoring, reviewing, and if necessary, modifying these goals. She presented a patient narrative for a 16 year old school girl who had been a

7 7 client of the service, and outlined the substantial progress which the girl had made in achieving the agreed goals. Mr. Ross explained that a significant proportion of funding spent on inpatient Brain Injury Rehabilitation in the private sector had been rebalanced and refocussed to community based services. Mrs. Stobie noted issues raised by Mr. Clark about the sufficiency of resources and linkages with Headway. She explained that the position with regard to resources would be better informed by an assessment of the service at the end of year one; however, experience to date suggested that resources were adequate. She explained that the Team was not presently resourced to provide stroke rehabilitation. She confirmed, also, that linkages with other services/service providers, included Headway. Mrs. Mahal expressed appreciation to Mrs. Stobie and to members of the Community Brain Injury Team for their contribution to establishing this key service. 2013/155 BOUNDARY CHANGES 1. Noted the report and commended the service provided by the Community Brain Injury Team. The NHS Board considered a report on changes to the Health Board boundary. Mr Sloey explained that the report had been prepared to update the NHS Board on progress towards the alignment of Health Board and Local Authority boundaries. He explained that, following the announcement in June by the Cabinet Secretary for Health and Wellbeing, a joint Steering Group for NHS Lanarkshire and NHS Greater Glasgow and Clyde had been initiated with several key workstreams now underway. He explained that the principal aim of the change was to overcome the administrative barriers which misalignment presented to integrated working, and to ensure that the areas affected became an integral part of the Adult Health and Social Care integration process set out in the Public Bodies (Joint Working) (Scotland) Bill. He advised that the changes would come into effect on 1 st April He highlighted the key issues associated with the change, as they related to: independent contractors; e-health; property and support services; directly managed services; human resources; public health/health improvement and finance and corporate services. He drew members attention, in particular, to the section of the report relating to financial consequences. He explained that the current view shared within the Steering Group, involving representatives from both NHS Boards, was that the communities involved in the boundary changes should receive their fair share of resources as defined by the National Resource Allocation Committee (NRAC) formula. Mr. Sloey noted issues raised in discussion around ensuring that General Practitioners and Clinical Governance staff were integrated; transferring best practice; and about any changes to the number of localities. He explained that there were a number of areas where Lanarkshire performance was demonstrably higher, and he confirmed that shared learning would be a key element of the change. He advised that the Prescribing Management Board would give further consideration to prescribing, taking account of performance in the areas that would transfer to Lanarkshire. This consideration would include prescribing spend and the illness burden of the population. He stressed the need to ensure the transfer of a fair share of resource allocation to Lanarkshire which reflected the levels of deprivation in the communities transferring. He confirmed that there would be no change to the number of localities within the Board s area, consequent upon the boundary changes. Mr. Lawrie endorsed these views. He suggested that it would be appropriate to draw on good practice from the process followed in recent years for the transfer of community staff from Glasgow to Lanarkshire which had produced demonstrable benefits for the staff concerned.

8 1. Noted the report on changes to the Health Board boundary, and acknowledged the progress to date being taken forward by a Joint Steering Group for NHS Lanarkshire and NHS Greater Glasgow and Clyde. 2. Asked to receive further progress reports, in particular addressing the areas of concern highlighted in the report, around continuity of care, travel and waiting times. Mr. Sloey 2013/156 WINTER PLAN The NHS Board considered a report on the NHS Lanarkshire Winter Plan 2013/14. Mr. Cunningham explained that the report had been provided to outline the current work and proposed actions being taken by NHS Lanarkshire and its partner agencies to address the anticipated additional pressures on health and social care services over the winter period 2013/14. He stressed that the plan would be formulated in a manner which complied with Scottish Government guidance, allowing an ongoing risk assessment in relation to progress and deliverability. He highlighted the key elements of the plan, in relation to: resilience; unscheduled and elective care; Norovirus; seasonal flu; management information; out of hours; communications and business continuity. He also outlined the principal components of the plan for Primary Care/General Practice, the Primary Care Out of Hours service/nhs 24 and the acute hospital service. Dr. Docherty highlighted the fact that the arrangements put in place within acute services for the winter of 2012/13 had had to be continued longer into 2013 than was anticipated due to continuing higher than normal levels of activity. He explained that inpatient admissions continued to increase year on year, bringing substantial additional pressures on the service, and he highlighted the need for further consideration to be given to putting in place a system to better match inpatient capacity to need. He