ARGYLL & BUTE CHP COMMITTEE MEETING Wednesday 29 … · 29/08/2012  · Argyll & Bute CHP Committee...

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Wednesday 29 August 2012 An Roth- Community Enterprise Centre Craignure, Isle of Mull 12.30pm – Lunch 1.00pm – Committee Meeting (to which members of the public are welcome to attend) AGENDA 1. Chairman’s Welcome Robin Creelman 2. Apologies Robin Creelman 3. Conflicts of Interests Robin Creelman 4. Minutes from Previous Meeting 4.1 Minute – 25 June 2012 (attached) Robin Creelman 5. Matters Arising 6. NHS Highland Organisational Issues Robin Creelman 6.1 Meeting of Highland NHS Board - 14 August 2012 (verbal) 6.2 Minute of the Meeting of Highland NHS Board – 5 June 2012 (attached) 7. Clinical Governance 7.1 Clinical Governance & Risk Management Report (attached) Pat Tyrrell 7.2 Infection Control Report (attached) Pat Tyrrell 7.3 Health Improvement Report (attached) Elaine Garman 8. Financial Governance 8.1 Finance Report (attached) George Morrison ARGYLL & BUTE CHP COMMITTEE MEETING 11am–12.15pm – Visit to Mull Progressive Care Centre
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Transcript of ARGYLL & BUTE CHP COMMITTEE MEETING Wednesday 29 … · 29/08/2012  · Argyll & Bute CHP Committee...

  • Wednesday 29 August 2012 An Roth- Community Enterprise Centre

    Craignure, Isle of Mull

    12.30pm – Lunch

    1.00pm – Committee Meeting (to which members of the public are welcome to atte nd)


    1. Chairman’s Welcome Robin Creelman

    2. Apologies Robin Creelman 3. Conflicts of Interests Robin Creelman 4. Minutes from Previous Meeting 4.1 Minute – 25 June 2012 (attached) Robin Creelman 5. Matters Arising 6. NHS Highland Organisational Issues Robin Creelman

    6.1 Meeting of Highland NHS Board - 14 August 2012 (verbal) 6.2 Minute of the Meeting of Highland NHS Board – 5 June 2012 (attached)

    7. Clinical Governance 7.1 Clinical Governance & Risk Management Report (attached) Pat Tyrrell 7.2 Infection Control Report (attached) Pat Tyrrell 7.3 Health Improvement Report (attached) Elaine Garman 8. Financial Governance 8.1 Finance Report (attached) George Morrison


    11am–12.15pm – Visit to Mull Progressive Care Centr e

  • 9. Staff Governance 9.1 Argyll & Bute CHP Partnership Forum 12 July 2012 (attached) Derek Leslie/

    David Logue 9.2 Argyll & Bute CHP Partnership Forum Away Day Feedback (verbal) David Logue

    9.3 PDP/R and eKSF Implementation (attached) David Logue 10. Performance Management

    10.1 Delayed Discharge (attached) Derek Leslie 10.2 Admissions, Discharge & Transfer (ADT) Policy Audit (attached) Pat Tyrrell

    11. Mental Health Services Modernisation Project

    11.1 Update Report (attached) John Dreghorn

    12. AOCB*

    13. Date, Time & Venue for Next Meeting Wednesday 31 October 2012 at 10.30am, Meeting Room s J03-J07, Mid Argyll Community Hospital & Integrated Care Ce ntre, Lochgilphead

    * to be notified to Chairman in advance of meeting

    The Committee Meeting will be followed by a Public Meeting

  • Argyll & Bute CHP Committee Date of Meeting : 29 August 2012

    Agenda item : 4.1



    Argyll & Bute Community Health Partnership Aros Lochgilphead Argyll PA31 8LB

    Mid Argyll Community Hospital and

    Integrated Care Centre

    27 June 2012

    Present Mr Robin Creelman, Chairman, Argyll & Bute CHP

    Mr Derek Leslie, Director of Operations, Argyll & Bute CHP Dr Michael Hall, Clinical Director, Argyll & Bute CHP Ms Pat Tyrrell, Lead Nurse, Argyll & Bute CHP Ms Elaine Garman, Public Health Representative, Argyll & Bute CHP Ms Mary Wilson, AHP Representative, Argyll & Bute CHP Ms Elizabeth Reilly, Area Dental Committee Representative Ms Tricia Morrison, CVO Representative, Argyll & Bute CHP Mr Duncan Martin, Chairman, Public Partnership Forum Councillor Elaine Robertson, Argyll & Bute Council Representative Councillor George Freeman, Argyll & Bute Council Representative

    In Attendance Apologies

    Mr George Morrison, Head of Finance, Argyll & Bute CHP Mr David Ritchie, Communications Manager, Argyll & Bute CHP Caroline Henderson, Clinical Services Manager, Oban, Lorn & Isles Hospital Mr Stephen Whiston, Head of Planning Contracting & Performance, Argyll & Bute CHP – by vc – agenda items 6 and 7 Dr Jenny Hall, Research Fellow, Centre for Health Science, UHI, Inverness -by vc – agenda item 13.3 Mrs Sheena Clark, PA to Director of Operations - Minute Secretary Mr Garry Coutts, NHS Highland Mr David Logue, Head of HR, Argyll & Bute CHP Mr John Dreghorn, Project Director, Mental Health Modernisation Ms Glenn Heritage, CVO Representative Ms Dawn Gillies, Staffside Representative Mr Donald Barr, Area Optical Committee Representative Mr Neil Robinson, Area Pharmaceutical Committee Representative Mr Cleland Sneddon, Argyll & Bute Council Representative Mr Jim Robb, Argyll & Bute Council Representative

    1 CHAIRMAN’S WELCOME The Chairman opened the meeting by welcoming everyone to the Mid Argyll Hospital and Integrated Care Centre. Mr Creelman paid tribute to Mrs Katy Murray who sadly passed away last month, and recognised her many commitments and her contribution to the work of the CHP Committee and Public Partnership Forum.

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    Mr Creelman acknowledged the significant work of Mr Bill Brackenridge on behalf of the CHP during his 6 year term of office as Chairman. 2 APOLOGIES Apologies for absence were noted as above. 3. CONFLICTS OF INTEREST No conflicts of interest were declared. 4. MINUTE FROM PREVIOUS MEETING 4.1a Minute of Meeting held on 25 April 2012 The Minute of the meeting on 25 April 2012 was accepted as a complete and accurate record of the meeting. The Committee: • Approved the content of the Minute of the meeting on 25 April 2012. 4.1b Minute of Public Session – 25 April 2012 Mr Creelman stated that he had welcomed the public’s comments advising their concerns on specific NHS and community care matters within the Bute locality, which enabled the CHP to consider and respond to the questions raised. With regard to question two of the Minute, the incident detailed had been fully investigated and an action plan, agenda item 4.1c, has been drawn up to address the issues raised. 4.1c Bute Locality – Public Session Action Plan The CHP Committee commended the circulated plan which detailed the actions by the CHP in response to the points raised during the public session. Mr Leslie advised that the public session and discussions had been valuable to the CHP in addressing the issues raised and to ensure an effective system of communication between agencies. It was noted that the Marie Curie Manager has met with the patient concerned to discuss the issues raised. Mr Creelman stated that the CHP’s response had been positive, well investigated and actioned. Ms Robertson emphasised the need to work to the care plan and ensure availability of documentation to record and highlight any issues. Ms Tyrrell advised that this was part of the quality assurance process. The Committee: • Noted the contents of the Minute of the Public Session, 25 April 2012 and the actions of

    the CHP to address the concerns and issues raised.

  • Argyll & Bute CHP Committee Date of Meeting : 29 August 2012

    Agenda item : 4.1


    5. MATTERS ARISING FROM PREVIOUS MEETING HELD ON 25 APRIL 2012 Health Improvement – Breast Feeding – Ms Tyrrell reported that the CHP had received a gold award for stage 3 of the UNICEF accreditation and was a tribute to all staff involved. Harm Reduction Services – Ms Robertson enquired if needle exchanges were operational in all areas of the CHP. Ms Garman advised that in areas of the CHP where this was not the case, David Greenwell and Pharmacy representative were having discussions to progress and resolve any issues. 6 COWAL 24/7 REVIEW BRIEFING REPORT The circulated paper provided the CHP Committee with a progress report on the review undertaken with regard to the future provision of the GP out-of-hours arrangements in Cowal and the review of the medical input into the hospital and in respect of day time and out-of-hours in Cowal Community Hospital. Mr Whiston reminded the Committee that the review resulted from the GP who previously provided the Strachur out-of-hours cover deciding in 2007 to opt out of providing this service. The subsequent arrangement with the Tighnabruaich practice to cover the out-of-hours ceased in 2010 when the GP also decided to opt out. The review, which runs until September/October 2012, is being carried out by the Cowal 24/7 Review Group which was set up in October 2011 and is jointly chaired by a member of the public and a Helensburgh & Lomond GP/Locality Clinical Director. The group includes representatives from communities, Public Partnership Forum, Argyll & Bute Council, town and rural GP practices, hospital casualty and out of hours service GPs, nursing and staff from Cowal Community Hospital and the Cowal community, Scottish Ambulance Services, Cowal Community Management, Argyll & Bute CHP Management and the Union. The Scottish Health Council local representative has also attended meetings to provide support and direction and to help craft and design the process to involve and engage with the public. Mr Whiston highlighted that the review is taking into account a number of national policies, including :

