NHS KIRKLEES
Minutes of the Trust Board Meeting held on Wednesday 25 November 2009 at 9.15am in the Boardroom at St Luke’s House, Huddersfield Present: Rob Napier Mike Potts Vanessa Stirum Mehboob Khan Rob Millington Valerie Aguirregoicoa Tony Gerrard Imran Patel Dr David Anderson Dr David Wood Sheila Dilks Carol McKenna Dr Judith Hooper In attendance: Helena Corder Peter Flynn Sue Ellis Steve Brennan David Thompson Pauline Kershaw Alison Fearnley Sarah Lindley Sue Smith Laura Pope
Chairman Chief Executive Non-executive Director and Vice Chair Non-executive Director Non-executive Director Non-executive Director Non-executive Director Non-Executive Director Chair of Professional Executive Committee Professional Executive Committee Representative Executive Director of Patient Care and Professions Executive Director of Commissioning and Strategic Development Executive Director of Public Health Director of Corporate Services Director of Performance and Information Director of Human Resources and Organisational Development Deputy Director of Finance Observer/LINkS Representative Executive Assistant Corporate Governance Administrator Head of Communications Assistant Director of Quality and Clinical Governance (Agenda Item KPCT/09/213 only) Human Resources Trainee (work shadowing Sue Ellis)
It was noted that there were seven members of the public also in attendance. The Chairman opened the meeting by welcoming all those in attendance. It was noted that Steve Brennan, Deputy Director of Finance, was in attendance on behalf of Bryan Machin, Executive Director of Finance. Questions from the Public The Chairman gave members of the public an opportunity to raise any questions.
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Jean Moxon from Kirklees LINks asked what plans the Primary Care Trust (PCT) had to implement the recommendations from the recently published Department of Health guidance regarding the care of special care babies. Sheila Dilks advised that the PCT was undertaking a review of midwifery services which included the Special Care Baby Unit and the Neo-natal Intensive Care Unit which would include a review of staffing levels to ensure that services were fully resourced. It was AGREED that Sheila would find out what the current staffing levels were and report this information back to Jean. Bob Tomlinson enquired about waiting times for a patient requiring a knee and hip replacement. It was noted that this issue had been previously raised by David Thompson at the last meeting. Mike Potts confirmed that if the patient had been referred for a hip replacement following the assessment for a knee replacement a new referral would have to be made and therefore the 18 week waiting time would apply from the point of referral. It was recognised that 18 weeks would be the maximum amount of time the patient would be required to wait and that it was likely that the patient would be seen sooner depending on clinical need. Dr Anderson also provided reassurance that 18 week waiting times were continuing to reduce. A third question was raised by several members of the public regarding the closure of St Luke’s Hospital. In particular they enquired what the plans were for the future provision of mental health services, following an article that had been published earlier that week in the Huddersfield Examiner. In relation to this, there was concern regarding the number of beds that would be lost for mental health patients locally, particularly given the rising numbers of patients requiring access to mental health services during current economic downturn. Mike Potts advised that Calderdale and Huddersfield NHS Foundation Trust (CHFT) were responsible for the site at St Luke’s Hospital not NHS Kirklees. He explained that the PCT was due to move to new premises early 2010 and that the remaining services on the site were due to move to other premises by the end of 2010/11. It was noted that South West Yorkshire Partnership NHS Foundation Trust (SWYPHT) had undertaken a risk assessment in relation to in patient mental health bed provision remaining at St Luke’s once other services and organisations began to vacate the site. As a result of this the trust are suggesting that in patient beds should be expanded at both the Priestly Unit in Dewsbury and the Dales Unit in Halifax to enable the Trust to vacate the site by the end of 2010/11. This had been recommended to ensure the on going safety and security of both staff and patients. The outcome of the consultation on the future of mental health services which concluded that the St Luke’s site should close had indicated that alternative inpatient facilities would be provided at the yet to be developed Acre Mill site adjacent to HRI. Unfortunately this had not progressed as previously expected and this had resulted in SWYPFT having to reassess the situation post 2010/11. It was AGREED that Mike Potts would raise the above concerns with Steven Michael, Chief Executive of South West Yorkshire Partnership NHS Foundation Trust, and that he would feedback to the person raising these concerns if they left their contact details. In addition it was AGREED that Carol McKenna would arrange for an item to be put on the Agenda of the next Mental Health Partnership Board meeting to be held on 7 December 2009 to discuss these issues.
