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KIRKLEES COMMUNITY HEALTHCARE SERVICE BOARD

Minutes of the Kirklees Community Healthcare Services Board (The KCHS Board) held on 26 March 2010 at 13:30 – 17:00 in Beckside Court Meeting Room 2 I

Suzy Brain England OBE, (Chair) (SBE) Robert Flack, Director of KCHS (RF) Munir Ahmed, Non Executive Director (MA) Pam Lumb, Head of Therapies (PL) – Representing TQ Janice Boucher – Finance and Performance Lead (JB) Patricia Drake, , Non Executive Director (PD) Barry Lane, Assistant Director of HR (BL)

In attendance:

Lyn Milnes - Minute Taker (LM) Apologies for Absence There were apologies for absence received from: Tina Quinn, Clinical and Operations Lead of KCHS (TQ) Gwen Ruddlesdin – Head of Integrated Governance (GR) Declaration of Interest Declarations of Interests are recorded and held with The KCHS Board Secretary. Suzy Brain England and Munir Ahmed declared they are standing for election as a councillor in Kirklees.

KCHSB 10 141 b

Minutes of The Previous Meeting The minutes of the Kirklees CHS Board meeting held 26th February 2010 were agreed as a true and accurate record and were signed by the Chair. Matters Arising Matters arising were recorded on the attached action sheet numbered KCHSB 10 141d .

ACTION

REPORTS KCHSB 10 142

ACTION 1 - Case reviews - Serious case review should be put on the closed agenda so lessons can be learned and The KCHS Board is aware of any issues.

Managing Directors Report RF presented his report to the Kirklees Community Healthcare Services Board (KCHSB) summarising the previous months activity: 

Contract Negotiations Outline contract for 2010/11 has now been agreed. Commissioner agreed to include an agreement to no financial penalties for not achieving access targets where there is no 1


baseline demand agreement. Deadline for signing contracts is before 31 March, additional agreements to the contract in process of being finalised. 

Home Valley Hospital Development Work has begun to get final business case underway for the redevelopment of Holme Valley. Development partner being sought through the procure 21 process. Plans still in draft form but a smaller development is now more likely within existing footprint of the building. Service plans currently being revised final decision expected within the next 4 weeks. RF informed The KCHS Board of the work involved for the hospital development and said that discussions are taking place with commissioners about how rehab will fit in. A discussion took place about Pinderfields losing 120 beds and the consequences to KCHS. RF said the predictive risk tool is impressive showing we can take some control and case manage. Intermediate care needs a longer discussion

Partnerships with secondary care Discussions have taken place regarding, transforming community services guidance and how we can achieve the CQUIN developments – in particular end of life care. Further detailed reports will be brought to The KCHS Board in the coming weeks.

Union activity There is now a union rep in place working with staff and colleagues to help through the forthcoming changes.

The KCHS Board RECEIVED and NOTED the Managing Directors Report. ACTIONS

ACTION 2 - RF bring back plans for the HVMH development to the next KCHS Board meeting. ACTION 3 – PD, RF and SBE to discuss Intermediate care outside the meeting.

KCHSB 10 143 a/b

Finance and Performance Lead Update Janice Boucher presented the Finance report to update The KCHS Board on Finance & Performance for February and expected risks to full year position The purpose of this report is to update The KCHS Board on the following: 

Financial performance for February and expected risks to full year position

Benefits achieved through cost reduction programmes since September 2009

Budget 2010/11 Update

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2009/10 Current Position Overall, we have seen continued favourable movement in February costs against Budget resulting from receipt of additional income and a further reduction in headcount. Overall costs were £6k favourable in month bringing YTD position £23k favourable. Paid headcount has reduced from 955 last month to 946 (including the Corporate transfers) and is now below funded for the first time by 6 Full Year risk to Budget circa £50k. Our reduced risk reflects the continued focus on cost and vacancy control. Key movements include:£294k Risk identified last month £(50)k further reduction in headcount 9WTE for 2 months £(74)k further reduction in Interpreter Costs £(42)k QOF & income in GP practices, and Speech Therapy Income. £(41)k Administration/Other under spends £(33)k Reduction in Flagship bed usage £55k Full Year Risk as at February 2010 There are a number of actions which require continued effort to minimise our overall risk to full year: 

