NHS KIRKLEES
Minutes of the Trust Board Meeting held on Wednesday 28 October 2009 at 9.15am in the Boardroom, St Luke’s House, Huddersfield Present: Rob Napier Mike Potts Vanessa Stirum Mehboob Khan Rob Millington Valerie Aguirregoicoa Imran Patel Tony Gerrard Dr David Anderson Bryan Machin Sheila Dilks Carol McKenna In attendance: Helena Corder Peter Flynn Sue Ellis David Thompson Deborah Collis Tracy Small Tina Quinn Rabinder Bhachu Pauline Kershaw Alison Fearnley
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 Executive Director of Finance Executive Director of Patient Care and Professions Executive Director of Commissioning and Strategic Development Director of Corporate Services Director of Performance and Information Director of Human Resources and Organisational Development Observer/LINkS Representative Assistant Director of Public Health Deputy Director of Patient Care and Innovation Clinical and Operations Lead, Kirklees Community Healthcare Services (KCHS) Agenda item KPCT-09186) Communications Manager Executive Assistant Corporate Governance Administrator
The Chairman opened the meeting by welcoming all those in attendance. It was noted that Deborah Collis, Assistant Director of Public Health, was in attendance on behalf of Dr Judith Hooper, Executive Director of Public Health. Questions from the Public It was noted there were no members of the public in attendance. However David Thompson raised a question on behalf of a patient regarding waiting times. It was noted that a patient had been referred to a knee specialist for treatment however on examination it became evident that the patient required a hip replacement and the Consultant was unable to perform the knee operation until the patient had undergone surgery for a hip replacement first. Mr Thompson wanted to know if the 18 week waiting time started again from being referred separately for a hip replacement. It was noted that this was a separate referral, so unfortunately the 18 week waiting time would start again. Page 1 of 16
KPCT/09/172
Apologies for Absence Apologies for absence were received from Dr Judith Hooper, Executive Director of Public Health and David Wood, Professional Executive Committee Representative.
KPCT/09/173
Declarations of Interest No Trust Board members declared interests in any of the agenda items.
KPCT/09/174
Minutes of the meeting held 29 September 2009 The minutes of the Trust Board meeting held on the 29 September 2009 were AGREED as a true and accurate record subject to the following amendment; The third sentence of the third paragraph regarding the minute KPCT/09/167 regarding the Statement of Preparedness for the Pandemic due to the Pandemic H1N1 2009 Virus should read – It was recognised that business continuity plans were in place with all key health and social care partners and that critical care capacity within Acute Trusts can be increased to 200%, with plans to increase this further to 300% if required.
KPCT/09/175
Matters Arising KPCT/09/169
Care Quality Commission/Public Declaration (Safeguarding)
Sheila Dilks confirmed that the Declaration had been uploaded onto the PCT’s website as agreed at the last meeting. She also confirmed that the PCT was fully compliant with regard to the number of named and qualified posts. KPCT/09/176
Chief Executive’s and PEC Chair’s Report Mike Potts presented his report to the Board highlighting the following: •
Mid Yorkshire Hospitals NHS Trust (MYHT) The Board noted that Ed Anderson had been appointed as interim chair of MYHT from 1 November 2009 to 30 April 2010.
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• Yorkshire and Humber PCT Collaborative The Board noted that the PCT’s levy contribution, and other sources of income to the Yorkshire and Humber PCT Common Fund for 2008-09, was spent in accordance with the agreed priorities, approved by the Auditors of the host PCT. In addition it was noted that £79.5k was unspent and had been carried forward into 2009-10 Collaborative Common Fund to be spent in line with the current years agreed priorities. It was also noted that copies of the 2009-10 prospectus of collaborative programmes was being circulated to the Board for information, together with the HSJ collaborative supplement, published on 1 October 2009. •
Use of the PCT Seal The Board noted that the PCT Seal had been used on two occasions to seal the following documents: -
•
West Yorkshire Commissioning Forum (WYCOM) The Board noted that a West Yorkshire Commissioning Forum had been established to enable the relevant member NHS Commissioners to work together where cross boundary issues need to be addressed. It was noted that the following organisations are members of WYCOM: -
•
Lease for Unit 1 Ringway Centre, Huddersfield Sale of Shepley Health Centre – It was noted that this had been sold to a housing developer and that the PCT had agreed an overage agreement which may yield further income on the sale of this property.