    • Framework For The Sustainability of Services and the Medical Workforce in Remote Acute Care Community Hospitals

    • Health Improvement Scotland - Draft Quality Indicators ~ June 2011 Primary Care Out-of-Hours Services- publication June 2012

    and the review group are comfortable with the process being followed and the consideration of the options. Tables 1 and 2 of the report detailed what medical staff work in which areas over a 24 hour period, by shifts, departments and location. Table 3 detailed the nurse practitioner workforce resource in the casualty department. Mr Whiston asked members to be aware of the small number, 432, of GP out of hours home visits in the Dunoon town catchment area during January to December 2011, as reported in the activity profile report. Tables 4 and 5 detailed the 2011/12 budget for the existing service. The option appraisal process carried out during February/March 2012 was developed through engagement, discussion, refinement and reflection from all members of the review

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    group and relevant stakeholders. The outcome identified 17 options which reflected the complexity of the service and the expectations of the public and stakeholders and the determination of the group to ensure a comprehensive process was undertaken. During March/April 2012 the17 options were taken out for public consultation to :

    • review and to obtain feedback on patients’ experience • present the variety of information about the service and to ask questions about the

    current service. • consider the health and wellbeing profile information of Cowal’s population • look at the initial service alternative “options”

    The Cowal 24/7 group held a workshop on 19 April 2012 to undertake and review an assessment process to identify a shortlist of the options, assessing their compliance to the review objectives and parameters. Thereafter a report was produced identifying a viable shortlist of 7 options to put forward for formal appraisal, which was presented to the Cowal Project Group for its consideration and which was approved at its meeting on 26 April 2012. Mr Whiston confirmed that the options in the report were not ranked but were listed by option number, not option preference. The first stage of the option appraisal, non-financial benefits and risk, was completed on 21 June 2012, with the remaining stages due to be completed by October 2012, when the CHP Management Team and CHP Committee will receive a recommendation for consideration and decision to implement. Mr Creelman declared his particular interest as a resident of Cowal and stressed that the review and outcome required to be patient centred. In response to Mr Freeman’s enquiry about local Councillor representation on the Cowal 24/7 Group, Mr Whiston advised Councillor Bruce Marshall was a member. Mr Freeman expressed surprise that out of hours cover for Lochgoilhead was provided from the Vale of Leven Hospital and queried if the travel time to the Vale was less than to Cowal Community Hospital. Mr Whiston replied that travelling time was similar, i.e. 45 minutes to 1 hour, with the time obviously increasing due to any road closures. The consultation has reflected the conclusion by the community to include the option for Lochgoilhead to continue to receive out of hours provision from Vale of Leven Hospital. A detailed analysis was undertaken of home visits activity levels when it was reported that 50% of NHS24 call outs should have been categorised as ambulance hospital admissions. Dr Hall commented that to ensure clinical safety and surroundings for the patient, there is a need to move away from home visits, with only palliative care and mental health patients perhaps requiring a home visit. Mr Creelman emphasised the need for the home visit element of the out of hours provision to be fed into the review process. Mr Whiston responded that this issue has been raised and recorded with Clinicians on the Project Group during the appraisal process. Dr Hall advised the members on a recent visit to the Stirling Ambulance Service where the paramedic practitioner model was demonstrated. This out of hours cover has proved very successful in other rural communities, with no GP out of hours in small villages. It was noted that to develop this model requires a 2 year training programme to upskill paramedics. This specialist training requires Scottish Government initiative, but should not be seen as a GP replacement. Mr Leslie reiterated that whilst the process being carried out by the Cowal 24/7 Group was to address the challenges in sustaining out of hours services in Cowal, the challenges have a wider application and need to be addressed from a national and strategic perspective.

  • Argyll & Bute CHP Committee Date of Meeting : 29 August 2012

    Agenda item : 4.1


    The CHP Committee was required to determine that a reasonable engagement and information process has been followed, with an outcome which is not predetermined and has been fully monitored, with input from the Scottish Health Council, and has been conducted under and adhered to clear governance procedures. The need for partnership support in the process was noted and Mr Leslie advised that there is a natural requirement for Locality Managers to discuss the review at Local Area Community Planning Group (LACPG) meetings. Mr Freeman commented that this group is not a decision making body and Council endorsement should be sought through the Area Committee. Mr Whiston confirmed that information on the review had been submitted to all stakeholders to provide an opportunity to comment and participate.

    7. RENAL REPLACEMENT THERAPY SERVICES – ARGYLL & BU TE CHP Mr Whiston explained the background to the paper and the current service provision for Argyll & Bute haemodialysis and peritoneal dialysis patients. Haemodialysis is not provided within Argyll & Bute CHP. At the time of reporting there are 15 haemodialysis patients receiving treatment within NHS Greater Glasgow & Clyde and 3 North Argyll patients at the Belford Hospital in Fort William. Although the normal pathway for patients would be to the Vale of Leven Hospital, due to capacity issues, the 3 patients receiving their treatment at the Belford Hospital are as a result of either clinician referral or patient choice. Mr Leslie acknowledged Councillor Robertson’s involvement and engagement with the North Argyll residents in seeking the CHP’s participation in considering requests for a local satellite renal unit, which has attracted local and national interest. A representative group recently met with Mr Mike Russell, MSP and the Cabinet Secretary to discuss their proposals and the CHP provided a briefing to the Scottish Government, based on the content of the circulated report. The Cabinet Secretary had commented that dialysis needs will progress around the CHP and estimated numbers will rise due to the impact of demography and an increase in long term conditions and these factors need to be considered when looking at service provision. The Cabinet Secretary recognises the challenges facing the CHP and has received an assurance that patients will receive a rigorous standard of haemodialysis in a hospital setting.

    The Committee : • Noted the status of the review • Considered the issues with regard to the current service delivery arrangements:

    o day time Medical Input o out of Hours arrangements Dunoon o out of hours Arrangements Rural Cowal (Tighnabruaich & Strachur) o out of hours Arrangements Lochgoilhead

    • Noted the progression of the review process which has identified a short list of 7 options from the original 17 long list of options

    • Noted the next stage and timetable for completion of the review

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    It is important that the public and patients recognise the CHP’s acknowledgement of the travelling time and distance incurred by them, but also the requirement for the CHP to ensure an effective, sustainable and safe service. The normal pathway for patients would be to the Vale of Leven Hospital, which is currently running at full capacity. As the Belford Hospital, Fort William has capacity, at present 3 patients per week travel together by taxi for a return journey from the North Argyll to Fort William, at an annual cost of approximately £30k. The CHP are continuing their discussions with the Scottish Ambulance Service regarding the transport of the patients attending the Belford Hospital. Mr Creelman requested clarification that the 3 patients had chosen to travel to Fort William for treatment and was advised that for all it was a personal choice. In relation to an Argyll & Bute CHP Renal Development, Councillor Freeman asked for clarification on the disparity in the detailed capital and revenue costs within the report for Inverclyde Hospital unit and the Belford Hospital unit. Mr Whiston advised the costs should not be seen as ‘like for like’ as the scale of the dialysis unit within Inverclyde Hospital was significantly greater than the unit within the Belford Hospital, resulting in costs being significantly less in Fort William. There is no clear correlation between the number of units and the cost. Mr Leslie stated that the most appropriate cost comparator for Argyll & Bute CHP was the Belford Hospital, which is currently running under capacity. With the recent changes in guidance to the Highland & Islands Travel Scheme there is more of an incentive for the organisation to look at repatriating business back to NHS Highland. Mr Whiston concluded that the overview of the current and projected future demand for renal replacement therapy does not identify an appropriate geographic point within Argyll and Bute to establish a local service enhancing access to all residents. The capital and running costs of a stand alone unit are significant and the level of likely activity would not result in an affordable or cost effective use of the service and staff even based on a normal dialysis cycle for patients of 2-3 days. The location of existing units in Glasgow (Vale, RAH and IRH) and the proximity of the Belford Hospital to North Argyll clearly offers greater access in terms of proximity for the adjacent Argyll and Bute localities. The CHP should therefore look to work with NHS Greater Glasgow & Clyde & NHS Highland to plan for its future provision. Councillor Robertson thanked the CHP for addressing the concerns raised by North Argyll renal patients and was comforted by the content of the report and the assurances given by Mr Leslie that a full and detailed review is being undertaken, which should be completed by September 2012.

