Minutes of the Meeting held on Wednesday 25 August 2010 at 9.15 am in the Boardroom at Broad Lea House, Bradley Business Park, Huddersfield
Present: Rob Napier Tony Gerrard Mehboob Khan Rob Millington Vanessa Stirum Mike Potts Dr David Anderson Dr Judith Hooper Bryan Machin Carol McKenna
In attendance: Laura Campbell Helena Corder Peter Flynn Karen Hemsworth David Thompson Pauline Kershaw
Chairman Non-executive Director Non-executive Director Non-executive Director Non-executive Director and Vice Chair Chief Executive Chair, Clinical Executive Committee Executive Director of Public Health Executive Director of Finance Executive Director of Commissioning and Strategic Development
Assistant Director of Workforce Commissioning and Policy Director of Corporate Services Director of Performance and Information Assistant Director for Safeguarding Children and Vulnerable Adults Observer/LINkS Representative Executive Assistant to the Chief Executive
In addition, there were 3 members of the public in attendance. The Chairman opened the meeting by welcoming all those in attendance, in particular Karen Hemsworth, who was deputising for Sheila Dilks, Executive Director of Patient Care and Professions, and Laura Campbell, who was deputising for Sue Ellis, Director of Human Resources and Organisational Development. Questions from the Public The Chairman gave an opportunity for members of the public to raise any questions. David Thompson referred to page 257 of the minutes of the last meeting (Finance and Performance Committee Minutes - FPC/40/10) regarding overtrades with other providers, significantly Barnsley Hospital NHS Foundation Trust which is mainly spread across their elective and non-elective obstetric activity. David had previously made enquiries of Martin DeBono regarding the number of woman accessing obstetric services in Barnsley and at the time had received a reply detailing the numbers involved. Mike Potts reminded David that patients have a choice of where to access services and GPs will be offering Barnsley as one of the options available.
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A letter had been received from Cath Gleeson, regarding a COPD/heart failure service redesign focus group she had recently attended. This was brought to the Board’s attention as it was felt this group was very secondary care focused. Mike Potts agreed to discuss with NHS Calderdale and Calderdale and Huddersfield NHS Foundation Trust to ensure this work was conducted in partnership and that Cath’s observations were taken into account. KPCT/10/147
Apologies for Absence Apologies for absence were received from Valerie Aguirregoicoa, Non-executive Director; Imran Patel, Non-executive Director; Sheila Dilks, Executive Director of Patient Care and Professions; Sue Ellis, Director of Human Resources and Organisational Development.
Declarations of Interest David Anderson declared an interest in agenda item KPCT/10/154 - Use of thresholds in the calculation of “fair shares” on Practice Commissioning Budgets for 2010/11.
Minutes of the meeting held 30 June 2010 The minutes of the Trust Board meeting held on 30 June 2010 were AGREED as a true and accurate record.
Matters Arising KPCT/10/119 - 2012 Olympics – NHS Challenge As part of the Board sign up to this challenge, a PCT sports day had taken place on 18 August 2010. A high number of staff had taken part in this enjoyable event and photographs taken on the day will soon be available on the Intranet. The first session for PCT staff on how to remain as healthy as possible, has been arranged at Broad Lea House over the lunchtime period on Wednesday 25 August 2010, by the Health at Work team. Mehboob Khan reported that Kirklees Council have submitted a bid for the Olympic torch to come to Kirklees and suggested that the PCT may wish to support this bid.
Chief Executive’s and Clinical Executive Chair’s Report Mike Potts presented his report to the Board highlighting the following:
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Equity and Excellence: Liberating the NHS Mike said it was important that NHS Kirklees responds to the national consultation on the White Paper. Lead directors will be starting to engage with as many people as possible offering the opportunity for all views to be shared and fed back to the centre. When responses have been collated, this information will be shared with the Board via email, in order to meet the deadline for responses which is 11 October 2010. Since the last meeting, good progress has been made in engaging GPs in looking at numbers and size of GP Consortia required in the future. This work will continue with a view to reaching agreement on the number, size and model of working by December 2010. Key events between now and December include: • • • •
LMC/PCT co-sponsored event for all GPs – 27 September 2010 PCT/PBC Chairs meeting to consider PCT functions and where these might sit in the future. PCT/LA/PBC meeting to consider the future role of the LA and in particular shaping the Health and Well being Board. Regular monthly dialogue between PCT and PBC Chairs to take forward this agenda.
