Draft Minutes of the NHS Calderdale Board Meeting held on Thursday 29 September 2011 in the Shibden Meeting Room, F Mill, Dean Clough Mills, Halifax Present:
Angela Monaghan Ann Ballarini Alan Brook Roy Coldwell Andy Leary Trevor Lake Ann Liston John Mallalieu Mike Potts Matt Walsh Graham Wardman Keith Wright
Chair Executive Director of Commissioning and Service Development Chair of Clinical Commissioning Executive Non Executive Director Executive Director of Finance and Efficiency Non Executive Director Non Executive Director Non Executive Director Chief Executive Executive Medical Director Executive Director of Public Health Non Executive Director
Apologies for Sue Cannon absence: Stephen Griffiths
Executive Director of Quality and Governance (Nursing) Non Executive Director
Leader of Calderdale Metropolitan Borough Council Director of Human Resources and Organisational Development Associate Director of Business Intelligence Chief Operating Officer Head of Corporate Services Deputy Director of Quality and Professional Development Chief Executive of Calderdale Metropolitan Borough Council Board Secretary
Cllr J Battye Sue Ellis Deborah Graham Julie Lawreniuk Victoria Pickles Penny Woodhead Owen Williams Jane Brownlie
CHAIRâ€™S OPENING REMARKS The Chair referred to the fact that this would be the final meeting of the NHS Calderdale board in its present form and from October 2011 the Calderdale, Kirklees and Wakefield District Cluster Board would become the statutory Board for NHS Calderdale (as well as for NHS Kirklees and NHS Wakefield District). She advised that most of the executive team would be serving on the Cluster Board and four of the Non Executive Directors would either continue in their present role or were expected to become Non Executive Associates, but that Stephen Griffiths would be stepping down from his role as a Non Executive Director. The Chair paid tribute to the contribution Stephen Griffiths had made to the work of NHS Calderdale over the last three years. 1
The Chair also referred to the fact that this would be Andy Leary’s final meeting as Executive Director of Finance and Efficiency as he would be moving to a new role with another Primary Care Trust. 84/11
DECLARATIONS OF INTEREST Trevor Lake and John Mallalieu declared an interest in the item at Minute 95/11 and did not participate in the discussion or decision making on that item.
MINUTES OF THE MEETING HELD ON 4 AUGUST 2011 The minutes of the meeting held on 4 August 2011 were accepted as a correct record. MATTERS ARISING FROM THE MINUTES OF THE MEETING HELD ON 2 JUNE 2011
(a) National Paediatric Cardiac Surgery Review – Safe and Sustainable The Executive Director of Commissioning and Service Development presented this report which provided an update on the review of paediatric cardiac surgery services. Further to discussion at the June 2011 Board meeting, she advised that additional consultation sessions had been arranged to ensure greater engagement with the BME community since the initial sessions had not been well attended by that group. The Executive Director of Commissioning and Service Development referred to the timeline of the review, which was set out on page 3 of her report and added that the decisions on the review would be taken in a public meeting on 14 December 2011. (b) Update on Audit Committee’s review of the proposed Establishment Agreement for Calderdale, Kirklees and Wakefield District Cluster Partnership The Chair of the Audit Committee advised that although the Board had previously referred this item for consideration by the Audit Committee, it had subsequently been overtaken by events (specifically the proposal to form a Cluster Board [see Minute 94(b)/11 below]). He reported that the Audit Committee had therefore not considered this item. 87/11
PUBLIC QUESTION TIME There were no public questions.