    The Committee :

    • Considered the current profile of service delivery • Considered the future projections / need for Renal Replacement Therapy • Noted the current financial costs of hospital dialysis

  • Argyll & Bute CHP Committee Date of Meeting : 29 August 2012

    Agenda item : 4.1


    8. NHS Highland Organisational Issues 8.1a Draft Minute of Highland NHS Board Meeting –5 June 2012 The draft Minute was not circulated or tabled as it was noted as unapproved by the Chair of the NHS Board. Mr Creelman advised the Committee on a number of the points and actions resulting from the meeting. The approved draft Minute of 5 June 2012 will be included in the papers for the CHP Committee meeting in August 2012. The Committee: • Noted the CHP Chairman’s summary of the draft minute of Highland NHS Board –5 June

    2012 8.2 CHP Annual Report 2011/12 This document was circulated as an aid memoire of the activity of the CHP Committee during the reporting period 2011/12, and to inform on the role and remit, updated membership and future planning of the group. The Committee: • Noted the contents of the CHP Annual Report 2011/12 9. CLINICAL GOVERNANCE 9.1 Clinical Governance & Risk Management Repo rt Ms Tyrrell spoke to the previously circulated papers and highlighted a number of areas from the report. RISK MANAGEMENT Ms Tyrrell advised that the report focussed on the three categories of the highest reported incidents, medications, pressure ulcers and falls. Incidents Medications – in the final quarter of 2011/12 there were 24 medication incidents reported, which is a decrease in the previous reporting period. Of the 24 incidents, 21 had been finally approved and graded, 15 – insignificant, 5 minor and 1 moderate. The moderate incident was due to a power failure at a health centre resulting in vaccines not being stored at the appropriate temperature and subsequent loss of vaccines. Pressure ulcers – reporting is in the early stages, with NHS Highland’s zero tolerance of avoidable pressure ulcers leading to an improved focus across all care settings on effective risk assessment and care plans. Clinical Quality Indicators (CQI) are nationally agreed measures of quality which allows the assessment of performance against a range of key indicators. All inpatients wards in Argyll & Bute CHP monitor their compliance with the standards for pressure ulcer prevention and management on a monthly basis. With the improved compliance with CQIs, aiming for 95% or greater, there should also be a decrease in the number of pressure ulcers within the ward areas. Councillor Robertson highlighted the seemingly high figure of 7 incidences of pressure ulcers reported within Dunaros in January 2012. Ms Tyrrell explained that the rates reported were per 1000 occupied bed days.

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    Falls – all areas are now focussing on risk assessment and prevention of falls within all clinical settings, together with a wider community focus on falls prevention which is a key element of the Reshaping Care for Older People programme. The CHP Falls Co-ordinator works closely with clinical staff to provide support in implementing actions which reduce both the environmental and individual risks which can lead to people falling. Significant Event Reviews (SERs) Ms Tyrrell provided details of the recent report commissioned by the Cabinet Secretary for Health to review the clinical governance systems and processes of NHS Ayrshire and Arran, and in particular those relating to their management of critical incidents, adverse events, action planning and local learning. Ms Tyrrell advised that although the CHP currently has a robust system for identifying, conducting, reviewing and monitoring SERs, a review of our existing services will be carried out to ensure that we address any of the relevant findings from the report and the CHP Committee will be advised of the conclusions. Complaints Ms Tyrrell reported that to ensure adherence to the management of standard complaints, a number of complaints may require a comprehensive review, i.e. SERs. Due to the complexity of the review and the necessity to obtain information from other organisations, the process for achieving the 20 day response target can be delayed. Progress of investigating a complaint is tracked through the Datix system and complainants are kept informed of the timescale for receiving a final response by the NHS Complaints Team issuing a ‘holding’ letter. Councillor Freeman expressed some concern regarding the monitoring of primary care complaints and the notification of outcomes. Dr Hall advised that the complaint process for Primary Care is determined by the Scottish Government for independent practices to resolve any complaints locally. He also stressed that any issues identified directly to the CHP are thoroughly investigated and if required the Practice will be visited by the CHP Clinical Director and Primary Care Manager. Ms Tyrrell stated that new standards for management of complaints include Primary Care, a copy of which will be sent to Councillor Freeman for information. It was advised that in preparation of an annual appraisal, a GP should submit details of any complaints for discussion with the external appraiser. Ms Tyrrell referred to the NHS Highland patient opinion website where patients can submit comments/complaints and which is administered by the Complaints Team. The 2011/12 Patient Experience Survey of GP and local services provides details of people’s experiences, and individual practice reports are available. It was suggested that the Complaints process be an agenda item for a future Committee Development Session. Health & Safety The details in the circulated report relating to the following were noted :

    • HSE Improvement Notice • Risk Assessment • Workplace Inspection

  • Argyll & Bute CHP Committee Date of Meeting : 29 August 2012

    Agenda item : 4.1


    • Fire Safety Quality External Reviews The details in the circulated report relating to the following were noted :

    • Healthcare Environment Inspectorate • Care Inspectorate Child Protection Follow Through Inspection

    Scottish Patient Safety The details in the circulated report were noted. Better Together Survey The details in the circulated report were noted. Further analysis of the results is underway and will be presented to the CHP Committee in August 2012. The Committee: • Noted the contents of the Clinical Governance and Risk Management Report 9.2 Cleanliness, Hygiene and Infection Control Repo rt Ms Tyrrell spoke to the previously circulated paper and highlighted a number of areas from the report. Staphylococcus Aureus Bacteraemia (SAB) including M RSA: Ms Tyrrell reported that NHS Highland is well within the target of 0.26 cases per 1000 acute occupied bed days rate, with a reported figure of 0.18 April 2011-March 2012. Since the last report there have been two SAB cases in Argyll & Bute CHP, both of which were true community acquired cases and the patients were admitted to the Lorn & Islands Hospital. The roll out of a new screening process for MRSA has been completed across the CHP, with some outstanding medical records issues being addressed in Islay which is due for completion at end June 2012. Clostridium Difficile Infection (CDI): Ms Tyrrell advised that Argyll & Bute CHP reported incidences of CDI continues to be low, with one reported case in Lorn & Islands Hospital since the last report. Initiatives are continuing to reduce CDI cases and enhanced surveillance is carried out on every CDI case, with immediate feedback to staff. Hand Hygiene Argyll & Bute continues to meet compliance standards, with no complacency reported or evident within any area of the CHP. A mandatory module for all staff is available via E-learning on Learnpro NHS, with a revalidation/refresher period of 3 years.

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    A key way to prevent the spread of infections includes enhanced public engagement in the hand hygiene process, together with the availability of information at Cleaning and the Healthcare Environment Compliance rates for Argyll & Bute hospitals were as detailed in the circulated report. Ms Tyrrell advised a delay this month in reporting figures for Dunaros and Islay hospitals due to problems with access to a new system, which are being resolved. With regard to Argyll & Bute Council staff working within the newly built Mull Progressive Care Centre, Ms Tyrrell clarified that they will operate and be supervised within NHS Highland compliance guidelines, with audits regularly carried to ensure compliance. Outbreaks/Incidents A Significant Event Review on the Clostridium difficile outbreak in Raigmore Hospital in January 2012 has been completed. The findings from this report have been reviewed by the CHP Infection Control Group to ensure that any gaps in Argyll and Bute are addressed. During the last reporting period, Norovirus has been prevalent within the community setting and patients admitted with restrictions with symptoms to several hospitals within NHS Highland, including Glenaray Ward of Mid Argyll hospital. Mr Creelman commented on the need to review cleaning frequency and estates conditions, with items of risk being removed and areas repaired as required. Ms Tyrrell confirmed there is an awareness of these issues which are being closely monitored.

    Healthcare Environment Inspectorate (HEI) Ms Tyrrell advised that the final written report of the announced HEI inspection of Oban, Lorn & Islands hospital in April 2012 has been received. As well as excellent verbal feedback from the inspection team, the written report was very positive and noted that staff were complying well with national standards and requirements. Mr Creelman congratulated all staff for the continued high standard of compliance and their contribution to the very positive report. These comments were endorsed by Councillor Robertson. The Committee: • Noted the contents of the Cleanliness, Hygiene and Infection Control Report 9.3 Health Improvement Ms Garman spoke to the previously circulated paper which reported on the following areas : Childhood Immunisation There has been an uptake in Argyll & Bute of 96.3% of MMR1 by 5 years of age, against an NHS Highland average of 95.4% and a Scottish average of 96.4%. Efforts continue to tackle health inequalities and the need for immunisation uptake in every Practice is highlighted during Practice visits by the Primary Care Manager. It is necessary to continue to deliver a positive message to the public on the benefits of immunisation.

  • Argyll & Bute CHP Committee Date of Meeting : 29 August 2012

    Agenda item : 4.1


    Bowel Screening Argyll & Bute CHP recorded an uptake of 59.1% at end October 2010, against a national uptake of 53.7%, with a higher percentage of women than men locally and nationally recorded. Capacity issues within NHS Greater Glasgow & Clyde has resulted in a delay in Argyll & Bute patients receiving their pre-colonoscopy assessment appointments within 14 days of notification by the Scottish Bowel Screening Centre. The appointment of additional staff in NHS Greater Glasgow & Clyde has now provided more capacity within the system to achieve timeous appointments. Breast Screening Ms Garman advised that there is currently a national consultation underway to rationalise the use of mobile units in Scotland and the number of assessment centres, with consideration being given to combine assessment centres for screening and symptomatic patients. She and Mr Whiston recently attended a workshop to look at the use of the proposed merged service within small communities and the potential impact on the CHP and to consider access times. Cervical Screening Ms Garman reported that national uptake rates by women eligible for screening are falling. The CHP recorded an uptake of 79.5% at end of 2011, against a national target of 80%. In Argyll & Bute, as at end 2011, 16.2% of women defaulted on appointments. After three defaults the details of women eligible for screening appointments are removed from Practice lists. The importance of screening uptake is discussed and highlighted during Practice visits by the Primary Care Manager. Abdominal Aortic Aneurysm Screening The national programme will be phased in across the NHS Highland Board area this year, with the existing programme in North Highland migrating to the new national system. Argyll & Bute will implement the programme in October 2012 which will be delivered in eight centres throughout the CHP by existing radiographers together with healthcare support workers. If a positive screening is reported, patients will either be referred to vascular services in Glasgow or followed up by the local screening service and appropriate health promotion advice provided. Mr Leslie advised that the importance of screening should be on the agenda of Local Area Community Planning Group meetings and communities encouraged to participate in available screening programmes. The Committee: • Noted the contents of the Health Improvement Report 3.30pm - Dr Jenny Hall, Research Fellow, Centre for Health, University of Highlands & Islands joined the meeting by vc and it was therefo re agreed to move to item 13.3 and thereafter revert to the order of the agenda.

