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Minutes of the Trust Board Meeting held on Wednesday 27 February 2008 at 9.15am in the Board Room, St Luke’s House Present: Rob Napier Mike Potts Vanessa Stirum Rob Millington Valerie Aguirregoicoa Mehboob Khan Tony Gerrard Imran Patel Dr David Anderson Sarah Brackwell Bryan Machin Dr Judith Hooper Carol McKenna Sheila Dilks In attendance Helena Corder Peter Flynn Sue Ellis

Chair Chief Executive Non-executive Director and Vice Chair Non-executive Director Non-executive Director Non-executive Director Non-executive Director Non-executive Director Chair of the Professional Executive Committee Professional Executive Committee Member Executive Director of Finance Executive Director of Public Health Executive Director of Commissioning and Strategic Development Executive Director of Patient Care and Professions Director of Corporate Services Director of Performance and Information Director of Human Resources and Organisational Development Director of Provider Services Chair of the Patient and Public Involvement Forum Communications Manager Executive Assistant Corporate Governance Administrator Assistant Director of Workforce, Commissioning and Policy

Robert Flack David Thompson Peta Wolstencroft Pauline Kershaw Alison Fearnley Laura Campbell Six members of the public

The Chairman opened the meeting by welcoming all those in attendance. Questions from the Public The Chairman gave members of the public an opportunity to raise any questions. No questions were raised. KPCT/08/25

Apologies for Absence No apologies for absence were received.

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Declarations of Interest No Trust Board members declared interests in any of the agenda items.


Minutes of the meeting held 30 January 2008 The minutes of the Trust Board meeting held on Wednesday 30 January 2008 were AGREED as a true and accurate record once the following amendment was made: KPCT/08/13 Use of the Seal It was noted that the second paragraph should have read: The Board APPROVED the use of the PCT’s Seal in confirming the conditional contract for sale to (instead of the word of) Oakedale Developments in the sum £405,000.


Matters Arising KPCT/08/08 Performance Report Following the discussion at the last meeting regarding Primary Care Access and the concerns raised by Mehboob Khan, Carol McKenna confirmed that two of the GP Practices concerned have provided assurance that they do offer a mix of appointments. The PCT is working with the third GP Practice on improving their appointments system. Mike Potts confirmed he had liaised with Margaret Edwards, Chief Executive of Yorkshire and The Humber Strategic Health Authority, regarding the GUM and Chlamydia Screening targets who will take this issue up nationally. KPCT/08/15 Infant Deaths in north Kirklees Dr Hooper confirmed following the launch of the report at last months Board meeting a number of staff briefing sessions had been held across Kirklees and the serious issues had been well debated. It was recognised regionally that this region has a serious problem with infant deaths so there will be a regional summit during May, which will involve the Local Authority. In addition it was also noted that local MP Shahid Malik was also keen to support this work.


Chief Executive’s Report Mike Potts presented his report to the Board highlighting the following:

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Sheffield Children’s NHS Foundation Trust – Chair Appointment

The Board was advised that Stephen Hunter had been confirmed as the new Chair of the above Trust as from 1 February 2008. KPCT/08/29.2

Christopher Dicks

Mike advised the Board of the death of Christopher Dicks, Vice Chair of the Kirklees Partnership. The Board passed on their condolences to Christopher’s family, friends and colleagues. KPCT/08/29.3

NHS Next Stage Review

The Board was advised an event had been arranged by the Strategic Health Authority, on 6 March 2008, 9.30am – 4.30pm, at the Royal Armouries, Leeds. Further information can be obtained from Sarah Kocinski. KPCT/08/29.4

Holme Valley Memorial Hospital (HVMH)

The Board was advised a business case is to be produced by Turner Townsend for the refurbishment of HVMH. This is separate to the community hospitals overall bid and is expected to be sent to the SHA at the end of May 2008. There was a discussion regarding value for money of the refurbishment instead of a full redevelopment of the site. There was assurance that the site would be fit for purpose in years to come and that the plans would be shared with the Board at a future Board development session. It was also noted that James Drury had recently been appointed as Project Director of the Community Hospitals Programme. KPCT/08/29.5

Kirklees Partnership

The Board was advised that the Kirklees Partnership team is to carry out a review of the Partnership. Consultation will take place during February and March with members of all the Boards and key officers, to ensure the views of all partners are captured. It is aimed that the findings of the consultation along with some options for the future will be presented to Executive Management Group and Kirklees Partnership Executive in April 2008.