Transforming Community Services Mike explained that there is no progress report at today’s Board meeting as an extra-ordinary, single item agenda meeting is to take place on 1 September 2010 to consider KCHS’s Right to Request.
Petition to Save Dewsbury Hospital Kirklees Council received a petition from residents of Dewsbury about the future of the Hospital. This was forwarded to Judith Hooper to prepare a response. The response is included in the Chief Executive’s report and will be available on the Kirklees Council website.
Development of Public Health Services A letter has been received about the development of Public Health Services. Three Regional Directors of Public Health have been seconded to the Department of Health to look at the Public Health White paper. Judith Hooper agreed to feedback to Board.
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The Board were reminded that there would be six briefing/development sessions held over the year in order to keep up to speed with transition around the White Paper and also how the new national public health function is developing. •
The Health Informatics Service – Annual Report The Board noted the above report which is available on request from the Chief Executives’ Office.
Clinical Executive David Anderson reported that the new Clinical Executive has met twice and a development session has been arranged for 1 September 2010, to look at how the executive can best operate in order to provide clinical leadership and advice to the Board. The Executive intend in the future, to meet on a separate day from the Commissioning College. Discussion took place around the future role of GP consortia and Mike Potts explained it will be a small number of GPs who will take on the significant role. All GP practices will need to be members of the consortia and will be expected to shape and deliver the objectives set by their consortia to manage resources and to meet the needs of their local population. Rob Napier, together with David Anderson, thanked Mike and his senior team for the level of support being offered to GPs in taking forward this challenging agenda.
Finance Report Bryan Machin presented the Finance report for the period up to July 2010. He advised the Board that the level of financial challenge facing the PCT is significant and acute contracts are expected to overtrade significantly, based on three months’ information. There have been some successful contract challenges made with Mid Yorkshire and other aspects continue to be discussed. Bryan explained the need to focus on the level of efficiencies required and indicated that decisions made this year may impact on next year. As the updated planning assumptions have not yet been received for 2011/12, it is likely that these will be significantly different. It is not known as yet how the costs of delivering the management changes will be handled. Following discussions at last week’s Finance and Performance Committee meeting, a more comprehensive report will be produced for the October Board meeting. Page 4 of 11
Bryan stated that at this stage of the year, he believed that the PCT could achieve its control total of a £9.9m surplus. Mike Potts explained that he is working with other Chief Executives on how, together, we might manage activity going into CHFT. We will engage with GP consortia and clinicians and have clinical debate around working together to manage the overtrade. The SHA are also taking an interest in this. The Board NOTED reasonable assurances around the forecasted financial position and financial risk and also NOTED the scale of the efficiency challenge for 2011/12 supported work to develop efficiency plans to address this. KPCT/10/153
Performance Report Peter Flynn presented the Performance report to the Board which highlighted areas of under/over performance against the key performance indicators that contribute to the PCT’s annual performance rating or benchmarking data set for 2010/11. The CQC are no longer reporting PCT scores, but for information, Peter predicted that the score for NHS Kirklees for 2009/10 would have been “good”. Peter updated the Board on seven items. •
Yorkshire Ambulance Service Performance – there continues to be some concern about performance, however, the aggregate position is higher than last year. Carol McKenna explained that this may be as a result of the internal operational improvement plan, staff sickness being tackled and staff training being in place. YAS is now mid table nationally. It was acknowledged that more work still needs to be done to improve the position in Kirklees as there are still variations across localities. Performance is still poor in Kirkburton and Denby Dale but is better than previously reported. Rob Napier fed back from his meeting with Della Cannings, Chair of YAS. Della had taken on board the poor performance in Kirklees, particularly in Kirkburton and the valleys and it had been agreed to keep in touch regarding this issue. Mike Potts said there is a Kirklees specific action plan that has been agreed with YAS which is targeted to improve areas where there is still significant underperformance. Rob Napier said he is pleased that Overview and Scrutiny have put this issue on their work programme.
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There was a discussion on the levels of performance that could be expected in rural areas. Carol McKenna suggested that benchmarking with other similar areas would probably be required to determine what level of performance would be reasonable. •
A&E – Total time in A&E – the aggregate performance is being maintained.
