1

AGENDA ITEM 5

Lanarkshire NHS Board Kirklands Hospital

Fallside Road

Bothwell G71 8BB

Telephone: 01698 855500

www.nhslanarkshire.org.uk

Meeting of Lanarkshire NHS Board, held on

Wednesday 26th

March 2014 at 9.00am in the Board Room,

NHS Lanarkshire Headquarters, Kirklands Hospital, Bothwell

CHAIR: Mrs N Mahal, Non-Executive Director

PRESENT: Mrs L Ace, Director of Finance

Mr P Campbell, Non Executive Director

Dr A Docherty, Chair, Area Clinical Forum

Mr M Fuller, Non Executive Director

Dr H S Kohli, Director of Public Health and Health Policy

Professor R Lyness, Director for Nurses, Midwives and the Allied Health Professions

Councillor J McCabe, Non Executive Director (up to and including item 2014/56)

Mrs L Macer, Employee Director

Miss M Morris, Non Executive Director

Dr A Osborne, Non Executive Director

Mr I A Ross, Chief Executive

Mr C Sloey, Director, North Lanarkshire Community Health Partnership

Mrs S Smith, Non-Executive Director

Mr T Steele, Non Executive Director

Dr. I. Wallace, Medical Director

IN ATTENDANCE: Mr N J Agnew, Board Secretary

Mr C Cunningham, Interim Head, South Lanarkshire Community Health

Partnership

Mrs K Hamilton, Head of Communications

Mr A Lawrie, Director of Acute Services

Mr K A Small, Director of Human Resources

Dr A Cook, Director of Medical Education (for item 2014/49b)

Mrs P Milliken, Head of Clinical Governance and Risk Management (for item

2014/49a)

Mr M Wright, Chief Executive, National Education Scotland and member, Scottish

Government Governance and Improvement Support Team

Mr C Lauder, Head of Planning and Development (for item2014/51)

Mrs E Russell, Assistant Health Promotion Officer (for item 2014/57)

APOLOGIES: Councillor J Burns, Non Executive Director

Mr H Stevenson, Chief Officer, South Lanarkshire Health and Care Partnership

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ACTION

2014/43 WELCOME

Mrs Mahal welcomed colleagues to the meeting. She extended a particular welcome to Mr. Steele

and to Dr. Osborne, who were attending their first formal meeting of the NHS Board since their

appointment as Non-Executive Directors from 1st March 2014. She also extended a particular

welcome to Mr. Wright.

2014/44 DECLARATION OF INTERESTS

No interests were declared.

2014/45 CHAIR’S REPORT

a) Meeting of NHS Chairs

Mrs. Mahal referred to the briefing on the meeting held on 17th

March 2014, which she had circulated

to Non-Executive Directors, and confirmed her willingness to have further discussions with Non-

Executive Directors on any particular issues.

b) NHS Board Seminar: 13th

March 2014

Mrs. Mahal acknowledged the productive NHS Board Seminar on the issues of: Financial Planning;

Acute Nursing Workforce and Medical Workforce.

c) Patient Safety Week

Mrs. Mahal paid tribute to the successful Patient Safety Week, during week commencing Monday

17th

March 2014, including the excellent Patient Safety Conference held on 19th

March 2014.

d) Pharmacy Award

Mrs. Mahal confirmed that she had written to John Milne, Lead Pharmacist for Oncology at Wishaw

General Hospital, congratulating him and his staff on winning ‘Team of the Year’ in the recent

National Pharmacy Awards.

e)

Mental Health Nursing Forum Awards

Mrs. Mahal reported that the ‘Well Connected’: Social Prescribing for Mental Health and Wellbeing

in Lanarkshire was the Practice Excellence Award Winner, in the Community Care category at the

Mental Health Nursing Forum on 24th

March 2014. She would write to the team conveying her and

Board members’ congratulations.

Mr. Sloey reported that there had also been two ‘Highly commended’ recognitions for the

Motherwell Dementia Cafe, in addition to which, the University of the West of Scotland and

Lanarkshire Acute Mental Health Teams had been commended in relation to Dementia Champions.

2014/46

a)

CHIEF EXECUTIVE’S REPORT

Mid-Year Performance Review

Mr. Ross advised that the Draft Outturn Letter for the Mid-Year Performance Review had been

received for comment. This raised no material issues of concern. He would arrange for the final

version of the letter to be circulated to Board members.

Mr. Ross

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2014/47 MINUTES

The minute of the meeting held on 26th

February 2014 was submitted for approval.

THE BOARD:

1. Noted the minute, subject to noting that the References amongst those in attendance to Mr.

Steele and Dr. Osborne, as Executive Director designate, should read ‘Non-Executive Director

Designate’.

2014/48 MATTERS ARISING AND ACTION UPDATE

The NHS Board considered an Action Log Update, noting actions completed and actions

outstanding.

Mrs. Mahal reported that a Corporate Calendar would be issued to Board Members that day, with a

further update being issued to Board Members when Seminar dates were confirmed.

Mr. Agnew

Mrs. Mahal

THE BOARD:

1. Noted the Action Log Update

2. Agreed to consider a further update in April.

Mr. Agnew

2014/49 HEALTHCARE IMPROVEMENT SCOTLAND RAPID REVIEW OF SAFETY AND

MORTALITY

a)

Healthcare Improvement Scotland Rapid Review Action Plan

The NHS Board considered ‘Transforming Patient Safety and Quality of Care in NHS Lanarkshire’,

an update on progress with delivery of the Action Plan for implementation of the recommendations

arising from the Healthcare Improvement Scotland Rapid Review of Safety and Mortality in NHS

Lanarkshire Acute hospitals.

Mr. Ross explained that the report described progress to date and set out the way forward towards

implementation of the remaining recommendations. He advised that following the NHS Board

meeting, the finalised progress report, which built on the progress report to the Board in February,

would be submitted to the Scottish Government and the Governance Improvement Support Team.

Mr. Ross confirmed that following the NHS Board meeting on 26th

February 2014, the Chair and

members of the Executive Team had met with Scottish Government representatives and the

Governance Improvement Support Team on 28th

February 2014 to discuss progress at that point.

The Director General, Health and Wellbeing/Chief Executive of the NHS in Scotland, had been

supportive, and subsequently confirmed satisfactory progress to the Cabinet Secretary.

Mr. Ross assured Board members that transforming patient safety and quality of care in NHS

Lanarkshire continued to be the subject of intense focus. He highlighted the aim of achieving a

position where NHS Lanarkshire would be an employer of choice and confirmed that the progress to

date would be firmly aligned with the updated Organisational Development Plan.

Mr. Ross reminded members of the previous briefing to the NHS Board about correspondence with

the Chair from the Medical Staff Associations at each of the three acute hospitals. He reported that,

in response, he had accompanied the Chair and relevant Executive Director colleagues at recent

meetings with the Medical Staff Associations for Monklands and Hairmyres Hospitals, both of which

had been positive. Arrangements were being made to hold a similar meeting with the Medical Staff

Association at Wishaw General Hospital. He advised that the Director General, Health and

Wellbeing and Chief Executive of the NHS in Scotland had confirmed his preparedness to meet with

the Chairs of the Hospital Medical Staff Associations.

