Download minute of meeting of the

Highland NHS Board
1 December 2009
Item 3.4
MINUTE OF MEETING OF THE
RAIGMORE GOVERNANCE
COMMITTEE
Raigmore Hospital
Inverness
IV2 3UJ
Telephone 01463 704000
www.nhshighland.scot.nhs.uk/
Centre for Health Science
12 October 2009
Present
Mrs G McCreath, Non-Executive Director (Acting Chair)
Mrs P Courcha, Non-Executive Director
Ms S Eddie, General Manager
Mrs U Lyon, Lead Nurse
Mrs E Mackay, Partnership Forum Representative
Ms M Paterson, Highland Council Representative
Mrs K Underwood, Head of Finance
Mrs M Morrison, Clinical Governance and Risk Manager
Mrs R McGee, Health and Safety Manager
Mrs C Walker , Personnel Manager
Mrs M Dickson, Lead AHP
Mr D Flear, Highland Council Representative
In Attendance
Mrs L MacDonald, Scottish Health Council
Ms E Mead, Chief Operating Officer
Mr G Coutts, Chair, NHS Highland
Ms C Saich, Administrator/PA (Minutes)
Apologies
Mr N Small, CHP Representative
Dr R Harvey, Clinical Director, Raigmore Hospital
Ms P Dobbie, Patients Council Representative
Mr J Fry, Highland HealthVoices Representative
Ms L MacDonald, Highland Council Representative
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Apologies, Welcome and Introductions
Gillian McCreath advised that she would be chairing the meeting as Pam Courcha would be
arriving slightly later that 10.30am. Gillian gave a special welcome to Magnus Monahan,
Youth Convenor for Highland Council who was attending the meeting for the first time and
also welcomed Garry Coutts and Elaine Mead. Apologies were also noted.
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Minute of Meeting held on 17 August 2009
The minutes of the meeting held on 17 August were approved as an accurate record.
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Matters Arising
3.1
Development Day of 22 September 2009
A copy of the slides were distributed as a handout and comments noted from Pat Dobbie
who said how much she had enjoyed the day and had found it beneficial.
3.2
Patients Council 10 Year Celebration
Una Lyon reported on the very successful event held in the Town House on 18 September
chaired by Garry Coutts and attended by members of the Patients Council, past and present.
Good press coverage was achieved. Richard Carey, Chief Executive, NHS Grampian, who
had instigated the Patients Council also attended.
The Committee:
Noted the feedback on the Development Session and Patients Council 10 year Celebration
event.
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NHS Highland Organisational Issues
Board Organisational Issues:
Clinical Governance
Each of the operational units should prepare a report on achievement towards the Clinical
Governance and Risk Management Standards for consideration by their Governance
Committee.
The Committee:
Noted the Board Organisational Issue relating to reporting arrangement for Clinical
Governance.
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Clinical Governance
5.1
Clinical Governance and Risk Management Report
Mirian Morrison informed the group that managers can now run their own reports from the
Datix Incident Reporting system. Assurance was sought that adverse trends would be
identified through the Raigmore Management Team in answer to a query from David Flear, it
was clarified that one of the reasons for apparent high incidence rate in the Medical
Directorate was that this covered both the Emergency Department and also a group of
patients who’s behaviour was due to a clinical condition.
5.2
Health Care Acquired Infection
Una Lyon spoke to a very comprehensive paper around pulling together of every action plan
related to the HAI agenda. It is proposed that this more comprehensive report will be signed
off at the next Raigmore Hospital Infection Control Committee at the end of October.
The Governance Committee noted that the newly formed Healthcare Environment
Inspectorate (part of QIS) will be visiting Raigmore Hospital in December although further
unannounced visits are also likely.
Staph. Aureus Bacteraemias
The levels of this are currently on target and a draft report being prepared around a
prevalence study. This is an important measure in relation to one specific aspect of the
Scottish Patient Safety Programme, which is about to be spread across Raigmore Hospital.
Hand Hygiene
A number of national hand hygiene audits have resulted in 100% compliance results which is
excellent. The zero tolerance non compliance policy commenced on 1 October 2009.