highlighted the competing demands on medical staff time around the priorities associated with acutely ill patients, delivering the unscheduled care target and sustaining the primary care out of hours service. Mr. Cunningham suggested that the whole system approach on which the Winter Plan was predicated should facilitate the management of the inpatient admissions workload. He highlighted the inclusion within the Plan of surge capacity to introduce additional beds. He reported on the consideration being given to rates of payment for GPs working for the Out of Hours service, and the implications for maintaining viable safe rotas, particularly over the peak period during the festive season. He explained that it was the intention to, once again, enhance the GP contribution within Accident and Emergency Departments, as this had proved beneficial during the previous winter. He noted issues raised by Mr. Fuller about the need to consider the cultural implications of periods of significantly increased activity extending throughout the year, and about the variability in uptake of flu vaccination by staff. He suggested that consideration should be given to reviewing the approach to flu vaccination for staff. Dr. Wallace endorsed this view, and suggested that there may be for staff a duty of care issue around avoidable harm to patients. He confirmed that he would consider this matter further with Mrs. Lyness and Dr. Kohli. Dr. Wallace Mr. Lawrie endorsed the reported plans to enhance capacity to deal with the emergency workload, including emergency admissions. He confirmed the intention to enhance physician senior decision maker input at the front door at an earlier stage, since their contribution had proved to be material during the previous winter. 1. Noted and endorsed the progress in planning for winter and the suite of actions that were currently being developed for implementation. 2. Noted the actions that it was proposed would be taken in conjunction with partner agencies to address pressures during the winter period. 3. Asked to receive in October a costed and risk-assessed Winter Plan constructed in line with Scottish Government guidance. Mr. Cunningham 2013/157 HEALTH IMPROVEMENT ORAL HEALTH AND DENTAL SERVICES 8

9 9 The NHS Board considered a report on improving oral health and modernising dental services. Mr. Yeung explained that the report was provided to update Board Members on the progress of various initiatives aimed at improving the oral health of children and those adults with special care needs, and initiatives to modernise dental services in Lanarkshire. In a presentation, he highlighted a number of best practices and challenges ahead. In the area of best practises, he highlighted the substantial progress in Lanarkshire in delivering the Childsmile targets for Nursery and Primary 1 and Primary 2 schoolchildren. He also reported on substantial progress in the area of children with no obvious dental decay experience. He reported on the progress of the Smoke Free Smiling initiative, focussed on the Stop Smoking Service, which included an intervention to increase patient referrals from General Dental Practitioners to the Service. Mrs. Forsyth gave a presentation which highlighted the extent of compliance for decontamination requirements within the General Dental Service and the salaried Dental Service, and dental registrations in Lanarkshire at 31 st March Mr. Yeung concluded the presentation by highlighting challenges ahead around practice inspections and information technology. Mrs. Forsyth noted a question from Mrs. Mahal about any linkage between levels of registration and particular localities in Lanarkshire. She explained that any areas of pressure were the subject of a targeted, prioritised initiative to enhance uptake. Mr. Cunningham noted an issue raised by Dr. Wallace about the challenges associated with achieving the fluoride varnishing targets in deprived areas. He reminded members of discussion at the meeting of the NHS Board in August, when this was noted as one of the more challenging HEAT targets. He reported that this issue was currently the subject of work being taken forward by the Director of the Salaried Primary Care Dental Service. He reported that there was now agreement for both applications of fluoride varnish to be the subject of a single consent. He explained that the current process involved children being given invitations to take home to their parents, and highlighted the disadvantages of this approach. He also confirmed the intention to focus the endeavour on achieving improved uptake in the most deprived areas. Mr. Yeung reported that the HEAT target for application of fluoride varnish was proving to be challenging for Boards other than Lanarkshire. Mrs. Mahal thanked Mr. Yeung and Mrs. Forsyth for their presentation. She acknowledged the magnitude of the achievement in delivering the improvements reported, and asked that the Board s gratitude be conveyed to the personnel concerned. 1. Noted the report on Improving Oral Health and Modernising Dental Services, and welcomed the substantial improvement in Lanarkshire in relation to the Childsmile Programme and dental registrations. 2. Endorsed the local services and initiatives described in the report, which would contribute to the delivery of the three national Quality Strategy Ambitions by increasingly providing safe, person-centred and effective dental services. 2013/158 PROCUREMENT STRATEGY The NHS Board considered an updated Procurement Strategy. Mrs. Ace explained that, whilst the Procurement Strategy was not due for formal review until September 2014, an interim informal review had resulted in a proposed strengthening of the provisions on Sustainability. She highlighted the related insertion within the Strategy.

