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KIRKLEES PRIMARY CARE TRUST

Minutes of the Trust Board Meeting held on Wednesday 19 December 2007 at 9.15am in the Board Room, St Luke’s House, Huddersfield Present: Rob Napier Mike Potts Vanessa Stirum Mehboob Khan Tony Gerrard Rob Millington Sarah Brackwell Bryan Machin Carol McKenna

Chair Chief Executive Non-executive Director and Vice Chair Non-executive Director Non-executive Director Non-executive Director Professional Executive Committee Member Executive Director of Finance Executive Director of Commissioning and Strategic Development Executive Director of Patient Care and Professions

Sheila Dilks In attendance Helena Corder Robert Flack Peter Flynn Sue Ellis

Director of Corporate Services Director of Provider Services Director of Performance and Information Director of Human Resources and Organisational Development Assistant Director of Public Health Chair of the Patient and Public Involvement Forum Executive Assistant Corporate Governance Administrator Communications Officer Head of Estates and Facilities (in attendance for agenda item KPCT/07/234 only)

Deborah Collis David Thompson Pauline Kershaw Alison Fearnley Amanda Thomas David Henwood One member of the public

Rob Napier opened the meeting by welcoming all those in attendance. In particular he welcomed Deborah Collis, Assistant Director of Public Health, who was in attendance on behalf of Dr Judith Hooper, Executive Director of Public Health and Amanda Thomas from the Communications Team. Questions from members of the Public The Chairman gave members of the public an opportunity to raise any questions. No questions were raised. KPCT/07/222

Apologies for Absence

Apologies for absence were received from Imran Patel, Non-executive Director, Valerie Aguirregoicoa, Non-executive Director, Dr David Page 1 of 13


Anderson, Chair of Professional Executive Committee and Dr Judith Hooper, Executive Director of Public Health. KPCT/07/223

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

KPCT/07/224

Minutes of the last meeting held 28 November 2007 The minutes of the Trust Board meeting held on the Wednesday 28 November 2007 were AGREED as a true and accurate record once the following amendments were made. KPCT/07/200.9

NHS Litigation Authority (NHSLA) Assessment

It was AGREED to add the following sentence to the Minute However the PCT will have to achieve the Level 1 standard before it is eligible to be assessed at Level 2 standard. KPCT/07/203

Corporate Performance Report

It was AGREED to amend paragraph seven to read – Carol McKenna clarified the position and provided assurance that performance was on target for the Early Intervention in Psychosis service. KPCT/07/225

Matters Arising KPCT/07/206

Holme Valley Memorial Hospital: In Patient Development

Bryan Machin provided a verbal update regarding the proposals to undertake a ‘deep clean’ at Home Valley Memorial Hospital. He put forward two options for the Board’s consideration: Option A was to refurbish the entire ward prior to the deep clean at a cost of £81k. It was noted however that this would involve closing the ward for a period of one month. Option B was to redecorate and make good any necessary repairs/alterations at a cost of £31k which could be carried out without closing the ward.

second

Following discussion it was AGREED the most pragmatic approach would be Option B enabling the ward to remain open. It was AGREED the necessary work would be undertaken the week in February 2008.

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Mike Potts AGREED to report the outcome of this decision in his February Chief Executive Board report.

KPCT/07/226

Chief Executive’s Report Mike Potts presented his report to the Board highlighting the following: KPCT/07/226.1 Communication from Margaret Edwards, Chief Executive, NHS Yorkshire and the Humber The Board was briefed regarding some changes that the NHS Yorkshire and the Humber Board had agreed in respect of individual directors’ portfolios. KPCT/07/226.2

“Putting Commissioning into Practice”

It was noted that anyone wising to access this report from the Audit Commission re implementing practice based commissioning through good financial management, is able to do so via the Chief Executive’s office at St Luke’s House. KPCT/07/226.3