NHS Wakefield District NHS Kirklees NHS Calderdale Bradford and Airedale Teaching PCT NHS Leeds NHS North Yorkshire and York
Kirklees Safeguarding Children Board Annual Report A copy of the Kirklees Safeguarding Children Board Annual Report was circulated to the Board for information. The Board received this report noting the high profile nature of this work.
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•
Comprehensive Area Assessment (CAA) The Board noted that the PCT’s Comprehensive Area Assessment report would be published early December 2009.
•
World Class Commissioning Events The Board noted that two events had been arranged which Board members were asked to attend: -
5 November 2009 11 November 2009
•
Yorkshire and Humber Improvement Partnership – Six Month Review The Board noted that copies of the above review were being circulated to the Board for information.
•
Kirklees Commissioning College (KCC) Away Day Dr Anderson advised the Board that members of the KCC had met recently to consider the progress of the college to date and the implications on the commissioning structures around it. It was noted that the Board would be kept informed of the outcome of this work in due course.
•
Pandemic Flu Deborah Collis provided a verbal update on the local and national situation with regard to the latest information on Swine influenza. In particular the following points were highlighted: •
that the number of cases had continued to rise with the main increase being in the 15 to 24 year old age groups. It was recognised that the PCT had systems in place to re-open PCT antiviral collection points if demand continued to significantly increase.
•
the PCT had started to receive its allocation of vaccines for both seasonal flu and swine flu and that arrangements were in place to begin vaccinating priority groups. In addition the PCT was promoting the uptake of the vaccine to all frontline health and social care staff.
•
a national price had been agreed for GPs to deliver the vaccine to patients. GPs would be supported by district nursing staff in administering the vaccine to housebound patients. Page 4 of 16
•
during the peak of the pandemic it is anticipated that up to 5% of the workforce will be off sick. During the peak some elective activity may have to be postponed to cope with pressure on critical care capacity.
Deborah provided the Board with assurance that the PCT was as prepared as it could be to respond to the pandemic in the event of an increase in demand.. A confirm and challenge meeting would also be held with the Lead PCT regarding local resilience planning. The Board RECEIVED and NOTED the contents of the Chief Executive’s and PEC Chair’s Report. KPCT/09/177
Finance Report Bryan Machin presented the Finance report which updated the Board on the forecast financial performance for 2009/10, including associated risks and the actions being taken to manage these risks. In particular he advised the Board that as at the end of September the PCT was forecasting to achieve the control total agreed with the SHA and the requisite year end surplus of £2.9m. However it was emphasised that this would not be achieved without significant management action by the PCT and co-operative management across the whole Kirklees health economy. It was emphasised that there remain significant pressures on acute contract budgets, in particular as a result of overtrading reported by the PCT’s two main providers, Calderdale and Huddersfield NHS Foundation Trust and Mid Yorkshire Hospitals NHS Trust. It is anticipated that continued scrutiny of the trading reports being carried out by the PCT will lead to a reduction in the Trust’s income expectation to the level forecast by the PCT. In addition to the above it was noted that there are a number of other factors that need to be considered where there is a risk that expenditure may change from that currently forecast. These were highlighted to the Board as follows: • • • • •
Acute Contracts Leeds Teaching Hospitals Specialised Commissioning Group Primary Care Prescribing Continuing Care, Mental Health and Learning Disabilities Specialist Treatments
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A discussion ensued regarding the different relationships the PCT has with acute providers and how the PCT monitors contracts in various ways. It was emphasised that closer scrutiny of acute contracts was required. It was noted that the PCT was robustly challenging acute activity and information as appropriate and that all possible means of reducing revenue expenditure were also being explored. Other action being taken to reduce expenditure was noted as follows: • •
•
All expenditure of over £5000 that is not contractually committed is subject to review. Vacancy review for all posts proposed to be covered by permanent recruitment, temporary contracts or agency staff. This is being monitored by the Senior Management Team (SMT). The PCT has invested in new software that sits on GPs computers and suggests where appropriate a more cost effective drug alternative to that the GP proposes to prescribe.