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Finally David Thompson enquired what was happening in relation to services at the Barton Unit and whether or not these services were being moved to Huddersfield Royal Infirmary. Carol McKenna gave background to the issues and explained that the PCT was working with Calderdale and Huddersfield NHS Foundation Trust concerning a long-term service model for the provision of these services. KPCT/09/202
Apologies for Absence Apologies for absence were received from Bryan Machin, Executive Director of Finance.
KPCT/09/203
Declarations of Interest No Trust Board members declared interests in any of the agenda items.
KPCT/09/204
Minutes of the last meeting held on 28 October 2009 The minutes of the Trust Board meeting held on Wednesday 28 October 2009 were AGREED as a true and accurate record once the following amendment was made. It was noted that Deborah Collis was Assistant Director of Public Health not Deputy Director of Public Health.
KPCT/09/205
Matters Arising KPCT/09/176
Chief Executive’s and PEC Chair’s Report
• Pandemic Flu Dr Hooper advised that the level of flu activity had dropped to the same levels reported during August however the PCT remained prepared in the event of a sudden surge. Dr Hooper also reported that the distribution of vaccine supplies from the Department of Health (DH) was proving problematical. It was recognised that the PCT was feeding its concerns back to the DH in order that these issues could be resolved. In addition she clarified that the PCT was continuing to focus on vaccinating at risks groups as well as frontline health and social care staff. KPCT/09/206
Chief Executive’s and PEC Chair’s Report Mike Potts presented his report to the Board highlighting the following:
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Teenage Pregnancy National Support Team (NST) Visit to Kirklees – 13 October 2009 The Board received an update on the findings from the NST visit held on 13 October 2009 and noted the issues and recommendations for action that had been identified. It was recognised that the NST would be doing a follow up visit in six weeks time. Following this a more detailed action plan would be developed and agreed by partners.
• Yorkshire and Humber Regional Review of Dementia Services The Board received an update on the implementation of the National Dementia Strategy for information. •
Use of the PCT Seal The Board noted that the PCT Seal was used on 2 November 2009, relating to the lease for the new PCT Headquarters at Bradley Business Park.
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Business Readiness Assurance Confirmation The Board noted that a letter had been sent to the Strategic Health Authority on behalf of the Board, to confirm NHS Kirklees are assured and confident that both its provider services and the wider PCT had met the business readiness requirements.
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Kirklees Commissioning College Dr Anderson provided an overview of the recent work of the Commissioning College. It was recognised that the main focus of the last meeting was around Children, Young People and Maternity Services, coupled with discussions around the Mental Health Plan; restructuring the PEC into a Clinical Executive and focusing on the challenges of the Quality Innovation Productivity and Prevention (QIPP).
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Consultation on New Patients’ Rights for the NHS Constitution It was emphasised that the Board need to consider what this might encompass and what is needed from a local perspective. It was recognised that the PCT is to report back to the SHA the results of the engagement activities by 25 January 2010.
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• Quality Innovation Productivity and Prevention Mike highlighted the financial challenges the PCT is faced with over the next few years. The Board was reassured that work was continuing on the QIPP agenda and that this would be the main focus of discussions at the next Commissioning College meeting arranged for 9 December in order to make some clear recommendations to the Board. • Local Development Framework The Board was updated on the next stages of the LDF for Kirklees for information. Anyone interested in commenting of the LDF was asked to contact the Chief Executive’s Office. • Holme Valley Memorial Hospital It was noted that MP, Kali Mountford had officially opened the gardens at Holme Valley Memorial Hospital on Friday 20 November following the official opening of the Maple Ward by Paul Hudson, BBC weatherman, on 21 October 2009. •
Appointment of new Head of Communications The Board noted that Sarah Lindley had recently been appointed to Head of Communications at NHS Kirklees and welcomed her to the meeting.