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Healthcare Commission – Learning from Investigations

It was noted that the Healthcare Commission have recently published their report “Learning from Investigations”. Copies of this report may be requested through the helpline on 0845 601 3012, or downloaded from the Healthcare Commission website, KPCT/08/29.7

Gas Leak in Batley

Mike reported there had been a gas leak in Batley which involved evacuating approximately 1000 households. This incident led to the PCT having to instigate certain aspects of the PCT’s Emergency Plan to deal with the situation. Dr Hooper advised that the PCT had arranged an Emergency Planning exercise on Monday 10 March 2008. KPCT/08/29.8

Slaithwaite and Liversedge Procurement Exercise

Carol McKenna advised that the contract for the preferred bidder for the Slaithwaite practice (Drs Shamsee and Ward) was in the process of being signed. The signing of the contract for the preferred bidder for the Liversedge practice (Drs Khan and Ghafoor) was not quite at the same stage however there were no significant issues surrounding this. Carol advised that meetings were being arranged to give patients representatives involved in the consultation exercise an opportunity to meet with the new GPs. Dr Hooper advised that being a local resident there were reservations that had been expressed from members of the local community concerning the appointment of the GPs at the Slaithwaite practice. The Board was reassured that a robust, open and transparent procurement process had been undertaken in terms of awarding this contract to Drs Shamsee and Ward. Helena Corder confirmed if there were any issues surrounding this service concerning patient satisfaction, these need to the highlighted, so that they can be resolved in the early stages.

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Appointment of the West Yorkshire Emergency Planning Lead

Mike confirmed that Keith Lister had been appointed as West Yorkshire Emergency Planning Lead. Keith is currently the Senior Public Health Manager at Bradford and Airedale PCT. KPCT/08/29.10

Permanent Secretary to the Welsh Assembly Government

Mike advised that Gill Morgan, Chief Executive of the NHS Confederation has been appointed to the above post. Gill takes up her appointment in May and Steve Barnett, Director of NHS Employers, will be Acting Chief Executive. The Board RECEIVED and NOTED the contents of the Chief Executive’s Report. KPCT/08/30

PEC Chair’s Report David Anderson presented his PEC Chair Report to the Board highlighting the following: Dominic Gray had agreed to be the Technology clinical lead and Dr Bert Jindal had agreed to act as the clinical lead for Cancer on an interim basis. The second engagement event of the planning process (Route to a Solution) around future District nurse provision took place on 30 January. There was general agreement on the proposed model of configuring district nurse teams around practice units. It was noted that Dawn Gordon (PEC member who is a district nurse) will join the project steering group leading this work. Work is progressing to develop an integrated commissioning system embracing Practice Based Commissioning and the PCT/PEC. David provided feedback on the discussions that had taken place among GP colleagues around the implementation of the GMS Contract. He explained there were two options; Option A is to negotiate with the GPC and DH to reach an amicable agreement; Option B is if GPs do not agree to the proposed terms and conditions of the contract, the contract will be imposed on 1 April. The results of the GP vote are awaited.

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The Board RECEIVED and NOTED the contents of the PEC Chair’s Report. KPCT/08/31

Finance Report Bryan Machin presented the Finance report which updated the Board on the current financial position. He advised the Board that the PCT is still forecasting a surplus of £7.4m for 2007/08. This is proving challenging for the PCT in terms of keeping within this forecast. Further underspends as at month 10 include: •

Expenditure forecast on the Leeds service level agreement (£600k reduction)

Expenditure forecast on the Sheffield Teaching Hospitals NHS Trust service level agreement (£300k reduction)

NHS Non Contracted Activity due to a revised market forces factor forecast (£300k reduction)

Dental expenditure forecast (£300k reduction)

These have been in the main offset by increases in forecast expenditure in: •

GMS/PMS expenditure (£300k increase)

Planned spend from the reserves budget ( £1,600k increase)

The Board NOTED:


The income and expenditure position of the PCT; and

Forecast Performance against the PCT’s other key financial duties/targets.

