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Minutes of The KCHS Board (The KCHSB) held on 30 November 2009 at 12:45pm – 15:15pm in Beckside Court Meeting Room 2 I

In attendance:

Suzy Brain England OBE, (Chair) (SBE) Robert Flack, Director of KCHS (RF) Munir Ahmed, Non Executive Director (MA) Patricia Drake, , Non Executive Director (PD) Tina Quinn, Assistant Director and Operational Lead of KCHS (TQ) Janice Boucher – Finance and Performance Lead (JB) Barry Lane, Assistant Director of HR (BL) Gwen Ruddlesdin – Head of Integrated Governance (GR) Jane Wragg – Team Leader Health Visitor (JW) Michael Crowther – Head of Performance and Business Development (MC) Lyn Milnes - Minute Taker (LM) Apologies for Absence There were no apologies for absence. Declaration of Interest There were no declarations of interests on any of the agenda items in this meeting. A ‘Declaration of Interest’ form was handed to each member of the KCHS Board to complete and return to Lyn Milnes. It was agreed that the forms would be reviewed annually.


ACTION 1 - Lyn to ensure all Declaration of Interest forms are collated.


Minutes of The Previous Meeting The minutes of the Kirklees CHS Board meeting held 22nd October 2009 were agreed as a true and accurate record and were signed by the Chair. Matters Arising Page 2 - The KCHSB has acknowledged that Janice Boucher will be leading on the carbon reduction issue. Page 2 - JB informed the KCHSB that she has a meeting scheduled with Bryan Machin on 1st December 2009. JB will report to the KCHSB re: the meeting.


Managing Directors Report RF presented his report to the Kirklees Community Healthcare Services Board (KCHSB) highlighting the following points: 

Leadership Challenge Leadership challenge feedback sessions are now completed with 1

all of T30. Action plans are now in place. 

Community/secondary care network meeting with Mid Yorkshire Hospitals A network was created to move developments in Dewsbury forward more quickly. The group will meet once every two months, with the initial remit of looking at therapies, the walk in centre which is aiming to move from current site into A&E in Dewsbury Hospital and the diabetes network. The project is being led by Peter Horner who will provide regular detailed updates to the KCHSB.

National community dataset and performance metrics The DH is currently developing the national dataset for community services. These are currently being piloted at national level. The IT providers (Systm1) will be tasked with ensuring that all the data fields are being recorded. These will be mandatory from April 2011. The national draft of these datasets is due before March. KCHS is acting as one of the national pilots for the nationally set performance metrics. The metrics are to allow commissioners and SHA to get a clear view of community performance and make community provider boards more accountable for their performance. Further details will come to the KCHSB in the New Year. The KCHSB expressed concern that the WIC is not open 7 days a week. This is to go to the Governance Committee to be discussed before coming back to KCHSB.

Letter from Unions RF has received a letter from the regional Unite representative on behalf of all partner unions, requesting an update on our organisational form. RF responded by inviting them to come and meet Suzy and himself with the intention of discussing next steps with them.

An IIP assessor is due to meet RF and members of T7 in December. SBE expressed a wish to meet him with Robert.

The KCHSB RECEIVED and NOTED the Managing Directors Report. ACTION


ACTION 2 - Send the national draft datasets documentation to the Chair and 2 NED's when received ACTION 3 - Arrange some dates to discuss organisational form. Single issues meeting in the new year but discussions before Christmas. Finance and Performance Lead Update Janice Boucher presented the Finance report to update the KCHSB on proposed action plan to validate the current and forecasted financial position for 2009/10 and provide update on financial performance. At the previous meetings the KCHSB were updated with: 2

Process issues and concerns re Forecast Model

Full year financial risks in the range of £600k to £900k.

Request to contribute £750k to meet shortfalls within the PCT – no commitment has been made to deliver this, pending route to bring Forecast inline with Budget

Identified Gap against Budget of £900k in September, which comprised 2 elements: 

Contractual Variations of £343k

Gap as at September to bring Forecast back in line with Budget c £560k, plus proposed contingency of £140k, resulting in target saving of £700k

The current position shows additional risks have been identified through a review of October month end, primarily around accrual omissions of £126k and CQUIN costs of £63k, partially offset via contract variations and transfer of Marie Curie risk to commissioner. Net impact – risk of £103k. It is proposed to reduce the contingency of £140k to £37k to keep the target cost saving at £650k. There are four key areas which need to be addressed to ensure costs remain within budget.    