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Mr. Ross reminded members of the previous intimation of the work associated with the development

of a Clinical Strategy. He confirmed that he was in dialogue with the Director of Performance at the

Scottish Government about the processes for developing proposals around clinical change.

Mr. Ross reported that, in response to a request from the Governance Improvement Support Team,

information had been sent to the GIST about: clinical policy development and review; acute hospital

management structures; and governance actions; leadership and engagement. The responses to the

GIST would be shared with Board members.

Mr. Agnew

Mr. Ross reported that he and the Chair, accompanied by relevant Executive and Non-Executive

Directors, would meet with Scottish Government officials and members of the Scottish Government

Improvement Support Team and Robbie Pearson from Healthcare Improvement Scotland, on 11th

April 2014, to consider the March progress report on delivery of the Healthcare Improvement

Scotland recommendations. He reminded members of the Cabinet Secretary’s expectations of

substantial progress in this regard by 31st March 2014. He advised that he and Dr Wallace would

attend a meeting of the Parliamentary Health and Sport Committee on 22nd

April 2014. Following

their appearance, the Cabinet Secretary would appear before the Committee to report on progress

since the publication of the Healthcare Improvement Scotland Report.

Mr. Ross reported on correspondence from Healthcare Improvement Scotland about arrangements for

a meeting between HIS representatives and NHS Lanarkshire representatives to conduct a debrief of

the HIS review and to identify any lessons learned from the process. This meeting would be

independently facilitated. The date remained to be confirmed. Mr. Ross reported that the Healthcare

Improvement Scotland Review of Adverse Event Management would be held on 22nd

April 2014.

Mr. Ross acknowledged the substantial contribution made by a wide range of colleagues across the

system in NHS Lanarkshire to the substantial progress in the delivery of the HIS recommendations,

reflected in the updated progress report before the Board.

Dr. Wallace referred members to the circulated progress report and indicated that he would welcome

feedback from colleagues, either at the meeting or subsequently. He endorsed the emphasis placed

by Mr. Ross on the criticality of the delivery of the HIS recommendations by 31st March 2014, but

stressed the need, beyond that date, to continue the momentum around transforming patient safety

and quality of care in NHS Lanarkshire. This would include the implementation of a Quality

Assurance and Improvement Strategy, currently being drafted, which would be considered by the

Healthcare Quality Assurance and Improvement Committee and by the NHS Board.

Mr. Fuller referred to the recent communication from the Cabinet Secretary about Patient Opinion,

and sought clarification on the extent to which evidence of change in perception by users of the

service could be made available to the Cabinet Secretary and other interests.

Mrs. Lyness reminded Board members that she had embarked on a substantial review of the

Complaints Procedures, with the output of that work being reported to the NHS Board in June. She

explained that a key component of this work was around clarifying the means of capturing and

feeding back patient perception, and she outlined the various initiatives being pursued in this regard.

She explained that progress in relation to this work would be the subject of presentations during the

Complaints Masterclass on 4th

April 2014, along with the outcome of the learning events that had

been held, and revised proposals for the management of complaints. She explained that the

composite of this work would culminate in a blended approach to capturing and learning from the

patient experience.

Mrs. Lyness confirmed that, since January 2014, NHS Lanarkshire was fully subscribed to Patient

Opinion. She explained that postings to Patient Opinion had increased, with around 80% of postings

being positive. She advised that the presentation of the revised Complaints Procedure to the Board

in June 2014 would include a focus on the means of moving forward, increasingly, with patient-

centred care, with this approach being extended beyond Acute Services to Mental Health Services

and other Service areas.

5

Dr. Wallace noted and undertook to pursue, suggestions from Mr. Steele about further enhancing the

readability of the report through the addition of some narrative in explanation of the tables and the

Appendix. He also acknowledged the need to be more responsive to variation in performance, such

as that in relation to Sepsis 6.

Dr. Osborne endorsed the commendation from Mr. Ross in relation to the scale and pace of the

system response to the challenges posed by the need to implement the Healthcare Improvement

Scotland recommendations over a short timescale. She highlighted, as key, the importance of

continuing quality improvement, over time, and the need to demonstrate achievement in this area.

She also highlighted the need, beyond the March report to the Scottish Government and the planned

debrief on the review process, to consolidate the endeavour around quality improvement, going

forward.

Mrs. Macer endorsed the recognition of the effort and achievement by the Executive Team and staff

throughout the organisation in rapidly implementing the Healthcare Improvement Scotland

recommendations. She also endorsed the need to sustain and embed the arrangements through staff,

and stressed the crucial importance of continuing engagement with staff in this regard. She referred

to the review of the acute management structure, with enhanced leadership roles, and cautioned on

the need to ensure that responding to the associated additional challenges did not result in slippage

with previously held responsibilities and did not impact on other staff.

Mr. Lawrie assured members about the extent of the endeavour in reformulating and implementing

the new management arrangements for acute services, focussed on clear leadership and visibility,

with support and development for the individuals concerned. He also assured members about the

thought given to the supporting infrastructure which, he suggested, should address the issues which

Mrs. Macer had raised. He confirmed that the implementation of the new arrangements was

supported by an intensive Transition Plan which would be implemented during the period April –

June 2014.

Mrs. Smith confirmed her support for the comments and suggestions made about the presented

report. She reminded colleagues that at the meeting between Scottish Government representatives,

the Governance Improvement and Support Team and NHS Lanarkshire on 28th

February 2014, the

Director General Health and Wellbeing and Chief Executive of the NHS in Scotland had

acknowledged that there were some important service delivery issues which the Board, alone, could

not deliver. She suggested that the upcoming meeting of the Health and Sport Committee on 22nd

April 2014 might present an opportunity to highlight some areas where progress would require

Government or wider political support.

Dr. Docherty referred to his experience during a recent walkround, and stressed that the enhanced

leadership roles of the Hospital Director, Chief Doctor and Chief Nurse would be crucial to the

endeavour at an operational level, in support of transforming patient safety and quality of care. He

reported that he had recently met with members of the Area Clinical Forum, when discussion on the

new management arrangements within the Acute Division had highlighted the need for the

individuals discharging the enhanced leadership roles to recognise the need to engage with

professionals for specialist areas and services. Mrs. Lyness and Dr. Wallace acknowledged this

view and undertook to pursue this matter for their respective areas of responsibility.

Mr. Wright welcomed the views expressed by Board members during the consideration of this item

and also welcomed the strength of the declared commitment to sustainability of improvement. He

referred to the new Acute Division management structures and highlighted the importance of

Personal Development Plans and support for the new leaders. Mr. Small and Mr. Lawrie assured the

Board that this was an integral part of the transition arrangements, particularly in relation to team

dynamics.

Mrs. Lyness

Dr Wallace

Mrs. Mahal thanked Board members for their contributions to the consideration of this issue. She

highlighted, from the discussion, the tables and appendices to be enhanced through the addition of

some explanatory narrative. She acknowledged the intention to reintroduce the presentation of

patient narratives to the NHS Board.

