Date of Issue:21 September 2012

Assynt House

Beechwood Park

Inverness, IV2 3BW

Telephone: 01463 717123

Fax: 01463 235189Textphone users can contact us viaTypetalk: Tel 0800 959598

www.nhshighland.scot.nhs.uk

HIGHLAND NHS BOARD

MEETING OF BOARD

Tuesday 2 October 2012 at 8.30 amBoard Room, Assynt House, Beechwood Park, Inverness

AGENDA

1 Apologies

1.1 Declarations of Interest – Members are asked to consider whether they have an interest todeclare in relation to any item on the agenda for this meeting. Any Member making adeclaration of interest should indicate whether it is a financial or non-financial interest andinclude some information on the nature of the interest. Advice may be sought from the BoardSecretary’s Office prior to the meeting taking place.

2 Minute of Meeting of 14 August 2012 and Action Plan (attached)(PP 1 – 26)

The Board is asked to approve the Minute.

2.1 Matters Arising

3 PART 1 – REPORTS BY GOVERNANCE COMMITTEES

3.1 Argyll & Bute CHP Committee – Draft Minute of Meeting held on 29 August 2012(attached)

(PP 27 – 42)3.2 Highland Health & Social Care Committee – Draft Minute of Meeting held on 7

September 2012 (attached)(PP 43 – 50)

3.3 Audit Committee – Draft Minute of Meeting held on 11 September 2012 (attached)(PP 51 – 60)

3.4 Clinical Governance Committee Assurance Report of 7 August 2012 (attached)(PP 61 – 82)

3.5 Staff Governance Committee Draft Minute of Meeting held on 28 August 2012(attached)

(PP 83 – 92)3.6 Improvement Committee Assurance Report of 3 September 2012 and Balanced

Scorecard (attached)(PP 93 – 108)

3.7 Area Clinical Forum – Draft Minute of Meeting held on 9 August 2012 (attached)(PP 109 – 118)

3.8 Health & Safety Committee – Draft Minute of Meeting held on 6 August 2012 (attached)(PP 119 – 128)

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3.9 Asset Management Group – Draft Minute of Meeting of 21 August 2012 (attached)(attached)

(PP 129 – 134)The Board is asked to:(a) Note the Minutes.(b) Note the Clinical Governance Committee met on 7 August 2012. Note the Assurance Report and agreed actions resulting from the consideration of the

specific items detailed. Note that the next meeting of the Clinical Governance Committee will be held on 13

November 2012.(c) Note that the Improvement Committee met on 3 September 2012. Note the Assurance Report and agreed actions resulting from the review of the specific

topics detailed and the Balanced Scorecard. Note that the next meeting of the Improvement Committee will be held on 5 November

2012.

3.10 NHS Board and Board Development Meeting Dates 2013 and NHS Highland Calendar ofMeetings 2013Report by Elaine Mead, Chief Executive (attached)

A list of dates for Board Meetings and Board Development Meetings has been drafted forapproval, as well as a list of dates for NHS Highland Governance and Professional AdvisoryCommittee Meetings for 2013.

. (PP 135 – 138)The Board is asked to:

Approve the dates for meetings of the NHS Board and Board Development Sessions for2013.

Approve the calendar of meetings for the next year.

Council/Highland NHS BoardJoint Committees

3.11 Argyll & Bute Health & Care Strategic Partnership – Minute of Meeting of 25 July 2012(attached)

(PP 139 – 146)3.12 Highland Council Partnership – Adult & Children’s Services Committee – Minute of

Meeting of 23 August 2012 (attached)(PP 147 – 168)

The Board is asked to:

Note the Minutes.

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4 PART 2 – THE HIGHLAND QUALITY APPROACH

4.1 The Highland Quality Approach – Next Steps / ImplementationReport by Linda Kirkland, Head of Business Transformation and Lesley Anne Smith,Head of Quality on behalf of Deborah Jones, Chief Operating Officer and Anne Gent,Director of Human Resources (attached)

The Highland Quality Approach captures the spirit of how NHS Highland is working toimprove care and outcomes for people in Highland. It describes our ways of working, valuesand behaviour. It recognises how important it is to improve the health of the population andget the experience of care right for individual people, every time.

(PP 169 – 174)The Board is asked to

Note the formal launch of the Highland Quality Approach on 5 September at EdenCourt.

Note various updates on the work streams to implement the Highland QualityApproach.

Discuss any additional actions required to support promotion, development andimplementation of the Highland Quality Approach.

4.2 Patient Rights (Scotland) Act 2011Report by Moira Paton, Mirian Morrison, Margaret Brown and Maimie Thompson onbehalf of Heidi May, Board Nurse Director (attached)

The Patient Rights (Scotland) Act 2011 aims to improve patients’ experiences of using healthservices and to support people to become more involved in their health and health care. Thispaper summarises the content of and duties inherent in the Act, and provides an assessmentof the progress of implementation of the different elements of the Act.

(PP 175 – 180)The Board is asked to:

Note the elements of the Patient Rights Act. Note progress made regarding the implementation of each of these elements.

4.3(a)

(b)

Inequalities Action PlanUpdate on Inequalities Action PlanReport by Margaret Somerville, Director of Public Health and Health Policy (attached)

This paper summarises the work taking place across NHS Highland in response to nationaland local initiatives and outlines an approach to reducing inequalities for the Board to discussand approve. (PP 181 – 192)

Update on Action to Reduce Inequality taken since the Publication of the 2011 AnnualReport of the Director of Public HealthReport by Dr Tara Shivaji, StR Public Health on behalf of Dr Margaret Somerville,Director of Public Health and Health Policy, NHS Highland

The annual report of the Director of Public Health published in 2011 considered the extentand impact of inequality on the health of the population of NHS Highland. The Merkinch areaof Inverness was identified as a particularly vulnerable area. This report provides an updateon work undertaken to date. The work done would not have been possible without the activeparticipation of a number of voluntary partners and members of statutory agencies in theMerkinch area and their contribution is gratefully acknowledged.

(PP 193 – 198)

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The Board is asked to:(a) Note progress on existing programmes designed to reduce health inequalities across

NHS Highland and partners. Endorse the proposed approach to tackling inequalities in NHS Highland.

(b) Note the engagement and commitment of the voluntary sector in addressing the issue

of inequality in Merkinch. Note the findings and recommendations resulting from this community consultation

process. Note the contribution to corporate objectives of action by partners committed to a wider

health improvement agenda in Merkinch.

4.4 Director of Public Health Annual ReportPresentation and Report by Margaret Somerville, Director of Public Health and HealthPolicy (attached)

The theme of this year’s annual report is the health and well-being of older people. Thispaper contains the report summary and recommendations; the full report will be availableelectronically by the Board meeting along with some paper copies.

(PP 199 – 202)The Board is asked to:

Note and discuss the content and recommendations of the report.

5 PART 3 – CORPORATE GOVERNANCE / ASSURANCE

5.1 NHS Highland Standing Orders & Scheme of DelegationReport by Kenny Oliver, Board Secretary, on behalf of Elaine Mead, Chief Executiveand Nick Kenton, Director of Finance (attached)

The existing Board Standing Orders were approved at the NHS Board in June 2011 and haveoperated in this format since then. The Standing Orders, and the Governance arrangementsthey support have changed over the last year as a result of the integration of Adult SocialCare services from 1 April 2012.

(PP 203 – 244)The Board is asked to:

Approve the Standing Orders. Approve the Scheme of Delegation.

5.2 NHS Highland Financial Position as at 31 August 2012Report by Nick Kenton, Director of Finance (attached)

(PP 245 – 256)The Board is asked to:

Note the current forecast remains breakeven by the end of the financial year. Note the underlying operational forecast of £12m split between;

- Adult Social Care £2m- NHS Care £10m

Note the further deterioration in the Raigmore financial position.

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5.3 Infection Control ReportReport by Liz McClurg, Infection Control Manager and Dr Emma Watson, InfectionControl Doctor on behalf of Heidi May, Board Nurse Director & Executive Lead forInfection Control (attached)

(PP 257 – 324)The Board is asked to:

Note the contents of the Infection Control Report.

5.4 Adult Support and Protection – National ReviewsReport by Jan Baird, Director of Adult Care on behalf of Elaine Mead, Chief Executive(attached)

The Adult Support and Protection Committee (ASPC) of the Highland Partnershipreceived a report from the Quality Assurance sub-group highlighting a number of currentNational Reports relating to incidents of Adult abuse or neglect. The Quality AssuranceGroup had reviewed these reports and was asked to provide assurance to the committee thatall recommendations had been considered across partners in Highland and any outstandingactions were being progressed.

(PP 325 – 330)The Board is asked to:

Note the actions and process being followed. Note the role of the Adult Support and Protection Committee. Note the proposal for further assurance reports.

5.5 Highland Strategic Commissioning GroupReport by Jan Baird, Director of Adult Care on behalf of Elaine Mead, Chief Executive(attached)

During the development of the Lead Agency model for adult and children services, it wasrecognised that there would be a requirement for a strategic Group to oversee the PartnershipAgreement and specifically the Commission.

(PP 331 – 340)The Board is asked to:

Agree the role and remit of the Strategic Commissioning Group. Agree that this role and remit will be reviewed for effectiveness twelve months after the

first meeting. Note further developments around commissioning in Children’s services.