A discussion ensued regarding slippage on investment schemes and whether there were any particular areas where the Board would want to avoid slippage. It was AGREED that information in terms of slippage on investment schemes would be shared with Board at the next Non-executive Directors meeting. In addition there was a discussion regarding what progress had been achieved on the Quality, Innovation, Productivity and Prevention Plan (QIPP). It was reported that the SMT were going to undertake more detailed work on 9 November 2009 to determine how the QIPP could be agreed and robustly performance managed. It was AGREED that the outcome of this work would be fed back to the Board next month. Latest information suggested that Kirklees Community Healthcare Services (KCHS) had a significant challenge to achieve a £750,000 surplus which had been requested by the PCT this year. The Board requested the opportunity to evaluate the associated financial risks in more detail. It was acknowledged that this would be achieved via the Finance and Performance Committee and at Non-executive Director meetings.
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Finally a discussion ensued regarding reducing primary care referrals to secondary care. It was AGREED that Carol McKenna would scrutinise the data and work with Practice Based Commissioning colleagues on how this could be achieved. It was noted that the Board would continue to receive further updates on the PCT’s forecast financial position at its forthcoming meeting. 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/09/178
Annual Health Check Rating 2008/09 The Board was presented with the results of the PCT’s Annual Health Check from the Care Quality Commission. It was recognised that the overall performance rating for PCTs is made up of two parts: ‘quality of financial management’, which looks at how effectively a trust manages its financial resources; and ‘quality of commissioning’, which is an aggregated score of performance against national standards, existing commitments and national priorities. For each section, Trusts are give a rating of ‘excellent’, ‘good’, fair’ or ‘weak’. It was noted that the PCT scored a rating of ‘good’ for financial management and ‘good’ for the quality of services provided. In addition the PCT had ‘fully’ met all its core standards, as both a commissioner and provider of health services. It was acknowledged that the scores are an overall improvement from 2007/08 when the PCT was rated ‘fair’. Peter Flynn provided a summary of the performance areas which were achieved, underachieved or failed and highlighted the areas for improvement. In particular he pointed out where the PCT needed to improve to achieve a score of ‘excellent’. It was recognised that the PCT would not be able to achieve a score of ‘excellent’ if Yorkshire Ambulance targets are not achieved. The Board noted the performance achieved by surrounding NHS organisations. It was recognised that performance had declined in some areas compared with last year’s scores.
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There was a discussion regarding the drop in performance from ‘excellent’ to ‘good’ at South West Yorkshire Mental Health Trust (SWYMHT) and where they had failed to achieve. Sheila Dilks said she was far more assured by the level of services provided this year and AGREED to feedback to the Board on the areas of improvement. The Board NOTED the PCT Annual Health Check rating for 2009/10 and noted the areas of improvement. The Board also wished to acknowledge the hard work and dedication of all those involved in achieving these scores. KPCT/09/179
Mid Year Performance Report Peter Flynn presented the Mid Year Performance report to the Board. It was recognised that the report highlights performance and achievement across the full breadth of PCT business, not just national targets. The main areas of concern/risk noted within the report were: • • • •
Yorkshire Ambulance targets New referrals for cancer treatment Chlamydia screening Stroke
Yorkshire Ambulance Targets It was noted that the areas for improvement had been subject to detailed discussion by the Finance and Performance Committee. There was a comprehensive discussion regarding the Yorkshire Ambulance Service targets and why the target for Category A calls was continuing to be breached. It was recognised that a senior YAS representative had attended the last Finance and Performance Committee meeting to report against actions previously agreed. Carol McKenna highlighted the key issues and the actions that had been put in place to improve performance. Carol confirmed that YAS had been served with a formal improvement notice. There was a discussion regarding increased demand in other PCT areas eg Bradford and Airedale and how this impacted on YAS performance in Kirklees.