6

She confirmed the intention to issue to all Board members, the responses to the Governance

Improvement Support Team on: clinical policy development and review; acute hospital management

structures; and governance actions around leadership and engagement. She also acknowledged the

potential opportunity which the meeting of the Parliamentary Health and Sport Committee on 22nd

April presented to signal the need for dialogue with the Scottish Government about the need for

clinical change. She acknowledged the discussion about the Acute Hospital Management structures

and restated the need, at an operational level, to strengthen linkages between the triumvirate of

leaders at hospital level and professions/professionals.

THE BOARD:

1. Approved the report on ‘Transforming Patient Safety and Quality of Care in NHS Lanarkshire’,

which provided an update on progress with delivery of the Action Plan for implementation of the

recommendations arising from the Healthcare Improvement Scotland Rapid Review of Safety

and Mortality in NHS Lanarkshire Acute hospitals.

2. Noted that the finalised progress report would be submitted to the Scottish Government and the

Governance Improvement Support Team.

3. Asked for feedback from the meeting with the Scottish Government and the GIST on 11th

April

2014, the debrief meeting with Healthcare Improvement Scotland and the meeting of the

Parliamentary Health and Sport Committee on 22nd

April 2014.

4. Asked to receive further progress reports on transforming patient safety and quality of care in

NHS Lanarkshire.

Mr. Ross

Mr. Ross

Dr. Wallace

b) Postgraduate Medical Education and Training

The NHS Board considered a report on Postgraduate Medical Education and Training which

included: a report produced by NHS Education Scotland (NES) detailing the implications of the HIS

Rapid Review for Postgraduate Medical Training in NHS Lanarkshire; an update on Medical

Education in general and the report on the outcome of a recent visit by the Deanery to psychiatric

training.

Dr. Wallace introduced this item and stressed that the issues covered in the reports aimed at further

developing and improving Postgraduate Medical Education were a key part of the NHS Lanarkshire

aim to be the safest healthcare system in Scotland.

Dr. Cook endorsed this view. He highlighted the essential link between the training environment

and a culture of safety and quality, and patient care.

Dr. Cook spoke to the circulated reports, paying particular attention to the Action Plan arising from

the recent visit by the Deanery to psychiatric training. He reported that for the reasons described

within the reports, Lanarkshire was currently on enhanced monitoring by the General Medical

Council. He stressed the need for visibility of Postgraduate Medical Education at Board level, and

confirmed the intention to include PGME as an integral part of the quarterly medical staffing report

to the NHS Board. He highlighted the need for Postgraduate Medical Education to be firmly placed

within the Clinical Governance structure, more formally than had been the case up until now. He

also highlighted the need, increasingly, to quality assure the educational environment. He reported

on the need for a degree of restructuring within the Medical Education Department and confirmed

that this was being taken forward. He referred members to action 11 within the report on the

outcome of the Deanery visit to Psychiatric training, which set out items highlighted for investigation

by the GMC or PAQ surveys and findings and confirmed that an Action Plan to address these issues

was being developed.

Dr. Wallace highlighted the importance of staff engagement and confirmed the intention that this

would be site-based and would include ‘Meet the Director of Medical Education and Medical

Director’ sessions.

7

Dr. Cook acknowledged an issue highlighted by Mr. Ross about Healthcare Improvement Scotland

recognition that junior medical staff which HIS had engaged with had confirmed that they felt

supported by Consultants. He explained that the issue for junior medical staff was, however, more

related to the impact on them from the extent to which the system was, for much of the time,

overstretched.

Dr. Docherty confirmed the extent to which clinical teams were pressed across the three acute sites,

particularly at night. He emphasised Consultant willingness, outwith normal hours, to be contacted if

required. He suggested that there might be merit in conducting a review to identify occasions when

Consultant input should have been initiated, but was not.

Mr. Wright, in his capacity as Chief Executive of National Education Scotland, endorsed the

contributions from Dr. Wallace and Dr. Cook. He welcomed the fact that the reports highlighting the

issues described had been brought to the NHS Board, along with a commitment to continue to

consider quarterly reports at Board level, consistent with the General Medical Council view on the

profile which Postgraduate Medical Training should have. He highlighted the quality of the learning

environment as an important predictor of quality of care. He described the GMC role, in terms of

having access to data that might predict a failure, such as in relation to the Mid-Staffordshire

Foundation Trust and the GMC role in relation to the recognition and approval of trainers. He

stressed the importance of ensuring that Lanarkshire was as attractive a training environment as

possible to trainees. He explained that NES would undertake enhanced monitoring in this regard.

He drew members’ attention, in particular, to the section of the report on the implications of the HIS

Rapid Review of the safety and quality of care for acute adult patients in NHS Lanarkshire for

Postgraduate Medical Training in Lanarkshire, relating to the way forward for training in

Lanarkshire, and commended this approach to the Board.

Dr. Kohli made an observation about the crucial importance and benefit of regular dialogue with

trainees regularly during the course of their appointment and enquired about the views of trainees in

psychiatry. Mr. Sloey acknowledged this view. He suggested that the most significant driver of the

training environment was the service model and how that model operated across multiple sites, not

least in relation to the three acute adult inpatient sites in Lanarkshire.

Miss Morris endorsed the need for Lanarkshire to be as attractive an employer as possible to trainees

and enquired whether trainees had a designated mentor. Mr. Fuller referred to the reported enhanced

monitoring by the GMC and sought clarification on the nature and impact of that monitoring, and the

nature of the governance arrangements. He also sought clarification on the way forward in the event

of a difference of opinion about the required skills and competencies and in the event that

Lanarkshire faced insurmountable recruitment challenges. Mrs. Smith welcomed the Action Plan

presented and the assurance that it was deliverable. She enquired as to whether there were any

impediments to implementation, such as finance, that the Board needed to be sighted on. Councillor

McCabe referred to Appendix E to the report which set out 2012 and 2013 GMC training issues for

the Lanarkshire Acute Hospitals and highlighted the fact that approximately 50% of the areas

described raised issues about understaffing.

Dr. Cook confirmed that all trainees had an Education Supervisor, with most having a Clinical

Supervisor. He advised that, in most cases, both roles were fulfilled by the same individual. He

reported that further careful consideration would be given to obstacles to implementation of the

Action Plan, and he advised that further clarity was being sought about supporting professional

activities time linked to Consultant job plans, within which, education and training was not currently

explicit.

Mr. Wright confirmed that NES would be happy to input to an NHS Board Workshop Seminar on

Postgraduate Medical Education. He described the GMC role, in the context of similar roles for the

GNC and the NMWC, in setting standards across the United Kingdom for ensuring a high quality

training environment. He also described the Scottish system of Postgraduate Medical Education, for

which NES, as a statutory body, was responsible to the Scottish Government. He explained that any

conflicts of opinion were resolved in partnership between NES and the Director of Medical

Education.

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He highlighted the key opportunity which existed, enhanced by the reports before the Board, to

engage with and understand the views of trainees in relation to the training environment and the

associated quality of care.