5.6 Chief Executive’s and Directors’ ReportEmerging Issues and UpdatesReport by Elaine Mead, Chief Executive (attached)

This month’s report incorporates updates on: District Partnerships NHS Highland Annual Event and Annual Review – 5 September 2012 Regional Planning – North of Scotland Planning Group and West of Scotland Planning

Group NHS Highland Engagement with School Pupils

(PP 341 – 350)

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The Board is asked to:

Note the Emerging Issues and Updates Report.

6 FOR INFORMATION

6.1 Date of next meeting

The next meeting of the Board will be held on 4 December 2012 in the Board Room, AssyntHouse, Inverness.

6.2 Any Other Competent Business

7 Close of Meeting

BOARD PAPERS – PART 1

REPORTS BY GOVERNANCE COMMITTEES

(AGENDA ITEMS 2 – 3.12)

Headquarters: Assynt House, Beechwood Park, INVERNESS IV2 3BW

Chair: Garry CouttsChief Executive: Elaine Mead

HIGHLAND NHS BOARDMEETING

2 OCTOBER 2012

Highland NHS Board2 October 2012

Item 2(a)

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HIGHLAND NHS BOARD

Assynt House

Beechwood Park

Inverness IV2 3BW

Tel: 01463 717123

Fax: 01463 235189

Textphone users can contact us via

Typetalk: Tel 0800 959598

www.nhshighland.scot.nhs.uk/

DRAFT MINUTE of MEETING of theBOARD

Board Room, Assynt House,Beechwood Park, Inverness

14 August 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 WedgwoodDr David AlstonCllr John McAlpineMr Bill BrackenridgeMs Elaine Mead, Chief ExecutiveDr Ian Bashford, Board Medical DirectorMrs Anne Gent, Director of Human ResourcesMr Nick Kenton, Director of FinanceMs Heidi May, Board Nurse DirectorDr Margaret Somerville, Director of Public Health & Health Policy

Also present Dr Helen Bryers, Head of Midwifery (Item 101)Mrs Jan Baird, Transitions Director (Items 88 & 89)Mr Eric Green, Head of Estates (Item 95)Ms Deborah Jones, Chief Operating OfficerMrs Linda Kirkland, Head of Business TransformationMrs Gill McVicar, Director of Operations, North & West (Item 92)Mr Kenny Oliver, Board Performance ManagerMrs Lorraine Power, Board Services AssistantMr Brian Robertson, Head of Adult Social CareMr Nigel Small, Director of Operations, South & Mid (Item 92)Mr Simon Steer, Head of Community Care (Item 90)Mr Stephen Pennington, Scottish Care (Item 90)Mr Donald MacLeod, Highland Community Carer Forum (Item 96)Ms Maimie Thompson, Head of Public Relations & Engagement

Welcome – The Chair welcomed Ms Deborah Jones, Chief Operating Officer, to her first Boardmeeting since commencing her role at the beginning of July.

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http://www.nhshighland.scot.nhs.uk/

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72 Declarations of Interest

Board members declared the following interests:

Garry Coutts – Scottish Social Services Council (SSSC), ex officio of SSSC on the CareInspectorate, University of the Highlands and Islands.

Myra Duncan – Member of Scottish Government Joint Improvement Team Action Group onReshaping Care in relation specifically to item 4.4 on the agenda.

Colin Punler – Member of Pentland Housing Association Board in relation to item 4.4 on theagenda.

Robin Creelman – Associate with the Health Environment Inspectorate (HEI) Gillian McCreath – Foster Carer Ian Gibson – Volunteer Action Badenoch & Strathspey Ray Stewart – Member of Unite and Staffside Chair Sarah Wedgwood – Non-Executive on Penumbra.

The Board

a Noted the Declarations of Interest.

73 Minutes of Meetings

The following minutes of meetings were approved:

5 June 2012 18 June 2012 – Board in Committee

Minute of 5 June 2012 – Mr Stewart highlighted an omission from page 13 – Membership ofCommittees, Report by Garry Coutts, Chair, NHS Highland – he was appointed as a member ofthe Audit Committee

Electronic Board Papers – Mr Creelman asked that the page numbering on the electronic versionof the papers match the paper copies. It was agreed that this would be in place for the next Boardmeeting.

Board Rolling Action Plan – Mr Stewart enquired what the position was the next edition of the NHSHighland newspaper. Ms Mead confirmed that a second edition is currently in production and willbe published soon.

The Board

a Approved the Minutes of Meetings held on 5 and 18 June 2012.

b Noted the Board Rolling Action Plan.

c Noted that issue around page numbering of Board papers would be resolved by the nextBoard meeting.

d Noted that a second edition of the NHS Highland newspaper was currently in production.

74 Matters Arising

No matters arising were identified

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REPORTS BY GOVERNANCE COMMITTEES

75 Argyll & Bute CHP Committee – Draft Minute of Meeting held on 27 June 2012

Mr Creelman, Chair of Argyll and Bute CHP fed back to Board on a good example of working inpartnership with the public where at the end of a previous CHP meeting a number of issues wereraised by members of the public attending the meeting. Following the meeting an action plan onthe issues raised was produced and worked through and fed back at the meeting on 27 June to thepublic members’ satisfaction. Mr Creelman also noted that Argyll and Bute CHP had recently beenaccredited with a gold award from the UNICEF Breastfeeding initiative. Changes in Out of Hoursprovision in Cowal were being supported by the local newspaper and a new model of Out of Hourscare in Lismore was a good example which Mr Creelman suggested might be useful for the Boardto hear more about at a future Board Development session. Finally on Finance Mr Creelmanexplained that there was some concern regarding the out turn relating to the Service LevelAgreement with NHS Greater Glasgow and Clyde (NHS GG&C), in particular the ability to takemoney out of the Service Level Agreement to fund repatriation of services to Argyll and Bute. TheChair acknowledged that these were not new issues and the Director of Finance confirmed that hehad planned meetings with colleagues in Argyll and Bute CHP and NHS GG&C to try andunderstand the costing model that NHS GG&C currently utilise.

Mike Evans referred to item 10.1 – Finance and asked about the level of expenditure on drugsincurred by the CHP that previously had been picked up by NHS GG&C. The Chair confirmed thatthese were often new drugs but that the numbers were likely to very small and funding would havebeen built into the Service Level Agreement, Mr Creelman agreed and added that benefits werealso gained when other drugs become generic and therefore cheaper.

76 Mid Highland CHP & North Highland CHP Committees – Draft Minute of Meeting heldon 22 June 2012

The Chair confirmed that the existing CHPs – North, Mid and South East had continued to meetuntil the establishment of the Highland Health and Social Care Governance Committee.

Mr McLennan, Chair of Mid Highland CHP explained that he had agreed to chair a joint meeting ofMid Highland CHP and North Highland CHP Committee. He highlighted a couple of things, the firstwas to bring to the Boards attention a very good protocol for handling critical incident reviews andcomplaints that Dr Paul Davidson – Clinical Director North and West Operational Unit had pulledtogether and felt it was worth sharing across the rest of the organisation. The second was therecognition of amount of excellent redesign work that is going on across the area.

The Chair agreed that there is an impressive amount of redesign work going on and that staff weregrasping the opportunities presented through integration and it is important that the Board is kept upto date with progress with these redesign initiatives.

Mr Punler expressed some concern with the lack of information relating to social care finance andcomplaints following integration – both of which will be key in ensuring that integration isprogressing well. Nick Kenton explained that the budget information was proving a real challenge,the Month 3 figures presented were notional, however he was hopeful that month 4 would havemore robust figures. Elaine Mead confirmed that Brian Robertson, Head of Adult Social Care wascontinuing to monitor, with the Social Care Management Teams, the adult social care budgets ashe had previously done when in Highland Council. The Chair asked that Highland Health andSocial Care Governance Committee review the month 4 figures in detail and confirmed that theImprovement Committee would continue to pick this up.

Mr Gibson asked what the issues were in relation to Social Care complaints. Mr Brian Robertson,Head of Adult Social Care explained that currently there were still 2 systems but work was ongoingto see how they could be integrated, however there were some statutory requirements thatHighland Council still had to fulfil which were different from the NHS.

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Mr Robertson confirmed that a report would be prepared for the first meeting of Highland Healthand Social Care Governance Committee. Sarah Wedgwood informed the Board that at the nextClinical Governance Committee they have a planned learning session on complaints and would behappy to share the good practice. The Chair confirmed that the intention was to integrate thesystems but as a minimum in the interim the existing reporting must remain.

Dr Michael Foxley expressed his pleasure that some progress was being made with proposals toreplace the Belford Hospital as highlighted in item 7. The Chair agreed and asked that the ChiefExecutive and Director of Finance seek to establish a mechanism to oversee this development.

77 Raigmore Hospital Committee – Verbal update of Meeting held on 11 July 2012

The Chair asked that issues surrounding Finance and Hospital Acquired Infections be held for lateron in the agenda when they come up as substantive items.