Audio-able hand hygiene signage units have also been installed and although have received
mixed reactions will soon have recorded messages from our own staff.
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MRSA Screening Programme
Kenny Steele (Directorate General Manager) is to chair the highland wide project board to
oversee this programme which aims to start screening by January 2010.
Finally, Una Lyon gave an update on plans in dealing with a pandemic flu which included
proposals for the vaccination of staff at Raigmore Hospital which begins in November.
5.3
Maria Dickson spoke to her paper in relation to the pre-school vision screening
service. Maria Dickson informed the Committee of the options for a service and Mid and
South East Highland CHP’s to assist them in achieving parity with North and Argyll and Bute.
It was noted that the design of the service in these CHP’s would be less expensive that the
service currently provided in North and A&B as presently configured. It was then asked if
had been considered reconfiguring the entire service to release savings which would assist
in implementing the service in Mid and South East Highland CHP’s. Mr Coutts asked that
this be investigated and confirmed. An option appraisal around delivering an equitable
service across NHS Highland will be presented to the Corporate Team this month.
In response to a question Maria Dickson informed the committee that to provide an Orthoptist
lead service would cost an additional £80K per year, whilst the school nurse option, overseen
by an Orthoptist would cost around £20K per year. The committee welcomed the ambition of
creating equity across NHS Highland and suggested that capacity in Moray may be helpful.
The Committee:
Noted the contents of the Clinical Governance and Risk Management Report.
Noted the contents of the Raigmore Infection Control Action Plan and Pandemic Flu plan.
Noted the current situation with regard to the pre school vision screening programme.
Noted the ongoing work within the Orthoptic Department at Raigmore Hospital to address
issues related to the pre school vision screening programme.
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Health and Safety Report
Rosie McGee spoke to her report and informed the committee that a needs analysis around
the number of fire evacuation rescue sheets was being carried out. The committee also
noted that the Health and Safety Executive would be inspecting Raigmore Hospital with
regard to the management of asbestos on 10 November 2009. It was also noted that with
regard to provision of first aid at work a paper will go to the NHS Highland Health and Safety
Committee for approval.
The Committee:
Noted the contents of the Health and Safety Report.
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Financial Governance
Karen Underwood spoke to her finance paper and Susan Eddie advised the committee
around the specific processes put in place by the Raigmore Hospital Management Team
during the month of September to bring more focus and direction to the achievement of the
Savings Plan. She also updated the committee that almost no vacancies had been approved
for advert during the last two months and this close scrutiny around vacancy management
was critical to the achievement of the savings plan. She reported that over the next few
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months all decisions made around the achievement of the savings plan must have
incorporated a risk assessment around patient safety which must not be compromised and
ensuring that the patient experience must remain as a high quality.
Susan Eddie also updated the committee that at the end of September although the rate of
overspend had levelled there was still a monthly overspend of £150K. A number of longer
term proposals are currently being discussed with clinicians and staff reps which would bring
more sustainable savings during 2010/11. However, the Raigmore Management Team are
finding it difficult to identify sufficient savings between now and the end of March 2010 to
ensure that the outstanding 2.8M is achieved.
It has therefore been agreed that from 21 October 2009 the NHS Highland Executive Team
will work closely with the Raigmore Hospital Management Team to support them in bringing
the budget back into line.
David Flear acknowledged the challenge for Raigmore Hospital but confirmed that with the
£3.4M overspend within Highland Councils Social Work Services the two services needed to
work very closely together to ensure any decisions made by NHS Highland did not negatively
impact on Social Work service. Elaine Mead, Chief Operating Officer, emphasised that as a
health system there is a need to redesign services and use every pound for patient care,
ensuring that clinical colleagues are engaged in the process. She also stated that the
current pressure on the Raigmore Hospital budget would have an impact on the rest of the
organisation and its ability to breakeven.
Pam Courcha requested the Management Team to provide more information on risks around
the budget management decisions and sought information on the potential financial
pressures around new guidelines on food in hospitals. It was noted that the risks around
achieving the savings plan targets included some low volume/high cost cancer drugs which
were being prescribed although they had not been predicted. It was also noted that the
Raigmore Hospital Catering Manager was working on costing proposals with regard to new
guidelines around food in hospitals and that these would be brought to the budget
management discussions.