10 Mrs. Smith confirmed that the Audit Committee had considered and endorsed the amendment to the Procurement Strategy at its meeting on 3 rd September Approved the change to the Procurement Strategy. 2013/159 PUBLIC BODIES (JOINT WORKING) (SCOTLAND) BILL INTEGRATION OF ADULT HEALTH AND SOCIAL CARE SERVICES The NHS Board considered a report on the Public Bodies (Joint Working) (Scotland) Bill for the Integration of Adult Health and Social Care Services. Mr. Ross explained that the report was provided to confirm the intention of Government, as set out within the Public Bodies (Joint Working) (Scotland) Bill, to make recommendations on the way forward for NHS Lanarkshire, in partnership with both North and South Lanarkshire Councils, to create two integrated Health and Social Care Partnerships in Lanarkshire to meet the requirements of the legislation. He commended the work undertaken by Mr. Sloey and Mr. Cunningham in drawing the report together. He explained the Body Corporate and Lead Agency models that could be adopted, and reported agreement with North and South Lanarkshire that the Body Corporate model would be the preferred integration model for Lanarkshire. He highlighted the need for further clarification on a range of issues, including: the services to be included within the scope of the Health and Social Care Partnerships; the funding contribution from Health and the Local Authorities; the structural framework; Councillor input to the Health and Social Care Partnerships, having regard to the views of COSLA. He reported that a priority would be to move forward with the appointment of Chief Officers for each of the North and South Lanarkshire Health and Social Care Partnerships, given the need to operate in transition prior to full implementation in He advised that NHS Chief Executives were drawing together a paper highlighting for the Scottish Government the range of issues on which further clarity was required, including the intention with regard to the commissioning of Acute services. Councillor Burns commended the progress of the discussions to date. He reported on discussions earlier that morning within South Lanarkshire Council around the Chief Officer role and governance issues. He stressed the critical importance of the Health and Social Care Partnerships operating to a shared agenda and a joint purpose. He also stressed the need for clarity and agreement about the number of Councillors to serve on the Health and Social Care Partnership Board. He emphasised the South Lanarkshire commitment to ensuring that the integrated arrangements would operate effectively, and he stressed the need for clear reporting mechanisms, building upon the existing mechanisms in place within Health and the Local Authorities. Mrs. Mahal stressed the need to firmly address the issue highlighted by Mrs. Macer at the Annual Review on 29 th August 2013, about the need for full staff engagement and communication as a key element of progressing the arrangements through transition to full implementation. She noted the need highlighted by Mr. Fuller for the composition and remit of the Transition Board to be clarified, and confirmed that further information in this regard would be brought to the NHS Board. In addition, Board members would be involved in the further discussion and debate about key issues going forward. She acknowledged and commended the extent of negotiation to date to reach the point of tripartite agreement on the adoption of a Body Corporate Model. She reported on discussion at the recent meeting of Chairs, when Chairs had acknowledged the democratic difference between the Body Corporate model and the Lead Agency model. However, NHS Chairs were clear that neither model should materially detract from the contribution of Non-Executive Directors and Local Elected Members. 10 Mrs. Macer expressed her disagreement with this view. She highlighted from the Appendix to the paper, the Workforce strand, which indicated as a strength, continuity of employer, terms and conditions, etc. if implemented in ways that did not involve potential staff transfer. However, she

11 contrasted this with Section 11 of the Public Bodies (Joint Working) (Scotland) Bill, which made reference to the Body Corporate as an employer, and expressed concerns around adherence to staff governance where staff were employed by the Body Corporate. Mrs. Mahal noted the issues highlighted by Mrs. Macer. She acknowledged that there remained several key areas for which further national guidance was awaited, and suggested that it would be appropriate to return to these issues when the guidance became available. Mr. Sloey noted issues raised by Mr. Anning about the process leading to agreement on a Body Corporate Model, and the compelling gains associated with this model. He suggested that structural issues were less significant than delivering a vision that would further enhance the partnership in North and South Lanarkshire to produce demonstrable benefits and outcomes for residents. He suggested that it would be important to move forward through establishing the Transition Board, with a remit which would include addressing the issues and concerns highlighted in