Mike Evans, Chair of Raigmore Hospital Committee apologised that there was no draft minuteavailable – this was due to the timing of the meeting and annual leave. Mr Evans updated on KyleCourt, the Raigmore Hospital Patient Lodge and advised that Mr Chris Lyons, Director ofOperations – Raigmore was planning to undertake a full review of accommodation on theRaigmore site. He also advised that the position regarding waiting times had improved withminimal breachers and the previous issues in orthopaedics having been addressed. Mr Evans wasalso seeking clarification regarding the continued development of the Raigmore dashboard whichthe committee had found very useful. He was also pleased to note that Staff Governance andHealth and Safety issues were discussed and highlighted a slightly worsening position with regardto sickness absence which historically had had a good sickness absence rate.

Ms Deborah Jones, Chief Operating Officer, explained with regard to the dashboard developmentthat she had commissioned a piece of work to review information provision across the organisationwhich would report in December. The key aim of the report was to ensure that managers had themost up to date information at their finger tips. Sarah Wedgwood asked that the development ofquality dashboards be considered as part of the above review.

Mr Gibson felt that there was still an underlying concern regarding the management of waiting listsat Raigmore – there appeared to be a disconnect between the meeting of waiting time targets andthe costs associated with waiting list initiatives. Ms Jones confirmed that she was meeting on aweekly basis with the Raigmore Management Team to review waiting times.

The Chair was please to hear that Raigmore Management Team was looking at Kyle Court. Thiswas a well used facility with high user satisfaction, but in old out of date facilities. He also notedthat this was not just a Raigmore issue as the facilities were used by patients travelling from allparts of NHS Highland and beyond.

78 South East Highland CHP Committee – Draft Minute of Meeting held on 14 June 2012

Gillian McCreath, Chair of the South East Highland CHP Committee updated on the last meeting ofthe Committee. She was pleased to see that the handling of complaints had improved through theimplementation of an improved methodology and that this would be carried over to the newOperational Unit. Mrs McCreath fed back that she felt that the Management Team were reallylooking forward to the opportunities offered by the new Operational Unit and the integratedservices.

Mr Gibson asked the Board Medical Director for an update regarding the involvement of theScottish Ambulance Service (SAS) in Significant Event Reviews (item 3). Dr Bashford explainedthat progress was being made and that SAS had a much more open culture, but the Board had torecognise that SAS have a different structure and process. Dr Bashford will bring a future reportback to the Board on this issue.

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79 Audit Committee – Draft Minute of Meeting held on 18 June 2012

Mr Mike Evans, Chair of the Audit Committee explained that this meeting had been to discuss theend of year accounts and that there were no material issues and the year end accounts wererecommended for approval by Highland NHS Board.

80 Staff Governance Committee – Draft Minute of Meeting held on 22 May 2012

Mr Colin Punler, Chair of the Staff Governance Committee fed back on the issues discussed at thelast meeting, he confirmed that a short life working group had been established to look at thelessons learnt from the review of the management culture in NHS Lothian. Mr Punler explainedthat there were a few issues that had arisen as a consequence of integration; one was thatalthough a significant number of staff had been transferred to NHS Highland, there was a lack ofsupport staff in areas such as Health and Safety and Personnel which was having an impact. Healso explained that the organisation should be congratulated on achieving the lowest levels ofsickness absence for 3 years.

It was also noted that NHS Scotland was due to publish new Staff Governance Standards and thatthis would require the revision of some of NHS Highland existing policies and development of newones. Mrs Anne Gent, Director of Human Resources explained that the new standards clarify staffand employee’s responsibilities which would be picked up in a later paper. Mrs Gent alsomentioned that for the first time the Committee had considered some staff stories which had beenreally helpful in hearing how staff governance is put into practice.

The Chair commended operational management for the achievement of the lowest sicknessabsence levels for a number of years, recognising that a lot of effort had gone into better absencemanagement, and that we couldn’t afford to be complacent on this issue.

81 Improvement Committee – Assurance Report of 2 July 2012 and Balanced Scorecard

Sarah Wedgwood, Vice Chair of Highland NHS Board was pleased to note that the Board had puta level of support into Raigmore to assist with managing the finances and waiting times. Ms EMead confirmed this was the case and further update would be provided to the next ImprovementCommittee.

Dr M Foxley was pleased to see the real actions being taken to improve our carbon emissions andin particular the work done by our Energy Champions. He also raised some concern that withregard to Endoscopy services that Belford Hospital was not being fully utilised and what is beingdone to address. Ms Mead explained that this had been an ongoing issue but that patients werereluctant to go to another site particularly of they had already been seen elsewhere. She hasasked Ms D Jones, Chief Operating Officer to look at the endoscopy service for both new andreturn patients as a matter of priority. The Chair agreed that the principles around this issue hadalready been agreed but recognised the need for further discussion.

Mr Bill Brackenridge explained that the Carbon Management Group was in the process of finalisinga Carbon Improvement Plan and that it would be presented to the next Board Meeting. Mr NKenton, Director of Finance added that the business case further on the agenda relating to aBiomass Boiler for Raigmore Hospital will greatly improve our progress towards reducing ourcarbon emissions and energy consumption.

82 Area Clinical Forum – Draft Minute of Meeting held on 31 May 2012

Dr Iain Kennedy, Chair of the Area Clinical Forum confirmed that the Forum received assurancesfrom Raigmore Hospital’s Patient Services Divisional General Manager, around a revision ofadministrative procedures so that patients will be seen timeously for follow-up appointments acrossvarious hospital clinics.

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He reported back some key messages from the national ACF Chairs’ meeting with the CabinetSecretary and particularly Nicola Sturgeon’s statement that disinvestment in the acute sector hasalways been the most difficult thing in NHS Scotland.

Dr Kennedy asked members to note a reference to the ACF non-ministerial annual review, andconfirmed that they had their internal review on 31 July with the Board Chair, Chief Executive andBoard Medical Director and would agree key points to report to the Board’s annual review on 5September.

Dr Kennedy added that the Area Clinical Forum met again last week and elected Doug Hutchesonto Vice Chair, notably the first time a clinical psychologist has held any office on the Forum. TheForum also rigorously debated NHS Highland’s service for adults with Diabetes and Dr Kennedyprovided threefold advice to the Board. Firstly: the Clinical advice from the whole ACF is thatdiabetes should continue to be predominantly delivered in general practice, with the specialistservice freed up for complex cases. Secondly: clinicians wish to see the Managed ClinicalNetwork for Diabetes strengthened now, so that the membership fully reflects the professionalswho deliver around 85% of the diabetes service: namely Practice Nurses, Family Doctors andPractice Managers and thirdly: the Forum asked to obtain full information regarding historicalfunding for people with diabetes up to the present day, so that the ACF can execute it’sconstitutional function to advise the Board regarding resource prioritisation.

With regard to Diabetes services, Ms Mead was aware that negotiations were ongoing, butconfirmed that the Board is still committed to delivery of services in Primary Care, but recognisedthat in order to support this fully some additional Diabetes Nurse Specialists will be required tofurther support those delivering services in Primary Care. Ms Mead asked Dr Kennedy who fromthe Management side was involved in the ACF discussions, Dr Kennedy confirmed that there wasno management input to the discussion.

Dr Bashford confirmed that the Diabetes Managed Clinical Network (MCN) was progressing andrecognised that they need to change their membership to recognise the role Practice Nurses takein the management of diabetes in the community. Dr Margaret Somerville, Director of PublicHealth and Health Policy confirmed that new guidance on MCN’s had recently be received andfocused on strengthening MCN’s accountability and reporting mechanisms which would help thefurther development of the Diabetes MCN.

Sarah Wedgwood expressed concern that the Area Clinical Forum seemed to be a very largecommittee and that it didn’t seem to reflect integration. Dr Kennedy explained that Area ClinicalFora were statutory bodies and therefore membership was prescribed. The Chair agreed thatperhaps this could be looked at and asked Dr Bashford, Ms Mead and Dr Kennedy to review thestructure of clinical involvement. Ms Mead also added that work was ongoing to establish an AreaPractice Committee which would be a professional committee for Social / Care Workers whichwould have a position regarding status that would be the same as the Area Clinical Forum, and inthe future they may merge.

81 NHS Highland Area Psychology Advisory Committee – Constitution and Terms ofReference

The Board approved the constitution and terms of reference for the NHS Highland AreaPsychology Advisory Committee

83 Health & Safety Committee – Minute of Meeting held on 17 May 2012

Mrs Anne Gent, Director of Human Resources welcomed the recent appointment of Mr AlasdairLawton to the Chair of the Health & Safety Committee. Mrs Gent then highlighted the followingissues – there was some discussion on the impact of integration, particularly in some of thespecialist areas such as Health & Safety.

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Mrs Gent drew particular attention to work that was ongoing around the development of integratedcommunity stores across the area, which would promote person centred care through the provisionof safe equipment when required.

Ms Sarah Wedgwood asked what lessons had been learned from the lone working pilot. Mrs Gentconfirmed that this had been a pilot of a new way of managing lone working which had identifiedsome issues that require addressing before taking any further and may result in development of afurther revised model. It was also noted that Mirian Morrison, Clinical Governance DevelopmentManager was present but not recorded as in attendance.

84 Pharmacy Practices Committee – National Appeal Panel – Decision in respect ofUnits 2 and 3 Cradlehall Shopping Centre, Inverness

The Board noted the decision of the National Appeal Panel.