Corporate Performance report Peter Flynn presented the Corporate Performance report to the Board. Mike Potts provided feedback on a meeting with the Strategic Health Authority concerning where improvement in performance is required. The main areas of concern were: •

18 week waiting time targets Page 6 of 15

• • • • •

A&E MRSA Yorkshire Ambulance Service Community Matrons Financial planning ie delivering on the surplus

There was a discussion regarding the achievement of the 18 week waiting time target. It was recognised that Mid Yorkshire Hospitals Trust was working hard to achieve this target and that robust systems and process were in place. Peter Flynn reported that in December the Access to GUM clinic target reached 93.9% which is now above the trajectory and advised that this position is expected to be maintained. Peter advised that the information about the process used in Kirklees to request Chlamydia Screening had been discussed with the SHA. The SHA in turn had discussed this with the Health Protection Agency and the outcome was still that requests for screening that did not use the prescribed approach would not be counted. Peter reported that there had been two further patient waiting time breaches to report: • •

A 26 week Inpatient breach at Leeds Teaching Hospitals. This breach is due to lack of elective capacity to treat. It was noted it is likely that this patient will breach again. A 13 week Outpatient breach. This is due to the cancellation of a clinic. This has since been rescheduled.

Valerie Aguirregoicoa enquired what actions were being taken to address the capacity issues at Leeds. Carol McKenna explained that alternative providers were being contacted to see if they can offer treatment instead of patients being referred to Leeds. She reassured the Board that this situation was being robustly monitored via the Strategic Health Authority. In addition it was recognised that the PCT was undertaking a capacity and demand exercise to ascertain if demand can be met and to model in any additional capacity which might be required during the next financial year. The Board RECEIVED and NOTED the Corporate Performance Report. KPCT/08/33

NHS Next Stage Review update Mike Potts briefed the Board on the latest timetable of the NHS Review being carried out by Lord Ara Darzi. He advised that during April 2008 ‘Confirm and Challenging’ meetings will take place with each of the leads of the Clinical Care Pathway Groups, the Page 7 of 15

supporting Chief Executive and the SHA. The purpose of these meetings is to discuss in more detail the group’s finding and to secure SHA support. Implementation of the NHS Next Stage Review will be incorporated into the World Class Commissioning assessments planned for the autumn 2008 which will be undertaken by the SHA. A Board development session will be organised concerning this. KPCT/08/34

Business Planning Update Peter Flynn presented the Business Planning update report to the Board. He explained that the Business Planning process for 2008/09 had delivered a set of approved Business Cases to the timetable originally identified. In total 35 Business Cases had been approved at a total revenue cost for 2008/09 of £5.9m. It was recognised that revenue costs at this stage are indicative. Peter summarised the Business Cases which had been proposed and explained the evolution of the Health Improvement Teams for 2008/09. It was recognised that lead directors have been assigned and clinical leads appointed to HIT Teams to ensure the correct level of clinical engagement takes place. In addition it was noted that for each business case above £100k in value a detailed specification will be produced. The long-term conditions business case will be brought as a special case to the Board. Valerie Aguirregoicoa declared an interest in Business Case CSD/09/09 concerning Mental Health, as a member of West Yorkshire Police Authority. It was recognised that equality impact assessments are being carried out on all Business Cases to ensure they impact on the areas of greatest need ie impact on health inequalities. Rob Millington assured the Board that a robust process had been followed in developing and approving the Business Cases. It was recognised there would be a huge impact on delivering training to staff to support developing the services covered by the Business Cases and that none of this would be delivered without expertise. Dr Hooper reflected on public health’s experience of developing programme management systems and confirmed she would be working closely with Sam Williamson, Head of Strategic Business Planning, on developing a robust system. The Board welcomed the report and gave thanks to Sam Williamson. The Board AGREED to: Page 8 of 15

• • • KPCT/08/35

APPROVE the confirmed use of the process which had been adopted in the evaluation of the business cases submitted. APPROVE the allocation of revenue budget required to meet the objectives of each scheme. NOTE the plans for the continued use and evolution of the Health Improvement Teams (HITs).

Securing Equitable Access in Primary Care Carol McKenna introduced the Securing Equitable Access in Primary Care Report to the Board. She explained that all PCTs are required to undertake a procurement exercise for a ‘GP led health centre’ during 2008 and circulated an outline service model that summarises the proposed primary care procurement, timescales and expectations around this. Carol advised that having considered a range of possible options, it is proposed that the procurement for KPCT should focus on a ‘GP led health centre’ for Dewsbury, based in Dewsbury Health Centre. This would support addressing the health needs identified through the Joint Strategic Needs Assessment, and also respond to the fact that the Dewsbury and Mirfield locality has the highest numbers of patients per GP/Nurse Practitioners in the PCT. It was noted that the PCT was required to submit the outline service model for this exercise to the Strategic Health Authority by 21 February and that the PCT is awaiting comments on the first draft. Attention was drawn to the guidelines/core criteria. It was noted that the timescales were challenging. It was recognised that the PCT is required to procure a ‘GP led health centre’ in addition to the urgent care procurement process. In light of this the Board was mindful of achieving value for money and ensuring complimentary services and not duplication. In addition it was recognised that the development of the Primary Care Strategy was fundamental to this work as well as reducing health inequalities. It was noted there would be a future Board Development session on the development of the PCT’s Primary Care Strategy. The Board AGREED to: •

NOTE the contents of the report and ENDORSE the proposal to procure new services for the Dewsbury area in line with Government policy on access to Primary Care.