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It was recognised that the PCT needs to work more proactively in managing the contract with YAS and ensure that the PCT is working jointly with YAS to improve performance. In addition there was a discussion regarding how YAS was tackling historical industrial relations. It was recognised that cultural changes can take a significant time to embed. The Board was asked to consider what radical solutions could be put forward to improve YAS targets. In the meantime the PCT would escalate its concerns regarding YAS performance via Bradford, the lead PCT for managing the contact. Long Term Conditions There was a discussion regarding improving the management of patients with Long Term Conditions. Sheila Dilks explained the increase in the number of emergency bed days and the actions being taken to reduce these. It was recognised that investment in the provision of alternative models of care including the recruitment of Community Matrons and Specialist nurses was beginning to have an impact but would take time to embed. The Board RECEIVED and NOTED the contents of the Mid Year Performance Report and APPROVED the actions being taken to address the areas of over/under performance. KPCT/09/180
Investors In People Assessment Report Sue Ellis presented the Investors in People Assessment Report to the Board. She explained that following the IIP assessment in July 2009 the PCT had been asked to put in place a short term action plan to develop leadership frameworks that set out both what the organisation expects from its leaders and how leaders should manage their teams. Sue summarised the progress to date and the action which had been put in place and agreed by the IIP group following the assessment. It was recognised that the Investors in People Group and directorate champions would continue to monitor organisational progress against the action plan until 2010. In addition a three month review meeting had been arranged with John Taylor, the IIP assessor, in mid November to assess the organisations progress with leadership frameworks. It was recognised that the review may slip to December. Page 9 of 16
The Board RECEIVED and NOTED the report and APPROVED the action plan and funding the second part of the assessment. KPCT/09/181
World Class Commissioning (WCC) – Year Two Carol McKenna introduced the World Class Commissioning – Year Two report to the Board. She explained that the report summarised the detail around the WCC assurance process and highlights the work that is underway to prepare the organisation for this assessment. Carol highlighted the key steps and timescales over the next few months and the action required. The Board reviewed the timescales and local actions. It was recognised that the Board would give due attention to governance self-certification, competency assessment and the setting of outcome trajectories at two specific sessions planned for Thursday 5 November and the morning of Wednesday 11 November. The Board discussed the frameworks for prioritising investment and disinvestment. It was recognised that there needs to be clear objectives and consistency within the prioritisation framework and that this would be further developed at the forthcoming WCC events in November. The Board NOTED the timescales for WCC Year two and the actions planned for the coming months. The Board ENDORSED the prioritisation framework as it stood to date and AGREED to the sharing of this with key partners for their views.
KPCT/09/182
Transforming Community Services Carol McKenna introduced the Transforming Community Services (TCS) report to the Board. She explained the purpose of the report was to remind the Board of the requirements of national guidance on Transforming Community Services and update the Board on a range of actions underway to deliver the TCS agenda, in particular: • • •
The development of the Community Services Commissioning Strategy Update the Board on work undertaken to support business readiness assurance Understanding the Estates Toolkit
To present the Community Services Commissioning Strategy for consideration prior to submission to the Strategic Health Authority (SHA) on 31 October 2009. Page 10 of 16
It was noted that the Board had had an opportunity to comment on the Strategy prior to the Board meeting at the Non-executive Directors meeting, and that following that meeting a number of further comments had been incorporated in the document. It was noted that the PCT is required to submit a statement of assurance on business readiness to the SHA by 31 October 2009. The Board was provided with assurance that the PCT is in a position to confirm this assurance and is confident that both provider services and the wider PCT have met the business readiness requirements. It was noted that the PCT had agreed with the SHA that there was no requirement to complete the formal Estates Toolkit, as the PCT already has an Estates Strategy in place that contains an assessment of the condition of the community and primary care estate. It was noted that the Estates Strategy had been submitted to the SHA. The Board AGREED to: • • • KPCT/09/183
NOTE the requirements of the national agenda on Transforming Community Services. ENDORSE the Community Services Commissioning Strategy, prior to submission to the SHA NOTE and ENDORSE the work done on business readiness and community and primary care estate.