The Board

a Noted the Minutes.

b Noted that a future report would be submitted to the Board on the involvement of theScottish Ambulance Service (SAS) in Significant Event Reviews.

c Noted the Staff Governance Committee met on 22 May 2012. the Assurance Report and agreed actions resulting from the consideration of the

specific items detailed. that the next meeting of the Staff Governance Committee would be held on 28 August

2012.

d Noted that the Improvement Committee met on 2 July 2012. the Assurance Report and agreed actions resulting from the review of the specific

topics detailed and the Balanced Scorecard. that the next meeting of the Improvement Committee would be held on 3 September

2012.

e Remitted to the Board Medical Director, Chief Executive and Chair of the Area ClinicalForum to review the structure of clinical involvement in the Area Clinical Forum.

f Approved the Constitution of the NHS Highland Area Psychology Advisory Committee.

g Agreed that the minute of the Health & Safety Committee meeting held on 17 May 2012should be amended to reflect that the Clinical Governance Development Manager was inattendance.

H Noted the decision of the National Appeal Panel.

Council/Highland NHS Board Joint Committees

85 Argyll & Bute Health & Care Strategic Partnership – Minute of Meeting of 30 May 2012

Mr Bill Brackenridge updated on the last meeting of the Argyll and Bute Health & Care StrategicPartnership by stating the meeting had not been quorate, however discussion included thecontinued good performance on delayed discharges and they are working towards the new HEATtargets. Following the recent Council elections it was agreed that the constitution of thePartnership needed to be reviewed.

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Mr Robin Creelman agreed with this, stating that representation had been a long standing issue atthis meeting. The Chair asked that he and the Chief Executive be kept involved in discussionregarding the constitution in order to ensure that there is some consistency between the twoCouncil areas.

86 Highland Council – Adult & Children’s Services Committee – Minute of Meeting of 21June 2012

Mr Ian Gibson updated on the last meeting of the Adult and Children’s Services Committee wherethe key items discussed included the development of District Partnerships which the Chair agreedwas a key element of continued joint working with Highland Council. Dr M Somerville felt that theCommittee had a huge agenda and will have to develop some very clear mechanisms to haveassurance provided on a number of key areas. The Chair was clear that the Committee shouldseek assurance from NHS Highland on Adult Social Care matters and focus its agenda onproviding assurance on Children’s Services issues. Dr D Alston agreed that the focus of theagenda for these meetings would be key.

The Board

a Noted the minutes.

b Noted the need to review the constitution of the Argyll & Bute Health & Care StrategicPartnership and to ensure the Chair and Chief Executive were involved in discussions toensure some consistency between the local authority areas.

CORPORATE GOVERNANCE / ASSURANCE

87 Training for Board and Governance Committee MembersReport by Kenny Oliver, Board Secretary on behalf of Garry Coutts, Chair, NHSHighland

The Chair re-confirmed the Boards commitment to run a programme of training for its Board andGovernance Committee Members. The 5 elements of the programme were outlined as

On Board Training On Board + Training Understanding the Finances Understanding Statistics Understanding Audit and Risk

The first session – On Board Training, delivered by CIPFA was scheduled for 19 and 20September and was almost fully subscribed. The Chair explained that the plan was to run theprogramme over 2 years and that all members should attend all 5 sessions at some point duringthe 2 year period. Mr Gibson expressed some concern that the new members of Highland Healthand Social Care Governance Committee would not get training this time around as a number of theProfessional Advisory Committees had yet to identify their representative. Ms Wedgwood waspleased that the training was on offer to all committee members including the publicrepresentatives.

The Board

a Noted the development of a training programme for Board and Governance Committeemembers and the requirements outlined regarding attendance.

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

This report focused on 3 main areas:

The development work required to ensure long term solutions to some of the interimarrangements agreed from 1 April e.g. Payroll, Remote and Rural AHP services etc.

The progression of integrated models for central/corporate support services. The consideration of further integration opportunities e.g. with Education, Housing etc.

The report went on to describe progress in a number of key issues, property – licenses to operatewere currently being finalised, with further options for longer term solutions being explored.Further work was being progressed in relation to cradle to grave services, including LearningDisabilities as to where to best position these services. Payroll – had progressed quicker thanplanned and it was hoped that staff would transfer to the NHS payroll system in November. Aspreviously discussed some issues regarding Health and Safety resource had arisen and inconjunction with colleagues in Highland Council some temporary solutions had been put in place.IMT remained one of the major risks associated with integration and the Programme Board hadrequested an update on progress. Finance – VAT and Insurance issues remained but work wasongoing with the Scottish Government. Performance Management was fairly well established andwork was ongoing with the Scottish Government to establish an evaluation process. An End ofProgramme Report had been completed and was now available. Finally a proposal for thedevelopment of vision had been approved for adult services. One area of concern the reportraised related to the recruitment of a Programme Manager which had been delayed.

The Chair welcomed the early implementation of some of the issues identified and in particular thedevelopment of a vision for adult services. Mr Ray Stewart expressed some concern regarding thedelays in recruitment of a Programme Manager, the Chair agreed to raise this is an issue withHighland Council with a view to speeding up the process.

A number of comments were made regarding the positive feeling at operational levels for theopportunities that integration presents but recognise that it may still take up to 2 years before thebenefits begin to be realised.

The Chair asked that a small group come together to look to develop a work plan which takesforward the issues identified in this report and others presented to the Board later in the agenda sothat the Board can monitor progress and ensure the original aims of integration are beingdelivered.

The Board

a Approved the progress on the forward plan, moving on from planning for integration

b Agree the outstanding issues and actions being progressed to address them and bringforward proposals for a work plan to monitor these issues and actions and keep the Boardinformed.

89 NHS Highland Strategic Risk Register – Adult Social Care Services and Children’sServicesReport by Jan Baird, Director of Adult Care and Lesley Anne Smith, Head of Qualityon behalf of Elaine Mead, Chief Executive

A report was presented to the Board which set out the three main types of risks relating to AdultSocial Care, detailing whether the risks were strategic, operational and significant. The risksidentified had been picked up from the Highland Council Social Work Service Plan 2011/12, theHighland Council Corporate Risk Register at March 2012 and the risks that NHS Highland’s

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Internal Auditors picked up in their May 2012 report. In addition, 2 Gateway Reviews had beenconducted and both highlighted Information Management & Technology (IMT) and in particular theability to share information and communicate across the services.

The risks identified had been split into strategic and operational risks. The strategic risks had nowbeen added to NHS Highland’s Strategic Risk Register; the operational risks had been passed onto the Director’s of Operations to include in their Operational Unit Risk Register.

Mr Ian Gibson asked what actions are being taken forward to tackle the risks identified as he feltthere was not enough detail present. Mrs Jan Baird confirmed that the risk register had followedthe standard NHS Highland format and a more detailed plan with actions and risk owners identifiedwas available. Dr David Alston felt that both Highland Council and NHS Highland’s Risk Registersdidn’t allow sufficient detail to be captured. The Chair confirmed that one of the planned trainingsessions for Governance Committee members will be on Audit and Risk.

Mrs Anne Gent, Director of Human Resources, asked to assured that the Health and Safety risksidentified through the Area Partnership Forum and Health & Safety Committee were captured. MrsBaird confirmed that it formed part of the Integration Programme Board.

The Board

a Approved the NHS Highland Strategic Risk Register for Adult Social Care Services andChildren’s Services

b Agree the management and assurance arrangements for NHS Highland’s Strategic Risksrelating to Adult Social Care Services and Children’s Services.

Mrs Myra Duncan left the meeting.

90 The Highland Change PlanReport by Simon Steer, Head of Community Care on behalf of Elaine Mead, ChiefExecutive

Mr Simon Steer introduced Mr Stephen Pennington who represents the Third and IndependentSector who co-produced the report presented to the Board. Mr Steer reminded the Board that thiswas the Change Plan for NHS Highland and Highland Council. The NHS Highland Argyll and ButeCouncil Change Plan had already been agreed by NHS Highland. The plan presented was a rollforward of the previous year’s plan. The rigor of the 3 to 1 return in investment remainedunchanged despite the challenges to deliver. The under spend from year 1 had been spread overthe remaining years – £3.1m in year 1 and £3.9m for year 2 and 3, however it should be noted thatas yet the speed of return had still to be identified. One of the key differences in NHSHighland/Highland Council’s Change Plan is in the way we work with the 3rd Sector which ensurestheir involvement throughout.

Ms Sarah Wedgwood sought some clarification regarding the sustainability of posts/projects thathave been funded through the Change Fund. The Chief Executive explained that this was acomplex issue and the ability to build in additional capacity would take time, hence the plan wasnot just about bidding for extra resource.

Some discussion then took place regarding the statistical information that was contained within thePlan and whilst the information presented was comprehensive it was agreed that measures wouldbe developed that will show progress and be a measure of success or otherwise. Ms Meadexplained that the Change Fund was now part of the Directors of Operations work plans and notseen as a separate exercise. The Chair confirmed that reporting to the Highland NHS Board onthe progress against the Change Plan would form part of the previously described report.