Headcount KICES Contract variations Target saving of £650k

The Target savings were allocated out across budget holders to look at how they could save, but looks like there will be a £500,000 deficit. The KCHSB enquired what will happen if this is not achieved. It was stated that Kirklees PCT and the SHA will ask what is being done to resolve this. The budgets needs to break even to be a credible organisation. It was agreed to discuss headcount not funded at the F,P&BD meeting on 17th December 2009. A discussion took place about the use of agency staff TQ informed the KCHSB that agency staff is not used, staff are pulled from an internal bank or from other services. The KCHSB enquired if there is a written protocol. TQ will review process to commission bank staff. Michael Crowther presented the performance report to update the KCHS Board. KCHS is in the process of developing an Integrated Performance Framework, to ensure the strategic objectives of the organisation are delivered throughout the organisation. Current work is concentrated on Performance against national priorities as well as developing a range of Performance measures for each service which have been consistent with commissioners. KCHS is currently making significant progress towards achieving national 3

priorities and existing commitments set out in the Annual Health Check. There are also some areas of concern where remedial action plans are being developed to improve current performance levels. MC explained the amber red and green highlights in the October annual health check document 2009/10 which is included with his report document The KCHS Board expressed a wish to have an opportunity to understand the DNA’s MA is to meet with MC. The KCHSB RECEIVED and NOTED the Octobers performance highlights and exceptions and work that is underway to improve performance in key areas. ACTION

ACTION 4 - TQ to review process to commission bank staff. To be brought back to next KCHSB meeting in January. ACTION 5- MA to discuss KICES and stock checks with JB outside the meeting. ACTION 6 – A More detailed report to be submitted to the F,P&BD meeting ACTION 7 - MA is to meet with MC to discuss and understand performance and the DNA’s


Clinical and Operational Leads Update TQ updated the Board with the Clinical and Operational Leads report highlighting: Infection Prevention and Control KCHS is finalising a Service Level Agreement with Infection Prevention and Control. As a result from January 2010 KCHSB will have their own Infection Prevention and Control Nurse who will report to Gwen Ruddlesdin and will work to ensure high levels of infection control throughout all services. Building capacity: health visiting A follow up meeting was held at the SHA to look at next steps in building health visitor capacity across Yorkshire and Humber. It was agreed the work needs to continue. There will be three sub groups looking at competencies, hosting of students and developing costings for all elements of the service. Performance issues Podiatry, Community Occupational Therapy, Paediatric Speech and Language Therapy are all experiencing significant challenges in achieving 18 week targets.   

Podiatry will be implementing their escalation plan which means the withdrawal of social nail care for independent sector residential and care homes initially and then across the rest of the service. Community OT have an action plan in place and the waits are beginning to decrease. Speech and Language Therapy are developing an option appraisal report identifying solutions and risks which will inform the decision making process. 4

Community Matrons The Community Matron team is well on the way to developing the appropriate skill set to meet their objectives. The second quarterly report demonstrated a reduction in admissions and length of stay for patients known to the community matron service. It is expected this will continue in future reports. Swine flu Activity around swine flu is decreasing though a third surge is predicted. The vaccination program for front line staff is underway although uptake is low as staff are saying the safety of the vaccine is not yet proven because it has been authorised so quickly. Posters will be displayed to encourage staff to have the vaccine. The KCHSB support the staff having the immunisation. The Board agreed that they also have a duty of care to support the uptake of the seasonal flu vaccination School nursing A further meeting is due to be held with commissioners at the beginning of December to agree the service specification as well as the level of service that will be delivered within the current financial envelope. The KCHSB RECEIVED and NOTED the Clinical and Operational leads report. AREAS REQUIRING DECISION KCHSB/09/109

Strategic Business Plan ‘Defining Delivering the future’ Taking our strategy forward This report details the work that is underway to develop the Kirklees Community Healthcare Services (“KCHS”) five-year Strategic Business Plan. Progress has already been made in outlining the mission and vision for KCHS. The next steps that will be taken are intended to build the vision so that there is a clear blueprint for Community Services in Kirklees. This will allow us to identify the strategic objectives that underpin the Strategic Business Plan. It has been proposed to initiate a process that will engage and consult with internal and external stakeholders, to confirm the vision by creatively considering the six main clinical areas that are contributed to. Six groups will be set up that will report back to a stakeholder event in Mid January. The output from the ‘Defining the Future forums’ will be presented to KCHS board on 22nd January, and as a result the strategic objectives will be agreed. Recommendations The KCHSB is requested to review and agree the proposed plan and specifically: 1. The Journey Plan detailed in Appendix 1 2. The Pathway Focus Group process detailed in Section 4 3. The objectives / outputs for each Focus Group Session detailed in Section 5. 5

4. That the findings of the Focus Groups will be shared and added to by external stakeholders as described in Section 6. 5. 2-page summary reports from each Pathway group being presented to KCHS Board on 22nd January to inform the development of the Strategic Business Plan. A discussion took place and BL flagged up to the KCHSB the forums are engaging with staff but not representatives. Unions will be invited in January to the stakeholder meeting. Janice is uncomfortable about sharing certain information at the external stakeholder event. RF to obtain clarity on what should be shared. This to be discussed at the next T7. Outcome to be brought back to KCHSB meeting on 22nd January 2010. Permission was sought from the KCHSB who agreed in principal the following:   

KCHSB support production of the strategic plan for which a budget will be obtained The KCHSB support the six routes, recognising what mapping crossed to funding. The KCHSB agreed that they were not ruling out stakeholder engagements, but would like further definition.