Continue Vacancy control, although we may need to reassess those areas with service challenges

School nurses to be in line with funded position by May 2010

KICES stock take and valuation of stock scheduled 17 March 2010

At September 2009, we identified a full year risk of £897k. This has been reduced to £55k through key actions. KCHS is required to deliver £2.0m Cost Improvement to meet the financial targets for 2010/11. Throughout the budget setting process, routes have been identified to meet a significant proportion of this but still leaves a residual unidentified gap of £245k which has been agreed to be allocated across budgets. The KCHS Board congratulated the finance team for the magnificent turnaround through Janice’s leadership and Robert’s support. The KCHS Board agreed : 

The freeze will have to be handled differently to meet challenges.

KCHS have learned about the need for controls and managing information and understanding we are all in this together.

The plan to continue vacancy control.

The KCHS Board RECEIVED AND NOTED the Finance report.

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Tabled

Corporate SLA Action Plan Janice handed out a document which updated The KCHS Board on the status of the SLA’s. RF explained the difference between contracts and SLA’s. The contracts are with the PCT and SLA’s are with other providers. High value SLA’s need to be signed off and closed before the year end. The KCHS Board agreed that they support Janice to purchase direct services that are required and pull the plug on things that are not. The priority is to provide services for patients.

ACTIONS

KCHSB 10 143 c/d

ACTION 4 - MA suggested that Quality Board reports and Patient Safety reports should be brought to The KCHS Board. Performance Report Janice Boucher reported on Michael Crowther’s Performance Report informing the KCHS Board that KCHS is in the process of developing an Integrated Performance Framework. The strategic objectives for the next five years are currently being developed and will be finalised in the Strategic Business Plan to be published in June 2010. The development of the performance framework will be directed at tracking the achievement of strategic objectives. Performance reporting in 2009-10 is concentrated on Performance against key national priorities while we are developing a range of Performance measures for each service, to develop evidence and understanding of quality and value for money for all the services we provide. KCHS continues to achieve significantly against national priorities and existing commitments set out in the Annual Health check. There are, however, some areas of concern where remedial action plans are being developed to improve current performance levels. In addition there are some improvements required against locally agreed priorities. KCHS Board is asked to note:  February’s Performance highlights and exceptions.  Remedial action plans that are in place  Further risks identified regarding the achievement of Performance priorities. The KCHS Board RECEIVED and NOTED the performance report.

KCHSB 10 144

Clinical and Operational Leads Update PL updated The KCHS Board on the following: 

Commissioning for Quality and Innovation (CQUIN) Regional indicators were due to be signed off at an SHA meeting 4


on 23rd March 2010. Local indicators are subject to further negotiations, which are due to start on 24 March 2010. 

School Nursing Individual meetings have been held with all the affected individuals. In total 186 hours of Band 3 time has been lost. The commissioners and KCHS will work together to minimise the impact of this.

The KCHS Board RECEIVED and NOTED the Clinical and Operational leads report. KCHSB 10 144 a

Record Keeping Action Plan – FNP Team A record action plan was included in the pack of papers to inform The KCHS Board of the issues, actions, date and responsibility lead.

Tabled

Dermatology Pam Lumb presented a paper on Dermatology on TQ’s behalf. The report is provided to inform The KCHS Board of the current issues within the dermatology service and the impact these have on meeting the 18 week stretch targets. It also highlights the difficulties encountered in ensuring satisfactory links to secondary care are available and therefore the supervision requirements of the GPWSis are met. There could be a financial risk to the service if additional investment is required to ensure we meet the stretch targets and also meet the supervision requirements of the GPWSis. The risk assessment is not meeting stretch targets and also sustainability of service. The KCHS Board feels that there are risks if we don’t provide the service. The Impact on a 2 week wait is extra activity to be expected, PD wanted to see low numbers impact on patients included in the paper. RF said this has been centre lead in PCT for 18 months and has not picked this up. PD said she would like to see a more detailed document from the Governance Committee.