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Dr Foxley asked why the figures for completion of single shared assessment indicated that therewas significant delay in completing the assessment. Mr Brian Robertson, Head of Adult SocialCare explained that the definitions used were from the Department of Health and whilst there wereno un-necessary delays in completion of assessments there were some issues with submitting theinformation into the Social Care Information system (Carefirst). The Chair asked that progressagainst this specific area be picked up at a future Improvement Committee.

The Board

a Agreed the Change Plan

b Noted the development of joint planning arrangements.

c Agreed the plan, and associated use of under spend and increase allocation monies, willbe developed as part of a Strategic Commissioning Plan for the next 3 to 5 years.

d Noted that progress regarding completion of single shared assessments would bereported to a future meeting of the Improvement Committee.

91 NHS Highland Financial Position as at 30 June 2012Report by Nick Kenton, Director of Finance

Mr Nick Kenton, Director of Finance first presented the capital position, beginning by welcomingthe new Asset Management Group structure. The capital plan had changed slightly from the lastreport – reducing from £9.118m to £8.867m as a result of a change in the funding formula andradiotherapy equipment no longer being required. Mr Kenton also advised that the newpresentation style had been amended and now showed the PFI plans, the appropriate salary costsare charged to capital and further detail on the major specific projects.

Mr Kenton then went on to describe the current position regarding revenue expenditure whichshowed a current over spend of £1.8m but explained as the Social Care budgets were not yet fullytransferred there was an assumption the these will break even. The Chair and Chief Executiveconfirmed the agreement with Highland Council remained in place, that spending remained asprevious years and that the same controls were in place as if Adult Social Care was still part ofHighland Council. Mr Kenton highlighted that the Adult Social Care budget was highlightedseparately. The forecast for the year end showed a £10m overspend, however the formal positionwas a forecast breakeven and the Director of Finance remained confident of achieving this. Abreakeven position would require the Operational Units to breakeven, the position at RaigmoreHospital to improve by £1m by the end of the year and Corporate Services and others by £2m., Itwas noted this would be largely non recurrent funding, although some further benefit was expectedfrom the introduction of further generic drugs and finally some changes in accounting policy mayprovide a benefit of around £500k.

The Chair explained that whilst the Operational Unit plans presented to the Board today did nothave any figures attached to the programmes identified that they will deliver some savings. TheChair also encouraged the Board to hold its nerve for the longer term game of the Highland QualityApproach. The Chief Executive expressed some significant concern regarding the RaigmoreHospital position and she has asked the Chief Operating Officer to work closely with theManagement Team. Ms Deborah Jones confirmed that she and a number of other SeniorManagers were spending a considerable amount of time looking at the systems across theRaigmore site. They were attending weekly finance meetings and she was confident that theywould deliver the £1m+ savings target and would continue to provide the Board and ImprovementCommittee with assurance that plans are on track to deliver.

Mr Ray Stewart expressed concern regarding the worsening position particularly in areas such asthe Surgical budget where the over spend continued to rise.

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The Chief Executive explained that there had been an escalation of costs, but more importantlythey are doing the same things in the same way and need to redesign their systems across thehospital system and the way the patients flow across the system. Ms Jones explained that theteam are currently looking at care capacity, bed utilisation and understanding the costs all alongthe patient journey. She added that by the end of December they hope to see some improvementand then during the last 3 months of the year seek to recoup the savings. She plans to bring anupdate regarding the Raigmore Plan to the next Board Meeting, the Improvement Committee andthe Highland Health and Social Care Committee.

Dr Alston felt that the Board needs to have early discussion with Highland Council to ensure thatthe right budget is transferred, and he would welcome the involvement of NHS Highland in theHighland Council’s upcoming budget discussions. The Chair welcomed the opportunity and hopedthat this would start to look at some longer term plans rather than the short term measurescurrently being implemented.

The Chair acknowledged that it could take time for the plans to come to fruition, but welcomed theassurance from the Director of Finance that NHS Highland would breakeven. He appreciated thetime and effort being put into Raigmore Hospital by the Chief Operating Officer and her team andexpected further regular discussion at the Improvement Committee and Highland Health andSocial Care Finance Sub Group. The Chair also asked for a development session for the Boardmembers to be arranged to allow them to look at the level of financial detail as a Board they shouldbe concerned with. Finally he confirmed that all of the plans previously mentioned should beactioned with no compromise on patient safety and waiting times targets.

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.

d Noted that an update on the Raigmore Saving Plan would be submitted to the next BoardMeeting, the Improvement Committee and the Highland Health and Social CareCommittee.

e Noted the request by the Chair for a future development session for the Board membersto allow them to look at the level of financial detail as a Board they should be concernedwith.

92 Quality Approach to Improvement in 2012/13, 2013/14 and 2014/15Reports by Directors of Operations on behalf of Elaine Mead, Chief Executive

Reports from Argyll and Bute Community Health Partnership, North and West Operational Unit andSouth and Mid Operational Unit were presented to the Board. It was noted that Raigmore HospitalOperational Unit had presented their plan to the last Board Meeting.

The chair welcomed the consistent approach across all 3 reports but asked that some form ofmonitoring of progress against these plans needs to come back to the Board at regular intervals.He added that NHS Highland had been in steady state for a number of years but through the pastyear and for a number of years to come, the Quality Improvement Agenda and the Integrationagenda had instigated a significant change and there was a need to ensure that our performancemanagement systems match this pace of change. The Chief Executive also welcomed theapproach but highlighted that whilst there was quite a long list of quality improvements, some maytake a while to come to fruition.

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Mr Okain MacLennan asked what was happening around some of the key issues that the oldCommunity Health Partnerships were dealing with such as Out of Hours and Remote and RuralIssues. Ms Elaine Mead explained that these issues were still on the agenda and NHS Highlandwas working with the Scottish Government and others to progress. Mrs Gill McVicar, Director ofOperations – North and West, felt that both the local communities and Scottish Government weredeveloping a more realistic approach to the problems, she had noticed that there was bettersupport from the local communities where they were recognising the need to change and had abetter understanding of the issues involved and the potential solutions.

Dr Iain Kennedy asked what other areas the Operational Units were looking at which would buildon the success of the recent dermatology work where the balance of care shifted from secondarycare to primary care. Mr Nigel Small, Director of Operations for Mid and South agreed that thedermatology model was worth applying in other areas but no specific decisions had been made.

The Chair noted the reports and thanked the Directors of Operations for their work in compilingthem.

The Board

a Noted the Operational Units approaches to Quality Improvement 2012/2015.

b Noted the need for regular updates to the Board on monitoring progress against theplans.

93 Infection Control ReportInfection Control Annual Work Plan 2011/12 – End of Year ReportInfection Control Annual Work Plan 2012/13Reports by Liz McClurg, Interim Infection Control Manager and Dr Emma Watson,Infection Control Doctor on behalf of Heidi May, Board Nurse Director & ExecutiveLead for Infection Control

Ms Heidi May, Board Nurse Director introduced the reports presented to the Board and noted thatthe recent Health Environment Inspection (HEI) report would also be covered in this section buthadn’t been on the agenda as the report had been embargoed until after the Board papers hadbeen released.

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

Staphylococcus aureusbacteraemia (SAB)

HEAT Target 26 per 100,000 bed days, (0.26 per 1,000bed days).

NHS Highland rate April – June 2012 is 21.7 per 100,000bed days, (0.217 per 1,000 bed days).

Clostridium difficile HEAT Target 39 per 100,000 bed days, (0.39 per 1,000OBDs).

NHS Highland rate April – June 2012 is 40 per 100,000total occupied bed days, (0.40 per 1,000 OBDs) in patientsage 65 and over.

Hand Hygiene National Compliance 95%.

Compliance with hand hygiene 97% in May and June2012.

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Cleaning and the HealthcareEnvironment

National Compliance 90% and above.

Cleaning Compliance 95% in May and 92% in June 2012.

Estates Monitoring Compliance 96% in May and 95% inJune 2012.

HEI Inspections Lorn & Islands - 1 requirement and 4 recommendations.

Belford - 1 requirement and 5 recommendations.

MacKinnon Memorial - 1 requirement and 3recommendations.

An unannounced visit was undertaken in RaigmoreHospital on 26th & 27th June 2012. The report is awaited.

Significant HAI incidents /outbreaks, emerging threats

In June 2012, a source of meropenem resistantpseudomonas was linked to the Intensive Care Unit,Raigmore Hospital which was temporarily relocated toallow a thorough and rapid cleaning process.

There were Norovirus outbreaks in Raigmore andCaithness General Hospitals and two NHS Care Homes inMay 2012.

Antimicrobial PrescribingNational Indicators

Hospital based empirical prescribing - non compliant.

Surgical prophylaxis – compliant.

Primary care empirical prescribing – compliant.

Surgical site infections (SSIs) There has been an increase in post discharge CaesareanSection SSIs January 2012 - March 2012 above the 95%confidence limit with a rate of 6.8% (10 infections from 146procedures). Inpatient infections were nil during this timeperiod.

Orthopaedic surgical site infection rates remain low, andwithin anticipated levels.

Work is ongoing with the colorectal surgeons to reduce theSSI rate in elective patients. There were no elective SSIsin May 2012.