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    13.3 Isle of Lismore Evaluation Report Dr Jenny Hall highlighted the key points from the circulated final report - executive summary :

    • Background to the report • Aims and objectives of the evaluation • Study design methods • Findings and views of the community • Recommendations

    The detail of the report on the aims, objectives and recommendations of the proposed new model has previously been shared with the Lismore community. Mr Creelman commented that although some of the issues raised are unique to Lismore, the majority are common to rural areas, i.e. concerns of an island setting being ‘cut off’ from medical and social care services due to weather conditions. Councillor Robertson advised that the outcome of the evaluation process has shifted the balance of care on Lismore and has provided some confidence to the island residents, with the majority of the recommendations probably already achieved. She congratulated all the participants in the review. Ms Henderson reiterated the usefulness of the report and confirmed that a number of the recommendations have been actioned. Engagement with the community will continue and a community sub-group will be set up to deal with any emerging issues. Ms Tyrrell advised that GPs are pivotal in ensuring community confidence on how risk is managed. An emergency planning exercise will be carried out with Argyll & Bute Council. Ms Garman advised that as part of emergency planning, it is important that Electricity Boards have accurate postcode information to ensure that vulnerable patients who may require assistance are easily identified. Mr Creelman stated that there is a specific policy available which Electricity Boards should adhere to when dealing with vulnerable cases. Mr Martin enquired if a telehealth pod was available on the island. Ms Henderson confirmed the availability of a unit and advised that earlier issues around a telephone signal have been resolved. Mr Leslie commented that initially the presentation did not reflect the level of CHP engagement with the public. It is important to continue to build community confidence and to refresh public engagement. Mr Leslie asked that a report detailing the strands of improvement in service delivery is brought to a future CHP Committee meeting. Mr Leslie credited the Lorn and Islands team in their involvement in achieving a positive outcome for the Lismore community. The Committee: • Noted the contents of the Isle of Lismore Evaluation Report

  • Argyll & Bute CHP Committee Date of Meeting : 29 August 2012

    Agenda item : 4.1


    10. FINANCIAL GOVERNANCE 10.1 Finance Report Financial Position Mr Morrison spoke to the circulated report and advised that for the two months ended 31 May 2012 the CHP recorded an overspend of £86,000, with the main pressure being unachieved savings targets. Table 1 of the paper provided a summary of budgetary performance across Argyll & Bute CHP for the two months ended 31 May 2012. Cost pressures have been identified in three localities, commissioned services and management and corporate budgets. Mr Creelman enquired if there was provision within the budget for new drugs. Mr Morrison confirmed this was the case for patented drugs but that the value fluctuates depending on the drug. The CHP prescribing team work with GPs to ensure best use of the prescribing budget. Dr Hall advised that a number of drugs previously issued to the community by NHS Greater Glasgow & Clyde are now being charged to the CHP. Mr. Freeman asked for clarification on the inclusion of forecast slippage of £950k against budget reserves. Mr. Morrison explained that this was effectively a balancing figure required to support a year-end forecast break-even position for the CHP. In effect it included two elements; genuine forecast slippage on budget reserves and also a requirement to address forecast overspends across the CHP. Mr. Morrison acknowledged that the presentation was not entirely clear and agreed to separate these two elements in future reports to improve clarity. Mr Leslie advised that use of reserves is a legitimate management response and decision, without which there would be a risk of not preserving existing services. Mr Creelman confirmed that he was satisfied with Mr Morrison’s reporting of this point. Cost Improvement Programme 2012/13 A cost improvement plan of £5m was approved for 2012/13 by the CHP. Several of the cost improvements will arise naturally (e.g. prescribing drugs coming off patent, restricted uplift to SLA values), however a balance of £2.24m requires to be delivered through management action. To support managers in their efforts to achieve cost improvements a number of quality and efficiency reviews will be undertaken across Argyll & Bute, with any improvements generated contributing to the targets held by individual budget managers :

    - Commissioned services - Prescribing costs - Out of hours services - Radiology services - Laboratory services - Administration services - Service Quality (Infection control/Fall prevention/Tissue viability) - Energy costs - Transport services - Catering services - Domestic services - Procurement - Allied health profession - Maternity services

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    Mr Leslie acknowledged that 2012/13 will be a financially challenging year, particularly for operational units but provided an assurance that the CHP can achieve efficiencies without affecting front line services and can make a beneficial impact on service quality. Mr Leslie provided additional details of the quality and efficiency reviews :

    - Out of hours services – a wider, strategic scrutiny will be undertaken to look at the disposition of assets and services.

    - Commissioned services – the methodology applied by NHS Greater Glasgow & Clyde will be questioned to ensure that any efficiency savings achieved by them are subsequently reflected in charges to the CHP.

    Mr Martin highlighted the service review currently being undertaken by NHS Greater Glasgow & Clyde and the requirement for the CHP to be fully sighted on developments. Mr Leslie advised that Mr Whiston has made representation to NHS Greater Glasgow and Clyde around the engagement process. Highlands & Islands Travel Scheme (HITS) Mr Morrison advised on a national decision to transfer funding from HITS to health boards baseline allocations, with the CHP receiving a budget of £1.6m per annum, which is protected for cost increase for 2 years. This transfer creates both financial risks and opportunities for the Board/CHP. The Core Team recently discussed and agreed an initiative to review the use of HITS funding to ensure efficiency in allocation of patient travel payments throughout the CHP. Financial System The new national financial system is now operational with the CHP data now on the new reporting system. Mr Morrison reported that delays in the implementation in the system resulted in overdue payments to suppliers for several weeks at the start of April 2012 and delayed budget input and the development of budget reports at the start of the financial year. Forecast Outturn for 2012/13 Mr Morrison advised that there is scope to implement measures to control expenditure and operate within budget to deliver a year-end break-even position, which is contingent on three main actions : - managers take early action to identify and implement measures to achieve savings. - managers exercise control over emerging cost pressures. - settlement of the patients services contract with NHS GG&C is agreed at an acceptable and affordable value. The Committee: • Noted the contents of the Finance Report 11. STAFF GOVERNANCE 11.1 Argyll & Bute CHP Partnership Forum Draft Minute - 19 April 2012 The Argyll & Bute Partnership Forum minute of 19 April 2012 had been previously distributed and the contents were noted.

  • Argyll & Bute CHP Committee Date of Meeting : 29 August 2012

    Agenda item : 4.1


    The Committee: • Noted the contents of the Argyll & Bute CHP Partnership Forum Draft Minute of

    19 April 2012 11.2 Argyll & Bute CHP Partnership Away Day – 31 M ay 2012 The CHP Committee agreed to defer this item to the next meeting to enable discussion and feedback from Staffside representatives. 11.3 PDP/R and eKSF Implementation The distributed paper reported that work is continuing to deal with the shortfall in the target of 80% completion. A number of actions have been proposed and interim targets set to address the issues identified in relation to Bank staff to ensure that they are engaged with and participate in the review process. Mr Leslie advised that the focus for the 1st quarter of 2012/13 will be the completion and signing off of Bank staff reviews. 10 PARTNERSHIP WORKING 12. PARTNERSHIP WORKING 12.1 Argyll & Bute Public Partnership Forum Draft N otes – 29 May 2012 Mr Martin advised that only a few members attended and therefore the meeting was not quorate. It has been agreed to appoint an interim Vice Chair until July 2013 when elections for both the Chair and Vice Chair would take place. Mr Martin, Mr Creelman and Ms Champion will meet to discuss the integration agenda. Councillor Robertson highlighted the non-attendance of a Social Work representative on the group. Ms Tyrrell will follow up this with Anne Austin, Service Manager, Community Care Resources, Argyll & Bute Council. The Committee: • Noted the contents of the Argyll & Bute CHP Partnership Forum Draft Minute of

    19 April 2012

    The Committee: • Noted that this fell short of the target of 80% and demonstrated that considerable work

    remains outstanding in relation to including staff who are on employee “bank”, in the PDP/KSF process.

    • Noted the interim targets for April - June 2012 • Approved the proposed actions to address this shortfall and engage with bank staff in

    relation to KSF. • Noted progress against trajectory for 2012/13.