discussion, including a robust performance framework and a governance and accountability system that would assure the delivery of aims and objectives to an appropriate quality standard. Mrs. Mahal restated the importance of the integration model building on the existing strong partnerships between Health and the Local Authorities. She stressed the requirement for a comprehensive Communications and Engagement Plan to underpin the transition, and she restated her acknowledgement of the need for further clarity on the implications of some key elements of integration. She re-emphasised the commitment to full engagement with the NHS Board in the next steps, including to ensure that Board members had clarity about the implications of the change, with particular regard to a focus on the demonstrably improved outcomes envisaged for the population. She suggested that this latter issue might best be explored in detail in a further seminar. 1. Supported the proposed Body Corporate model. 2. Asked the Chief Executive to continue dialogue with North and South Lanarkshire Councils, respectively, in establishing Transitional Boards within each Partnership area. 3. Asked that the necessary arrangements be put in place to move to the appointment of a Chief Officer in both Partnerships. 4. Asked to receive further progress reports, including clarity on the key issues highlighted in discussion, and agreed to hold a further event to explore in detail the implications of the change, and the intended beneficial outcomes for the resident population. Mr. Ross Mr. Ross 2013/160 ANNUAL REVIEW 2013 The NHS Board considered a paper and the Annual Review Outturn Letter from the Minister for Public Health. Mrs. Ace explained that the paper introduced the Ministerial Annual Review Letter, confirming the main points and actions agreed during discussions at the Annual Review held in Hamilton on 29 th August Mr. Ross noted an issue raised by Mrs. Macer about the need to add to action point 5, greater emphasis on increasing system performance around the Knowledge and Skills Framework. He asked Mr. Small to bring a report in this regard to a future meeting of the Corporate Management Team. Mr. Small reported on discussion at the meeting of the Organisational Development Group on 24 th September 2013, following which the Deputy Director of Human Resources and a member of her team would meet that day to discuss the setting up of a support team for the Knowledge and Skills Framework, with a remit to produce an Action Plan to improve uptake. Mr. Small Mrs. Lyness reported that the Nursing and Midwifery Council was embarking on revalidation for nurses, which would bring a requirement for evidence of continuing professional development. 11 Mrs. Macer suggested that the action arising from the Annual Review might be strengthened through

12 including explicit reference to Ensuring and supporting learning and development for staff. Mrs. Mahal expressed appreciation to everyone involved in the preparations for the Annual Review, and to staff across the system for their contribution to the satisfactory performance in Lanarkshire. 1. Noted the Annual Review Letter, and endorsed the proposed mechanisms for taking forward the agreed key action points, including the strengthening of action point 5 as suggested by Mrs. Macer. 2. Asked to consider, at an appropriate point in time, an update report on progress in the delivery of the key action points. Mrs. Ace Mrs. Ace 2013/161 PERFORMANCE REPORTS a) The NHS Board considered a report on Financial Performance to 31 st August Mrs. Ace reminded Members that the Board was expected to live within its Revenue Resource Limit, with authority to use 0.990m of its 4.528m brought forward funds, reserving 3.538m to use in the following year. She explained that, to achieve this the target position at the end of August 2013 would be a 1.474m underspend. She advised that the Board was reporting a 1.107m overspend, as 2.581m more expenditure had been incurred in the first five months than had been expected. She explained that whilst both Community Health Partnerships and the Corporate Services remained within budget, the Acute sector was overheating, and outlined the known contributory factors. She reported that underspend and slippage from other budgets could be applied in-year to provide temporary cover. However, if the costs within the Acute sector could not be brought back in line with budget, this would have a significant impact on the Board s future financial plans. She assured members about the extent of the endeavour to fully understand the pressures within Acute Services, in order that corrective action could be taken. She reported on the position with regard to achievement of the efficiency savings target, and the work underway to identify the remaining balance, which had reduced to 3.954m. Mrs. Ace reported satisfactory performance in relation to Capital. She explained that some risks existed in relation to the ability to progress elements of capital works at Monklands Hospital during the year; however, there were other schemes on which capital funding could be utilised. Mrs. Ace confirmed that the Board would receive capital funding