Decontamination The Central Decontamination Unit has been awarded ISO13485:2003 accreditation for another year.

A planned preventative maintenance programme is inplace for the washer disinfectors which are beyond theirlife expectancy.

A programme of audit of all General Dental Practitionercontractor decontamination units will be complete by theend of September 2012.

Ms May explained that NHS Highland’s Clostridium Difficile rates had been very good but withoutbreaks at the beginning of 2012, the use of a new disinfectant, and the introduction of a newtesting regime, the rates had increased.

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In particular the introduction of the new disinfectant meant that it takes domestic staff longer toclean areas than previous methods, this resulted in some of the previous cleaning schedules beingcompromised, which contributed to dust building up in some ward areas, which NHS Highland hadjust picked up when the HEI inspection took place. New staff were now in place to ensure cleaningschedules were met and the new disinfectant is used as it was proving very effective in tacklingClostridium Difficile.

Ms May then went on to outline a new improvement tool – “Exemplar Wards” which was beingintroduced across all ward areas with the aim of reducing infection rates. The process involvestraining staff in enhanced control of infection tools and techniques and the training takes 6 weeks.Following the training the ward area is then “fogged” using Hydrogen Peroxide to ensure it iscompletely clean and then the staff, with their new skills, are reintroduced to the ward area.Currently monitoring the success of this technique, if it works it will be rolled out across otherwards.

Mr Ian Gibson asked how NHS Highland’s practice compared with national practice. Ms Mayexplained that comparison was more difficult at the moment as NHS Highland had introduced amore sensitive testing regime which not many other Boards were using yet. Mr Gibson askedwhere such decisions to introduce these new measures were made. Ms May explained that theInfection Control team identify improvements which they discuss with HEI, Health ProtectionScotland and the Scottish Government. She noted the Health Protection Scotland were about tointroduce new guidelines which would include a recommendation for the testing that we haveintroduced, also that NHS Highland was leading the way with these changes.

Mr Robin Creelman agreed that the testing and cleaning methods being described were usedsuccessfully in other areas. He went on to express some concern that the dusting issues were notpicked up at an earlier stage as the implementation of any new system of cleaning should be riskassessed. Ms Myra Duncan asked that when new testing or cleaning methods are introduced, thatthese be highlighted on the graphs presented in the report. Ms Sarah Wedgwood asked why thenew testing regime had been introduced, Ms May explained that it would diagnose more peoplewith Clostridium Difficile and allow hospital staff to manage patients more quickly. Mr OkainMacLennan agreed, explaining that it will allow us to undertake more root cause analysis and learnthe lessons.

Finally Ms May went on to the recent HEI report. She explained that the report was as a result ofan unannounced visit to Raigmore Hospital on the 26 and 27 June 2012. The report indicated thatstandards had dropped below acceptable levels within Raigmore, that the control of domesticservices resource was poor, that roles and responsibilities were not clear and ward areas weredusty. The report also commended Raigmore on a number of areas of good practice – these werethe domestic staff being involved in the staff briefings, acknowledgement of the work done to thefabric of the building and finally the procedures for patient isolation were good. She went on to saythat Raigmore Hospital Management Team had responded by implementing a number ofimmediate improvements and developed an action plan which had been signed off by the HEI andwas being progressed through weekly Control of Infection meetings which Ms May is attending tosupport the Lead Nurse. She has also asked for some support from Health Protection Scotland.

Mr Robin Creelman expressed some disappointment and embarrassment that this situation hadarisen, so soon on the back of the serious incident review that was reported at the last Boardmeeting, which would suggest that there is a fairly significant systems failure. He went on to askwhether a public member had been involved in drawing up the action plan and signing it off. MsMay confirmed that no public member was involved and she would seek to remedy this as a matterof urgency. Mr Colin Punler felt that the actions arising from previous reports have not beenimplemented and wondered whether there should be more independent scrutiny for this type ofreview. Mr Ray Stewart stated that he still felt that Raigmore was a good hospital, butdisappointed and concerned at the loss of public confidence. He felt that there were still a numberof staffing issues that need to be looked at and would bring these up at a future Staff GovernanceCommittee.

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The Chair welcomed the discussion at Staff Governance Committee but reminded everybody thatstaff have various mechanisms to report issues across the whole organisation. The ChiefExecutive confirmed that mechanisms have been put back in place with Raigmore across a widespectrum of issues – HAI, Waiting Times, Finance etc which will see controls in place includingfurther monitoring and scrutiny. The Chair confirmed that the Staff Governance Committee willover see the staffing components of these reports and the Clinical Governance will provide thecontrol to ensure that the recommendations from the HEI report are implemented and both willprovide assurance to the Board.

Mr Gibson asked what the Board was planning to do in response to the recent press statementfrom the Royal College of Nursing – which stated that NHS Highland Senior Management Teamhad taken their eye off the ball whilst pursing the integration agenda. He felt that in fact there willbe great benefit from integration. The Chair agreed to write to the RCN to set the record straight.

Infection Control Annual Work Plan 2011/12 – End of Year Report & Infection ControlAnnual Work Plan 2012/13

Ms May introduced the 2011/12 End of Year report – confirming that it was completed prior to theHEI report, and it covers the key areas of work. She added that the 2012/13 Work Plan picks upsome of the previous years actions that were not completed. Mr Okain MacLennan confirmed thatone of the key elements of the work plan for this year is the plan to review governancearrangements across the whole area of Infection Control.

The Board

a Noted the contents of the Infection Control Report.

b Noted the recent HEI report and confirmed the areas to be taken forward by StaffGovernance Committee and Clinical Governance Committee.

c Noted the Infection Control Work Plan 2011/2012 – End of Year Report.

d Noted and approved the Infection Control Work Plan 2012/2013.

94 Chief Executive’s and Directors’ Report – Emerging Issues and UpdatesReport by Elaine Mead, Chief Executive

This months report covered the following:

Integration of Adult Health and Social Care in Scotland – Consultation Response Internal Audit Review of NHS Waiting Times Management Regional Planning – North of Scotland Planning Group Briefings for May and June 2012 Scottish Public Services Ombudsman: Annual Letter 2011-12 Tain Business Case Update

Ms Elaine Mead confirmed that the Internal Audit Review of NHS Waiting Tines Management wasprogressing and NHS Highland had already provided a comprehensive pack of information to theAuditors prior to the start of the audit.

The Board

a Noted the emerging issues and updates report.

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95 Raigmore Hospital Biomass Installation Business CaseReport by Eric Green, Head of Estates on behalf of Nick Kenton, Director of Finance

Mr Eric Green, Head of Estates introduced the report explaining that the business case is to bringabout the replacement of the existing oil fired boilers in Raigmore Hospital with Bio Mass boilers.Mr Nick Kenton, Director of Finance explained that the business case had already been submittedto the Scottish Government seeking capital funding to progress. He explained that if successfulthis project would deliver on a number of areas, in particular the generation of recurring revenuesavings. Mr Mike Evans welcomed this proposal and emphasised the very quick return on theinvestment which was likely to be 3.8 years. Dr Michael Foxley explained that lessons learnedfrom the implementation of Bio Mass boilers throughout the Highland Council would indicate thatworking with one company from design to installation was a real benefit. Mr Eric Green confirmedthat learning from other sites, would be taken into consideration.

The Board

a Approved the Raigmore Biomass Business case for the Main Building andAccommodation Block at Raigmore Hospital.

b Note the impact on NHS Highland carbon emissions.

c Note the revenue savings this project generates.

The Board adjourned at 12.45 pm for lunch and resumed at 1.15 pm.

STRATEGY AND POLICY

NHS Highland Strategic Framework

96 Supporting Highland’s Carers 2012-2015Presentation by Donald MacLeod, HCCF and Report by Theresa James, Adult CareIntegration Manager on behalf of Jan Baird, Director of Adult Care

Mrs Jan Baird introduced Donald MacLeod from Highland Community Care Forum who presenteda number of slides which focused on some recent work that the Forum had undertaken to look atwho best to engage with carers. The main findings were that carers were in support of change,there should be more carer involvement than ever before, staff not involving carers and there weresome barriers to carer engagement. This resulted in the development of 4 standards forengagement with carers:

to meet the cost of carer involvement to ensure caring role is maintained a commitment to resource engagement with carers carers to be treated on a equal footing carer’s views are really listened to.

The benefits expected from adopting these standards were increased trust, mutual understanding,person centred services, increased job satisfaction for the carer and the professionals. Mrs Bairdthanked Mr MacLeod for his presentation, then went on to explain that work is now ongoing todevelop a Carers Strategy with a draft ready by the end of November 2012, which will bepresented to the Board in December. Finally Mrs Baird drew the Boards attention to the contractfor Carers Centre Services and Carers Advocacy Service which has been agreed for a 3 yearperiod – this will cover carer information, support to all carers, carers informed about their ownhealth needs, work force training and carer training.

Dr Michael Foxley asked what the proposals were for local engagement with local serviceproviders; Mr MacLeod said that HCCF were in the process of identifying the significant number of

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local carer groups throughout the area, this will then help them identify strategies for localengagement. Dr Margaret Somerville felt that the strategy needs to be clear who carers are as noteverybody classes themselves as carers, this will be particularly important as with an agingpopulation the number of carers will only increase. Mrs Baird agreed and added that the workforce training they are looking at will involve staff across the organisation who may come intocontact with people who are undertaking a caring role.