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Embrace Yorkshire and Humber Infant and Children’s Transport Service Mike advised the Board about the implementation of a new transport service dedicated to handling neonatal and paediatric transfers throughout Yorkshire and Humber. It was noted that a phased approach to implementing the service would become effective from 1 December 2009 leading to a fully operational service by 1 April 2010.
The Board RECEIVED and NOTED the contents of the Chief Executive’s and PEC Chair’s Report. KPCT/09/207
Finance Report Steve Brennan presented the Finance report which updated the Board on the forecast financial performance for 2009/10, including associated risks, and actions being taken to manage these risks. He explained that the PCT was still forecasting to meet its statutory duties subject to a high degree of risk. In particular it was noted there still remained significant pressures on acute contracts. The position had improved by £2m from that reported for the pervious months due to the ongoing management actions being taken. Page 5 of 16
The Board was reassured that work was ongoing with acute trusts to further reduce expenditure. In addition it was recognised that further work was being undertaken with Practice Based Commissioners to explore appropriate ways of reducing elective and non-elective activity for the remainder of the financial year and beyond. Dr Anderson advised that the focus of their discussions would be to define areas that would have the most impact on reducing inappropriate admissions to Accident and Emergency departments by exploring alternative care pathways within primary care. Sheila Dilks also provided assurance that CHFT and Mid Yorkshire Hospitals NHS Trust (MYHT) were robustly assessing patients presenting at A&E departments to determine alternative treatment pathways and reduce inappropriate admissions. A discussion ensued regarding what alternatives the PCT had explored if the PCT was unable to achieve the control total following implementation of the actions described above and those outlined in the Finance report. It was recognised that the Finance and Performance Committee was continuing to explore this in more detail. It was AGREED that Steve Brennan would discuss this in more detail at the Board Development session due to take place on 3 December 2009. Tony Gerrard requested that the next Finance report highlighted the impact of the Medium Term Financial Plan. Sue Ellis went on to describe the discussions at the local Partnership Forum (meeting with staff side representatives). She reassured the Board that good relationships had been established within the partnership forum and that they were well informed regarding the PCT’s challenging financial position and the need to work together on workforce issues. Rob Millington stated that the Finance Report did not reflect the rigour and strength of the work of the Finance and Performance Committee in mitigating the financial risks. He emphasised that Minutes from the Finance and Performance Committee and Trust Board meetings need to reflect the seriousness of the financial position and that the Board was robustly challenging the actions being taken by the PCT to mitigate the risks. Valerie Aguirregoicoa raised concern regarding expenditure on Continuing Care services. Carol McKenna explained that changes in the national framework had resulted in a significant impact on expenditure. Finally the Board discussed the probability figures outlined in table two of the report summarising the main financial risks. It was recognised that this would be discussed in more detail at the Board Development session.
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It was recognised that the Operating Framework would be crucial to understanding and shaping the Medium Term Financial Plan. The Board remained concerned regarding the financial position and the actions being taken to mitigate the risks and welcomed the opportunity to discuss this in more detail at the Board Development session. The Board NOTED the forecast financial position and the financial risk and EMPHASISED its commitment to achieving financial targets by minimising all avoidable expenditure. KPCT/09/208
Performance Report Peter Flynn presented the Performance report to the Board. It was recognised that the report had been scrutinised by the Finance and Performance Committee in more detail at its meeting held on 18 November 2009. The main areas of risk highlighted were: •
Yorkshire Ambulance Service (YAS) Performance Targets Peter explained that YAS was now in formal ‘turnaround’ mode. It was noted that recovery plans would run well into next year. Mike Potts provided feedback from a Chief Executives meeting held with Martyn Pritchard, Chief Executive of YAS. He confirmed it had been suggested that a small group is established to work alongside Martyn on how ‘turnaround’ could be achieved. Following discussion it was AGREED that Rob Napier would write to Kathryn Riddle, Chief Executive of Yorkshire and the Humber Strategic Health Authority to express the Board’s concern regarding YAS continuing poor performance. It was recognised that it is crucial that YAS provide the PCT with regular performance data to enable the PCT to contribute to improving performance and reducing demand. It was recognised that this area of work would continue to be robustly managed and that Board to Board meetings would continue to be held on a quarterly basis.
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3 Month Maximum wait for revascularisation It was noted that this section needed removing from the report as this had been miscalculated.