from the Scottish Government for the West of Scotland Satellite Radiotherapy Hub. She reported that it would be timely to begin the 2014/15 financial planning process at the earliest opportunity. Mrs. Mahal reported that at its meeting on 23 rd October 2013, the Acute Operating Management Committee had had a detailed discussion about the analysis of the acute overspend, and the corrective actions to address the situation. Discussion highlighted Non-Executive Director concerns about the overspend position on Revenue, against the backcloth of the Board having previously agreed a balanced financial plan. However, there was recognition that factors contributing to the overspend, such as the need to maintain winter surge beds for far longer than had been planned, were largely outwith the Board s direct control. However, the need was highlighted to identify the full range of contributory factors to the overspend, and to consider what lessons for future financial planning and management might be drawn from that exercise. This action was considered to be particularly appropriate, given the move to Integration of Adult Health and Social Care. Mrs. Ace noted Members concerns about the overspend position. However, she suggested that Revenue performance at this point in the financial year should be viewed within the context of the totality of over 1b of expenditure within NHS Lanarkshire. She restated that there was a robust management plan to ensure financial recovery in the current year. She reminded members of her reference to the challenges which the system would face in 2014/15, and suggested that the early financial planning for the next year might usefully include a Board Seminar when some of the key issues could be explored in detail.

13 Mrs. Mahal endorsed the need for early financial planning, and asked that consideration could be given to extending the Board Seminar scheduled for 4 th November 2013 to accommodate this issue. Mr. Agnew Mr. Sloey stressed the need to take a corporate perspective in considering and managing the Revenue overspend position. However, he expressed a concern about continued reliance on revenue underspends within the Community Health Partnerships to balance the position, because elements of the CHP underspends were a consequence of restraint, against a backcloth of areas within the Community Health Partnerships which were operating below funding establishment. Mr. Lawrie assured members that significant management action was being taken to identify the full range of contributory factors to the overspend within acute services, and to redress the position. Mr. Ross endorsed the need for early consideration of financial planning for 2014/15, given the range of unavoidable resource pressures that would require to be managed during the coming financial year. THE BOARD b) Waiting Times 1. Noted the actual Revenue overspend of 1.107m as at 31 st August Noted the planned in-year deficit of 0.990m per the approved Financial Plan and the target cumulative surplus of 3.538m as at 31 st March Noted progress to date on Cash Releasing Efficiency Savings (CRES) Schemes. 4. Noted the Capital Plan revised forecast and expenditure of 2.007m in the five months to 31 st August Asked to receive a further report. Mrs. Ace The NHS Board considered a report on Waiting time and other access guarantee set by the Scottish Government at August, and progress against National Waiting Time Guarantees as they impacted on access to Mental Health Services. Mr. Lawrie reported continued good progress in the majority of waiting time targets. He advised that pressures remained on the delivery of the outpatient standard, mainly within the specialties of Neurology, Respiratory and Rheumatology, and confirmed that work continued to address the pressures. He reported that unscheduled care performance had improved during June and July, but for August was at the level of 93% overall. He explained that a material factor influencing performance was time to first assessment at Monklands Hospital and Wishaw General Hospital. He explained some of the contributory factors, and advised that a meeting with Consultant medical staff at Monklands Hospital and Wishaw General Hospital to consider the issues was arranged. Unscheduled care performance at Hairmyres Hospital continued, largely, to be satisfactory. Mr. Lawrie advised that during the course of the current week levels of presentations were akin to those usually experienced in January. He reported that unscheduled care performance for today was 97%, and advised that, despite the pressures, the indications were that the system was operating more efficiently than at the same time in He reported on confirmation of Scottish Government funding of the order of 900,000 to support the delivery of the Local Unscheduled Care Action Plan. Mr. Sloey reported a generally positive trajectory in relation to delivery of the waiting time guarantees for mental health. He advised that he was working with Peter McCrossan, Associate Director for the Allied Health Professions, to address the small numbers of cases which negatively impacted on waiting time performance. 1. Noted the report on waiting times. 2. Asked to receive a further report. Mr. Lawrie 13