The Chair confirmed the Boards support for the proposal and asked that the final submission istaken back to the Board once it is ready.

The Board

a Approved the proposals for the development of a new Adult Carers Highland Strategy.

b Noted the award of the Carers Centre Service Contract to Highland Community CareForum.

c Noted the principle for community engagement and endorsed the intention to develop aHighland plan to promote and support the participation of carers in strategic andimplementation groups.

d Noted that a revised Carers’ Strategy would be presented to the December meeting ofthe Board.

97 The Highland Quality Approach – Next StepsReport by Linda Kirkland, Head of Business Transformation and Lesley Anne Smith,Head of Quality on behalf of Elaine Mead, Chief Executive

Anne Gent, Director of Human Resources explained that the report presented to the Board was anupdate on progress to date and seeking endorsement to continue to develop the Highland QualityApproach.

The first stage would be to develop a much more explicit work programme to help the organisationperformance manage the Quality Approach. The work programme will be worked up andpresented to a future Board Meeting.

The Chair confirmed that there was complete agreement that we are committed to the HighlandQuality Approach and also confirmed endorsement of the HQA logo.

The Board

a Noted progress made on the development of the Highland Quality Approach.

b Endorsed the continued requirement to visit and learn from other high performing healthand social care systems.

c Discussed how the Board would provide continued direction and leadership to furtherdevelop and implement the Highland Quality Approach.

98 NHS Highland Quality Objectives 2012-14Report by Anne Gent, Director of Human Resources

Anne Gent, Director of Human Resources confirmed that the Objectives presented to the Boardwere the result of the alignment of a number of key documents which would help clarify thedirection of travel for the Executive Team for the next 2 years. She confirmed that the objectives

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were already part of the Senior Executives objectives for the next year and this would roll outacross the rest of the organisation. Mrs Gent felt that there were some questions to be answeredin relation to how we measure success and how we roll these objectives out to the widerorganisation.

Mrs Sarah Wedgwood said that in a previous organisation she had used a Theatre Group to roleplay the objectives and that had proved very effective; she agreed that these types of objectivesare difficult to measure. Mr Bill Brackenridge welcomed the direction of travel and felt theobjectives started to make the Highland Quality Approach real for staff.

The Chair confirmed the endorsement of the approach for the next 2 years but emphasised theneed to make the objectives measurable.

The Board

a Endorsed the Quality Objectives for 2012/14 and Discuss the proposed rollout.

b Noted that the approach to implementing quality objectives is fundamental to successfuldelivery of the NHS Highland Quality Approach.

99 The Highland Quality Approach – Developing our Values and BehavioursReport by Anne Gent, Director of Human Resources

Anne Gent, Director of Human Resources introduced this paper, saying that it builds on therecently launched national Staff Governance Standard which puts more rights and responsibilitieson staff. In addition national work on Improving Dignity @ Work – Give Respect/Get Respecttoolkit and some local work on customer care led to a project team coming together to look at NHSHighland’s Values and Behaviours. The team had spent some time reflecting on what customercare looks like in the NHS and this led to a number of pilot projects being run across theorganisation where the two key elements of Values and Behaviours were explored. The ExecutiveTeam will go through the process next.

Ray Stewart, Employee Director welcomed the report – it pulled a number of common themestogether and provides a good starting point for taking forward the Staff Governance Standard.

The Chair welcomed the report and congratulated the team on the good work – he asked that theproject team report through the Staff Governance Committee to ensure all these strands arebrought together.

The Board

a Noted the existing and new work streams which would create and sustain a culture ofongoing improvement of customer care, innovation and engagement.

b Noted the launch of the Staff Governance Standard.

100 The Highland Quality Approach to Workforce Planning and DevelopmentReport by Pam Cremin, Workforce Planning Officer on Behalf of Anne Gent, Directorof Human Resources

Anne Gent, Director of Human Resources, introduced the Workforce Development Plan to theBoard explaining that it incorporated Learning and Development and builds on the key challengesoutlined in the Local Delivery Plan for 2012/13. The plan followed the same format as previousyears and confirmed that the monitoring arrangements were already in place.

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The Board agreed that NHS Highland needed to develop a longer term strategic approach toworkforce planning, rather than the just the one year required by the Scottish Government.

The Board

a Noted the NHS Highland Workforce Development Plan 2012/13

b Noted the key workforce risks and challenges for NHS Highland.

c Noted the Workforce Plan Rolling Action Plan 2012/13.

101 NHS Highland Maternity Services StrategyReport by Helen Bryers, Head of Midwifery on behalf of Heidi May, Board NurseDirector

Helen Bryers, Head of Midwifery introduced the Maternity Services Strategy to the Board, sheexplained that the strategy set out the vision and priorities, the model of care, the local prioritiesand work plan for maternity services for the next 2 years. There were 4 key principles – womenand family centred, giving the best possible start, safe services, effective and accessible services.Dr Bryers also confirmed that the implementation of the strategy and the monitoring of itseffectiveness will be done through the Maternity Services Strategy Group

Dr Michael Foxley sought assurance that maternity services were linked into the IntegratedChildren’s Services as this would be key to ensuring that children are given the best possible start.Dr Margaret Somerville agreed this was important and also felt that the new HEAT target onaccess to antenatal care by the 12th week would help the ensure mothers are engaged withservices at the earliest opportunity and will allow for the key health messages to delivered early.Ray Stewart asked where the workforce issues were covered in the strategy. Helen Bryersconfirmed that at the current moment the workforce was in a healthy state but did acknowledgethat this would change in the coming years. Mr Bill Brackenridge welcomed the comprehensivestrategy but felt there was little about the important role siblings and fathers play.

The Chair summed up by saying that the Board approved the strategy, but asked that during thenext year the strategy be refreshed and cover integration, siblings and fathers role and ensure thatthe data is as up to date as possible.

The Board

a Approved the Maternity Services Strategy and Strategy Workplan, subject to this beingrefreshed during the next year as discussed.

102 Alcohol & Drugs Partnership StrategiesReport by Debbie Stewart, Co-ordinator/Development Officer on behalf of MargaretSomerville, Director of Public Health.

Dr Margaret Somerville, Director of Public Health explained that there were two strategiespresented – one for Northern Highland and one for Argyll and Bute. These reports are requestedby the Scottish Government on an annual basis. Both reports show that NHS Highland was wellplaced to achieve the new HEAT target of accessing drug and alcohol treatment.

Dr Michael Foxley asked what the Partnerships were doing about teenage drinking, in particularbinge drinking, Dr Somerville said that work was in progress with Highland Council and otherpartners on this issues and through the Police they had introduced a new policy of takingintoxicated young people home to their parents, which allows conversations to be had in the homeon the effects of binge drinking.

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Mr Ian Gibson recommended the excellent progress made in using the Alcohol Brief Interventionswhich has proven to be a very effective tool. Dr Somerville agreed and confirmed that the ABImethodology was being rolled out beyond the NHS which would provide a significant increase inopportunities for ABI’s to take place.

The Board

a Noted the new requirement to submit annual reports from each ADP to the ScottishGovernment covering a range of indicators

b Noted progress in developing the ADP strategies in Highland and Argyll and Bute.

103 Any Other Competent Business

Annual Event/Annual Review – Wednesday 5 September 2012 – The Chair asked that allBoard Members should register to attend this event being held in Eden Court as soon as possible.

104 Date of Next Meeting

The next meeting of the Board will be held on Tuesday 2 October 2012 at 8.30 am in the BoardRoom, Assynt House, Beechwood Park, Inverness.

The meeting concluded at 2.30 pm.

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FOLLOW UP FROM BOARD ACTION PLANS – JUNE 2011 ONWARDSThose items shaded grey are due to be removed from the Action Plan as they have been completed, or will be considered atthe next Board.

Highland NHS Board2 October 2012

Item 2(b)

Meeting Item Action / Progress Outcome

Board 07/06/11 Audit Committee Hospital and Community Health payments to GPs in Argyll andBute – to seek clarification on this issue and report back to theBoard in due course.

Future Board – letter received from SG21/10/11 – being progressedBeing reviewed by national PrimaryCare Leads with a view to providingadditional guidance.

Board Dev.08/08/11

Archie Foundation Update The Chair advised that he felt it was necessary for a protocol tobe in place regarding similar style projects to ensure that thesewere brought to the attention of the Board in a timely fashion.

Chair / Chief Executive to progress.

Board 04/10/11 Matters Arising Patient / Public Representatives on Committees – an actionshould be added to the Board Rolling Action Plan in relation toappointing patient and public representatives to governancecommittees.

Work in progress

Pharmacy Practices Committee Report to be prepared for Board members on the supportavailable to applicants, as the new way of working was verycomplex.

Work in progress

Patient Experience at GovernanceCommittees

To consider whether patient experiences should also beconsidered at the Board as well as governance committees.

Chair to consider

Board 06/12/11 Internal Evaluation of NHSHighland Newspaper

To bring forward proposals to the Board early in 2012 on theproduction of two editions of the newspaper in the spring andautumn

2nd

Edition of Newspaper to beissued. Copy now being pulledtogether.