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Accident and Emergency targets It was reported that A&E performance was currently on target however there was pressure in the system at MYHT concerning non-elective activity and emergency admissions. It was recognised that this was being robustly monitored by MYHT and that Mike Potts had discussed this with Julia Squire, Chief Executive of MYHT. In addition Mike had contacted Liz Nixon to see if the actions that had been put in place following the outcome of her review on A&E services had been sustained.
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18 week waiting time targets Overall it was reported that performance remained strong both at CHFT and MYHT. It was recognised that there was pressure around achieving neurology 18 week waiting times. It was emphasised that this would continue to be robustly monitored.
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CAMHS It was noted that the PCT may have been over cautious in its assessment awarding three areas with a ‘red’ traffic light. It was noted that discussions were taking place with CHFT concerning these services specifications.
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Choose and Book It was noted that the Choose and Book target had reached 56% which was the highest achieved to date. It was recognised that the system would improve further when CHFT complete the move to Directly Bookable Services.
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Cancer It was AGREED there would be a more detailed report on Cancer performance at the next meeting following concern raised by the Board about some emerging issues.
The Board RECEIVED and NOTED the NHS Kirklees performance against the key performance indicators and APPROVED the action being taken to address areas of under/over performance. KPCT/09/209
Board Assurance Framework Helena Corder presented the Board Assurance Framework update report to the Board. She explained that there had been some technical difficulties in producing the report but good progress had been made with the overall structure and content as well as developing the Risk Register. It was noted that the key areas of risks included: • • •
The overall financial position Ambulance service performance Safeguarding Page 8 of 16
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Delivery of world class commissioning agreed performance improvement
Helena gave an overview of the BAF and explained the format of the report in more detail. It was recognised that the Senior Management Team was undertaking some further work on the BAF on how to identify risks and controls. It was acknowledged that SMT would oversee that the overall system was working effectively but individual sub-committees would manage their own risks. Finally Helena provided the Board with assurance that the level of risk reporting within the organisation was improving. It was AGREED that the Board would receive a further update on the BAF in January 2010 and would continue to receive quarterly updates from there on. The Board RECEIVED and NOTED the content of the Board Assurance Framework and report. KPCT/09/210
Policy on the provision of Gender Dysphoria Services (Adults) Carol McKenna presented the Policy on the provision of Gender Dysphoria Services for adults to the Board. She explained that the Yorkshire and Humber Specialised Commissioning Group (Y&HSCG) had reviewed the commissioning arrangements for Gender Dysphoria services with a view to agreeing an SCG wide commissioning policy. It was noted that the Y&HSCG adopted the policy at its meeting in October and was now being brought to the attention of the Board for approval. The Board was provided with assurance that all SCG work was assessed against the Quality Innovation Productivity and Prevention agenda and that the PCT can agree how referrals are paced. It was suggested that patients should be signed up to an evidence based research programme. It was AGREED that Carol McKenna would explore this in more detail. Dr Anderson also suggested that it would be useful to include information regarding the referral routes. There was a discussion regarding the referral criteria for treatment which was not clear within the policy. It was recognised that the policy referred to paragraph 3.8.1 which appeared to be missing from the policy. It was AGREED that Carol McKenna would look into this following the meeting.
