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Minutes of the Trust Board Meeting held on Wednesday 25 May 2011 at 9.15am in the Boardroom, Broad Lea House, Bradley Business Park, Huddersfield Present: Rob Napier Rob Millington Tony Gerrard Valerie Aguirregoicoa Imran Patel Mehboob Khan Mike Potts Dr David Anderson Andy Leary Sheila Dilks Dr Judith Hooper Carol McKenna In attendance: Sue Ellis Helena Corder Peter Flynn Dr David Kelly Dr Steve Ollerton Sue Cannon Cath Gleeson Pauline Kershaw Alison Fearnley

Chairman Non-executive Director Non-executive Director Non-executive Director Non-executive Director Non-executive Director Chief Executive Chair Clinical Executive Committee Executive Director of Finance and Efficiency Executive Director of Patient Care and Professions Executive Director of Public Health Executive Director of Commissioning and Strategic Development Director of Human Resources and Organisational Development Director of Corporate Services Director of Performance and Information Chair of the North Kirklees Health Alliance Chair of the Greater Huddersfield Commissioning Consortium Executive Director of Quality and Engagement for NHS Calderdale Local Involvement Network (LINk) Representative Executive Assistant Corporate Governance Administrator

There was one member of the public also in attendance. The Chairman opened the meeting by welcoming all those in attendance. He particularly welcomed Andy Leary the new Director of Finance and Efficiency for Calderdale, Kirklees and Wakefield District Cluster Partnership, Sue Cannon who is currently Executive Director of Quality and Engagement for NHS Calderdale and from 1 June 2011, the new Executive Director of Quality and Governance (Nursing) for the Cluster Partnership. In addition Cath Gleeson was welcomed to the meeting who is the new Local Involvement Network Representative. Cath was also in attendance to present the results from a survey carried out by LINk into access and related aspects of GP practices across Kirklees.

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Cath circulated an Executive Summary report to the Board and gave a short presentation on the conclusions and recommendations from the survey. It was noted that the overall results were positive in that the majority of people were happy with the service provided by their GP practices in Kirklees. However a minority experienced a poor level of service in some aspects, especially relating to appointments and staff attitudes. A few patients had ongoing individual complaints which were unresolved. A discussion ensued regarding surgeries having O845 telephone numbers and this being more costly for patients. It was emphasised that GPs have the option to use these numbers but do have to demonstrate that premium rates are not being charged. Dr Kelly enquired about the ongoing complaints, which practices were involved and what the PCT was doing to resolve these. Cath explained that full details could be found in the main report which she encouraged the Board to read and made a plea for NHS Kirklees to follow these up. This was AGREED by the Board. The Board also discussed the need for engaging differently with members of the public in the future and how this could be improved. It was recognised that the Board was sighted on this and would be working closely with the GP Consortia to develop this further in the future. Finally, it was acknowledged that ambulance response times within the Denby Dale and Kirkburton areas had still not improved. It was recognised that there would be a wider discussion around this topic when the Board discussed the Performance Report. The Board RECEIVED and NOTED the report and AGREED to follow up the conclusions and recommendations. KPCT/11/78

Apologies for Absence Apologies for absence were received from Vanessa Stirum, Nonexecutive Director and Vice Chair.


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


Minutes of the last meeting held 27 April 2011 The minutes of the Trust Board meeting held on Wednesday 27 April 2011 were agreed as a true and accurate record once the following amendment was made: KPCT/11/67 – Agreement of the Terms of Reference for GP Consortia Executive Committee and Finance, Strategy, Performance and Risk Committee to make them a Sub Committee of the Board

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It was AGREED that the minutes should be changed to reflect the following concerning the Finance, Strategy, Performance and Risk Committee Terms of Reference: The Board AGREED to RETAIN the existing Terms of Reference subject to: amending the title of this committee to Strategy, Finance and Performance Committee undertaking a general review to embrace strategy reviewing the membership details KPCT/11/81

Matters Arising KPCT/11/66 Cluster Partnership Arrangements The Board noted that the Revised Scheme of Delegation and Reservation would be presented to the Board for approval in June. The Board noted that Matt Walsh had been successfully appointed to the post of Medical Director for the CKW Cluster Partnership. Julie Lawreniuk had been appointed as Chief Operating Officer for NHS Calderdale replacing Matt Walsh. Carol McKenna confirmed that meetings were currently being set up for the GP Consortium Executive Committees and that Nonexecutive Directors were being briefed around the detail of these meetings.