Dr. Cook confirmed that the results of the 2014 GMC National Training Survey, which went live that

day, would become available in June, and he confirmed that this would harmonise with the timing of

the next medical staffing report to the NHS Board.

Mrs. Mahal thanked fellow Board members, and Mr. Wright for their contributions to the

consideration of this important issue. She confirmed that the option of a Board Seminar on

Postgraduate Medical Education with National Education Scotland input, would be explored further.

THE BOARD:

1. Noted the report and the attached Appendices on Postgraduate Medical Education and Training.

2. Agreed to consider further reports at future meetings.

Dr. Wallace

2014/50

a)

CLINICAL QUALITY ASSURANCE

Clinical Governance Corporate Report

Dr. Wallace highlighted the principal elements of the circulated Clinical Governance Corporate

Report.

Dr. Wallace noted an observation from Mr. Campbell about the suspension of the measure around the

quality ambition in relation to Food, Fluid and Nutrition. He confirmed that the measure would be

restored to the report when a new target was confirmed. Mrs. Lyness explained that there had been a

process measure for this quality ambition, but no outcome, and she stressed the need for a more

meaningful measure. She explained that further information in this regard would be presented over

the next few months. She reminded Board members that the report on Older People in Acute Care

had been circulated and confirmed that further reports on the work in relation to Food, Fluid and

Nutritional care would be reported to the Healthcare Quality Assurance and Improvement

Committee.

Dr. Wallace noted an observation from Mr. Ross about the reported increase in cardiac arrest rates,

against the backcloth of previous reports of a reducing trend. He explained that the increase should

be viewed in the context of the small numbers involved and highlighted the endeavour around

protecting the deteriorating patient from avoidable cardiac arrest. Mrs. Lyness assured Board

members that all cardiac arrests were reviewed, with a key aim of identifying any learning from

cases, as a key component of the Deteriorating Patient Workstream.

Dr. Wallace reported that seven day readmission rates for medicine had increased and highlighted the

intention to undertake random case sampling of readmitted patients, with the aim of identifying any

trends.

Mrs. Milliken noted a request from Mrs. Mahal for clarification of the timescale for the review of

medicines reconciliation and reporting on the outcome to the NHS Board. She confirmed that this

would feature as a key component of the prioritised Patient Safety Programme currently being

developed which would be presented to the NHS Board in the first instance.

Dr. Wallace noted an observation from Miss Morris in relation to the aspirin target not being met

and, whilst acknowledging the importance of meeting some of the more straightforward targets, he

explained that performance in this regard was, nevertheless, improving. He also confirmed that the

Dashboard Report would be further refined. Mr. Lawrie assured members that the aspirin target, and

other elements of stroke target compliance, were monitored on a week by week basis.

9

THE BOARD:

1. Noted the Clinical Governance Corporate Report.

2. Asked to receive a further report.

Dr. Wallace

b) Healthcare Associated Infection

Dr. Wallace highlighted the principal issues from the Healthcare Associated Infection update, with

particular regard to the improvement in the rate for staphylococcus aureus bacteraemias and for

clostridium difficile. He advised that the report had been the subject of detailed consideration by the

Acute Operating Management Committee at its meeting on 25th

March 2014. Mr Campbell, Chair

of the Acute Operating Management Committee, confirmed the thoroughness of the consideration of

the issue on 25th

March 2014, with the report before the Board being supported by a more detailed

report. This, overall, confirmed a significant reduction in the level of HAI, with significant numbers

of infections imported, rather than generated on site.

THE BOARD:

1. Noted the Healthcare Associated Infection update.

2. Asked to receive a further report.

Dr. Wallace

2014/51 WEST OF SCOTLAND SATELLITE RADIOTHERAPY HUB

The NHS Board considered a Full Business Case for the West of Scotland Satellite Radiotherapy

facility.

Mr. Lauder highlighted the principal elements of the Full Business Case and the accompanying paper

which followed the presentation of the Outline Business Case to the NHS Board in mid 2013. He

reported that the Beatson Cancer Charity had recently been relaunched and indicated that this may

provide an opportunity for some enhancement to the level of provision.

Mrs. Ace reported that the capital implications of the development would be met by the Scottish

Government. She advised that the revenue implications would be shared between constituent

Boards and that the Lanarkshire component was included within the Financial Plan.

Mr. Lauder noted issues raised in discussion about the potential which the location of the satellite

facility presented to reduce inequity in outcomes. He reported that this specific issue had been

considered in detail in the Option Appraisal exercise, against the backcloth of a widely-held

perception that locating the Unit in Lanarkshire could improve access to radiotherapy for older

people.

Mr. Fuller referred to the assumptions on which the Full Business Case was based, with particular

regard to the provision of two linear accelerators and capacity to extend to a third and a fourth linear

accelerator. He sought reassurance on the extent to which the initial provision would be sufficient to

comfortably accommodate demand.

Mrs. Macer confirmed having raised with Mr. Lauder the issue of community benefits deriving from

the development and advised that a date had now been set to meet with the main contractor to pursue

this issue. She highlighted issues around workforce planning and sought reassurance in relation to

confidence about there being a sufficiency of staff to meet the needs of the new facility, with

particular regard to concerns raised by the Society of Radiographers. Mrs. Macer also sought clarity

on the issue of staff transfer to Monklands from the Beatson Oncology Centre in Glasgow.

Mr. Lauder explained that the Strategy was based on the provision of two linear accelerators to meet

current needs, with plans for a third linear accelerator for the immediate future and for a fourth linear

accelerator looking further ahead. He explained that there would not be a requirement to pay for the

fourth linear accelerator in capital charges, nor for the third linear accelerator in terms of full fit-out.

10

He reported that the main contractor for the development was a ‘Fair Pay’ employer, and intended to

take on apprentices, linking with secondary schools and Curriculum for Excellence. He also

confirmed that the Society of Radiographers was engaged and was directly involved in the

Programme Board for the development. He reported that the pace of progress was now increasing.

He explained that there was no shortage of applicants to work in the facility and assured Board

members that staff transfer from the Beatson Oncology Centre in Glasgow to the Lanarkshire facility

would be entirely optional for the staff concerned.

Mr. Lauder explained the West of Scotland Cancer Network and West of Scotland Regional Planning

Group responsibility for the governance arrangements which would include a specific monitoring

role in the build phase. He restated that the financial arrangements would be based on a trading

account with revenue costs shared proportionately between constituent Boards. He confirmed that

the monitoring Committee role would continue, with Lanarkshire input.

Mr. Ross noted a request from Dr. Osborne for reassurance in relation to the scrutiny and

governance responsibilities for patients treated within the facility. He explained that the management

of the construction and the associated money flows would be the responsibility of Lanarkshire as the

constructing Board. He explained that the provision of clinical services would be planned through

the Regional Cancer Network, with the governance responsibility for the provision of radiotherapy

services residing with NHS Greater Glasgow and Clyde. He confirmed that Lanarkshire would work

closely with NHS Greater Glasgow and Clyde in relation to the integration of cultures.