Comprehensive Area Assessment

A joint consultation document by the Audit Commission, Commission for Social Care Inspection, Healthcare Commission, HM Inspectorate of Constabulary, HM Inspectorate of Prisons, HM Inspectorate of Probation and Ofsted, had been produced. This will inform people of how well local public service providers are serving them and the prospects for their quality of life in the future. It will emphasise local priorities in sustainable community strategies and new local area agreements and will be primarily concerned with outcomes for residents, service users and taxpayers, with a particular focus of people whose circumstances make them vulnerable. It was AGREED that Comprehensive Area Assessment should be the subject of a future Board development session. KPCT/07/226.4

Kirklees Physical Activity Team Award

The Kirklees Physical Activity Development Team has been assessed as the best in Great Britain. This work is crucial to improving health and reducing health inequalities and this award is a great achievement. The Board congratulated the team. KPCT/07/226.5

Cancer Reform Strategy

This strategy was launched by the Department of Health on 3 December 2007 and sets out the Government’s vision for delivering Page 3 of 13


world class health services within five years. It is intended the strategy will build on the significant progress made on tackling cancer, since the publication of the NHS Cancer Plan in 2000. The Cancer Reform Strategy may be accessed on: ttp://www.dh.gov.uk/en/Publicationsandstatistics/PublicationsPolicy AndGuidance/dh081006. A copy of the Executive Summary was circulated to the Board for information. KPCT/07/226.6

State of Healthcare 2007

The Audit Commission has published the above document. The report sets out the main improvement and challenges in services in England and Wales during 2006/07 and six key challenges for service providers. Anyone wishing to access the report can do so via the Chief Executive’s office at St Luke’s House. KPCT/07/226.7 Clinical

The National Institute for Health and Excellence (NICE)

Mike Potts advised the Board that a NICE Question Time session was being held on 16 January 2008 between 12.30pm and 1.30pm followed by a Public Board Meeting at Northern General Hospital, Sheffield, if anyone was interested in attending. The Board RECEIVED and NOTED the contents of the Chief Executive’s Report. KPCT/07/227

PEC Chair’s Report Sarah Brackwell presented the PEC Chair’s Report to the Board in the absence of Dr Anderson, PEC Chair. It was noted that the closing date for applications for clinical leads had been extended for a further two weeks to give the opportunity for as wider field of clinical engagement as possible. The PEC is looking at improving communication. Ideas being considered range from regular PEC bulletins to a rolling programme of clinical forums. These ideas will be explored further and developed in the New Year. The Board RECEIVED and NOTED the contents of the PEC Chair’s Report.

KPCT/07/228

Finance Report Page 4 of 13


Bryan Machin circulated the Finance report which updated the Board on the current financial position. He advised the Board that the report had to be tabled due to the timing of the meeting. Bryan advised that the PCT was now forecasting a surplus of £5.2m for 2007/08. This forecast is based on the assumptions that the contingency reserve currently held by the PCT is utilised within the financial year. Should the balance in the contingency reserve not be required this financial year the PCT would achieve a £7m surplus. Bryan summarised the significant changes to the financial forecasts: •

A reduction in the expenditure forecast on the Leeds SLA (£0.7m reduction).

A reduction in the expenditure forecast to take place in the independent sector (£0.5m).

A reduction in expenditure forecast for Age Related Macular Degeneration (£0.5m)

A reduction in the expenditure forecast on the South West Yorkshire Mental Health SLA (£0.4m)

A further reduction in prescribing expenditure forecast (£0.4m)

Further reduction in Public Health and Headquarters forecast budget expenditure (£0.6m)

An increase in expenditure forecast on the Calderdale and Huddersfield Foundation Trust SLA (£1.0m increase)

It was noted these changes lead to the forecast of the £7m surplus. The Board also noted the significant financial variances outlined in the report. The Board NOTED: •

The income and expenditure position of the PCT and the associated risks;

The forecast performance against the PCT’s other key financial duties/targets.