ACTION

ACTION 5 - The KCHS Board agrees this to go on to the governance agenda and reports to have more figures and impact assessments and clear route map then come back in to The KCHS Board.

Workforce Report No workforce report received. However, The KCHS Board did request that the workforce reports in future should include targets as well as historical data. ACTION

ACTION 6 - Workforce Report to include targets as well as historical data on reports. 5


KCHSB 10 147

Letter to Chairs re: Francis Report 22 3 10 The Francis report was discussed. Sheila Dilks has prepared a report which TQ will review and write an action plan to email to The KCHS Board, if this is agreed it can go to The KCHS Board to Board. The KCHS Board agreed that this was not much risk for KCHS. Draft will be ready early next week.

ACTION

ACTION 7 – TQ to prepare draft report after discussions took place on the Francis report for early next week. Staff Survey The Staff Survey paper has just been released and KCHS has shown a vast improvement three years ago KCHS had 10 red areas this year only 2 red areas. The KCHS Board agreed that KCHS will need to improve in some areas. The KCHS Board is pleased with the results and said well done but they do recognise there will be hard times ahead. The key messages will go out to staff.

ACTION

ACTION 8 – An action plan will be put in place as is every year through the workforce planning meeting.

MINUTES FOR INFORMATION KCHSB 10 133

Minutes of Finance, Performance & Business Development meeting held 18 February 2010 The KCHS Board RECEIVED and NOTED the Minutes of the Finance, Performance & Business Development Minutes of Workforce Committee No minutes available Minutes of Governance Committee meetings No minutes available KEY MESSAGES 1. Volcanic ash and annual leave You will all be aware of the impact the volcanic ash cloud is having on European travel arrangements. The KCHS board are keen to ensure the organisation has a flexible approach towards staff leave – meaning that if travel plans are such that leave needs to be delayed or extended then KCHS will be as flexible as possible. Whilst the organisation can’t give free leave to people, KCHS will ensure that individuals are able to work time owing over the course of the whole year. 2. Vacancy control Our vacancy control continues and The KCHS Board appreciates the flexibility required of staff to make this approach work well. All the vacancies which have not been filled have been recorded to ensure 6


services are covered and help keep track of the over all staffing situation throughout KCHS. 3. Staff Survey The results of the latest Staff Survey are really good and show marked improvement when compared to the previous survey. It’s encouraging to see that staff is reporting positive developments. For instance, the results are in the top 20% in the country and more than 60% said they worked in a well structured team environment when the national average is 50%. Compared to the previous year more staff report having well-structured appraisal and received support from their immediate manager. The KCHS Board is aware of the difficulties facing staff in the year ahead and pledges to work with you to make the coming months as manageable as possible. 4. Organisational form Board members discussed further at this meeting the integrated care model agreed as the potential way forward for KCHS when they met with the NHS Kirklees Board recently. The proposal, which is to be fully explored before a final decision is made, is that we integrate across the health and social care community. We are currently discussing this with the local authority and the local NHS organisations. The KCHS Board acknowledges the scale of the work required before a decision can be reached. Any Other Business ACTION

ACTION 9 - Patient safety impact should be put on The KCHS Board paper front cover ACTION 10 - Statement of Internal Control JB is meeting with Helena Corder next week the Statement of Control will need to be signed off by The KCHS Board. ACTION 11 – The KCHS Board Assurance Framework and Risk Register to be put on the agenda at The KCHS Board April meeting. Date and Time of Next Meeting The next meeting will be held on 30 April 2010 from 08:30 - 12:00 Beckside Court MR 2

…………………………………………….. Signed by Chair of Kirklees CHS Board

………………………………………….. Dated

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