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    13. PERFORMANCE MANAGEMENT 13.1 Delayed Discharge/Joint Performance Report Mr Leslie provided an update on the previously circulated report which detailed the CHP’s performance against the Scottish Government Target. There was one reported breach of >6 weeks, due in part to issues around the case being examined through partnership and the process of submitting the census. Actions have been undertaken to resolve the issues identified. The Committee: • Noted the contents of the Delayed Discharge Report. 13.2 Admissions, Discharge & Transfer (ADT) Policy and Audit Mr Leslie requested that this agenda item be deferred to ensure appropriate scrutiny of circulated report and attached policy document. The Committee: • Agreed the deferment of this agenda item to the next meeting. 14. MENTAL HEALTH SERVICES MODERNISATION PROJECT 14.1 Update Report Mr Leslie advised that this update is reported in various fora throughout the CHP. A number of points were highlighted from the report. Inpatient Services - since the last reporting period the bed compliment has been reduced by 1 to 40 beds. Resettlement Group – is continuing work on plans to discharge/transfer the small number of patients with highly complex needs requiring specialist long term care. Mock HAI Inspection – Heidi May, Director of Nursing recently undertook a mock HAI inspection of ICU, Succoth and Tigh na Linne. An action plan will be drawn up to resolve the issues raised. An update on the work to be carried out will be included in the next report to the CHP Committee. Mr Creelman commented that it is important to recognise and manage any HAI risks. Ms Tyrrell advised that this is a national issue within Mental Health facilities and national guidance is provided by Mental Welfare Commission and HEI. Communications and Engagement – a series of public and staff engagement events were held during May/June 2012 to provide a project progress update. The Committee: • Noted the current key issues and progress against the action plan

  • Argyll & Bute CHP Committee Date of Meeting : 29 August 2012

    Agenda item : 4.1


    15 PAPERS FOR NOTING 15.1 eHealth Steering Group Minute, 2 May 2012 The Committee: • Noted the eHealth Steering Group Minute of 2 May 2012 16 AOCB There was no other competent business highlighted. 17 DATE, TIME & VENUE FOR NEXT MEETING : Wednesday 29 August 2012 at 10.30am An Roth Community Enterprise Centre, Craignure, Isl e of Mull

  • Highland NHS Board14 August 2012

    Item 2(a)



    Assynt House

    Beechwood Park

    Inverness IV2 3BW

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    Board Room, Assynt House,Beechwood Park, Inverness

    5 June 2012 – 8 30 am

    Present Mr Garry Coutts, ChairMr Robin CreelmanMrs Myra DuncanMr Mike EvansDr Michael FoxleyMr Ian GibsonDr Iain KennedyMr Alasdair LawtonMrs Gillian McCreathMr Okain McLennanMr Colin PunlerMr Ray StewartMs Sarah WedgwoodMs Elaine Mead, Chief ExecutiveDr Ian Bashford, Board Medical DirectorMrs Anne Gent, Director of Human ResourcesMr Nick Kenton, Director of FinanceMs Heidi May, Board Nurse Director

    Also present Dr David Alston, Non Executive Board member designateMrs Jan Baird, Transitions Director (Items 53 & 54)Mr Eric Green, Head of Estates (Item 67)Dr Rod Harvey, Clinical Director, Raigmore Hospital (Item 36)Mrs Linda Kirkland, Head of Business TransformationMr Chris Lyons, Director of Operations, Raigmore Hospital (Item 57)Una Lyon, Lead Nurse, Raigmore Hospital (Item 57)Cllr John McAlpine, Non Executive Board member designateMrs Gill McVicar, Director of Operations, North & West (Item 63)Dr Ken Oates, Consultant in Public Health Medicine (Item 64)Mr Kenny Oliver, Board Performance ManagerMr Mike Perera, Mental Health Projects Manager (Item 63)Mrs Lorraine Power, Board Services AssistantMr Brian Robertson, Head of Adult Social CareMr Nigel Small, Director of Operations, South & Mid (Item 63)Dr Lesley Anne Smith, Head of Quality (Item 58)Mrs Cathy Steer, Head of Health Improvement (Item 61)Mr Simon Steer, Head of Community Care (Item 62)Ms Maimie Thompson, Head of Public Relations & EngagementDr Emma Watson, Infection Control Doctor (Item 36)

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    Apologies – Apologies were received from Mr Bill Brackenridge and Dr Margaret Somerville,Director of Public Health and Health Policy.Welcome – The Chair welcomed Mr Alasdair Lawton and Dr Michael Foxley to the Board meeting.Mr Lawton and Dr Foxley had recently been appointed as Non Executive Board members for NHSHighland from 1 June 2012 for a period of 4 years. The Chair also welcomed Dr David Alston andMr John McAlpine who had been nominated by Highland Council and Argyll & Bute Councilrespectively and had still to be formally appointed to the Board.

    35 Declarations of Interest

    Board members declared the following interests: Garry Coutts – Scottish Social Services Council (SSSC), ex officio of SSSC on the Care

    Inspectorate, University of the Highlands and Islands. Myra Duncan – Member of Scottish Government Joint Improvement Team Action Group on

    Reshaping Care. Colin Punler – Member of Pentland Housing Association Board and in relation to item 5.3

    on the agenda, an employee of Dounreay. Ray Stewart – Member of Unite and Staffside Chair Sarah Wedgwood – Non-Executive on Penumbra.

    The Board

    a Noted the Declarations of Interest.

    The Chair advised that item 4.7 on the agenda, the Control of Infection Report, would beconsidered prior to other business on the agenda.

    36 Infection Control ReportReport by Liz McClurg, Interim Infection Control Manager and Emma Watson,Infection Control Doctor on behalf of Heidi May, Board Nurse Director & ExecutiveLead for Infection Control

    Heidi May, Board Nurse Director introduced Dr Emma Watson, Infection Control Doctor and DrRod Harvey, Clinical Director, Raigmore Hospital to present the report to the Board. In addition tothe usual Infection Control Report there were additional updates on Staphylococcus aureusbacteraemia (SAB) in NHS Highland and the Significant Event Report in relation to the Clostridiumdifficile outbreak at Raigmore Hospital in January 2012.

    The Executive Summary of the main Infection Control Report, which summarised the keyinformation in the report, is detailed below:

    Staphylococcus aureusbacteraemia (SAB)

    Target of 0.26 cases per 1000 acute occupied bed daysmet and exceeded.

    NHS Highland rate April –March 2012 is 0.18.

    Clostridium difficile Target of 0.39 per 1000 total occupied bed days in patientsaged 65 and over met and exceeded.

    NHS Highland rate April –March 2012 is 0.26.

    Significant Event Review on the Clostridium difficileoutbreak in Raigmore Hospital in January 2012 completed.

    Hand Hygiene Compliance with hand hygiene 97% in March and April2012.

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    Work on how to achieve consistent compliance with allstaff groups ongoing.

    Cleaning and the HealthcareEnvironment

    Cleaning Compliance 93% in March and 95% in April2012.

    Estates Monitoring Compliance 95% in March and 96% inApril 2012.

    Maintaining the fabric of patient areas in older buildings toenable effective cleaning is a challenge. The effectivenessand application of existing monitoring tool is beingreviewed

    Significant HAI incidents /outbreaks, emerging threats

    Clostridium difficile infection outbreak in Ward 2CRaigmore Hospital April 2012. An incident debrief hasbeen held.

    A Significant Event Review is not planned, as therecommendations from the one undertaken following theoutbreak in January will apply

    Nationally norovirus outbreaks are continuing to arisedespite the time of year. Wards in Caithness General andRaigmore hospitals have been closed to admissions.

    Antimicrobial Prescribing Continuing compliance above 95% with antibiotic choice inmedicine and choice and duration of prophylaxis incolorectal elective surgery. Working with general surgeryto improve compliance above median of 91%.

    Surgical site infections Orthopaedic and caesarean section surgical site infectionsrates remain low, and within anticipated levels.Work is ongoing with the colorectal surgeons to reduce theSSI rate in elective patients.

    Decontamination Risks identified and detailed in the main report regardingwasher disinfectors, local decontamination units in Argyll &Bute, decontamination of instrument compliance inIndependent Dental Practitioner practices.

    During discussion on the main Control of Infection Report, Dr Watson confirmed that NHSHighland maintained its performance as one of the highest performing Board in Scotland andemphasised that all operational units were monitored in relation to cleaning and hygiene andmonitoring antibiotic prescribing. In relation to work in the community it was confirmed that MrBrian Robertson, Head of Adult Social Care would work with infection control teams regarding carehomes and the social care sector.

    Significant Event Review – Raigmore Hospital

    Heidi May, Board Nurse Director then referred to the Significant Event Report following theClostridium difficile outbreak at Raigmore Hospital in January 2012. The Raigmore SeniorManagement Team, led by Dr Rod Harvey, Clinical Director undertook a Significant Event Review(SER) to understand what had happened and with the intention of reducing risk of furtheroutbreaks occurring in the future. Dr Harvey then gave a presentation to the Board regarding theSER. A significant event was defined as:

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    An event that did or had the potential to cause serious harm to an individual or group ofindividuals (patients or staff);

    An unusual or extraordinary clinical event with or without an adverse outcome; An event that may cause reputational damage to the organisation.

    The presentation outlined the process for a Significant Event Review, the process for the Reviewmeeting, summarised the reasons behind the outbreak and the recommendations of the review.The reasons given for the outbreak were:

    Sub optimal standards of cleanliness in some ward areas Capacity issues with domestic & nursing staff

    Poor infrastructure Availability of single rooms Degraded washing & toilet facilities difficult to clean

    A vulnerable patient population Use of proton pump inhibitor drugs No evidence of inappropriate antibiotic use

    After the presentation there followed a lengthy and detailed discussion by the Board on theSignificant Event Review. Some of the issues raised included:

    Whether families were usually involved in the formal process of a review and if they hadsight of the final report. It was noted that families were not usually involved in the reviewalthough the report was shared with the patient / family once complete.

    It was confirmed that the process for SERs was the same across NHS Highland. Sharing of lessons learned was done via the Clinical Governance Forum and the Infection

    Control Improvement Group. While it was acknowledged that the learning was shared thiswas not written formally and the Board Nurse Director confirmed that she would follow upthis issue, possibly with a formal flow chart.