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KPCT/07/229

Corporate Performance Report Peter Flynn presented the Corporate Performance report to the Board. He explained that this report was the first of a six monthly detailed Performance report which the Board would receive. The report highlighted current performance against high priority targets that contribute to the PCT’s annual Performance Rating, together with a mid-year progress report against other national and local priorities for the PCT and where appropriate, details the action being taken to improve performance. It was noted that the report had been reviewed by members of the Finance and Performance Committee and recommendations were put forward regarding the content and style of the report. Peter pointed out that the Finance and Performance Committee would receive a detailed update on the PCT’s progress towards meeting the 18 week waiting time target at its next meeting, to provide assurance that this was on target. Carol McKenna gave an update on performance against the Yorkshire Ambulance Service target. It was noted that demand had increased above the planned level and YAS has advised that the level of performance against the ‘Category A’ 8 minute target is currently forecast to be 74.7% for the year. Within the YAS overall figures, the year-to-date performance against ‘Category A’ 8 minute target for Kirklees PCT is 71.3%. It was AGREED that Carol would look at options for additional investment into this service. There was a discussion regarding meeting the 48 hour access to GUM target. It was noted that significant changes had been made following the visit from the National Support Team (NST), particularly at Dewsbury. The consultant at Dewsbury has shared his achievements with Calderdale and Huddersfield NHS Foundation Trust and the NST believe the 48 hour access target will be difficult but achievable by April 2008. It was noted however that the main obstacle is the inability to recruit to the GU consultant vacancies. Mike Potts clarified he was negotiating some additional sessions with the help of Dewsbury’s consultant with a view to running some clinics at the University Practice. A discussion ensued regarding incentive schemes to improve access to Chlamydia screening. Deborah Collis AGREED to feedback comments to the Sexual Health Team. The Board acknowledged that there had been a change in target definition for breast screening within the last few months and that the volume of screening had risen. The Board was reassured that there was a robust action plan in place for improving the breastfeeding target. This topic would also form the basis of a future PEC discussion. Page 6 of 13


Finally, Carol McKenna reassured the Board that activity was ongoing to lift performance against the Choose and Book target. The Board RECEIVED and NOTED the Corporate Performance Report. KPCT/07/230

Provider Services Report Robert Flack presented the Provider Services report to the Board. He advised the Board that future reporting to the main Board would be on a quarterly basis. He explained the report provided an overview of the current developments within Provider services and the key operational services, as well as giving detail on the current service improvement activity. The Board received an overview of the developing four key work streams. These are: • • • •

18 Week implementation plan Adult services integration board HR and workforce planning SystmOne implementation group

It was noted that a long term programme of organisational development, particularly around leadership, was due to commence mid January. The development programme looks at all areas of front line leadership from personal behaviours to clinical practice to financial management. It was noted that recruitment to Provider services posts had been positive. It was recognised that there were more newly qualified people coming out of training and that the new buildings were attracting more people to the area, along side the PCT’s reputation as an employer. Robert advised that the first Route to Solution event was well attended by GP practices and feedback had been positive. The next event was due to take place on 30 January 2008. The Board received an update on the latest developments in localities. The specific areas of achievement and concern were highlighted. One of the main areas of concern had been recruiting to Health Visiting posts in Dewsbury and Batley. Robert clarified that progress had been made to appoint nine new Health Visitors and that there had been a high calibre of applicants. It was noted that systems and processes had been improved in all Provider services in order to ensure performance against the 18 week target could be delivered and improved. Page 7 of 13


It was noted that Contraception and Sexual Health services were now being offered across Kirklees. ‘Mystery shoppers’ would be visiting the drop-in clinics in Huddersfield in the New Year to establish if services have improved, following concerns expressed about the suitability of the environment and the welcome given to young people. The reports from the transitional change teams were received and noted. Attention was drawn to the level of complexity of these reports. It was recognised that the interpreting service had been under significant pressure for some time. Robert clarified that the PCT was working in partnership with Dewsbury College to improve this service. Multidisciplinary working with local partners and organisations was recognised as being a fundamental way forward. Vanessa Stirum congratulated the Provider Services Team and confirmed that significant progress had been made towards developing Provider services and improving reporting mechanism. It was recognised that a Provider Services Strategic Plan would need to be developed. The Board was encouraged by the Provider Services report and thanked Robert and his team for all their hard work. The Board RECEIVED and NOTED the Provider Services report. In addition the Board received a further report regarding the future status of PCT Provider Services. The report highlighted the current status of the commissioning provider split and recommendations to be put in place for the next 12 months. Mike Potts reassured the Board that this approach was consistent with the Operating Framework and highlighted the next steps. These are: •