The KCHSB RECEIVED, NOTED and APPROVED the Strategic Business Plans ACTION

ACTION 8 - Interim business plan to be sent out to NEDS. ACTION 9 - The output from the Defining the Future forums will be presented to KCHS board on 22nd January, as a result the strategic objectives will be agreed. ACTION 10 - A separate strategy needs to be put in place. RF and SBE to discuss out of the meeting. Take advice from BL and bring back to KCHSB in January. ACTION 11 - RF to obtain clarity from T7 on what should be shared at stakeholder event. This to be discussed at the next T7. Outcome to be brought back to KCHSB meeting on 22nd January 2010


Workforce Report, including actions on sickness monitoring BL presented the Workforce report to advise the KCHSB regarding workforce information for KCHS staff for the 3 month period ending 30th September 2009. The information has been obtained from the Electronic Staff Record (ESR) system. More detailed reports are now provided at monthly intervals to the managers as part of the performance management reporting process. The sickness target of 4.9% shown in the report is down; the cost of sickness has been highlighted in report. There are two employment tribunal claims pending. Further updates concerning both cases will be given in due course. 6

BL highlighted that there are 30 Long term sick from nursing work force The KCHSB would like to see what is being done about this and how is the monitoring getting these people back into work. BL informed the KCHSB that processes are in place and there is a policy. The KCHSB has requested assurance that policies and procedures are being followed. Maternity leave is high. The KCHSB needs to decide where we are prepared to back fill for maternity leave this will come back to the KCHSB when necessary Reporting needs to be influenced by where we are seeing ourselves. BL to meet SBE and NEDS about tribunals and policy and procedures. The KCHSB RECEIVED and NOTED the workforce Information Report ACTION

ACTION 12 - BL to bring back HR monitor case work that’s on going and a report can be brought back from HR. ACTION 13 - Workforce committee might want to meet sooner or later bring this forward ACTION 14 - BL to meet SBE and NEDS about tribunals and policy and procedures. Project Plan Report A project plan is being developed by HR to ensure all relevant staff registers with the ISA at the appropriate time. The cost of ISA registration for each employee required to register is £64 per employee. The risk assessment is High-Criminal offence if KCHS knowingly employs an employee without ISA registration once scheme implemented. Registration requirements also link to Care Quality Commission standards It was reported previously that there will be an extra cost in the first two years. It is only going to impact on new recruits. 2011 will be a bigger impact when the rest of the existing staff will need to be registered. The KCHSB RECEIVED and NOTED the workforce Information Report


KCHS Terms of Reference The TOR is in line with the Department of Health guidance on Transforming Community Services and the development of the PCT as a world class commissioner, Kirklees Community Healthcare Services (KCHS) has been established. It was agreed that ‘Capacity and Capability of the work force’ to be added. The KCHSB enquired who has got professional accountability it was confirmed that TQ has got this but it needs to be made clearer in the TOR. 7

Scheme of delegation document has no links to the business plan it is important that this should be included. The Scheme of Delegation has been approved by Kirklees PCT. The KCHSB agreed that sub committee should be omitted from the front sheet. ACTION

ACTION 15 - Capacity and Capability of the work force’ to be added ACTION 16 - Clarify in the TOR that TQ has got professional accountability. ACTION 17 - Scheme of delegation to be sent out to the KCHSB ACTION 18 - TQ to meet Sheila Dilks every month to discuss accountabilities ACTION 19 - Scheme of delegation to be linked to the business plan


Intermediate Care Deferred to next meeting


Minutes of Extraordinary Board meeting Held 12th November 2009

An extraordinary board meeting was held to discuss CQC core standards compliance return. Resolved: The KCHS Board agreed that the proposed submission provides reasonable assurance of compliance with the CQC core standards for 2009 – 2010. Sue Smith presented the CQC core standards to the main board for signing off and presented a good picture of the work that has been done ACTION

ACTION 20 - It was recommended the NEDS should see Gwen to obtain understanding of this.


Minutes of Finance, Performance & Business Development held 22nd October 2009 The KCHSB RECEIVED and NOTED the Minutes of Finance, Performance & Business Development


Minutes of Workforce Committee held 29th October 2009 The KCHSB RECEIVED and NOTED the minutes of Workforce Committee. Minutes of Governance There were no minutes available Any Other Business


The new registrations standards of the CQC will need to be signed off. ACTION

ACTION 21 – The sub committee and KCHSB to have an extra ordinary meeting or to discuss in a conference call to sign off the CQC Date and Time of Next Meeting The next meeting will be held on 22 January 2010 from 9.00 am - 11.30 am Beckside Court MR 3.

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

………………………………………….. Dated


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