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Yorkshire Cancer Network – Colorectal and Head and Neck Peer Review and Action Plan Carol McKenna introduced the Yorkshire Cancer Network – Colorectal and Head and Neck Peer Review and Action Plan to the Board. She explained that the Yorkshire Cancer network has requested that it is brought to the attention of all Boards. Attention was drawn to the local action plans for the PCT area. It was noted that the Yorkshire Cancer Network will oversee the implementation of identified actions. The Board reviewed the issues highlighted in the report. It was acknowledged that the issue on page 27 of the report concerning head and neck surgery at Calderdale had been rectified. The Board ENDORSED the role of the Yorkshire Cancer Network in overseeing the implementation and monitoring of the action plans.


Local Area Agreement (LAA) Second Draft Dr Judith Hooper presented the second draft of the Local Area Agreement (LAA) to the Board. She explained that the second draft of the LAA had to be submitted to the Government Office Yorkshire and the Humber (GOYH) by 5 March. Work will be carried out between now and the formal sign off in June 2008 to confirm the indicators and targets to be included in the LAA. The list of indicators were highlighted to the Board, and the Board noted the progress to date. It was acknowledged that the list of priorities need to be realistic and agreed by all partners. Dr Hooper emphasised that partnership working in Kirklees was robust. Finally it was requested that all abbreviations in reports are written in full first. The Board RECEIVED and AGREED the priorities within the Local Area Agreement.


Equality and Diversity Update Helena Corder presented the revised Equality and Diversity Scheme to the Board. Helena explained that since the Board agreed the Draft Single Equality Scheme in April 2007 this had been revised in the light of minimal comments from staff and the public and following Board approval will be changed on the PCT website. Page 10 of 15

It was noted that the scheme is developing well but progress was slow. A full review and progress report will carried out in June/July 2008 following recruitment of a Project Officer in Equality and Diversity for the PCT. It is anticipated that this post will be advertised early March. The Board NOTED the content of the report and APPROVED the minor revisions to the scheme. KPCT/08/39

Joint Strategic Needs Assessment (JSNA) Dr Judith Hooper gave a presentation on the Joint Strategic Needs Assessment to the Board. She explained that this is a jointly produced review of needs across and within Kirklees. It should form the basis for planning service development and is seen as a key building block of the commissioning process. The JSNA groups Kirklees people into Children and Young People or Adults. In total there are 130 indicators of health issues for children and Young People and 32 health and social needs indicators for Adults. Dr Hooper highlighted the main health challenges facing children and young people. These are: • • •

Dying before their first birthday Personal unhappiness and social isolation Obesity, which is rising year on year

There are underlying factors that affect one or more of the challenges. Therefore the proposed key issue are: • • • •

Food Alcohol use Emotional well-being Educational attainment

The following were also noted as being crucial: • • •

Smoking tobacco Physical inactivity Sexual health

The health and well-being key issues for adults were also highlighted: Specific populations: • •

Older people Adults with disabilities Page 11 of 15


Conditions: Developmental • Mental ill-health • Dementia • Obesity • Pain including musculo-skeletal Targeting • Heart disease and stoke • Diabetes Behaviours Developmental • Food • Alcohol Targeting • Physical activity • Smoking Wider factors Targeting • Housing condition and options • Employment • Isolation and social networks • Educational attainment Dr Hooper described the steps which will be taken to improve health inequalities in the next six months. It was recognised that investment was necessary in the areas of greatest need to reduce health inequalities and that a joint approach towards funding resources was fundamental, coupled with a robust programme management system. The Board AGREED to SUPPORT the Joint Strategic Needs Assessment. KPCT/08/40

Alcohol and Substance Misuse in the Workforce Policy Sue Ellis introduced the Alcohol and Substance Misuse in the Workforce Policy to the Board. She explained that the policy had been reviewed last year and the Senior Management Team and Staff Partnership Forum were consulted. The policy was developed by the HR Shared Page 12 of 15