Work should continue to build capacity and capability within the PCT's provider arm to ensure that it can function as a stand alone organisation. This will position it well to respond to any future changes.

The Service Level Agreement between the PCT and the provider arm and associated performance management arrangements should be developed and strengthened.

Engagement in the wider SHA network of provider services organisations should continue as a means of sharing good practice and keeping abreast of developments across Yorkshire and the Humber.

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It was AGREED that Mike Potts and Bryan Machin would attend Provider Services Board meetings on a quarterly basis as they are still the accountable officers. It was AGREED Sue Ellis would report the from the report to the Partnership Forum on 19 2007.

recommendations December

The Board AGREED:

KPCT/07/231

That the PCT Provider arm remain at arms length for at least 12 months (up until December 2009), unless the national or regional picture alters significantly.

That work should progress as detailed in the next steps in section five of the report.

NHS Review update Mike Potts provided a verbal update to the Board. He confirmed this work was beginning to gather pace in terms of the next stages. It was noted that the Clinical Care Pathway groups had completed their reports and that these would be reviewed by PEC Chairs’ and Medical Directors initially. An engagement event had been arranged for 5 February 2008 at the Cedar Court Hotel involving key partners from the Local Authority etc which was being led by Sheila Dilks. An Operational Plan would be produced by the end of March 2008 and final reports published in June 2008. The Board RECEIVED and NOTED the NHS Review update.

KPCT/07/232

The Operating Framework 2008/09 The Board received a copy of the Operating Framework published on 13 December 2007. Mike Potts introduced the report and explained that this document sets out the specific business and financial arrangement for the NHS during 2008/09. It describes the priorities for the year including the introduction of local stretch targets alongside national priorities, the development of payment by results and tariff details, polices that support transformation including world class commissioning, engaging with staff, patients and public and delivering choice. In addition the framework within which the NHS will plan and have its performance assessed is also described. The timetable in terms of the business processes was noted. Page 9 of 13


It was recognised that there would need to be significant commitment from staff and clinicians in order to deliver this work. The Board RECEIVED and NOTED the 2008/09 Operating Framework. KPCT/07/233

World Class Commissioning The Board received information circulated as part of the launch event for world class commissioning which took place on 3 December 2007. It was noted this document is key to delivering the Operating Framework. It was noted that a Trust Board development session around world class commissioning would be held in January 2008. The Board RECEIVED and NOTED the content of the report.

KPCT/07/234

Draft Estate Development Strategy Bryan Machin introduced the Draft Estate Development Strategy to the Board. He explained that following approval of the document in draft form the following stakeholders will be consulted to ensure that the PCT is clear about stakeholder sign up and that realistic opportunities for co location of services are identified, and that future public transport provision is informed by the PCT’s development strategy: • • • • •

Kirklees Councillors KMC LMC Individual GP Practices Metro

David Henwood, Head of Estates and Facilities, joined the meeting. He provided the context against which the strategy was developed and highlighted the key priorities. It was noted the Estates Development Strategy had been produced to provide an initial way forward in relation to estates issues. It sets out the current condition of the PCT’s estate and that of GP independent contractors. It was acknowledged that this document needed to be underpinned by a Strategic Services Development Plan (SSDP) for the PCT. There was a discussion regarding the capacity and affordability to deliver this work. David explained that there were ways in which the PCT can manage this by buying in independent contracts or recruiting to the Estates team. It was recognised that 50% of the schemes were already being developed. Page 10 of 13