Chief Executive’s and Clinical Executive Committee Chair’s Report Mike Potts presented his report to the Board highlighting the following: GP Commissioning Consortia (GPCCs) Each of the two GPCC shadow boards are now meeting regularly and focusing on priority development areas. Health and Well Being Boards It was noted that the first full shadow meeting would now take place on 20 July 2011, not in June as stated in the report. Transforming Community Services The Board noted that progression towards establishing Locala Community Partnerships CIC as a social enterprise continues at pace and is currently on target.

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NHS Listening Exercise The opportunity to comment on the Government’s Listening Exercise, comes to an end on 31 May 2011. Any comments need to be sent to Pauline Kershaw. Principles of Staff Assignment It was noted that alignment of relevant staff to GP consortia would be undertaken by the end of June. Use of PCT Seal The Board noted that the PCT Seal had been used on two occasions since the last meeting in relation to the Variation to the Contract for Primary Medical Care Services for a GP Led Health Centre at Dewsbury Health Centre and the Deed of Covenant and Release relating to Cleckheaton Health Centre. NHS Challenge Sports Day

The Board noted that the PCT is holding another Sports day which will be taking place on Friday 10 June from 12pm to 2.30pm at the Leeds Road sports complex. Activities will include: kwik cricket tri-golf Nordic walking rounders football chair workout touch rugby buggy fit (for mum’s on maternity leave with small tots!) Staff Awards 2011 The Board noted that this year’s Staff Awards Event will take place on Friday 1 July at 7.30pm at Cedar Court Hotel, Ainley Top, Huddersfield. This is to celebrate the achievements of NHS Kirklees as we move into a period of change and thank staff for their continued dedication to the NHS. The Board RECEIVED and NOTED the contents of the Chief Executive’s and Clinical Executive Committee Chair’s Report.

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Finance Report Andy Leary presented the Finance Report which updated the Board on the revenue budgets of NHS Kirklees for 2011/12. He explained that the changes to the budgetary position were as a result of progress made in signing contracts for healthcare services since the March Board, notably with Calderdale and Huddersfield NHS Foundation Trust (CHFT). It was highlighted that there was an anticipated pressure of £3.5m based on contracts now signed and expected values of these nearing completion. It was therefore proposed to release £3.5m from the in year contingency of £4.5m. This ensures that budgets are funded at the level of signed contract, and leaves an in year contingency of £1m which is held to cover risk of Quality, Innovation, Productivity and Prevention (QIPP) slippage. Carol McKenna went on to explain the basis of the contract agreed with CHFT and how this would be managed on a ‘floor and ceiling’ basis. Concerning this it was recognised that demand activity would need to be proactively managed and Carol provided assurance about this process. The Board was concerned regarding the level of contingency which was left and whether this was enough. It was noted that there would be an opportunity for further discussion around this in the private session. The Board NOTED the progress being made to sign contracts and the financial implications of these as described in the report.


Performance Report Peter Flynn presented the Performance report to the Board. He explained that the report highlighted performance against key performance indicators that contribute to the PCT’s annual benchmarking data set, together with an end-year performance report against other national and local priorities for the PCT and where appropriate the detailed action being taken to improve performance. The main highlights from the report included: Ambulance – Category A calls meeting 8 minute standard It was noted that the 75% target for this had not been achieved (72.4%). It was acknowledged that there was a variation in performance across different localities within Kirklees, however this had generally improved over time.