Revised Risk Management Strategy Helena Corder presented the revised Risk Management Strategy to the Board for approval. She explained that the revised risk management strategy takes account of the following: • • •
National patient Safety Agency (NPSA) requirements Transforming Community Services PCT risk management system development and the use of the Performance Accelerator system
It was recognised that there needs to be consistency in terms of wording ie where reference is made to Kirklees Community Healthcare Services etc. The Board acknowledged that the strategy was a comprehensive document that needs to be operationalised throughout the organisation. The Board CONSIDERED and APPROVED the content of the revised Risk Management Strategy. Page 11 of 16
KPCT/09/184
Home Working Policy Sue Ellis presented the Home Working Policy to the Board for approval. She explained that this was a new policy, written by the HQ Workforce Management Group which had been consulted upon with SMT and Staff Partnership Forum members. It was recognised that the policy had been developed as a 21st Century flexible working solution which would also reduce, to some extent, daily office occupancy levels (and therefore car parking demand) at the new Bradley Park HQ building. It was noted that the maximum amount of time an employee would work from home would be 40% of their working week. It was noted that working from home would be subject to agreement between manager and employee, and also subject to a risk assessment of the home working environment. Helena Corder AGREED to progress the most appropriate and effective way of assessing such health, safety and risk assessment requirements. Mehboob Khan advised something similar had been trialled within the local authority and he agreed to share the learning from this with Helena. It was noted that Valerie Aguirregoicoa had some comments on the Policy which would be shared with Sue Ellis outside of the Board meeting. The Board APPROVED Home Working Policy.
KPCT/09/185
Policy Agreement Regarding Facilities and Time Off for Recognised Representatives of Staff Organisations Sue Ellis presented the Policy Agreement regarding Facilities and Time Off for Recognised Representatives of Staff Organisations to the Board. She explained that the policy had been revised following review with Staff Partnership Forum members and amended to comply with current organisation policy format and structure. Sue briefly highlighted the main changes to the policy. The Board APPROVED the Policy Agreement Regarding Facilities and Time off for Recognised Representatives of Staff Organisations.
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KPCT/09/186
Kirklees Community Healthcare Services Quarterly Report Tina Quinn, Clinical and Operational Lead for Kirklees Community Healthcare Services (KCHS), joined the meeting to present the KCHS Quarterly Report to the Board. She explained that the report sets out a new approach to KCHS’s quarterly report to the NHS Kirklees Board. It was noted that the report did not cover any quality or performance requirements, but highlights the development of KCHS in its drive towards independence and summarises the current major risks. It was noted that Suzy Brain England who is currently in the role of acting Chair of Mid Yorkshire Hospitals had been appointed as new Chair of KCHS. Suzy would take up her appointment on 2 November 2009. In addition to Suzy’s appointment further interviews had been planned to appoint two lay members of the KCHS Board. It was highlighted that quality and performance exception reporting would be included within the corporate Performance report to the Board. It was emphasised that there needs to be more emphasis on risk reporting within future reports. It was also suggested that the report should include information around the development of clinical engagement. Tina discussed the risk areas noted in the report. Concerning this it was recognised that KCHS are currently forecasting a high level of risk over achieving a balanced year end position. Tina provided the Board with assurance that an action plan had been put in place to mitigate this risk. The Board RECEIVED and NOTED the report and APPROVED the approach to reporting subject to the above suggestions.
KPCT/09/187
Kirklees Partnership – Sustainable Community Strategy 2009/12 The Board was presented with the 2009/12 Kirklees Partnership – Sustainable Community Strategy. It was recognised that the Board had been previously consulted on the strategy which signals the strength of the PCT’s partnership with the local authority in tackling health inequalities. It was recognised that good progress was being made to implement the strategy and that the next step was to further develop work on the seven localities.