CHIEF EXECUTIVE’S REPORT The Chief Executive gave an oral report and confirmed that considerable attention was presently being concentrated on the transitional arrangements to the new NHS structure. He referred to appointments having been made to the Strategic Health Authority (North East) and to the announcement that Joyce Catterick would not be seeking re-appointment to the post of Chair of the South West Yorkshire Partnership Foundation Trust (SWYPFT). The Chief Executive extended his good wishes to Andy Leary, Executive Director of Finance and Efficiency in his new post and reported that the process to appoint a replacement Interim Executive Director of Finance and Efficiency was on-going, but in the meantime Julie Lawreniuk would be acting as Executive Director of Finance and 2
Efficiency. He also reported that Yorkshire Ambulance Service was presently undertaking a public consultation exercise on its foundation trust application and the PCT would have an opportunity to comment in due course. DECISION That the Chief Executive’s oral report be noted. 89/11
PATIENT SAFETY AND QUALITY REPORT The Deputy Director of Quality and Professional Development presented this report which provided an update on progress in implementing the patient safety strategy 2009-2012 and provided an overview of quality and patient safety activities. A Non Executive Director referred to the discussion at the previous Board meeting in respect of the increase in the incidence of pressure ulcers reported by Calderdale and Huddersfield Foundation Trust (CHFT). The Deputy Director of Quality and Professional Development advised that this had been discussed at the regular meeting with CHFT officers in September 2011, they had wanted to look into the matter further and it was to be discussed again at a further meeting scheduled for October 2011. A Non Executive Director commented upon the report’s reference to the Care Quality Commission’s concerns regarding care provided in some of the Castlebeck Care Group homes. He noted the steps outlined in the report to review the four Calderdale residents presently placed in Castlebeck homes and asked whether their Care Plans were being adhered to. The Director of Public Health confirmed that the Continuing Care Team was regularly monitoring the situation and that the Care Plans were presently being followed. DECISIONS 1. That the quality dashboard and current quality performance information be received. 2. That the update on the current position in relation to the Commissioning for Quality and Innovation scheme be received. 3. That the update on recent Care Quality Commission activity be received. 4. That the update on the National Quality Board report – Maintaining and Improving Quality during Transition be received. 5. That notification of the peer review of children’s social care be received.
BOARD ASSURANCE FRAMEWORK AND HIGH LEVEL RISK LOG The Head of Corporate Affairs presented this report which introduced and included at its appendices the Board Assurance Framework and the High Level Risk Log. She asked that the board confirmed that these documents gave an accurate reflection of the present situation to be handed on in accordance with 3
the new governance arrangements which would be coming effect in October 2011.
The Chair referred to page 3 of the Board Assurance Framework and asked about a timeline for the gaps assurance column of the Health Care Associated Infections item. The Executive Medical Director advised that the Clinical Commissioning Executive had already received a report on this issue and there was no longer a gap in the assurance. DECISIONS 1. That the Board Assurance Framework be approved. 2. That it be confirmed that the Board Assurance Framework and the High Level Risk Log represent a true picture of the risk profile of NHS Calderdale. 91/11
CORPORATE PERFORMANCE REPORT The Associate Director of Business Intelligence presented this report which provided a summary of current performance in Calderdale. The Chair commented that this report showed very positive and strong performance and was one of NHS Calderdaleâ€™s legacy documents to the Cluster Board. She thanked everyone involved in achieving this position. Discussion took place on the difficulty in achieving progress against the target for reducing childhood obesity. The Chief Executive of Calderdale Metropolitan Borough Council commented that the Health and Wellbeing Board would be considering whether the existing health and local authority partnership had sufficient leverage to bring about the required change or whether a different approach needed to be considered, such as targeting schools. The Leader of Calderdale Metropolitan Borough Council also referred to the possibility of use of less traditional approaches, such as the Incredible Edible project. A Non Executive Director referred to the third page of the appendix to the report which indicated an increase in the total amount of time spent by patients in the Accident and Emergency (A & E) Department at the Calderdale Royal Hospital and he asked whether this was due to a problem with bed availability. The Associate Director of Business Intelligence advised that there were no indications of capacity issues, but this might be related to attention presently being focused on the entire activity in A & E to try to reduce the number of inappropriate attendances, which in turn would free up staff resources to enable quicker throughput of the cases that did required A & E attendance. Reference was also made to the aim of increased support of primary care to ensure that older people in particular did not attend A & E unnecessarily. DECISIONS 1. That the current levels of achievement made in Calderdale be noted.