The information provided by Mr. Ross notwithstanding, Mrs. Mahal asked that further assurance

about the governance and reporting arrangements be brought to a future meeting.

THE BOARD:

1. Approved the Full Business Case for the development of the Lanarkshire Beatson Radiotherapy

Unit at Monklands District General Hospital.

2. Agreed that the Director of Finance would provide a letter of support for the Full Business Case

as part of the submission to the Scottish Government Capital Investment Group.

3. Asked to receive further assurances about the governance and reporting arrangements for the

facility.

Mr. Ross

2014/52 INTEGRATION OF ADULT HEALTH AND SOCIAL CARE

a) Integration of Adult Health and Social Care

The NHS Board considered an update report on the Public Bodies (Joint Working) (Scotland) Bill –

Integration of Adult Health and Social Care Services.

Mr. Cunningham outlined the principal elements of the report. He confirmed the appointment of Mr.

Campbell as Vice-Chair of the South Lanarkshire Transition Integration Board. He also reported

that further work was being taken forward on the services ‘in scope’. He advised that an

Organisational Development Plan had been submitted to the Scottish Government against the

Scottish Government funding of £7m available to support OD. He explained that there was broad

similarity in the approach within North and South Lanarkshire, with recognition that they were

different partnerships.

THE BOARD:

1. Noted the update on Integration of Health and Social Care Services.

2. Asked to receive a further report

Mr. Cunningham

11

b) South Lanarkshire Health and Care Partnership Transition Integration Board

The NHS Board received the minute of the meeting of the South Lanarkshire Health and Care

Partnership Transition Integration Board held on 11th

February 2014 along with a summary report on

the key issues considered at the meeting held on 11th

March 2014.

Mr. Cunningham highlighted the principal issues considered, with particular regard to the

modification of the Programme Plan for South Lanarkshire.

Mr. Campbell highlighted the issue of a Communications Plan, and discussion to identify key

stakeholders, and the means and timescale for engaging with them. Mrs. Hamilton elaborated on

the communications issues in terms of work being taken forward with South Lanarkshire

Communications personnel taking account of the legally-defined individuals/groups which would be

engaged, and having regard to the current means of communication in relation to Reshaping Care for

Older People.

Mr. Ross confirmed that he was in discussion with the Chief Executive of North Lanarkshire about

potential dates for meetings of the North Lanarkshire Transition Integration Board.

Councillor McCabe acknowledged the work to date and the further work planned. He highlighted the

need, as far as possible, to avoid staff turmoil during the transition, and stressed that, fundamentally,

Health and the Local Authority were serving the same constituents. He suggested that there was a

potential for the scope of integration to extend beyond adult care. He stressed that children, families

and social justice remained the responsibility of the Local Authority. He also stressed that

partnership and consensus was key in progressing matters. Mrs. Mahal and Mr. Ross acknowledged

this view and confirmed the intention to meet with the Chief Executive of North Lanarkshire and

appropriate elected members. They also acknowledged the need for early notification and resolution

of any conflicts.

THE BOARD:

1. Noted the continuing progress to develop Integrated Health and Social Care Partnerships in

North and South Lanarkshire.

2. Noted that the appropriate communication and engagement process would be undertaken in

agreeing future models of service provision and wider change issues, with this forming part of

the key milestones.

3. Agreed to continue to receive updates at future meetings on the progress being made in the

establishment of Health and Social Care Partnerships.

Mr. Sloey

Mr. Cunningham

2014/53 LOCAL DELIVERY PLAN

The NHS Board considered the Local Delivery Plan 2014/15.

Mrs. Ace explained that the copy of the Final Local Delivery Plan 2014/15 before the Board had

been submitted to the Scottish Government Health and Social Care Directorates on 14th

March 2014,

for sign-off by 31st March 2014. She drew members’ attention to Annexe 1 to the LDP, viz: Route

Map to the 20:20 Vision: A Strategic Assessment of A Health Board’s Capability and Capacity to

Deliver the 20:20 Vision for Primary Care.

Mr. Small highlighted the need to consider the formulation of the Corporate Objectives against the

Local Delivery Plan. He confirmed that the Corporate Objectives would be brought to a future

meeting of the NHS Board. He explained that formulation of the Corporate Objectives would take

account of the consideration of a draft by the Remuneration Committee on 4th

March 2014, when the

need was highlighted to reframe the presentation to enhance usefulness to the public, and the use of

the Local Delivery Plan as the driver.

12

THE BOARD:

1. Noted the final Local Delivery Plan submitted to the Scottish Government Health and Social

Care Directorate on 14th

March 2014.

2. Agreed to receive, at a future meeting, a copy of the formal agreement letter confirming sign-off

by the Scottish Government Health and Social Care Directorates at 31st March 2014.

Mrs. Ace

2014/54 FINANCIAL PLAN

The NHS Board considered the Financial Plan 2014/15 to 2016/17.

Mrs. Ace explained that the paper sought Board approval for the NHS Lanarkshire Revenue and

Capital Plans for the three year period 2014/15 to 2016/17. She explained that the 2014/15 Plans

were submitted in greater detail as they would form the basis of the budgets to be released to the

Service. She advised that the future years’ figures served as a financial framework for planning.

Dr. Wallace

Mrs. Ace reminded Board members of the consideration given by the Audit Committee on 4th

March

2014 to a paper on 2014/15 to 2016/17 Financial Plan estimates, assumptions and risks, which had

been issued to all Board members. She referred, in particular, to the section of that paper which

outlined the Prescribing Risk Assessment. She also referred to the NHS Board Seminar on 13th

March 2014 when the Financial Plan had been a major focus of consideration.

Mrs. Ace highlighted the principal elements of the Revenue Plan, with particular regard to the

efficiency savings requirement. She reported on the level of efficiency savings which, for 2014/15,

was secure, and stressed to the Board the considerable challenge in the delivery of the balance. She

restated the information given to the Audit Committee on 4th

March 2014 and at the Board Seminar

on 13th

March 2014 about the pressures associated with Prescribing. She explained that a key

component of the Prescribing Strategy involved the introduction of an Incentive Scheme for Primary

Care and described other elements of prescribing within Hospital Services.

Mrs. Ace referred members to Appendix 1 to the presented paper which set out Additional

Allocations Expected. She stressed the need for the Board to commit to a substantial focus on

efficiency, to support its aims and aspirations around patient safety.

Dr. Wallace noted an observation from Mr. Fuller about an assumption in relation to generating

sizeable efficiency savings from an area, viz: primary care prescribing, where the Board had limited

control. He explained the approach to major cost-effectiveness schemes in this area, based on

relatively easily realisable savings which would have no impact on patient care. He advised that this

involved therapeutic drug switches and confirmed GP support for this endeavour, including through

the GP Sub-Committee of the Board’s Area Medical Advisory Committee. He advised Board

members that prescribing incentive schemes had already proved successful in other Board areas of

which he had experience.

Councillor McCabe enquired about the Board’s ability for control specifically in relation to repeat

prescriptions. Mr. Campbell endorsed the assumptions within the paper. He sought clarification on

the timescale for reviewing the wider strategic issue of reviewing the model, through shifting the

balance of care from acute to primary care and the community.