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The Board RECEIVED and SUPPORTED the 2009/12 Sustainable Community Strategy. KPCT/09/188
Environmental Programme Update Helena Corder introduced the Environment Programme update report to the Board for information. She explained that the purpose of the report was to update the Board on the actions being taken to mange the agenda around carbon reduction. The Board acknowledged that the NHS is one of the largest producers of carbon in the country and that the NHS is committed to reducing carbon emissions by 10% by 2015. Helena explained the actions that are currently underway to achieve the required reduction in carbon and to help demonstrate that the NHS is committed to its responsibility to contribute in managing the environment. It was recognised that the PCT was working on developing an Environment Strategy. The Board acknowledged that the PCT needs to embed carbon reduction into the culture of the organisation and consider the green impact on everything that it does. It was recognised that the Strategy would be endorsed by the SMT and embedded throughout the organisation. The Board was asked to demonstrate its commitment to managing the carbon agenda by signing an Accord which provides a partnership agreement that recognises the threat to health and healthcare delivery and the PCT’s contribution to developing a low carbon health economy. It was noted that a suggestion had been made by the region wide Carbon Action Steering Group and Carbon Action Yorkshire to link the signing of the Accord with the planting of a tree for each Board meeting as a symbolic gesture to demonstrate the Trust commitment to carbon reduction and tackling climate change. The Board NOTED the actions being taken to date and AGREED to the signing of the Carbon Reduction Accord and the planting of a tree or trees at the new Trust Head Quarters.
KPCT/09/189
National NHS Staff Survey 2008 – Update Report Sue Ellis presented the Board with an update on the actions undertaken to date following the 2008 National NHS Staff Survey. The Board NOTED the progress to date on the four key findings for which the PCT had been asked to improve on. Page 14 of 16
KPCT/09/190
Minutes of the Professional Executive Committee The Board RECEIVED and NOTED the minutes of the PEC held on 12 August 2009.
KPCT/09/191
Minutes of the Audit Committee The Board RECEIVED and NOTED the minutes of the Audit Committee held on 22 July 2009.
KPCT/09/192
Minutes of the Governance Committee The Board RECEIVED and NOTED the minutes of the Governance Committee held on 12 August 2009.
KPCT/09/193
Minutes of the Finance and Performance Committee The Board RECEIVED and NOTED the minutes of the Finance and Performance Committee held on 22 July and 19 August 2009.
KPCT/09/194
Minutes of the Kirklees Community Healthcare Services Board The Board RECEIVED and NOTED the minutes of the Kirklees Community Healthcare Services Board held on 30 July 2009.
KPCT/09/195
Minutes of the Communications and Public Relations Committee The Board RECEIVED and NOTED the minutes of the Communications and Public Relations Committee held on 8 July 2009.
KPCT/09/196
Minutes of the Strategic Development Committee The Board RECEIVED and NOTED the minutes of the Strategic Development Committee held on 4 June, 6 August and 10 September 2009.
KPCT/09/197
Minutes of the Kirklees Commissioning College The Board RECEIVED and NOTED the minutes of the Kirklees Commissioning College.
KPCT/09/198
Minutes of the Yorkshire and Humber Specialised Commissioning Group The Board RECEIVED and NOTED the minutes of the Yorkshire and Humber Specialised Commissioning Group held on 18 September 2009. Page 15 of 16
KPCT/09/199
Kirklees Partnership Executive Actions The Board RECEVIED and NOTED the Actions of the Kirklees Partnership Executive held on 27 August and 6 October 2009.
KPCT/09/200
Any Other Business There were no items of any other urgent business.
KPCT/09/201
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 25 November 2009.
Questions from the Public The Chairman gave a final opportunity for any members of the public to raise any questions. David Thompson once again raised the issue that patients and members of the public visiting Huddersfield Royal Infirmary (HRI) were continuing to smoke outside the main entrance of the hospital despite the Trust installing designated smoking shelters. Mike Potts provided assurance that he had continually raised this issue with Diane Whittingham, Chief Executive of Calderdale and Huddersfield NHS Foundation Trust, who had provided assurance that use of the new shelters would be robustly monitored. It was suggested that the Local Improvement Network is asked to raise this issue with the Membership Council and the governing body of the Hospital Trust. This concluded the content of the Public Board meeting and the Chairman declared the meeting closed at approximately 1.00pm.
Chairman’s Signature: ………………………………….
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Date: ………………