2. That the areas of performance requiring continued focus and mitigating action taken in respect of them be noted. 3. That the developments associated with the strategic outcomes and impact on future governance for these indicators be noted. 92/11
ANNUAL AUDIT LETTER The Chair of the Audit Committee advised that the Audit Letter had also been presented to the Audit Committee. He referred to the fact that this Audit Letter was very positive, with an unqualified opinion having been given on the Annual Accounts, a finding that there were appropriate arrangements in place for securing efficiency and value for money and that the former NHS Calderdale Provider Services function had been satisfactorily transferred to its new provider partners. DECISIONS 1. That the content of the Annual Audit Letter 2010/11 be noted. 2. That the finance and executive teams be congratulated in achieving this strong and positive result.
FINANCIAL AND EFFICIENCY REPORT The Chief Operating Officer presented this report which provided an update on the forecast financial position for 2011/12 and risks associated with achieving the target surplus of ÂŁ3.6m by the end of the financial year. It was noted that although the RAG (red, amber, green) rating on many of the QIPP projects had been rated as amber (on page H6 of the report), good progress had been made and it was anticipated that most of the targets would be achieved. In discussion, reference was made to the present situation with the CHFT contract. It was reported that although there was still an outstanding issue regarding the non-elective threshold, it was not felt this constituted a financial risk to delivery of services at the contract cost. A Non Executive Director expressed the view that the arrangements around the CHFT contract this year appeared to be working well and with the opportunity for any under-spend being able to be used towards the anticipated winter pressures. It was noted that there was presently an under-trade on several contracts, although the reasons for this varied. The Chair referred to the 19.7% variation from the plan for nonemergency short term admissions at CHFT. The Chief Operating Officer reported that this had been unexpected but might be one of the consequences of changes made in 2010/11 to the way in which patients were processed through A & E. DECISION That the Financial and Efficiency report be received and the key risks and mitigating actions be noted.
FINANCE AND PERFORMANCE COMMITTEE â€“ MINUTES OF THE MEETINGS OF 24 MAY 2011, 28 JUNE 2011 AND 4 AUGUST 2011 5
DECISION That the minutes of the meetings of the Finance and Performance Committee held on 24 May 2011, 28 June 2011 and 4 August 2011 be received. 94/11
CALDERDALE TRANSITION PROGRAMME (a) Legacy Report The Head of Corporate Affairs presented this report which referred to the forthcoming move, on 1 October 2011, from separate Boards for each of the three PCTs in the Cluster to one single Board for NHS Calderdale, NHS Kirklees and NHS Wakefield District. A legacy report had therefore been prepared which set out the key areas of performance and delivery and issues and actions to be addressed by the Cluster Board and its sub-committees in respect of NHS Calderdale. The Head of Corporate Affairs sought comments from the Board as to whether this transition report gave an accurate reflection of the position in Calderdale or whether any additional items needed to be added. Board members suggested that specific reference be made to workforce issues (which could be included within the corporate performance report) and that Patient Safety and Quality needed to include information on Serious Case Reviews (SCRs), Serious Untoward Incidents (SUIs) and any â€œCause for Concernâ€? issues (all of which usually needed to be considered in the private session of Board meetings). It was also suggested that, in view of the fact that the Cluster Board would be covering a wider area, local focus (on Calderdale, Kirklees and Wakefield District respectively) also needed to be made. DECISION That the legacy report be accepted as an accurate reflection of the current situation in Calderdale subject to the inclusion of information on workforce issues, SCRs, SUIs and Cause for Concern reports and with a suggestion that a local focus be retained where appropriate.