Dr. Osborne endorsed the need for justifiable efficiencies, but highlighted the need for clarity in

relation to the management of identified risks, and any overall risk in relation to the Board’s

initiative, within the context of any requirement for wider political support. Mr. Steele enquired

whether the alignment of the Local Delivery Plan and the Corporate Objectives would encompass

efficiency savings.

Mr. Ross confirmed that the production of Corporate Objectives for 2014/15, aligned to the Local

Delivery Plan, would include efficiency savings. He also acknowledged the need to move forward

with system redesign, around shifting the balance of care from an acute focus to a primary care and

13

community focus.

Dr. Wallace confirmed that the endeavour, both locally and nationally, around Prescribing included

campaigns to reduce waste. He also advised that patients on repeat prescriptions should be reviewed

regularly by their General Practitioner.

Mrs. Ace endorsed the need to shift the balance of care and to consider new models of care. She

highlighted the need to articulate the approach to this strategic aim which would involve a model of

care that was less reliant on beds. Mr. Campbell endorsed this view and stressed the need to move

ahead with this work at the earliest opportunity.

Dr. Docherty suggested that the new integrated Health and Social Care Partnerships could be the

vehicle for ensuring the earliest appropriate discharge of patients from inpatient beds and preventing

inappropriate admissions. Whilst agreeing with this view, Councillor McCabe stressed that Health

and Care Partnerships should not be viewed as the only solution to bed blocking through delayed

discharge.

THE BOARD:

1. Approved the Financial Plan 2014/15 – 2016/17.

2014/55 ACUTE NURSING - WORKFORCE PLANNING

The NHS Board considered a report on Acute Nursing – Workforce Planning.

Mrs. Mahal reminded Board members that the issue had been the subject of detailed consideration at

the NHS Board Seminar held on 13th

March 2014 when Mrs. Lyness had described, in detail, the

processes through which workforce planning had been taken forward and the outcomes and

recommendations arising from that work. Mrs. Mahal reminded Board members of the key issues

that arose from the discussion at the Seminar around: the need for consistent application of policies;

redeployment; assurance in relation to the clinical model; the need to address variation; the

application of the workforce tools and senior professional judgement; proposed new investment

relative to current spend; value for money in relation to the level of investment proposed and

external validation for the outcomes from the investment.

Mr. Ross

Mrs. Lyness explained that, in the last twelve months, there had been unprecedented scrutiny of NHS

staffing levels and highlighted, in particular, the Healthcare Improvement Scotland recommendations

focussed on nurse staffing levels. She reminded members of the approach to the application of the

workforce planning tools. She restated the senior professional view that an investment of 123.05

WTE/£4m was required, but explained that a first phase investment of 96.73 WTE/£3.15m would

enhance the current workforce levels and improve service efficiency and quality, allowing the Board

to seek reassurance from her about effective rostering before further investment was made.

Mrs. Lyness assured Board members that external validation had been sought for the workforce

planning tools used. She highlighted a key assumption that as services were reconfigured, resulting

in a reduced reliance on beds, consideration would be given to redeploying staff, consistent with

shifting the balance of care from acute services to primary care and community services. She

acknowledged the importance of effective, efficient rostering and explained that rostering

‘Masterclasses’ were currently being held. She also acknowledged the key importance of

monitoring and reporting in relation to the impact of the investment proposed. She explained that

there was in place an Acute Nursing Governance Group whose Terms of Reference had been revised.

In addition to the consideration which that group would give to the issue, monthly reports on the

progress of the investment would be provided to the Acute Divisional Management Team, with two-

monthly reports being presented to the Acute Operating Management Committee.

Mrs. Lyness reported that she had attended the Acute Divisional Management Team for discussion

about patient safety and the nursing influence on that key imperative.

14

She highlighted the need to encourage the use of the ward-based dashboard as an important

operational tool which would contribute materially to assessment of patient safety issues.

Mrs. Lyness assured Board members that the proposed level of investment would be supported by a

detailed Implementation Plan, based on the commencement of recruitment of the additional staff in

July 2014. She advised Board members that there was not a shortage of nurses available to recruit.

She reported that the Nursing and Midwifery Council had raised some concerns through the

University of the West of Scotland, but stressed that reassurance in relation to mentorship

arrangements in Lanarkshire had been provided to the NMC.

Mrs. Lyness noted a request from Mr. Fuller for clarification of any negative consequences of not

making the full £4m of investment currently. She explained that the re-run of the nursing workforce

tools had been accompanied by a detailed ward by ward risk assessment, to inform the prioritisation

of investment. She assured Board members that from this work she was confident that the level of

investment proposed, coupled with improved rostering and monitoring, would lead to significantly

safer nurse staffing levels than currently. She reported that an external expert had been

commissioned through the Chief Nursing Officer’s office to work with Lanarkshire on progressing

workforce planning in relation to care of the elderly staffing.

Mrs. Ace outlined for Board members the impact of the Board’s approval for the level of investment

proposed, with particular regard to the level of recurring resource remaining to support investment

decisions. She also outlined for members the level of non-recurring resource that was available for

one-off investments.

THE BOARD:

1. Agreed an investment of £96.73 WTE/£3.15m in acute nursing, with ongoing rigorous review.

2. Agreed that reporting on the progress of the investment should be to the Acute Divisional

Management Team and to the Acute Operating Management Committee in the first instance, but

asked that a report on the measurement of the impacts of the investment be brought to the Board

at a future meeting.

Mrs. Lyness

Mr. Wright acknowledged the strength of the messages which the Board’s decision to invest at the

level described conveyed and suggested that this should be communicated to patients and the public

and to staff. Mr. Ross confirmed that the communication arrangements in this regard were in hand.

Mrs. Mahal expressed appreciation to Mrs. Lyness and to Mrs. Sandilands and their colleagues for

the work undertaken to inform the presentation of the recommendations to the NHS Board.

2014/56 MEDICAL STAFFING

Dr. Wallace advised that the medical staffing position was largely unchanged from that reported to

the Board on 26th

February 2014. He reminded Board members of the areas of pressure. He

explained that with effect from August 2014 there would be an additional six FY2 posts coming in to

Lanarkshire. He reminded members of the progress report on risk assessment for medical staffing

given at the NHS Board Seminar on 13th

March 2014 and confirmed that the product of that work

would be presented to the Board in May 2014.

Mrs. Ace reported on investment of £316k for extra trainees.

THE BOARD:

1. Noted the update report on Medical Staffing.

2. Asked to receive a further report.

Dr. Wallace

15

2014/57 NO SMOKING POLICY

The NHS Board considered a revised NHS Lanarkshire No Smoking Policy 2014.

Dr. Kohli introduced the revised No Smoking Policy. He reminded Board members that the revised

Policy had been considered by the NHS Board on 29th

January 2014, when there had been agreement

on the need for some further consideration to be given to the position regarding e-cigarettes, and the

indicative costs associated with implementation. He explained, for members, the principal changes

to the Policy since that time which included the removal of e-cigarettes from the disciplinary route.