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Mike confirmed that he had a meeting arranged with the new Chief Executive of the Yorkshire Ambulance Service (YAS), David Whiting, where he would raise the Board’s concerns regarding this. Finally it was noted that the Category B target (calls meeting 19 minutes) would no longer be a target in 2011/12. Diabetic Retinopathy Screening It was noted that this target had been achieved (108%). Accident and Emergency (A&E) It was noted that this target had not be achieved (94.99%) against a target of 95%. It was acknowledged that in particular Mid Yorkshire Hospitals NHS Trust (MYHT) had struggled to meet this target, the year to date figure being 92.5%. It was highlighted that ambulance turnaround times were not being achieved particularly at Pinderfields. Peter provided assurance that measures were being taken to improve the handover time of patients between YAS and the A&E Departments. In addition work was ongoing with clinicians to reduce the number of inappropriate admissions. Emergency Bed Days It was noted that this target was beginning to come back in line across Kirklees. Cancer – 2 month wait It was noted that all cancer targets had been achieved. 18 Weeks Referral to Treatment This target had not been met. This was largely due to a backlog of patients that already exceeded the 18 week limit at MYHT. The Board was reassured that a recovery plan was in place and that this will be monitored via the Contract Board with Mid Yorkshire and Wakefield District PCT. Stroke Care The Board noted that achievement of this target continued to be challenging particularly at MYHT. MRSA The Board noted that this target had not been met. The MRSA objective for NHS Kirklees in 2010/11 was no more than 18 cases. The final outturn was 20 cases. The Board acknowledged that the 2011/12 target was further challenging – no more than 13 cases. The Board was reassured that an action plan had been developed to assist Page 6 of 11

in achieving the MRSA objective for 2011/12 which would be monitored by Kirklees Infection Control Committee. Choose and Book It was noted that performance had continued to deteriorate over the year. The Board acknowledged that the Kirklees Local Enhanced Service for Choose and Book was discontinued (through the QIPP programme) during 2010/11 and that this may have continued to the deterioration in performance. It was noted that evidence from other organisations had not shown this effect. Smoking during pregnancy The Board was disappointed that despite numerous measures being put in place to improve this position there had still been little or no improvement. Dr Hooper described some of the initiatives which had been put in place to improve this and confirmed that systems were generally working better over the last year. However it was emphasised that there are a lot of complex health and social care issues particularly in the Dewsbury and Batley areas and that smoking is used as a coping mechanism to deal with these problems. The Board acknowledged that whilst there were a number of performance targets that had not been met, overall performance had continued to improve. The Board NOTED NHS Kirklees performance against the key performance indicators and APPROVED the actions being taken to address areas of under/over performance detailed in the EndYear Performance Report for 2010/11. KPCT/11/85

Clinical Quality Report Sheila Dilks presented the Clinical Quality Report to the Board. She explained that the report highlighted; areas of improvement, good practice and areas where we need to focus our attention. Sheila provided a comprehensive overview of the report highlighting the key issues for each of the PCT’s main providers. It was recognised that overall the report highlights positive improvements however it was emphasised that the PCT still needed to remain vigilant to maintain a high quality of service offered to patients. The main areas of concern included: Maternity Services at Dewsbury District Hospital The quality of hospital discharge Page 7 of 11

Cath Gleeson commented that there was no information about patient complaints and how these were being managed. Sheila provided assurance that complaints were reviewed via the Quality Board and AGREED to include information on this in the next report. Rob Millington stated that there needed to be greater focus on quality outside of this report via the contract management arrangements and the new GP Consortia. Mike confirmed that Sue Cannon, Executive Director of Quality and Governance, and Matt Walsh, Executive Medical Director (of the Cluster Partnership) would have responsibility for making sure that quality remained a high priority. In addition the Director of Performance and Commissioning Intelligence was exploring how quality and performance reporting can be improved both to the PCT Board and the Cluster Partnership. Sheila also pointed out that we need to look at the correlation of all information available in greater depth. A discussion ensued regarding quality in Care homes. The Board acknowledged that there was a lack of consistent standards across Kirklees and that additional resource was needed to address this. Valerie Aguirregoicoa stated she would welcome a more in depth discussion around CQUINS at the Governance Committee. The Board RECEVIED and NOTED the Clinical Quality report and the progress made to date. KPCT/11/86

Mid Yorkshire Hospitals NHS Trust Transition to Foundation Trust Status – Progress Report The Board was presented with a report that provided additional information and clarity on the current position regarding MYHT’s transition and FT status. The Board noted that MYHT is currently in category 2 – NHS Trust with quality/financial/performance issues requiring external support to make ready for applying for FT status. The main areas of concern noted were: Maintaining financial stability Managing the business within the tariff based system Delivering consistent performance against the key performance criteria Demonstrating Board/management grip on the organisation