Service to use in Calderdale PCT and was approved by Calderdale PCT recently. The Board requested that the word ‘could’ be removed from the last paragraph of the policy statement. Sue AGREED to check how ‘substance misuse’ was defined. The Board APPROVED the Alcohol and Substance Misuse in the Workplace Policy. KPCT/08/41

Developing a Strategy for Services in Mid Yorkshire Hospitals – Report on Stage 1 Outcome Mike Potts presented the Developing a Strategy for Services in Mid Yorkshire Hospitals – Report on Stage 1 Outcome Report to the Board. Mike gave background to the development of the service strategy provided by Mid Yorkshire Hospitals NHS Trust. He explained this work had been undertaken in partnership with Wakefield PCT and Mid Yorkshire Hospitals NHS Trust and overseen by the Kirklees and Wakefield Partnership Board. The report summarises the outcome of Stage 1 of the agreed process for developing the service strategy and sets out the recommendations for work to be commissioned under Stage 2 of the agreed process. Mike emphasised that there were five services where the clinical evidence would indicate that clinical outcomes for patients could be improved if services were centralised. These services are: • • • • •

Trauma Neonatal intensive care Acute Stroke Services Childrens’ Inpatient surgery Chemotherapy

Stage 2 of the work would now look in more detail at the cases for change in the five areas identified and if at the end of the process centralisation or changes in service location are indicated then a period of full public consultation will be undertaken. State 2 would be completed by the end of June 2008. It was therefore AGREED that the Board would receive regular updates on the development of Stage 2. It was noted that a joint letter had been sent to GPs and that a briefing session would be organised for local elected members in the North of Kirklees. Page 13 of 15

The Board AGREED to: • • KPCT/08/42

SUPPORT the recommendations of the Kirklees and Wakefield Partnership Board and AGREE to commission Stage 2 of the work as detailed in the report.

Standards for Better Health 2008 Declaration Preparations The Board RECEIVED and NOTED the update on the PCT’s preparations for the 2008 Standards for Better Health Declaration.


Developing a Local Involvement Network (LINK) for Kirklees The Board AGREED to defer this agenda item to the Private session of the Board meeting.


Commissioning Policy on the Use of Cranial Banding in the Treatment of Positional Plagiocephaly and Brachycephaly The Board RECEIVED and NOTED the Cranial Banding Policy information.


Minutes of the PEC meeting held 16 January 2008 The Board RECEIVED and NOTED the minutes of the PEC meeting held on the 16 January 2008.


Minutes of the Finance and Performance Committee held 12 December 2007 The Board RECEIVED and NOTED the minutes of the Finance and Performance Committee held 12 December 2007. It was highlighted that members of the Finance and Performance Committee were happy that the actions to address the under achievements concerning mental health issues were sufficient.


Minutes of Yorkshire and The Humber Specialised Commissioning Group held 18 January 2008 The Board RECEIVED and NOTED the minutes of Yorkshire and The Humber Specialised Commissioning Group held 18 January 2008.


Any Other Business There were no items of any other urgent business.

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Date and time of the next meeting It was AGREED that the next meeting of the Kirklees PCT Trust Board would take place between 9.15am and 11.30am on Wednesday 26 March 2008 in the Board Room, St Luke’s House, Huddersfield.

Questions from the Public The Chairman gave a final opportunity for members of the public to raise any questions. David Thompson raised concern regarding pathology services being under resourced eg delayed cancer patient results. Carol McKenna advised that this issue was being addressed. Eugena Hayes enquired how the PCT would enable people to take up local physical activity services. Dr Hooper advised that there are many different initiatives which the PCT promotes to encourage people to take up a variety of community activities, however this cannot be enforced. Eugena asked the PCT to explore extending the Physical Activity and Leisure Scheme (PALS) beyond the 45 week programme or look at providing free access to physical activities for over sixties. It was recognised that this is being explored and that people can also apply for a Kirklees Passport, a council-run discount scheme administered by Kirklees Culture and Leisure Services. Mehboob Khan also advised that the Council is also exploring funding for day care services for older people which is likely to come into effect within the next 12 months. Rob Napier thanked Eugena for her questions and said that the Board would take her comments on board. This concluded the content of the Pubic Board meeting and the Chair declared the meeting closed at approximately 1.00pm.

Chairman’s Signature: ………………………………….

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Date: ………………