(b) Proposed governance arrangements for the NHS Calderdale, NHS Kirklees and NHS Wakefield District Cluster Board Trevor Lake and John Mallalieu declared an interest in this item and did not participate in the discussion or the decision The Head of Corporate Affairs presented this report which described the governance arrangements being developed to support a single Cluster Board for Calderdale, Kirklees and Wakefield District. It was noted that this followed the national model of governance being implemented under guidance from the Strategic Health Authority. The report outlined a requirement for two Non Executive Associates to be appointed to support the Clinical Commissioning Executive (CCE) governance arrangements and set out the progress made in the governance arrangements of the Calderdale Commissioning Group and the Health and Wellbeing Board. 6
The Leader of Calderdale Metropolitan Borough Council asked how the Cluster arrangements would impact on the development of the Health and Wellbeing Board. The Chief Executive responded that the Cluster Board’s role was largely one of oversight in relation to the establishment and development of the Health and Wellbeing Board. The Executive Medical Director advised that the recent inclusion of two Non Executive Directors on the CCE had brought a different perspective to CCE meetings and discussions, so the proposal for the membership to include two Non Executive Associates was welcomed. The CCE Chair expressed agreement with those statements and added that the sooner responsibility was passed to the CCE the more opportunity there would be for the CCE to develop its capacity prior to the abolition of the PCT in March 2013. A Non Executive Director commented upon the absence of the Transition Board from the structure diagrams attached to this report. In discussion, the Head of Corporate Affairs advised that since the Transition Board was not a formal Sub-Committee of the Board it should not be included in the structure diagrams. The Chair of the CCE commented upon the fact that the membership of the Cluster Board did not mimic that of the NHS Calderdale Board and although the Cluster Board included some clinical members they were not sitting on the Board in the capacity of representatives of the CCE. It was commented that this reflected the Cluster Board’s role of concentrating on monitoring and facilitating the transition rather than direct commissioning. However it was pointed out that every alternate Cluster Board meeting was to be held in public, so members of the CCE could attend such meetings as observers if they wished and this might be particularly appropriate for the Cluster Board meetings held in Calderdale. A Non Executive Director (being also the Chair of the Audit Committee) reported that the Audit Committee had been asked to review the proposed Terms of Reference for the CCE. The Audit Committee had suggested that an executive be made available to provide advice on conflicts of interest and that an appendix be added to the Terms of Reference setting out the key targets the CCE was being expected to deliver. The Chief Executive expressed the view that those targets would be better addressed through the CCE’s Work Plan rather than its Terms of Reference. It was suggested that it might be appropriate to hold a joint meeting of the Cluster Board and the CCE, where the CCE’s work plan could be discussed. The Executive Medical Director advised that the CCE was well aware of the importance of developing and delivering a Calderdale Business Plan. DECISIONS 1. That the report detailing the proposed governance arrangements for the Cluster be received. 2. That the fact that the Cluster Board would become the Board for NHS Calderdale with effect from 1 October 2011 be noted. 7
3. That the appointment of Keith Wright and Roy Coldwell as Non Executive Directors to the Cluster Board be noted. 4. That Trevor Lake and John Mallalieu be appointed as Non Executive Associate members of the Clinical Commissioning Executive. 95/11
EQUALITY AND HUMAN RIGHTS SCHEME ANNUAL REPORT 2010/11 The Head of Corporate Affairs presented this report which provided an overview of equality and human rights activity in NHS Calderdale between April 2010 and March 2011. The report also outlined progress on delivery and implementation of the Equality an Human Rights Scheme, provided compliance with the commitment and statutory duty to publish an annual report and recommended the approval and adoption of the NHS Equality Delivery System. It was noted that this report had been considered by the CCE on 8 September 2011. In response to a Non Executive Directorâ€™s question, it was reported that a process was on-going to establish what grade NHS Calderdale was thought to have reached in progressing towards the four Equality Delivery System objectives. A Non Executive Director referred to issues concerning problems with a ramp in the building of the Todmorden Health Centre. It was confirmed that equality and disability issues would now be addressed at an earlier stage on capital developments. A Non Executive Director referred to the fact that the Chair was temporarily acting as the lead on equality issues following the resignation of a former Non Executive Director in the summer of 2011. The Chair advised that the Cluster Board was to be asked to identify both a Non Executive lead and an Executive lead on equality as soon as possible. It was noted that the adoption of the NHS Equality Delivery System was not mandatory but was being recommended. DECISIONS 1. That the report be received. 2. That the Equality Delivery System be adopted. 3. That the Cluster Board be asked to identify both a Non Executive lead and an Executive lead on equality as soon as possible.