There was a discussion regarding the timescale for setting up a Strategic Service Development Group. It was noted a mapping exercise would need to be undertaken to establish what is required. It was recognised the Senior Management Team would be responsible for developing an action plan. The Board APPROVED the Draft Estate Development Strategy 2008/2013. KPCT/07/235

Budget Virement Policy Bryan Machin presented the Budget Virement Policy to the Board. He explained that this was a new policy to assist budget holders in the fulfilment of their budgetary responsibilities by setting out the rules under which resources can be transferred within a single budget or between budgets. It was noted that the Audit Committee had reviewed the policy at its meeting on 19 November and recommended that the Board approve the policy. The Board APPROVED the Budget Virement Policy.

KPCT/07/236 Survey

Yorkshire and The Humber NHS Public Satisfaction Helena Corder introduced the NHS Public Satisfaction Survey to the Board. She explained that the survey was carried out across the Yorkshire and Humber region and captures peoples perception and experiences of NHS services. A sample of the user questionnaire was circulated to the Board for information. Helena went on to give a presentation on the results of the survey. In particular it was noted that ambulance and GP services were rated high within the PCT area.

and

The Board RECEIVED and NOTED the results of the Yorkshire Humber NHS Public Satisfaction Survey.

KPCT/07/237 Kirklees Safeguarding Children’s Board Executive Summary: An Executive summary of the review undertaken following the death of a 4 year old child in November 2006 The Board was presented with Kirklees Safeguarding Children’s Board Executive Summary of a review undertaken following the death of a four year old child in November 2006. Sheila Dilks presented the report and explained that the report makes recommendations at a local and national level which will be monitored by Kirklees Safeguarding Children’s Board. It was noted there were some training issues which had now been addressed. Page 11 of 13


In addition an action plan had been developed and agreed with Provider services and will be closely monitored. Sheila pointed out that the action plan would be presented to the Board with the Safeguarding Children’s and Young People Annual Report. The Board RECEIVED and NOTED the Kirklees Safeguarding Children’s Board Executive Summary. KPCT/07/238

Minutes of the Professional Executive Committee The Board RECEIVED and NOTED the minutes of the PEC meeting held on the 14 November 2007.

KPCT/07/239

Minutes of the Finance and Performance Committee The Board RECEIVED and NOTED the minutes of the Finance and Performance Committee held on the 24 October 2007.

KPCT/07/240

Minutes of the Estates Strategy Committee The Board RECEIVED and NOTED the minutes of the Estates Strategy Committee held on 27 September 2008.

KPCT/07/241

Minutes of the HR/OD Shared Service Governance Board The Board RECEIVED and NOTED the minutes of the HR/OD Shared Service Governance Board meeting held on 17 September 2007.

KPCT/07/242

Minutes of the Yorkshire and Humber Specialised Commissioning Group – North Meeting The Board RECEIVED and NOTED the minutes of the Yorkshire and Humber Specialised Commissioning Group – North meeting held on 7 November 2007.

KPCT/07/243

Minutes of the Yorkshire and Humber Specialised Commissioning Group The Board RECEIVED and NOTED the minutes of the Yorkshire and Humber Specialised Commissioning Group meeting held on 16 November 2008.

KPCT/07/244

Any Other Business KPCT/07/244.1

Bulk Data Transfers

Peter Flynn advised the Board that the PCT was undertaking an audit of all data transfers involving personal identifiable information. Page 12 of 13


KPCT/07/245

Date and time of the next meeting It was AGREED that the next meeting of the Kirklees PCT Trust Board would take place between 9.15am and 11.30am on Wednesday 30 January 2008 in Meeting Room 1 at Beckside Court, Batley.

Questions from the Public The Chairman gave a final opportunity for members of the public to raise any further questions. No further questions were raised.

Chairman’s Signature: …………………………………. Date: ………………

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http://www.kirklees.nhs.uk/fileadmin/documents/meetings/January_08/Minutes_of_Public_Board_19.12.07_