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The Board NOTED the policy had been agreed by the Y&HSCG and APPROVED the policy subject to the above suggestions and clarification concerning the missing information concerning paragraph 3.8.1. KPCT/09/211
Mid Yorkshire Hospitals NHS Trust Service Strategy Mike Potts introduced the Mid Yorkshire Hospitals NHS Trust Service Strategy report to the Board. He explained that the report highlighted the responses received to the overall proposals arising from the Public Consultation on proposed service changes in Mid Yorkshire Hospitals NHS Trust. It was noted that the report also included a report by York Health Economic Consortium (YHEC) who had been engaged in analysing the feedback and providing an independent summary of the findings. Mike provided a brief overview of the findings. He explained that there had been 106 formal consultation responses received and that over 330 people had attended the public meetings. It was noted that there had been a balance in positive and negative responses to the overall proposals. However there was concern over the availability of transport, especially for visitors who did not have access to cars, especially at the furthest reaches of the Pontefract and Dewsbury catchments. In addition there was some confusion amongst the general public about what the range of services provided at each of the hospitals would be over and above those services that had been the subject of the formal consultation. It was recognised that further proposals around transport would be put forward in due course. It was noted that the level of engagement activity during the consultation was appropriate and that every effort was made to ensure that the local population had an opportunity to comment on the proposals. It was recognised however that public meetings in the Dewsbury area had been poorly attended. It was recognised that further work had been carried out to try and engage members of the public and that other options would be explored when undertaking future public consultations, as it was acknowledged that public meetings are not necessarily the best way of engaging with people. It was noted that Kirklees and Wakefield Joint Health Scrutiny Committee were supportive of the proposed service changes though concerned about the consequences if the business case for urology and lower GI services at Dewsbury Hospital is not approved. It was recognised that a decision would be made concerning this by mid December. They had also highlighted the need for transport to be addressed. Page 10 of 16
The Board made a plea that there should be no further reference to ‘Grasping the Nettle’, a report on a previous consultation, as this was significantly out of date. Dr Hooper made an observation that paragraph 5.1.1 was misleading and needed to be rephrased. It was AGREED that Mike would get some clarity regarding this statement. Finally the Board debated the recommendations put forward by the YHEC. On reflection the Board AGREED that these were representative of a balanced and sensible approach. The Board CONSIDERED the consultation report from YHEC and AGREED to proceed with the service changes set out in the consultation document subject to approval of the business case for the Dewsbury development by the SHA and DH; and ENDORSED the Partnership Board recommendation to accept the implementation issues and proposed actions set out in the report. KPCT/09/212
Transforming Community Services – The Next Steps Mike Potts introduced the Transforming Community Services – Next Steps report to the Board. He explained that the report outlined the next steps in the transformation process, following the submission of the business readiness assurance confirmation to the SHA. It also highlighted further work required on the organisational form of the PCT provider arms in line with national and SHA guidance. The Board noted the Market Analysis which had been completed across the full breadth of community services. It was recognised that this analysis also identified proposed priorities for detailed service reviews over the next 1 to 3 years. The Board requested more clarity on how this would be taken forward as well as timescales. It was noted that work would progress on the reviews of community services and as these are completed an assessment would be made of strategic fit with the PCT’s Community Services Commissioning Strategy. This would help determine future organisational form that would best ensure the delivery of the agreed strategy for community services. It was recognised that further guidance and support on the next steps and the way forward was awaited from the SHA. It was AGREED that the Senior Management Team would explore this in more detail when this had been received. In addition it was recognised that further work would continue on developing the criteria for assessing future provider models. It was emphasised that staff would continue to be updated on the progress of this work. Page 11 of 16
Rob Napier advised that Kirklees Community Healthcare Services (KCHS) had appointed a further two independent lay members in addition to the Chair and that he would be briefing them on the Market Analysis. The Board NOTED the content of the report and ENDORSED the proposed action to progress this work. KPCT/09/213
Kirklees Community Healthcare Services Standards for Better Health Mid-Year Declaration Sue Smith, Assistant Director of Quality and Clinical Governance, joined the meeting to present the KCHS Standards for Better Health Mid-Year Declaration report to the Board. Sue explained the purpose of the report was to summarise assurances received from KCHS on their mid-year compliance with the Standards for Better Health prior to PCT Board sign off. She confirmed that KCHS was proposing to declare ‘Fully Met’ against all Standards for Better Health. It was recognised that when seeking assurance from KCHS attention was given to ensuring that a range of evidence had been collated and quality assured and that areas of high risk and high profile had been thoroughly considered, and where appropriate additional evidence and assurance was sought e.g. patient safety, safeguarding, medicines management, privacy and dignity. In addition Sue explained the impending transition to the new system of registration required by the Care Quality Commission that the Board would be required to sign up for by April 2010. The Board NOTED the assurances provided within the report and AGREED to sign off the declaration. It was PROPOSED and AGREED that the CQC registration submission to would be signed off by the Board at an extraordinary Board meeting to be held on 13 January 2010.