In response to a question from Garry Coutts, Chair, Karen Underwood reported that the
vacancy management target for this year was £2.6M, which was £1M higher than the
previous year.
It was agreed that proposals with regard to meeting the budgetary targets needed to be
brought to the Governance Committee for an overview and further scrutiny to ensure that
there are no detrimental implications for patient care. A date for this was to be set for the
middle of November 2009. Action – Susan Eddie.
Mirian Morrison informed the committee that with regard to QIS Standards on food in
hospitals all four boards who have been audited have not succeeded in meeting all the
standards.
The Committee:
Noted the Raigmore and NHS Highland financial position and acknowledged the associated
challenges for 2009/2010.
Noted the current year to date (YTD) overspend of £1,695k.
Noted the forecasted overspend of £2.8M
Noted the current level of savings still to be achieved.
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Endorsed the current savings, action and recovery plan.
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Bed Reconfiguration
Maria Dickson talked to her overview paper on Bed Reconfiguration and noted that some
beds, for example in Orthopaedics, Gynaecology and Ophthalmology had already been
removed as they were not being used by patients. Maria informed the committee that it was
clear that we needed a broader view of overall bed usage in Raigmore Hospital and the
impact of other issues such as winter pressures, tighter discharge procedures and improved
links with Social Work colleagues, better planning of electives and contingency plans in place
for unexpected peaks in emergency admissions.
It was noted that NHS Highland was developing a vision for Rehabilitation Services across
NHS Highland for the medium and longer term. Currently, elderly rehabilitation is taking
place in every community hospital, residential homes and day hospitals. It was noted that
some of this duplicates the service in parts of Wards 2C in Raigmore Hospital and that there
were significant benefits to patients, for example; reduced chance of catching healthcare
acquired infection, if patients received their rehabilitation closer to home.
Maria Dickson informed the committee that the project board monitoring this project has
heard assurances from the CHPs that they will be able to meet the 1st of December deadline
as long as issues are resolved around discharge to care homes or discharge home with
community care packages. It was noted that the project board were pleased to hear that the
new home care providers system would be up and running in November.
The project board membership comprises:
Maria Dickson, Lead AHP Raigmore (chair)
Una Lyon, Lead Nurse, Raigmore
Rhiannon Pitt, South East CHP Rep
Nigel Small, South East CHP General Manager
Alison Phimister, Mid CHP rep
Frances Gair, Acting Area Manager, Inverness Social work
Nichola Summers, Medical Directorate Manager
Dr M Wilson, Consultant Physician
Dr J Chima, Consultant Physician
Iona MacGauran, Nurse Manager
Iain McRitchie, NHS Highland Rehabilitation Coordinator
Adam Palmer, Partnership
Elspeth Caithness, Partnership
Caroline Morrison, Personnel Manager
The Governance Committee agreed to accept the assurances from Raigmore and the CHPs
that the closure and transfer of the service can be affected on 1 December with the ward
closing in Raigmore Hospital on 20 December. The Committee noted the caveat that if all
the measures outlined by the CHPs and Social Work had not taken place by that time then
the ward would not close.
It was noted that the overall aim was that every member of staff would be redeployed into a
substantive post across the organisation and that the process of identifying these posts
which had been held vacant was well underway. In response to a question by Etta Mackay,
Head of Staff Partnership, Susan Eddie responded that the phased approach would avoid
having a ward open without any staff remaining to look after these patients.
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David Flear, Highland Council informed the committee that the home care budget currently is
overspent by £1.2M and he wished to know whether the patient’s families had been
consulted. The committee was informed that consultation has taken place with existing
patients who would continue their treatment in Raigmore Hospital. Pam Courcha requested
that a more substantial account be given of patient and public involvement in the monitoring
report. In response to a question by David Flear around the involvement of the joint council
and NHS Leaders group, Garry Coutts responded that it is currently part of every GPs GMS
contract that they look after the patients on their list when they are in their area. He also
reminded the committee that this proposal would impact on only around 7 patients in the
Inverness area at any one time. It was also noted by Elaine Mead that this proposal was a
key part of shifting the balance of care and that patients who can be rehabilitated back to
their previous level of independence would welcome this rather than lengthy stays in an
acute hospital.