14 c) Primary Care Out of Hours Services The NHS Board considered a report on the performance of the Primary Care Out of Hours Service for August Mr. Cunningham highlighted the principal elements of performance. He drew members attention, in particular, to the section of the report dealing with the HMRC decision about the employment status of sessional staff, and highlighted the need to fully understand the implications of that decision. He reported on increases to pay rates for doctors providing the service within other NHS Board areas and the consequent need to ensure that Lanarkshire rates remained competitive, in order to maintain a safe service, especially through ensuring that there would be sufficient staff available over the peak winter period. He reported that NHS 24 had changed their disposition arrangements, which had contributed materially to the management of activity within the Lanarkshire centres. He advised that the service would be subject to a thorough review, with the aim of maximising efficiency and ensuring that the service model was fit for purpose moving forward. 1. Noted the report on Primary Care Out of Hours services for August Asked to receive a further report. Mr. Cunningham 2013/162 OCCUPATIONAL HEALTH AND SAFETY The NHS Board considered the SALUS Annual Report, which provided an update on the progress of Occupational Health and Safety 2012/13. Mr. Kennedy highlighted the principal elements of the report which demonstrated good performance and progress across a number of key areas. Significantly, the Occupational Health and Safety Service had met all of the major Key Performance Indicators for the year. He explained that data within the Annual Report informed the SALUS Workplan for the following year. He drew members attention to the section of the report which outlined the key achievements and development areas for occupational health and health and safety. Mrs. Macer highlighted RIDDOR performance for the year, and cautioned that this needed to be viewed within the context that the criteria for RIDDOR reporting had changed substantially. She also highlighted from the Annual Report the work being done to explore the potential issue of misclassification of Datix entries, and welcomed the commitment to clarifying the coding arrangements. Mr. Kennedy acknowledged the change in RIDDOR reporting requirements which meant that RIDDOR performance data did not readily trend from the previous year. He reported that the endeavour in relation to Datix classification had been sustained, but highlighted the continuing need to reclassify the wrongly coded data. Mrs. Mahal highlighted discussion at the meeting of the Audit Committee on 3 rd September 2013 on the Governance arrangements for SALUS, when the Audit Committee had remitted the issue to the Corporate Management Team, to bring forward proposals for where the governance for SALUS should appropriately reside. 1. Noted the SALUS Annual Report 2012/13, and endorsed the proposed initiatives and ongoing work commitments. 2013/163 ALCOHOL AND DRUG PARTNERSHIP The NHS Board considered an Alcohol and Drug Partnership Annual Report 2012/ Mr. Sloey explained that, in accordance with funding and reporting arrangements, the Lanarkshire

15 Alcohol and Drug Partnership must provide an Annual Report to the Scottish Government. He explained that the report, prior to submission, had been shared with Community Planning Partners. He advised that the Annual Report was based on a self-assessment template, and used the Red/Amber/Green system to measure progress. He advised that the report contained the Financial Framework, progress towards the ADP Delivery Plan, and priority areas for the year ahead. He advised that the Annual Report confirmed satisfactory performance across the range of the priority areas for the year. Mr. Ross reported that the Cabinet Secretary for Health and Wellbeing had met with the Alcohol and Drug Partnership Team in recognition of the Partnership achievements. Mrs. Mahal expressed appreciation to Mr. Sloey, as Chair of the Alcohol and Drug Partnership, and to everyone concerned with the ADP for their contribution to the reported achievements during the year. 1. Noted and acknowledged the Alcohol and Drug Partnership Annual Report, and recognised the achievements within 2012/13 and priority areas for 2013/ /164 DEPARTMENT FOR WORK AND PENSIONS: PERSONAL INDEPENDENCE PAYMENTS Mr. Kennedy gave a presentation, which encompassed: the service staff complement; performance since the service commenced in July 2013; the risk description and control measures for the project and the current risk score; DWP volumes; assessor capacity; and the Quality Dashboard for the service. Mrs. Macer acknowledged that reputational risk had not yet materialised, and she enquired about the potential for this to arise as the outcome of assessments and subsequent DWP decisions resulted in the reduction or cessation of individuals benefits. Mr. Kennedy explained that data in this regard would be owned by the Department for Work and Pensions. He advised that in December 2013 the review of individuals already in receipt of payments would