SPECIALISED COMMISSIONING â€“ Yorkshire and the Humber Specialised Commissioning Group (i) Minutes of the Specialised Commissioning Group Meeting held on 27 May 2011 DECISION 8
That the minutes of the Specialised Commissioning Group Meeting held on 27 May 2011 and the decision summary for PCTs be adopted. (ii)
Minutes of the Specialised Commissioning Group Meeting held on 24 June 2011 DECISION That the minutes of the Specialised Commissioning Group Meeting held on 24 June 2011 and the decision summary for PCTs be adopted.
Minutes of the Specialised Commissioning Group Meeting held on 22 July 2011 DECISION That the minutes of the Specialised Commissioning Group Meeting held on 22 July 2011 and the decision summary for PCTs be adopted.
COMMITTEE MEETING MINUTES FOR APPROVAL In view of the committee structure changes, the Audit Committee, the Remuneration and Terms of Service Committee and the Risk Management Committee would not meet again in their previous format, so the minutes of their final meetings were presented for approval by the Board. DECISIONS That the minutes of the following meetings be approved: (a) Minutes of the meeting of the Audit Committee held on 16 September 2011 (b) Minutes of the meeting of the Remuneration and Terms of Service Committee held on 13 September 2011 (c) Minutes of the meeting of the Risk Management Committee held on 21July 2011
COMMITTEE MEETING MINUTES RECEIVED In addition to the Committee Minutes referred to earlier in these Minutes, the following meeting minutes were also received: (a) Audit Committee: Minutes of the meeting held on 10 May 2011 (b) Audit Committee: Minutes of the meeting held on 31 May 2011 (c) Calderdale, Kirklees and Wakefield District Cluster Partnership: Minutes of the meeting held on 7 June 2011 (d) Calderdale, Kirklees and Wakefield District Cluster Partnership: Minutes of the meeting held on 5 July 2011 (e) Calderdale, Kirklees and Wakefield District Cluster Partnership: Minutes of the meeting held on 2 August 2011 9
Clinical Commissioning Executive: Minutes of the meeting held on 16 June 2011 (g) Clinical Commissioning Executive: Minutes of the meeting held on 14 July 2011 (h) Clinical Commissioning Executive: Minutes of the meeting held on 4 August 2011 (l) Health and Social Care Partnership Board: Minutes of the meeting held on 8 June 2011 (m) Health and Wellbeing Board: Minutes of the meeting held on 8 June 2011 (n) Health and Wellbeing Board: Minutes of the meeting held on 26 July 2011 (o) Remuneration and Terms of Service Committee: Minutes of the meeting held on 26 May 2011 (p) Remuneration and Terms of Service Committee: Minutes of the meeting held on 12 July 2011 99/11
EXCLUSION OF THE PUBLIC DECISION As publicity of the subsequent business would be prejudicial to the public interest by reasons of its confidential nature, that representatives of the press and other members of the public be excluded from the meeting.
NHS Calderdale Board action sheet 29 September 2011 Report name
Action no. @
Comments (include, expected completion date, areas of concern etc)
Information to be included in the legacy report on workforce issues, SCRs, SUIs and Cause for Concern reports and with a suggestion that a local focus be retained where appropriate
Head of Corporate Affairs
Cluster Board to be asked to identify both a Non Executive lead and an Executive lead on equality as soon as possible.
Head of Corporate Affairs
Calderdale Transition Programme Equality and Human Rights Scheme Annual report
Published on Nov 4, 2011