Maria Dickson confirmed that in presenting the proposal to the patient’s council on 6 October
the response was very positive and there was a significant understanding around the
importance of adequate discharge planning and ensuring this works successfully for all
patients.
The committee agreed to support the proposed service transfer with the caveats already
discussed.
The Committee:
Noted the progress of the bed reconfiguration plan.
Supported the transfer of the Medicine for the Elderly Rehabilitation service to Community
Health Partnerships (CHP’s)
Noted the proposal for further rationalisation of Raigmore bed stock.
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Staff Governance
Cathie Walker spoke to the paper on sickness absence and the committee were asked to
note that the absence rate was slightly above the 4% national target. Significant work by
managers and staff side reps was ongoing to reduce this back to the previous level. In
response to a question around the cost of staff absence from David Flear, Susan Eddie
replied that many staff who are absent are not replaced; some will be replaced by bank staff
at same or less cost. Only a few staff, for example Medical Consultants, are replaced at
premium costs and this is avoided if at all possible. In answer to a question around agreed
staffing levels for numbers of beds Etta Mackay replied that cover will be made available if at
all possible. It was noted that Occupational Health had been supportive in encouraging
phased returns to work.
The Committee:
Noted the progress on the national target to reduce sickness absence to 4% or less.
Noted the progress on achieving the HEAT target for KSF and Personal Development Plans.
10
Performance
Balanced Scorecards
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Susan Eddie spoke to the paper and highlighted to the committee the reasons for the
patients who had breached their waiting time targets. It was noted that improved training had
taken place to ensure there was clarity around the responsibility for patients who are seen in
the periphery. Significant effort had been made to identify either input from NHS Grampian
the usual provider or input from the independent sector. None of this was available. It was
agreed that a full presentation with regard to specialty by specialty issues relating to
achieving the 9 week target by the end of March 2010 would be given at the next meeting.
The committee were also asked to note as an example the weekly report which is issued to
identify which patients still require an appointment for the month of October and how the
administrative team manage this to the end of each month.
It was noted that the pressure points currently include ENT and Neurology. Due to a gap
between demand and capacity additional waiting times initiative out patient clinics had been
agreed during September for ENT to ensure the targets were maintained. Further analysis
around consultants travelling time and the number of patients seen at each clinic is identified
potential areas of efficiency. With regard to Neurology it was noted that the NHS Highland
review of Neurology had resulted in funding being made available for a second consultant
Neurologist. However to date it has not been possible to recruit to this post putting the
service under significant pressure. Susan Eddie informed the committee that excellent
progress had been made through joint working with colleagues in the Belford Hospital, Fort
William with regard to General Surgery patients. Patient experience is very good and
positive comments have been received. Even taking account of this there is significant
pressure on the Raigmore Hospital General Surgery Department to deliver on cancer
patients.
Cancer Waiting Times
Susan Eddie asked the Governance Committee to note that having fallen back considerably
over the summer months the four week rolling average of compliance against the 62 day
target had returned to 97% which would have to be maintained. With regard to Endoscopy
although the 6 week target is being met there is still a significant challenge around meeting
the 2 week target for patients suspected of cancer who require an Endoscopy. The intention
is to use the new patient focussed booking system to ensure patients are selecting
appointments convenient to themselves.
The Committee:
Noted the contents of the Balance Scorecard.
Noted the Cancer Waiting times and Access papers.
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Any Other Competent Business
The committee noted that the Raigmore Hospital CT and MRI team have won a national
award for innovation and will represent Scotland at an awards ceremony in the House of
Commons in November. The committee passed on their congratulations to the team.
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Date of Next Meeting
It was agreed that due to the difficult financial situation a meeting would be held in mid
November to discuss the progress made on the budget recovery plan. This meeting will be
held at 10am on the 17 November 2009 in the Board Room, Centre for Health Science.
Date of the next full Raigmore Hospital Governance Committee Meeting 14 December, 10am
– 1pm.
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