commence, and highlighted the potential for adverse publicity in cases where the review resulted in individuals entitlement to benefit being rescinded. Mrs. Smith reported that the Internal Audit report on the service, considered by the Audit Committee on 3 rd September 2013 had given limited insurance in relation to those elements of the service relating to property, costs and set up of IT systems, although it had been recognised that the latter issue would be addressed, in time. She advised that the Audit Committee looked forward to considering the follow-up Internal Audit report. Mrs. Ace acknowledged the concern around increased property costs combined with lower volumes of activity. She also acknowledged the successful negotiations with ATOS in this regard, but stressed the need to maintain a keen focus on the management of risk. Mr. Kennedy noted a question from Dr. Docherty, and confirmed that on average, it was taking 2 hours to complete an assessment. However, he advised that addressing the issues around the set-up of IT systems may have a beneficial impact on the time taken to complete assessments going forward. 1. Noted the update on Department for Work and Pensions: Personal Independence Payments. 2. Asked to receive a further report with a more developed Dashboard, and asked that the issues and concerns raised in discussion be maintained under careful review. Mr. Small 2013/165 STANDING FINANCIAL INSTRUCTIONS 15 The NHS Board considered a report on the Review of Standing Financial Instructions, and revised

16 Standing Financial Instructions. Mrs. Ace explained that the Standing Financial Instructions were due to be updated in October 2014, but had been subject to an interim review to ensure that they remained up-to-date. She explained that no material changes had been made, and highlighted more minor changes reflected in the revision. She reported that, at its meeting on 3 rd September 2013, the Audit Committee had approved the revised Standing Financial Instructions. She advised that the SFIs would require further substantial revision on the implementation of the Integration of Adult Health and Social Care. 1. Accepted the updated Standing Financial Instructions. 2. Noted that the next review date was September Noted the requirement to further revise the Standing Financial Instructions in light of the Integration of Adult Health and Social Care. Mrs. Ace 2013/166 REPORTS FROM GOVERNANCE COMMITTEES a) Audit Committee: 3 rd September Mrs. Smith gave a verbal report on the principal issues considered by the Committee, including: the revised Procurement Strategy; the revision to the Financial Standing Instructions; the Internal Audit Report on Department for Work and Pensions : Personal Independence Payments; the External Audit Annual Report, which raised no material concerns; and a fraud update, from which Committee members had noted the endeavour to raise awareness of and to tackle fraud. b) Acute Operating Management Committee: 21 st August 2013 and 23 rd September 2013 The Committee noted the minute of the meeting held on 21 st August Mrs. Mahal, Committee Chair, reported that the meeting of the Committee on 23 rd September 2013 had included a useful visit to the Haematology Ward. c) North Lanarkshire Community Health Partnership Operating Management Committee: 14 th August 2013 and 11 th September 2013 The Committee noted the minute of the meeting held on 14 th August Mr. Anning, Committee Chair, reported on the principal issues considered by the Committee at its meeting on 11 th September 2013, with particular regard to Waiting Times; the development of an Acute Clinical Strategy. He reported that the Committee had also marked the retirement of Mary Castles, Director of Housing and Social Care within North Lanarkshire Council, and had acknowledged her material contribution to the work of the North Lanarkshire Community Health Partnership. d) South Lanarkshire Community Health Partnership Operating Management Committee: 26 th August 2013 The Committee noted the minute of the meeting held on 26 th August Mrs. Smith, Committee Chair, reported that Councillor Maureen Devlin from South Lanarkshire had been appointed to replace Councillor Handibode, and would co-chair the Committee. e) Staff Governance Committee: 1 st September 2013 The NHS Board noted the minute of the meeting of the Staff Governance Committee held on 1 st September 2013.

17 Mrs. Macer, Committee Chair, highlighted from the minute the presentation given to the Committee on Staff Experience. 2013/167 DATE OF NEXT MEETING: Wednesday 30 th October 2013 at 9.30am. 2013/168 MOTION TO MOVE INTO PRIVATE SESSION The NHS Board approved a motion to move into Private Session for the remaining item of business, due to the Commercial-In Confidence nature of the item. 2013/169 PHARMACY PRACTICES COMMITTEE The NHS Board considered the minute of the meeting of the Pharmacy Practices Committee held on 30 th August 2013, and endorsed the Committee s conclusions. Mr. Sloey reported that this was the first meeting of the Pharmacy Practices Committee to be held under the new administrative support arrangements, which had operated satisfactorily. NJA/MB 25/9/13 17