18 Weeks RTT Admitted Pathway – 82%. Mike Potts reported that there is a lot of work currently being done with Mid Yorkshire, particularly through Wakefield PCT, who lead on this contract. There are two main issues, one being the backlog of existing patients to be treated and two, the number of patients not being treated in 18 weeks. The problems in Mid Yorkshire are partly historical from the problems reported earlier in the year and also continuing inefficiencies in managing out patients. Mike had attended a meeting this week, where he had been assured we might reach our target. The definitive position will be known next week. Mike is to discuss the situation with Chief Executive colleagues. Carol McKenna felt the work done earlier in the year around demand management and consultant to consultant referrals is now having an impact, therefore, this is not believed to be a demand problem. Mike stressed that robust conversations were taking place about this issue.
Proportion of patients with breast symptoms referred to a specialist who are seen within two weeks of referral - Peter said Mid Yorkshire are addressing the challenges and performance has increased significantly over the last month.
Chlamydia Screening – Discussion is currently taking place amongst Directors of Public Health regarding the merits of screening for Chlamydia and the medical benefits.
Stroke Care: - TIA patients treated within 24 hours – Remains difficult to measure rationally, hence excluded in 2009/10 assessments. - Patients spending more than 90% of hospital stay on stroke unit – on target to deliver that level of stroke care.
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MRSA –Both CHFT and MYHT are over trajectory. However these trajectories are set much lower this year (compared to last year) and in absolute terms both CHFT and MYHT continue to improve.
Use of thresholds in the calculation of “fair shares” on Practice Commissioning Budgets for 2010/11 Bryan Machin presented the report and highlighted that the PCT had engaged widely with Practice Based Commissioners about PBC budgets for 2010/11 and most of the complexities and policy options have been worked through and agreement reached as to the approach to be taken. However, there remains one issue on which it has not proved possible to reach consensus; the use of thresholds in the calculation of PBC “fair shares” budgets. The argument put forward by North Kirklees representatives is that the utilisation of the threshold is preventing the required redistribution of resources to reflect need in Kirklees. They have proposed a methodology that halves the threshold. The Board received a recommendation that the PCT should follow the national toolkit calculations for the following reasons: •
In time, the GP commissioning consortia allocations will be made direct from the national NHS Commissioning Board, therefore, to deviate from national policy at this point does not seem appropriate. The thresholds exist because it is not possible to calculate an absolute fair share at sub PCT level. There is no evidence that there is differentially significant pressure on NK budgets. Some NK practices and consortia have generated considerable freed up resources.
The Board AGREED not to deviate from the national toolkit at this juncture. KPCT/10/155
Board Assurance Framework 2010/11 Helena Corder presented the Board Assurance Framework (BAF) and explained that some additions had been made to the original document in light of the White Paper. The document has been updated by directors and will be taken to SMT meetings on a regular basis. Carol McKenna and Bryan Machin are to have a conversation around the interface between Finance and Performance and Strategic Development Committees later in September. Carol agreed that in future, a risk register will be attached to the minutes of SDC meetings. Page 7 of 11
It was suggested that any changes to the risk register should form part of the minutes and a copy of the risk register is to be attached to minutes when circulated. Mike Potts is finalising director objectives and stated that risk management was included in all directors’ objectives. The Board NOTED the revised content of the framework for 2010/11. KPCT/10/156
Development of a Pharmaceutical Needs Assessment (PNA) for NHS Kirklees Lucianne Ricketts attended the meeting and explained that the PCT has a statutory duty to provide and publish a Pharmaceutical Needs Assessment (PNA) for NHS Kirklees, by 1 February 2011. The PNA will, from April 2011, form the basis for determining applications from potential new pharmacies to join the PCT’s pharmaceutical list. The PNA has been developed for NHS Kirklees under the auspices of the PNA Project Group and is now ready for formal public consultation. The consultation period is from 9 August to 15 October 2010. The final PNA document will come to the January 2011 Board for ratification, in order to meet the regulatory publication deadline of 1 February 2011. The PNA must be reviewed on a yearly basis to make sure it is up-to-date in terms of provision. Every three years, the PNA must undergo a robust review. Mike Potts congratulated Lucianne and all who had worked on this document. The Board RECEIVED the report.