    The Chair requested that further consideration be given to engaging with patients andfamilies at an appropriate stage in the process.

    The Board Nurse Director and the Board Medical Director gave assurance to the Board thatthe recommendation and actions in the report would be progressed and the action plansigned off.

    Reference was made to the issues around staff and staffing and the emphasis on reflectivelearning. Some of the workforce issues related to issues for the Staff GovernanceCommittee and the Highland Partnership Forum.

    The Chair asked that Una Lyon, Lead Nurse at Raigmore Hospital address the specificactions relating to staff and also highlighted the importance of staff completing Datixreporting of issues, particularly in relation to patient care.

    The Director of Human Resources confirmed that some of the issues relating to staff wouldbe followed up through the Staff Governance Committee.

    It was noted that there were no Terms of Reference in the report and Dr Harvey confirmedthat these were contained within Standard Operating Procedures and could be circulated tothe Board for information.

    A question was raised regarding the degree of independent of the Significant Event Reviewand it was acknowledged that as many of the people involved in the event were alsoinvolved in the review that there was not a great deal of independence, however the aimwas for people to reflect and learn from the event. The Chair was broadly independentalthough they too worked in the hospital.

    Mention was made of proton pump inhibitor drugs and Okain McLennan, Chair of theFormulary Committee confirmed that a formulary note had been issued linking the use ofthese drugs with Clostridium difficile and that this would be followed up with further advice.

    Following discussion the Chair confirmed that the Board had received assurance that lessons werebeing learned, issues around staffing were being addressed and the various actions being taken

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    forward. The various issues would be progressed via the Clinical Governance Committee and theStaff Governance Committee.Pseudomonas at Raigmore Hospital

    The Chief Executive then updated the Board on a situation relation to the Intensive Care Unit atRaigmore Hospital. As a result of routine testing the bacterium Pseudomonas was identified inthree patients who were being treated in the hospital. The clinical condition of the patients was notaffected and they had all since been discharged from hospital. As a precaution the InfectionControl and Prevention Team advised that the unit needed to be temporarily closed to allow athorough and rapid cleaning process. Cleaning and retesting had been done over the weekendand all patients and staff had returned to the unit on 4 June. Ms Mead confirmed that testing hadalso been undertaken in other high-risk areas such as renal, the Special Care Baby Unit (SCBU)and the Medical and Surgical High Dependency Units and these had all come back negative inrelation to Meropenem resistant Pseudomonas. On a question raised by one of the Boardmembers, Ms Mead explained that Pseudomonas is a very resistant bacterium that is often foundin soil and water. It is more likely to infect people who are hospitalised and have underlying healthproblems, particularly the very young and the elderly and is unlikely to cause serious infection inhealthy people.

    The Chair thanked those attending for the updates to the Board and highlighted the importance ofsuch learning exercises and the need for open and transparent reporting of these issues. Therewas a need for NHS Highland to focus on the learning and to ensure that any harm to patients isminimised and to ensure quality and safe care for all patients.

    The Board

    a Noted the contents of the Infection Control Report.

    b Noted that more detailed report on the recent Clostridium difficile outbreak at RaigmoreHospital.

    c Remitted to the Board Nurse Director to follow up the issue in relation to sharinglearning.

    d Agreed that further consideration be given to engaging with patients and families at anappropriate stage in the process.

    e Remitted to the Lead Nurse at Raigmore to address the specific actions relating to staffand noted that some of the issues raised would be followed up through the StaffGovernance Committee.

    f Remitted to the Clinical Director at Raigmore to circulate the Terms of Reference to allBoard members for information.

    g Noted the update on Pseudomonas at Raigmore Hospital.

    The Board adjourned at 9.30 am and resumed at 9.45 am.

    37 Minutes of Meetings

    The following minutes of meetings were approved:

    21 March 2012 3 April 2012 3 April 2012 – Board in Committee

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    The Board

    a Approved the Minutes of Meetings held on 21 March and 3 April 2012.

    b Noted the Board Rolling Action Plan.

    38 Matters Arising

    Mr Gibson referred to the action plan and the risk register relating to Adult Social Care which hehad anticipated being on the agenda for this Board meeting. Dr Smith confirmed that a reportwould be submitted to the next meeting of the Board in August. Dr Foxley referred to the GaelicLanguage Plan, which had been discussed at the last meeting and asked if he could have a copyof the plan. Reference was made to the NHS Highland newspaper and it was confirmed thatanother edition was planned for around the end of August 2012.

    The Board

    a Noted that a report on the Adult Social Care Risk Register would be submitted to theAugust Board meeting.

    b Agreed that a copy of the Gaelic Language Plan be sent to Dr Foxley, as requested.


    39 Argyll & Bute CHP Committee – Draft Minute of Meeting held on 25 April 2012

    In the absence of Mr Brackenridge, Mr Robin Creelman updated on items discussed at themeeting, including eKSF, delayed discharges which continued to be at a low level and the financialoutturn for the CHP. It was noted that the eKSF figures were not as good as anticipated and thatthe trajectory would need to be amended for 2012/13. Mr Creelman congratulated staff in relationto the financial position within the CHP. Dr Iain Kennedy noted that there had been no medicalleadership in attendance at the meeting and asked if he could offer any help in encouragingclinicians to attend. Mr Creelman advised that Dr Mike Hall, Clinical Director was a regularattendee at the meeting. He did confirm that it was sometimes difficult to engage with GPs andwould welcome Dr Kennedy’s assistance in this matter.

    40 Mid Highland CHP Committee – Draft Minute of Meeting held on20 April 2012

    Mr McLennan, Chair of Mid Highland CHP updated on items discussed at the meeting, includingWest Ardnamurchan Unscheduled Care and the significant progress made in relation to theEmergency Response Team. The Chief Executive confirmed that progress had been made,however there were still some anxieties among nursing staff and Ms Mead sought the Board’ssupport in assisting this group of staff and in providing the care necessary in this community. TheBoard endorsed the need to support this group of staff.

    41 North Highland CHP Committee – Draft Minute of Meeting held on 17 April 2012

    Colin Punler, Chair of North Highland CHP, updated on issues discussed by North Highland CHPCommittee including the High Risk Medicines Project and the North Highland CHP FinancialPosition. It was noted that the end of year position for the CHP was an overspend of £780k. MsWedgwood asked if the High Risk Medicines Project was one that would be rolled-out across NHSHighland and the Chief Executive confirmed that this project had been rolled out and the NorthCHP was the final area in this process.

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    42 Raigmore Hospital Committee – Draft Minute of Meeting held on 16 April 2012

    Mike Evans, Chair of Raigmore Hospital Committee updated on the last meeting of the RaigmoreCommittee including issues around discharge care plans, the Quality and Performance report,tissue viability, Kyle Court accommodation and JAG Accreditation. It was confirmed thatappropriate arrangements were in place regarding discharge planning. With regard to Kyle Court,the Raigmore Hospital Patient Lodge, the Chief Executive advised that a further report would besubmitted to the Senior Management Team regarding the usage of this facility and how theaccommodation might be managed in the future.

    Dr Kennedy commended Raigmore in relation to cancer access targets and advised that ChrisLyons, Director of Operations had attended the last meeting of the Area Clinical Forum to updateon waiting times for return patients.

    Mrs Gent, Director of Human Resources noted that there had been no real discussion on issuesrelating to staff governance, partnership working or health and safety and asked that these issuesbe considered at the next meeting.

    43 South East Highland CHP Committee – Draft Minute of Meeting held on 29 March2012

    Gillian McCreath, Chair of the South East Highland CHP Committee updated on the last meeting ofthe Committee and confirmed that it had been agreed to hold a final meeting of the Committee inJune. The Chief Executive confirmed that the operational units in Highland Council area had beenasked to hold another meeting of their committees as the new HH&SC Committee was nowunlikely to meet until August or September 2012. Dr Foxley asked about the various tiers ofmanagement in the new structure and if there was a structure diagram. The Director of HumanResources advised that there was a list and a version of the structure could be produced andissued to Board members.

    Mr Gibson referred to item 10.1 of the minute and the discussion on improving services relating topharmacy and prescribing and the reference to the Change Fund monies and whether there was3rd sector involvement. The Chief Executive confirmed that NHS Highland was working closelywith the 3rd sector and with the national team at Scottish Government and that work on theproposals should be finished by the end of June and a report would be submitted to the nextmeeting of the Board.

    The Board

    a Noted the Minutes.

    b Noted that Dr Kennedy had offered his support in relation to ensuring clinical engagementat the Argyll & Bute CHP and other committees as appropriate.

    c Endorsed the need to support nursing staff in the West Ardnamurchan area.

    d Noted that a report on Kyle Court Accommodation would be submitted to the SeniorManagement Team.

    e Remitted to the Chair and Director of Operations of Raigmore Hospital to ensure thatissues relating to staff governance, partnership working and health and safety wereincluded on the agenda for the next meeting of the Committee.

    f Agreed that the CHP / Raigmore Governance Committees in Highland Council areashould hold one further meeting as the new HH&SC Committee was now unlikely to meet

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    until August / September 2012.

    g Agreed that a structure diagram should be issued to Board members once available.

    h Noted that an update on the Change Fund Proposals would be submitted to the nextmeeting of the Board.