KPCT/09/214
Communications and Public Relations Activity Helena Corder gave a presentation to the Board updating on the actions taken to support the communications and public engagement strategy that was agreed as part of the World Commissioning assurance process. The presentation also covered key areas of communications and public engagement activity and a DVD made from the camper van project that took place over the summer which provided interesting insight into how the public perceive the PCT and their views of services.
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It was recognised that a joint communications plan was being implemented with the local authority and that the PCT was engaging with universities to explore alternative approaches to involving and engaging with people in the future. It was noted that a Patient and Public Involvement Toolkit had been developed as a guide for managers and front-line staff as they work to involve people. The Board NOTED and WELCOMED the informative presentation. It was AGREED that the Board would receive an update on Communications and Public Relations Activity twice a year. KPCT/09/215
2009/10 Annual Audit Letter and Use of Resources The Board was presented with the final version of the 2009/10 Annual Audit Letter and Use of Resources reports from the PCT’s external auditors, the Audit Commission, which had been previously considered by the Audit Committee. It was recognised that both reports were quite favourable but there were some areas for improvements which are supported by appropriate action plans. The Board RECEIVED and NOTED the 2009/10 Annual Audit Letter and Use of Resources.
KPCT/09/216
New HQ Progress Report The Board received an update on progress with the new PCT Headquarters. It was noted that activity in the five project streams was reported to be working overall to the project plan timescales. The following key timescales were noted by the Board: • • • • •
Handover of the building 18 December 2009 Tenders for facilities, IM&T and furniture to be let December 2009/January 2010 IT and furniture fitting out January 2010 early February 2010 Staged move in from 15 February 2010 Full catering facilities 1 April 2010
It was noted that the project was running to budget.
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It was recognised that a Green Travel Plan was being developed which was due for approval by the PCT alongside the Environmental Strategy. In addition a car parking charging system was being finalised and letters were being circulated to staff about how they could apply for a parking permit which also outlined the basis of parking charges. It was noted that permits would be charged for on a sliding scale and that there would be a flat rate for pay and display charges. It was noted that options had been put forward for naming the new meeting rooms. Most people were in favour of naming the meeting rooms after famous Kirklees people. Following discussion it was AGREED that the building would be named ‘Broad Lea’ House which is what the area was previously known as. The Board RECEIVED and NOTED the report. KPCT/09/217
Minutes of the Professional Executive Committee The Board RECEIVED and NOTED the minutes of the PEC held on 16 September 2009.
KPCT/09/218
Minutes of the Governance Committee The Board RECEIVED and NOTED the minutes of the Governance Committee held on 7 October 2009.
KPCT/09/219
Minutes of the Finance and Performance Committee The Board RECEIVED and NOTED the minutes of the Finance and Performance Committee held on 23 September 2009.
KPCT/09/220
Minutes of Kirklees Community Healthcare Services Board The Board RECEIVED and NOTED the minutes of Kirklees Community Healthcare Services Board held on 27 August 2009.
KPCT/09/221
Minutes of the Communications and Public Relations Committee The Board RECEIVED and NOTED the minutes of the Communications and Public Relations Committee held on 2 September 2009. David Thomson advised that Hazel Wigmore was not involved with LINkS. It was AGREED that Helena would seek clarity on her involvement.
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KPCT/09/222
Minutes of the Strategic Development Committee The Board RECEIVED and NOTED the minutes of the Strategic Development Committee held 8 October 2009.
KPCT/09/223
Minutes of Kirklees Commissioning College The Board RECEIVED and NOTED the minutes of Kirklees Commissioning College held 16 September 2009.
KPCT/09/224
Minutes of the Yorkshire and the Humber Specialised Commissioning Group The Board RECEIVED and NOTED the minutes of the Yorkshire and the Humber Specialised Commissioning Group held on 16 October 2009.
KPCT/09/225
Any Other Business There were no items of any other urgent business.
KPCT/09/226
Date and time of the next meeting It was AGREED that the next meeting of the NHS Kirklees Trust Board would take place between 9.15am and 1.00pm on Wednesday 16 December 2009 in the Boardroom at St Luke’s House.
Questions from the Public It was noted that there were no members of the public left in attendance. This concluded the content of the Public Board meeting and the chairman declared the meeting closed at approximately 1.00pm.
Chairman’s Signature: ………………………………….
Date: ………………
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