Looked After Children Report 2010 Karen Hemsworth presented the Annual Looked After Children’s Report and explained that the Looked After Children’s Team now sit with Kirklees Community Healthcare Services. Judith Hooper asked that the author of the report be asked to check the data for under 18 conception rates for Kirklees. Judith said there is a placement officer in Kirklees who checks placements for out of the area, but asked how the health needs are checked. Karen explained that there are currently reciprocal arrangements across the Yorkshire and Humber region whereby health advisers in those areas carry out health assessments. Page 8 of 11
Occasionally, if this does not happen, the Kirklees Health Advisors arrange for the health assessments to be carried out. Whilst it is clear that the placing authority is responsible for Looked After Children placed out of area, the current guidance fails to address some of the responsibilities for health assessments undertaking out of the area and consequently the approach is fragmented. There are also discrepancies in payments for health assessments and this issue is continually raised at national level. Mike Potts asked if anything else needed to be done. Karen said there is agreement regionally to continue to ask for this to be on the agenda nationally. Mehboob Khan asked for information around “hot spot” areas and if this could be provided by electoral wards. Mehboob is to forward letter from the Chair of the Kirklees Safeguarding Board about abolition of the PCTs. Mike suggested that the issue of children being placed in Kirklees from other areas that we are not aware of, should be flagged up with the SHA and he will write to them to request that they escalate this matter to the Department of Health and reassure us that this issue is being picked up. The Board supported this suggestion and NOTED the report. KPCT/10/158
Yorkshire and Humber PCT Collaborative Common Fund 2009/10 The report is to reassure the Board that their contribution to the Yorkshire and Humber PCT Collaborative Common Fund for 2009/10 has been appropriate in terms of agreed priorities and what the Collaborative was designed to focus on and also that NHS Kirklees have hosted this fund appropriately. The Board NOTED the content of this report.
Yorkshire and Humber PCT Collaborative – Delivery and Mainstreaming of Collaborative Programmes – January 2008 to June 2010 The report summarises the outcomes and achievements of the collaborative work programme and notes that as the Collaborative is winding down these programmes are being mainstreamed. Future collaborative working is now being focussed on a sub regional basis through West Yorkshire Commissioners (WYCOM) which is looking at how PCTs across West Yorkshire will need to work more closely together during the White Paper transition period. The Collaborative will cease to exist between September and December 2010. The Board NOTED the content of this report. Page 9 of 11
Revised Rolling Board Programme The Rolling Board Programme has been revised to respond to the internal and external changes as a result of the White Paper. If the Expression of Interest goes to a business case, this will need to go to a December Board meeting. Therefore, at the December Board Briefing Session, it will be necessary to have part of this session as a formal Board meeting. The Board APPROVED the revised rolling Board programme.
Minutes of the Governance Committee The Board RECEIVED and NOTED the minutes of the Governance Committee held on 16 June 2010.
Minutes of the Yorkshire and the Humber Specialised Commissioning Group The Board RECEIVED and NOTED the minutes of the Yorkshire and the Humber Specialised Commissioning Group held on 23 July 2010.
Minutes of the Strategic Development Committee The Board RECEIVED and NOTED the minutes of the Strategic Development Committee held on 10 June 2010.
Minutes of the Communications and Public Relations Committee The Board RECEIVED and NOTED the minutes of the Communications and Public Relations Committee held on 10 June 2010.
Minutes of the Human Resources and Organisational Development Shared Governance Board The Board RECEIVED and NOTED the minutes of the Human Resources and Organisational Development Shared Governance Board held on 15 March 2010.
Minutes of the Finance and Performance Committee The Board RECEIVED and NOTED the minutes of the Finance and Performance Committee held on 19 May and 23 June 2010.
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Minutes of the Kirklees Community Healthcare Service Board The Board RECEIVED and NOTED the minutes of the Kirklees Community Healthcare Service Board held on 30 April, 24 May, 24 June and 15 July 2010.
Actions of Kirklees Partnership Executive The Board RECEIVED and NOTED the actions of the Kirklees Partnership Executive from 3 June and 27 July 2010.
Any Other Business There were no other items of business.
Date and time of the next meeting It was AGREED that the next meeting of the NHS Kirklees Trust Board would take place between 9.15 am and 1.00 pm on Wednesday 27 October 2010 in the Boardroom at Broad Lea House, Bradley Business Park, Huddersfield. In addition, there will be an extraordinary single item agenda Board meeting to take place between 2.30 pm and 4.30 pm on Wednesday 1 September 2010 in the Boardroom at Broad Lea House, Bradley Business Park, Huddersfield.
Questions from the Public The Chairman gave a final opportunity for remaining members of the public to raise any further questions. No questions were raised. This concluded the content of the Public Board meeting and the Chairman declared the meeting closed at approximately 11.10 am.
Chairman’s Signature: ………………………………….
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