Mrs. Russell explained that, subject to the Board’s approval of the Policy, plans for implementation

were ready to be taken forward. She reported that NHS Greater Glasgow and Clyde was willing to

share with Lanarkshire their experience and learning to date from implementation of such a policy.

Mrs. Macer expressed her appreciation for the opportunity provided to the short life working group to

reconsider elements of the Policy, particularly with regard to the inclusion of e-cigarettes within its

scope and the removal of e-cigarettes from the disciplinary route. She responded to a question from

Mrs. Mahal and confirmed that the staff side was fully supportive of the Policy with these changes.

Mr. Ross reminded Board members of the requirement of the National Tobacco Control Strategy

2013 that ‘All NHS Boards would implement and enforce smoke-free grounds by March 2015’ and

stressed the need for Board support for this national imperative.

Dr. Kohli emphasised that the Board was not being asked at this stage to approve additional funding

for the implementation of the Policy.

THE BOARD:

1. Noted that the No Smoking Policy had been revised in line with the Scottish Government

directive for smoke-free hospital grounds by March 2015 and following consultation with local

stakeholders.

2. Noted staff side support for the Policy, with the removal of e-cigarettes from the disciplinary

route.

3. Noted that an implementation plan had been developed to support the revised policy.

4. Approved the revised No Smoking Policy 2014.

Dr. Kohli

2014/58 STRATEGIC RISK REGISTER

The NHS Board considered a report and an updated NHS Lanarkshire Strategic Risk Register. Mrs.

Ace confirmed that the Strategic Risk Register had previously been considered by the Audit

Committee.

Dr. Wallace highlighted the principal elements of the report and the Strategic Risk Register, with

particular regard to major risks around four hour unscheduled care performance and the fragility of

Primary Care Out of Hours Service staffing. He also highlighted for members, the addition of two

new risks relating to nursing workforce and medical workforce, both of which issues had been

highlighted by Healthcare Improvement Scotland and were being addressed through the additional

investment the Board had approved in nursing workforce and the current comprehensive risk

assessment for medical workforce.

Mrs. Smith, as Chair of the Audit Committee, indicated that she was content to recommend the

Board’s acceptance of the updated Strategic Risk Register.

16

Dr. Wallace noted an observation from Mr. Fuller and confirmed the intention, particularly for

serious adverse events, to move away from a traffic light system of grading. He reminded Board

members that the risk management approach was based upon the recommended Australian/New

Zealand risk matrix. He also reminded members that, by their nature, the risk rating for some issues

would remain ‘red’ for periods of time.

THE BOARD:

1. Approved the updated Strategic Risk Register.

2. Noted the new risks: risk ID 1127 – Nursing Workforce, and 1128 - Sustainability of Safe and

Effective Medical Workforce.

3. Confirmed assurance of the processes involved.

4. Noted emerging risks currently under consideration in relation to Integration of Adult Health and

Social Care.

5. Asked to receive further reports.

Dr. Wallace

2014/59 GENERAL HEALTHCARE AND FORENSIC SERVICES FOR PEOPLE IN POLICE

CUSTODY

The NHS Board considered an update report on General Healthcare and Forensic Services for People

in Police Custody.

Mr. Sloey highlighted the principal elements of the report and confirmed that the new arrangements

for the provision of services would go live on1st April 2014. He reported that the funding shortfall

previously highlighted to the NHS Board would be bridged, non-recurrently, from Alcohol and Drug

Partnership funds. He explained that, whilst the responsibility for provision of the services sat with

Health, accountability for the services remained with the Chief Constable. He assured members that

the Service was based on a robust clinical model, with strong clinical management arrangements in

place.

Mr. Sloey noted a question from Mr. Ross about the provision of upgraded accommodation. He

advised that the only site that would not be available on 1st April was in Hamilton and assured

members that an appropriate contingency plan was in place pending the availability of the main site.

Board members endorsed a commendation from Mrs. Ace for the scale of the achievement by Mr.

Sloey and his management team in implementing the transfer of responsibility for the provision of

the services to a significantly improved standard within the required timescale.

THE BOARD:

1. Noted the update report on General Healthcare and Forensic Services for People in Police

Custody.

2014/60 BOUNDARY CHANGES

The NHS Board considered a report on Health Board Boundary Changes.

Mr. Sloey highlighted the principal elements of the report which provided an update on progress

towards the alignment of the Health Board and Local Authority boundaries and which would come in

to effect on 1st April 2014. He highlighted, in particular, the significant background in relation to the

financial issues and advised that this was the subject of ongoing dialogue with Glasgow, towards

ensuring a fair and appropriate transfer of resource to Lanarkshire, with an overriding aim of

ensuring that neither NHS system would be disadvantaged.

17

He highlighted the potential impact of the application of the formula to transfer services to Primary

Care and Community which would result in a gradual transfer of funding to Lanarkshire over an

extended period. Members noted that the national Chief Executives Group and the Directors of

Finance Group would, in the first instance, consider the means by which this approach might be

rebalanced. Mr. Sloey reported that the issue would be discussed further at the meeting later that

day of the North Lanarkshire Community Health Partnership Operating Management Committee. He

advised that a further report on the financial issues would be brought to the Board in April.

Mrs. Mahal noted the issues highlighted in discussion about the transfer of funding and asked that the

report to the Board in April include the articulation of any risks.

THE BOARD:

1. Noted the update report on Health Board Boundary Changes.

2. Agreed to consider a more detailed paper in April 2014.

Mr. Sloey

2014/61 PERFORMANCE REPORTS

a) Finance

The NHS Board considered a Finance Report for the period ended 28th

February 2014.

Mrs. Ace reported that the Board remained on track to deliver to financial plan, with an eleven month

position of £3.28m underspend against brought forward and in-year resources. She reported also on

the closure of the efficiency savings gap and advised that capital expenditure also was on track.

THE BOARD:

1. Noted the report, and in particular the forecast that all three financial targets would be met.

2. Noted the £4.073m overspend to date in the acute division and the actions being taken to control

this.

3. Commended the effort by all involved to a successful financial outturn for 2013/14.

b) Waiting Times

The NHS Board considered a Scheduled Care Waiting Times Report and an Unscheduled Care

Performance update at the end of February 2014.

Mr. Lawrie highlighted the principal elements of the report. He drew members’ attention, in

particular, to unscheduled care performance which, during March, had been positive, with a

performance of approximately 93%. He stressed that the sustainability of unscheduled care

performance remained a challenge, but assured members that this was being actively managed.

Mr. Lawrie also highlighted, for members, the position in relation to Delayed Discharge

performance, with particular regard to the numbers involved and the impact on system capacity. He

outlined the immediate solution that had been agreed in partnership with South Lanarkshire Council

and reported that consideration was being given to a more sustainable solution for the medium and

longer term.

Mr. Campbell, as Chair of the Acute Operating Management Committee, emphasised the

consideration given to waiting times performance by the Operating Management Committee at its

meeting the previous day. In particular, he highlighted the discussion about unscheduled care and the

confirmation that there were measures in place aimed at sustaining improved performance. The

Acute OMC had also noted solid performance across the range of other waiting times.