    44 Audit Committee – Draft Minute of Meeting held on 15 May 2012

    Mr Ian Gibson, Chair of the Audit Committee updated on issues discussed by the Committee,including the Internal Audit report on Consultant Contracts and asked who was responsible for thiswork and for taking an overview. Anne Gent, Director of Human Resources advised that a numberof members of staff in the medical staffing team had taken ownership of this area of work ensuringthat Consultant Contracts were developed, reviewed and signed off, however the managementresponsibility was with the Operational Clinical Directors. It was noted that a further report wouldbe submitted to the Audit Committee in due course. There had been a detailed discussion at theAudit Committee on Integrating Care in the Highlands in relation to governance and assurance. Inrelation to the Laboratory Managed Service Contract Review it was noted that a report on progresswith the Action Plan would be submitted to the next meeting of the Committee. Regarding theminute of meeting of 15 May, Bill Brackenridge had been noted as being present and as anapology which required to be amended.

    45 Clinical Governance Committee – Assurance Report of 8 May 2012

    Sarah Wedgwood, Chair of the Clinical Governance Committee updated on issues discussed bythe Committee and confirmed that Senior AHPs now attended the meeting. There had been adetailed discussion on the eHealth Strategy and it was noted that the Information GovernanceCommittee and the Area Medical Records Committee would report back to the ClinicalGovernance Committee on progress.

    46 Improvement Committee Assurance Report of 30 April 2012 and Balanced Scorecard

    The Board noted the Improvement Committee Assurance Report of 30 April 2012 and BalancedScorecard. The Chair highlighted items that had been discussed, including Children & AdolescentMental Health Services (CAMHs) and Waiting List Management – use of Unavailability.

    47 Area Clinical Forum – Draft Minute of Meeting held on 29 March 2012

    Dr Iain Kennedy, Chair of the Area Clinical Forum, confirmed that he had updated on the meetingof 29 March 2012 at the April Board meeting and therefore gave a verbal update on the mostrecent meeting held on 31 May 2012. He highlighted the National Area Clinical Fora Chairs Groupwhich meets quarterly with the Cabinet Secretary. The four aims of the Group were to:

    1. Champion Quality2. Act as a direct interface between clinicians and the Government3. Report on Service Provision4. To positively challenge to ensure the best clinical outcomes for every person.

    48 Pharmacy Practices Committee – Minute of Meeting held on 10 April 2012

    The Board noted the minute of meeting held on 10 April 2012 in relation to pharmaceuticalservices at Units 2 & 3 Cradlehall Shopping Centre, Cradlehall Court, Inverness, IV2 5WD.

    49 Governance Committee Annual ReportsReport by Kenny Oliver, Board Secretary on behalf of Elaine Mead, Chief Executive

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    As part of the Annual Accounts process a number of Annual Reports relating to NHS HighlandCommittees are produced and considered by the Audit Committee. The reports circulated were:

    Appendix 1 – Audit Committee Appendix 2 – Staff Governance Committee Appendix 3 – Remuneration Sub-Committee Appendix 4 – Clinical Governance Committee Appendix 5 – Improvement Committee Appendix 6 – Risk Management Steering Group Appendix 7 – Endowment Funds Committee Appendix 8 – Argyll & Bute CHP Committee Appendix 9 – Mid Highland CHP Committee Appendix 10 – North Highland CHP Committee Appendix 11 – South East Highland CHP Committee Appendix 12 – Raigmore Committee Appendix 13 – Spiritual Care Committee Appendix 14 – Control of Infection Committee Appendix 15 – Health & Safety Committee Appendix 16 – Pharmacy Practices Committee

    The Chair welcomed the Annual Reports and referred to the time spend by the Board onscrutinising minutes of Governance Committees. In relation to the revised management structureit was also proposed to review the reporting to the Board by Governance Committees andconsideration was being given to the relevant committees submitting an assurance report to theBoard. Ms Wedgwood highlighted the need also for exception reporting to the Board. The Chairconfirmed that work was in progress to review the mechanisms in place and that the Chair, ChiefExecutive and the new Chief Operating Officer would do this, with input from the Board Secretary.

    The Board

    a Noted the Minutes.

    b Noted that Bill Brackenridge had attended the Audit Committee meeting on 15 May 2012and should therefore not be noted in “apologies”.

    c Noted: the Clinical Governance Committee met on 8 May 2012. the Assurance Report and agreed actions resulting from the consideration of the

    specific items detailed. the next meeting of the Clinical Governance Committee will be held on 7 August 2012.

    d Noted: the Improvement Committee met on 30 April 2012. the Assurance Report and agreed actions resulting from the review of the specific

    topics detailed and the Balanced Scorecard. the next meeting of the Improvement Committee will be held on 2 July 2012.

    e Noted the views of the Audit Committee on the attached Annual Reports of theGovernance Committees.

    f Noted that work was in progress to review the mechanisms for governance committees toreport to the Board and that this would be taken forward by the Chair, Chief Executive,Chief Operating Officer and Board Secretary.

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    Council/Highland NHS Board Joint Committees

    50 Highland Council Partnership – Joint Committee on Children and Young People –Minute of Meeting of 16 March 2012

    Mr Ian Gibson updated on the last meeting of the Joint Committee on Children and Young Peopleincluding Performance Reporting and Children’s Disability Services – Additional ResidentialRespite Provision.

    The Board

    a Noted the minutes.


    51 Membership of CommitteesReport by Garry Coutts, Chair, NHS Highland

    As a result of the recent decision to establish the Highland Health and Social Care Partnership andthe end of term for 2 experienced Board Members it was felt that this was an opportune time toreview and revise the membership of NHS Highland Board Governance Committees. Due to therecent Local Government Elections we are not able to identify the Local Authority Representativesuntil the administrations have been agreed.

    There had been circulated report detailing current membership of committees and proposedmembership. The Board agreed that Sarah Wedgwood should be appointed as Vice-Chair until30/06/14. The Board also agreed the Non-Executive membership on the following committees:

    Community Health Partnerships

    Highland Health and Social Care Partnership Ian Gibson – Chair(until Feb 2013)Gillian McCreathMyra Duncan

    Argyll & Bute Community Health Partnership Robin Creelman – ChairBill BrackenridgeLocal Authority Member – TBA

    Governance Committees

    Audit Committee Mike Evans – ChairMichael FoxleyGillian McCreathOkain McLennan

    Clinical Governance Committee Sarah Wedgwood – ChairIain KennedyAlasdair LawtonBill BrackenridgeMichael Foxley

    Staff Governance Committee Colin Punler – ChairRobin CreelmanIan GibsonRay StewartMyra Duncan

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    Endowment Funds Committee Ray Stewart – ChairIan GibsonBill BrackenridgeColin PunlerMike Evans

    Remuneration Sub-Committee Garry Coutts – ChairSarah Wedgwood – Vice-ChairIan GibsonRobin CreelmanColin PunlerRay Stewart

    Highland Council Committees

    Adult and Children’s Committee Ian GibsonGillian McCreathMargaret Somerville

    Joint NHS Highland and Argyll & Bute Council Committee

    Argyll & Bute Health and Care StrategicPartnership

    Robin Creelman – ChairLocal Authority Member – TBA

    Non-Executive Representation on other NHS Highland Committees

    Area Control of Infection Committee Okain McLennan – ChairGillian McCreath

    Health & Safety Committee Alasdair Lawton

    Pharmacy Practices Committee Bill BrackenridgeOkain McLennan

    Risk Management Steering Group Sarah Wedgwood

    Spiritual Care Committee Sarah Wedgwood

    Non-Executive Representation on other Committees/Groups

    National Appeal Panel for Entry toPharmaceutical Lists

    Okain McLennan

    Dr Foxley asked if Non-Executives who were not members of committees would still receiveagendas and papers. The Chair confirmed that all Board members would receive papers for eachof the governance committees and encouraged members to attend a variety of meetings eachyear.

    The Board

    a Agreed that Sarah Wedgwood be appointed as Vice-Chair until 30/06/14.

    b Agreed to the proposed membership for Highland Health and Social Care CommunityHealth Partnerships and that the Chair should be appointed until 30/06/14.

    c Agreed to the proposed membership for Argyll and Bute Community Health Partnershipand that the Chair should be appointed until 30/06/14.

    d Agreed to the proposed appointment of Chairs for the main Governance Committees to30/06/14.

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    52 Establishment of Highland Health & Social Care PartnershipReport by Garry Coutts, Chair

    At the Board meeting in December 2011, the Board agreed to establish a single operational unitcovering the whole of Northern Highland, co-terminus with Highland Council. This report updatedon progress with the establishment of the Highland Health & Social Care Partnership. MyraDuncan asked about third sector representation on the Committee and it was confirmed that one ofthe patient / public representatives would be from the third sector. Mr Stewart referred to page 259and highlighted that the wording regarding “Staffside membership” should be amended to read“Staffside membership x 2”. Mr Stewart also referred to section 6.6 on paged 261 relating to StaffPartnership and confirmed that it had been agreed that there would be 3 separate partnership fora,for Raigmore, North & West and South & Mid, rather than one overarching Partnership Forum.The Chair advised that the Highland Council would also have an Adult and Children’s Committee,which would include representation from NHS Highland.

    There followed some discussion on the name of the committee and the service. It was generallyagreed as there was no longer a “partnership” with Highland Council in view of the Lead AgencyModel that the word “partnership” should not be included in the name. Accordingly the Boardagreed that the Committee should be called the “Highland Health & Social Care Committee” whichrelated to the Highland Health & Social Care Service.