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Mike Potts confirmed MYHT’s financial position and the implications for 2010/11 and 2011/12. Concerning this it was recognised that there is an overall forecast deficit of £44m for 2011/12. The Trust has introduced a CIP target to achieve a £30m reduction on the £44m deficit figure however a plan for a further £14m is still required. Mike therefore explained that he had facilitated a number of discussions with Directors of Finance and Chief Executives of NHS Kirklees, NHS Wakefield District, NHS Leeds and the SHA to understand and agree a collective commissioner response to addressing the underlying financial challenge. Following discussion it was emphasised that NHS Kirklees had made no commitment to contribute towards the reported deficit at the present time. However it was recognised that alternative options might need to be sought to enable MYHT to achieve FT status by 2014. Mike also advised the Board that a Tri Partite Agreement had been set up between MYHT, SHA and the Department of Health. He explained that this describes the issues to be addressed, the timescales and what is expected of each party in achieving a successful transition to FT status. In addition Mike confirmed that the SHA was also agreeing a Package of Support to help MYHT. This includes further work/assessment that will be/has been commissioned to assist all parties make an informed decision about the level of support that will be required to achieve FT status or whether an alternative solution should be pursued. Furthermore it was noted that Finnamores had been commissioned to undertake a piece of work to look at the service models across MHYT’s three sites. It was recognised that a series of workshops have been arranged to look at the outcome of this work and that the Board would be kept informed of the findings. The Board also acknowledged that MYHT had established a Foundation Trust Board to oversee this work. The Board noted the function of this Board and the membership which included representation from each of the organisations involved and the GP Commissioning Consortia in North Kirklees and Wakefield. The Board NOTED the progress being made and the action that had been put in place to support delivery.

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Revised Terms of Reference (ToR) for the Governance Committee The Board was presented with Revised Terms of Reference for the Governance Committee in light of the transition arrangements to establish the foundations for the new commissioning system. It was noted that the ToR had not been fundamentally changed with key changes around the background information and membership details. In addition these had been reviewed by the Governance Committee where it was recommended that the Board formally adopt these. The Board REVIEWED the ToR. It was noted that the Exceptional Cases Committee needed adding as a Sub Committee reporting to the Governance Committee. In addition clarity was sought regarding who the Director of Transition was. It was recognised that this referred to Sheila Dilks’ new role and that as soon as her job title had been confirmed the ToR would be amended to reflect the correct title. The Board APPROVED the Revised Terms of Reference for the Governance Committee subject to the above amendments.


Minutes of the Governance Committee The Board RECEIVED and NOTED the minutes of the Governance Committee held on 9 March 2011.


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 15 April 2011. Valerie Aguirregoicoa asked for clarity regarding the arrangements for sharing financial risks in terms of the SCG contracts for 2011-12. Mike Potts and Andy Leary explained the various risk shares and the new mechanism for dealing with these.


Minutes of the Audit Committee The Board RECEIVED and NOTED the minutes of the Audit Committee held on 2 February 2011. Dr Kelly requested further information regarding the narrative in relation to fraudulent QOF payments. Tony Gerrard explained that the Audit Committee was still pursing assurance on whether there was a financial loss to the organisation and AGREED to provide Dr Kelly with feedback on the outcome of this investigation.

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Minutes of the Finance, Performance and Strategy Committee The Board RECEIVED and NOTED the Finance, Performance and Strategy Committee minutes held on 23 March 2011.


Minutes of the Kirklees Community Healthcare Services (KCHS) Board The Board RECEIVED and NOTED the minutes of the Kirklees Community Healthcare Services Board held on 25 March 2011. Dr Kelly was concerned regarding the statement on page seven of the minutes in relation to Community Care Teams. It was noted that Sheila Dilks was to pursue this point with KCHS.


Minutes of the West Yorkshire Sub Regional Commissioning Forum The Board RECEIVED and NOTED the minutes of the West Yorkshire Sub Regional Commissioning Forum Parts 1 and 2 held on 6 April 2011.


Any Other Business There were no items of any other urgent 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 9.15am and 1.00pm on Wednesday 29 June 2011 in the Boardroom at Broad Lea House, Bradley Business Park, Bradley.

Questions from the Public The Chairman gave the members of the public a final opportunity to raise any questions. No questions were raised. This concluded the content of the Trust Board meeting held in public and the Chairman declared the meeting CLOSED at approximately 12.10pm.

Chairman’s Signature: ………………………………….

Date: ………………

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