Board 07/02/12 Highland Health & Social CarePartnership – ProposedGovernance Arrangements

To review the governance arrangements once the structure hadbeen operational for one year.

Board June 2013

Board Secretary to undertake work on the role description formembers of the HH&SCP Committee.

Completed

Appropriate Board Development sessions to be arranged forBoard members regarding the HH&CSP.

Senior Operational Managementand Professional LeadershipArrangements NM&AHPs

A more detailed diagram of the structure to be circulated toBoard members for information.

Not yet finalised.

Board 03/04/12 Chair and Chief Executive to consider suggestion for a futurediscussion on the key priorities for the Board in relation to riskmanagement and the governance of risks.

Future Board / Brd Dev. Session

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2

Meeting Item Action / Progress Outcome

Board 05/06/12 Infection Control Report Clinical Director at Raigmore to circulate the Terms ofReference to all Board members for information.

The various issues would be progressed via the ClinicalGovernance Committee and the Staff Governance Committee

Board Members

Clinical Gov. Cttee & Staff Gov. Cttee

CHP Committees To issue a structure diagram to Board members once available. Board Members

Governance Committees – Reviewof Assurance to Board

To review the mechanisms for governance committees to reportto the Board.

Work in Progress

Procurement Strategy Senior Management Team to agree a Procurement Workplan. Added to SMT Forward Plan

Board 14/08/12 Matters Arising Electronic Board Papers to be numbered as Board Papers. Actioned for 02/10/12 Board

South East Highland CHPCommittee

A report be brought back to a future Board on the involvement ofScottish Ambulance Service in critical incident reviews.

Board Medical Director to action

Area Clinical Forum The Board Medical Director, Chief Executive and Chair of AreaClinical Forum to review structure of clinical involvement in theArea Clinical Forum.

Board Medical Director, CE and Chairof ACF to action

Health & Safety Committee Minute to be amended to reflect attendance of ClinicalGovernance Development Manager

Completed

Argyll & Bute Health and CareStrategic Partnership

Requirement to review the constitution of the Argyll & ButeHealth and Care Strategic Partnership and ensure that the Chairand Chief Executive are involved to ensure consistency betweenlocal authority areas.

Robin Creelman and Derek Leslie toaction.

Integrating Care in the Highlands –Forward Plan

Small group to be established to agree a work plan to takeforward issues on the forward plan and other items on theagenda in order that the Board can be informed of progress

Jan Baird and Deb Jones to action.

The Highland Change Plan Progress on completion of single shared assessments to bereported to Improvement Committee.

Report presented to ImprovementCommittee – 03/09/12

Area Financial Position Update on the Raigmore Savings Plan to be submitted to thenext Board Meeting, the Improvement Committee and HighlandHealth and Social Care Committee.

Improvement Committee – 03/09/12Board 02/10/12HH&SCC – 01/11/12

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3

Meeting Item Action / Progress Outcome

Board 14/08/12 Quality Approach to ImprovementReports by Directors of Operations

Progress against plans to be linked into Integrating Care in theHighlands work plan.

Jan Baird and Deb Jones to action.

Supporting Highland’s Carers2012-2015

Revised Carers’ Strategy to be presented to the Decembermeeting of the Board.

Board 04/12/12

NHS Highland Maternity ServicesStrategy

Approved the Maternity Services Strategy and StrategyWorkplan, subject to this being refreshed during the next yearas discussed.

Helen Bryers to action.

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26

Highland NHS Board2 October 2012

Item 3.1

MINUTE OF MEETING OF THEARGYLL & BUTE CHP COMMITTEE

Argyll & Bute Community HealthPartnershipArosLochgilpheadArgyll PA31 8LBwww.nhshighland.scot.nhs.uk/

An Roth- CommunityEnterprise Centre

Craignure, Isle of Mull29 August 2012

Present Mr Robin Creelman, Chairman, Argyll & Bute CHPMr Derek Leslie, Director of Operations, Argyll & Bute CHPDr Michael Hall, Clinical Director, Argyll & Bute CHPMs Pat Tyrrell, Lead Nurse, Argyll & Bute CHPMs Elaine Garman, Public Health Representative, Argyll & Bute CHPMs Mary Wilson, AHP Representative, Argyll & Bute CHPMs Elizabeth Reilly, Area Dental Committee RepresentativeMr Duncan Martin, Chairman, Public Partnership ForumCouncillor Elaine Robertson, Argyll & Bute Council RepresentativeCouncillor George Freeman, Argyll & Bute Council RepresentativeMr Cleland Sneddon, Argyll & Bute Council RepresentativeMs Glenn Heritage, CVO Representative

In Attendance

Apologies

Mr George Morrison, Head of Finance, Argyll & Bute CHPMr David Logue, Head of HR, Argyll & Bute CHPMr Stephen Whiston, Head of Planning Contracting & Performance,Argyll & Bute CHPMr Nick Kenton, Director of Finance, NHS HighlandMr Mike Evans, Chair of Audit Committee, NHS HighlandMrs Sheena Clark, PA to Director of Operations - Minute Secretary

Mr John Dreghorn, Project Director, Mental Health ModernisationMs Dawn Gillies, Staffside RepresentativeMs Liz McMillan, Staffside RepresentativeMr Jim Robb, Argyll & Bute Council RepresentativeMr Donald Barr, Area Optical Committee RepresentativeMr Neil Robinson, Area Pharmaceutical Committee RepresentativeMr David Ritchie, Communications Manager, Argyll & Bute CHPMs Tricia Morrison, CVO Representative, Argyll & Bute CHP

1. CHAIRMAN’S WELCOME

The Chairman opened the meeting by welcoming everyone to the An Roth-CommunityEnterprise Centre, Craignure, Isle of Mull.

2. APOLOGIES

Apologies for absence were noted as above.

3. CONFLICTS OF INTEREST

No conflicts of interest were declared.

27

http://www.nhshighland.scot.nhs.uk/

2

4. MINUTE FROM PREVIOUS MEETING

4.1 Minute of Meeting held on 27 June 2012

The Minute of the meeting on 27 June 2012 was accepted as a complete and accuraterecord of the meeting.

The Committee Approved the content of the Minute of the meeting on 27 June 2012.

5. MATTERS ARISING FROM PREVIOUS MEETING HELD ON 27 June 2012

Finance Report

Mr Evans asked for clarification on the reported use of ‘reserves’. Mr Morrison advised thatthis is localised terminology and refers to unallocated funds which are included in the yearend budget.

Highlands & Islands Travel Scheme (HITS)

Mr Freeman enquired about the timescale for the CHP review of HITS and if the governmentfunding had been fully devolved. Mr Morrison advised the partially devolved funding shouldbe fully devolved by 1 April 2014. The review to be undertaken will look at the availability ofdata on patient transport costs which currently is not fully informative and this will beresolved. It will also provide an opportunity to consider funding differently, particularly inIslay and Kintyre which have the highest patient travel costs, and will provide a clearerunderstanding of the allocation of patient travel payments, which are presently on areimbursement basis.

Mr Whiston advised that the Scottish Ambulance Service recently launched a newprogramme for booking the patient transport service which it is expected will result in ahigher demand in HITS claims.

Complaints

Mr Freeman commented on the previous discussion regarding monitoring of primary carecomplaints and advised that this was still an area of concern.

6. NHS Highland Organisational Issues

6.1 Meeting of Highland NHS Board Meeting – 14 August 2012

The NHS Board draft Minute and briefing note were unavailable for this meeting. MrCreelman reported that the two main items of discussion at the recent Board meeting werefinancial issues and HEI reporting.

Mr Leslie absolutely acknowledged the very limited time between the Board meeting of14 August and today, and also the impact of annual leave, etc at this time of year butreiterated the importance of the availability of a draft NHS Board Minute or briefing for thesubsequent CHP Committee meeting to ensure continued synchronisation of Minutes andgovernance discussions. Mr Creelman advised that he will highlight this point at the nextBoard meeting.

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3

6.2 Minute of Meeting of the Highland NHS Board – 5 June 2012

The Minute was circulated for information and noting.

The Committee Noted the above comments and the circulated Minute.

7. Clinical Governance

7.1 Clinical Governance & Risk Management Report

Ms Tyrrell spoke to the previously circulated paper and highlighted a number of areas fromthe report.

Risk Management

Incidents

The information provided reflects the position at 24 July 2012, when a total of 527 incidentswere reported in Argyll & Bute CHP during quarter 1 of 2012/13, representing an 8.8%reduction from quarter 4 of 2011/12 (578 incidents). The highest incidences reported were inthe MAKI locality, 275 (52.2%) and the lowest were in Helensburgh, 9 (1.7%), with thefigures reflecting the incidences being reported in hospitals.

During the 1st quarter incidents were graded with a consequence of major or extreme andwere categorised as:

grade 4 pressure ulcer developed in patient’s own home error in completion of referral letter medication dispensing error discharge planning

Each of the incidents was reviewed and actions identified to address any issues and gaps.

Mr Freeman queried the reported figure of 9 incidents for Helensburgh & Lomond incomparison to the higher numbers of incidences reported in the other CHP localities. MsTyrrell confirmed that a k