    The Board

    a Note the ongoing work to establish Highland Health and Social Care Partnership and inparticular the setting up of Highland Health and Social Care Partnership GovernanceCommittee.

    b Following discussion Agreed that the Committee should be called the “Highland Health& Social Care Committee” which related to the Highland Health & Social Care Service.

    53 Integrating Care in the Highlands – Forward PlanReport by Jan Baird, Transitions Director on behalf of Elaine Mead, Chief Executive

    As Planning for Integration reached conclusion and integrating services in the Highlands becomesa priority, a number of actions were carried forward to ensure the development of longer-termsustainable processes and procedures. This report updated on the Forward Plan for IntegratingCare in the Highlands. Section 2 of the report summarised the major areas of work and theproposals to take these forward, including property, finance, human resources and informationmanagement and technology (IM&T). The last meeting of the Planning for Integration ProgrammeBoard would be held on 11 June. The terms of reference for the group had been revised to reflectthat Highland Council and NHS Highland were now “Integrating Care in the Highlands” and thework would continue with a programme management approach. A revised risk register would alsobe submitted to the Programme Board. Dr Foxley asked about completion of the revisedInformation Sharing Protocol. Mrs Baird advised that while the date for completion had slipped thatall agencies were committed to this, including the local authorities, the police and the fire andrescue services. A question was raised regarding the monitoring and performance management inrelation to data sharing, the baseline information used and the performance measures. The Chairadvised that this would be an area of work for the Improvement Committee. Mention was made ofthe new Highland Strategic Commissioning Group and it was confirmed that the Programme Boardwould consider the role and remit on 11 June.

    The Board

    a Noted the forward plan moving on from Planning for Integration.

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    b Noted the proposed approach to ensure long term and sustainable arrangements are putin place to support the Integrated front-line services.

    c Noted the development of Programme scope for Central/Corporate services and theappointment of a Programme Manager.

    54 Integration of Adult Health and Social Care in Scotland – Consultation on ProposalsReport by Jan Baird, Transitions Director on behalf of Elaine Mead, Chief Executive

    The Scottish Government had launched its consultation on Integration, which would run until 31July. The Highland Partnership had of course implemented integration of adult and children’s’services under existing legislation namely the Community Care and Health (Scotland) Act 2002.The consultation document outlined the impact on current legislation and configuration ofCommunity Health Partnerships, detailing two options for partnerships to consider across Scotland.A Lead Agency model was one of the options. Jan Baird, Transitions Director updated on theconsultation, confirming that the consultation period had been extended to 11 September 2012.There was also tabled additional comments in relation to questions 7 and 17 of the consultationregarding committee arrangements and clinical involvement respectively. The Chair highlightedthe need for appropriate engagement with clinicians when they could have the most impact. TheChief Executive supported the Chair’s comments and also suggested that the word “fail” in thesecond paragraph of the tabled paper should be amended to read “have struggled”. In view of therevised timescale for submission of comments it was agreed that the final submission would besubmitted to the August meeting of the Board prior to submission to the Scottish Government. TheChair suggested that the draft response be circulated to Board members for any additionalcomments and it was noted that the draft would be further circulated to gather views acrossleadership and management forums in NHS Highland.

    The Board

    a Noted the consultation proposals.

    b Noted the consultation response drafted on behalf of NHS Highland.

    c Agreed further circulation of the draft to gather views across leadership and managementforums in NHS Highland.

    d Noted that the draft response would be circulated to Board members to allow furthercomments prior to submission to the August Board meeting.

    55 Interim Financial Position as at 31 March 2012Report by Nick Kenton, Director of Finance

    Mr Kenton updated on the interim financial position to 31 March 2012. The report was based uponthe most up to date information for the end of the financial year and should be viewed asprovisional as it was still subject to audit scrutiny. The current out-turn for 2012/13 highlighted thatthe Board had met its financial targets with a small underspend of £85,000 against the RevenueResource Limit (RRL) and a £8,000 underspend against the Capital Resource Limit (CRL), subjectto audit. Tables 1 and 2, provided a summary breakdown of the initial year-end out-turn andshowed a range of relatively small movements which net to an overall improvement of £85,000 onthe previous estimate of break-even. There were a number of reasons contributing to thismovement which were detailed in section 3 of the report and included:

    Improvements in prescribing positions Underspend in resource transfer Increases in tertiary costs – primarily cardiology

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    Table 3 detailed the levels of savings achieved and incorporated an additional column to highlightthe full year effect of 2011/12 savings and confirmed a recurring shortfall as previously estimated,to be carried into 2012/13 of just under £9m. Capital expenditure was summarised within table 4highlighting a minor underspend of £8,000.

    The Chair extended the thanks of the Board to all managers who had worked to achieve thefinancial out-turn of a £85,000 underspend for NHS Highland for 2011/12. He highlighted the AuditCommittee and the Board in Committee meetings to be held on 18 June to consider the NHSHighland Annual Accounts.

    The Board

    a Noted the financial out-turn of a £85,000 underspend.

    b Noted that this was subject to audit review.

    c Noted the non-recurrent savings carried into 2012/13.

    56 Approach to Benefits RealisationReport by Nick Kenton, Director of Finance

    The overall strategic direction for NHS Highland was based around a Quality & EfficiencyFramework. As part of this ethos, there had been a change in emphasis regarding the delivering ofefficiency improvements. This had seen an increasing focus on realising the financial benefits ofquality improvements as opposed to more traditional methods of reducing costs. There wasconsiderable international evidence of the value of this approach. However, it was recognised thatthe change in emphasis to a benefits realisation approach would take time to embed within anorganisation. The purpose of the report was to present a brief resume of the savings delivered in2011/12 in the context of this approach and to present a summary of the progress to date in2012/13. The Director of Finance spoke to the report highlighted the benefits realised in 2011/12which were detailed in 12 categories. The savings equated to £18.9m of which £10.9m was non-recurring.

    For 2012/13, it was mutually agreed to allocate the targets afresh and in effect to write off anytargets not met from previous years. The result is a set of financial targets that should beachievable for each unit, as well as a system-wide target that will require co-operation betweenunits. The targets could be broadly summarised as follows:

    Argyll & Bute CHP – 2.2%North & West Highland – 2% plus share of adult social care savingsSouth & Mid Highland - 2% plus share of adult social care savingsRaigmore – 3%Corporate services – 5%Pharmacy, facilities - 3%

    In addition to the above, for Northern Highland there is a target of £9m for system-wide benefitsrealisation arising from quality initiatives. It was anticipated that these would take time to deliverfinancial benefits and it was assumed that around £4.5m would delivered in the current financialyear, with the balance delivered in next financial year. Good progress was being made inidentifying efficiencies through tackling waste, harm and variation and this would be reportedthroughout the year. It was also vital that a system-wide approach is adopted in respect of benefitsthat require co-operation across management units and a group has been established thatincludes all Directors of Operations, chaired by the Director of Finance, to take this forward.

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    The Chair welcomed the report and the work in progress. Elaine Mead, Chief Executive referred tothe additional £9m target relating to system wide benefits and highlighted the need for qualitymeasures to be whole system and to ensure that savings were not double-counted.

    The Board

    a Noted the approach to benefits realisation.

    57 Raigmore Hospital Quality Approach to Improvement in 2012/2013, 2013/14 and2014/15Report by Chris Lyons, Director of Operations, Raigmore Hospital on behalf of ElaineMead, Chief Executive

    This report to the Board set out to summarise the approach to quality improvement adopted by theRaigmore Management Team. The approach adopted was in line with the Highland QualityApproach and the Highland Quality and Efficiency Plan. Mr Chris Lyons, Director of Operations atRaigmore Hospital presented the report to the Board. As well as outlining the approach adopted,the report covered quality improvement proposals in relation to reducing harm, variation and waste.In relation to some of the workforce issues, the Director of Human Resources confirmed that thesewould be addressed in the NHS Highland Workforce Plan, which would be submitted to the Augustmeeting of the Board. The Chief Executive advised that Raigmore would find it challenging todeliver the plans in isolation and this could only work with a whole systems approach. AccordinglyMr Lyons was working closely with the Director of Operations for South and Mid as well as theDirectors of Operations for other operational units. It was noted that the new Health & Social CareCommittee would monitor performance, with any issues being reported to the ImprovementCommittee. The report was welcomed and a question was raised as to whether this approachwould be replicated elsewhere in the system. The Chief Executive confirmed that this approachwas being adopted across the whole organisation including Argyll & Bute CHP and that similarreports would be submitted to the Board by the Directors of Operations in the other operationalunits. It was noted that while NHS Highland might see the benefits of some of the initiatives thisyear that others may not come to fruition until future years.

    The Board

    a Noted the approach to quality improvement in 2012/2013 by Raigmore HospitalManagement Team.

    b Noted the details of the quality improvement initiatives and the expected benefits of theimprovements planned and underway.

    c Noted the initial work to identify quality improvement in 2013/14 and 2014/15.

    d Noted that the NHS Highland Workforce Plan would be submitted to the August meetingof the Board.

    e Noted that similar Improvement Plans for other Operational Units would be submitted tothe next meeting of the Board.

    58 Hospital ScorecardReport by Lesley Anne Smith, Head of Quality on behalf of Elaine Mead, ChiefExecutive

    NHS Board Chief Executives agreed in November 2011 that it was important to establish a coreset of measures, which could be used to track a number of key areas of healthcare quality acrossScotland.