Consideration had also been given to Finance and Human Resources.

18

The Acute Operating Management Committee had also considered the Acute Division Management

structure a report from Jane Burns on Clinical Governance arrangements and a report on Healthcare

Associated infection where improved performance was welcomed.

Mr. Lawrie highlighted the consideration given by NHS Chairs at their recent meeting to cancer

waiting times, with particular regard to urology and to data on enhanced recovery after surgery. Mrs.

Mahal elaborated on these issues.

Mrs. Macer highlighted the need for a better understanding of the full range of contributory factors to

unscheduled care performance and the consequences of delayed discharge. Mr. Cunningham

explained the factors around Care Homes and the number of places required per month against the

number currently available. He re-emphasised the partnership working with South Lanarkshire

Council in this regard and the agreement of funding of additional places from June 2014. He also

explained the contribution of Homecare and the need for greater flexibility of use of the independent

sector in the provision of Homecare services.

Mr. Lawrie acknowledged the issues highlighted and stressed that addressing the combination of

unscheduled care and delayed discharge was a matter for the Health and Social Care Partnerships and

Acute Services working jointly.

THE BOARD:

1. Noted the reports on waiting times.

2. Asked to receive further reports.

Mr. Lawrie

c) Primary Care Out of Hours

The NHS Board considered a report on Primary Care Out of Hours Services.

Mr. Cunningham explained that the report was provided to update the Board on the performance of

the Primary Care Out of Hours Service from November 2013 to February 2014 and to advise of the

actions which had been taken to maximise coverage of GPs in the service over the peak winter and

holiday period. He drew members’ attention to the elements of the report relating to agreement on a

range of actions aimed at ensuring the sustainability of safe out of hours services. This included

agreement on the circumstances where enhanced rates of payment would be appropriate, a

prioritisation for the filling of rotas around the three main out of hours centres and the two satellite

centres in Cumbernauld and Lanark and the concentration of resources to address any risk in relation

to one hour performance. Mr. Cunningham also reported on the progress of the review of the

Service, the outcome of which would be reported to the NHS Board later in the year.

In the discussion that followed, members welcomed the action being taken aimed at the sustainability

of a safe service and the overarching review of the service.

Mrs. Mahal noted observations from Mr. Steele about 25% of out of hours referrals being for under

four year olds and the use of nurse practitioners at a level significantly below other Boards. She

asked that both issues would be explicitly addressed in future reporting.

Mr. Cunningham

Mrs. Lyness reported on universal pathway work in relation to under four year olds where evidence

suggested that the contribution of a named person, matched with the correct number of visits, could

reduce the occurrence of health and social care issues. She advised that the universal pathway would

report during the course of the following week.

Mr. Cunningham highlighted a potential for doctors who had been undertaking work with the

Custodial Healthcare Service to be recruited by the Out of Hours Service, given the new

arrangements for General Healthcare and Forensic Services for People in Police Custody from 1st

April 2014.

19

THE BOARD:

1. Noted the current position within NHS Lanarkshire with regard to the Primary Care Out of

Horus Service and the linkage to the situation at a national level.

2. Asked to receive a further report.

Mr. Cunningham

2014/62 STRENGTHENING GOVERNANCE: REVIEW OF COMMITTEE ASSIGNMENTS

The NHS Board considered a report on Strengthening Governance: Review of Committee

Assignments.

Mrs. Mahal reminded Board members of the background to the Strengthening Governance Review

and highlighted the principal elements of the report which included revised Committee Assignments

for Non-Executive Directors effective from 1st March 2014, these assignments having previously

been discussed and agreed with Non-Executive Directors.

Mrs. Mahal also highlighted other elements of the Strengthening Governance Review, viz: the

production of a corporate calendar of meetings; a checklist for Governance Committees; review of

Governance Committee Terms of Reference, having regard to the outcome of the current internal

audit review in this area. She also highlighted the need to align comments from the Governance

Improvement Support Team, with particular regard to Governance Committee Terms of Reference

being more explicitly aligned to the National Quality Ambitions.

THE BOARD:

1. Approved the revised Committee Assignments and Committee Chairmanships.

2. Reaffirmed its support for the designation of Link Non-Executive Directors for SALUS in

relation to Department for Work and Pensions: Personal Independence Payments; Information

Assurance and Care Assurance.

3. Endorsed the appointment of Sandra Smith as Vice Chair of the NHS Board until 31st July 2014.

4. Agreed to consider a further report on the ‘Strengthening Governance’ Review.

Mrs. Mahal

2014/63 GOVERNANCE COMMITTEE REPORTS

a) Clinical Governance Committee: 13th

February 2014

The NHS Board received and noted the minute of the meeting of the Clinical Governance

Committee, the key issues considered by the Committee having previously been included in a

summary report to the Board on 26th

February 2014.

b) Audit Committee: 4th

March 2014

The NHS Board considered a summary report on the key issues considered by the Audit Committee.

Mrs. Smith, Committee Chair, highlighted the key issues.

Mrs Lyness referred members to the report on organisational performance in relation to the review

and agreement of policies. She assured Board members that, contrary to the impression given at the

Audit Committee meeting, there had been no time when Child Protection Policies had been out of

date. The organisational position with regard to the development and review of policies was

reflected in a recent response to the Governance Improvement Support Team which would be

circulated to Board members.

Mr. Ross acknowledged an issue raised by Mrs. Macer in relation to the reporting of this issue to the

Audit Committee on 4th

March 2014.

20

He confirmed that this matter, and the processes for the review of policies, had been strengthened.

c) South Lanarkshire Operating Management Committee/Health and Care Partnership: 27th

January

2014 and 24th

March 2014

The NHS Board received and noted the minute of the meeting held on 27th

January 2014 and a

summary report on the key issues considered.

Mrs. Smith, Committee Chair, reported that the main issue considered by the Committee on 24th

March 2014 was Primary Care Out of Hours Services which the Board had considered earlier in the

agenda.

d) Acute Operating Management Committee: 25th

March 2014

Mr. Campbell, Committee Chair, had previously reported on the key issues considered by the

Operating Management Committee under the consideration of the waiting times report earlier in the

agenda.

2014/64 DATE OF NEXT MEETING

Wednesday 30th

April 2014 at 9.30am.

2014/65 MOTION TO MOVE INTO PRIVATE SESSION

The NHS Board approved a motion to move into private session for the remaining items of business.

a) Adverse Event

Dr. Wallace and Mrs. Lyness briefed Board members on an adverse clinical event. This would be

the subject of a serious adverse event review which would be reported through the Healthcare

Quality Assurance and Improvement Committee and, if appropriate, to the NHS Board. Dr. Wallace

and Mrs. Lyness assured Board members that the patient concerned had suffered no ill effects.

b) Neena Mahal – Scottish Asian Womens Lifetime Achievement Award

Mr. Ross reported that Neena Mahal had won a lifetime achievement award in the Scottish Asian

Womens Awards 2014. He outlined the key achievements which had contributed to this award.

Board members extended their congratulations to Neena Mahal on this substantial achievement.