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Minutes of the Trust Board Meeting held on Wednesday 28 November 2007 at 9.15am in the Board Room, St Luke’s House, Huddersfield Present: Rob Napier Mike Potts Vanessa Stirum Valerie Aguirregoicoa Imran Patel Tony Gerrard Rob Millington Dr David Anderson Bryan Machin Carol McKenna Dr Judith Hooper In attendance Peter Flynn Helena Corder Robert Flack Sue Ellis David Thompson Helen Haythorne Helen Bridges Tracy Small Bob Thomlinson Pauline Kershaw Alison Fearnley Julie Fothergill

Chair Chief Executive Non-executive Director and Vice Chair Non-executive Director Non-executive Director Non-executive Director Non-executive Director Chair Professional Executive Committee Executive Director of Finance Executive Director of Commissioning and Strategic Development Executive Director of Public Health

Director of Performance and Information Director of Corporate Services Director of Provider Services Director of Human Resources and Organisational Development Chair, Patient and Public Involvement Forum Communications Officer Assistant Director/Head of Information Analysis and Data Quality Deputy Director of Clinical Development and Innovation Observer Patient and Public Involvement Forum Executive Assistant Corporate Governance Administrator Kirklees Partnership Manager (in attendance for agenda item KPCT/07/207 only)

One member of the public Rob Napier opened the meeting by welcoming all those in attendance. In particular he welcomed David Thompson who has taken over from Pauline Cooper’s role as Chair of the PPI Forum as Pauline had resigned due to ill health. He also welcomed Tracy Small, Deputy Director of Clinical Development and Innovation, who was attending on behalf of Sheila Dilks, Executive Director of Patient Care and Professions, Helen Haythorne, Communications Officer who was attending on behalf of the Communications Team and Helen Bridges who had been recently appointed as Assistant Director/Head of Information Analysis and Data Quality.

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Questions from members of the Public David Thompson raised a query regarding a statement in the Chief Executive’s Report on page 20 of the Board papers, concerning the Government’s plans to promote patient choice and make patients more aware that they can be seen by private sector providers free of charge if they choose. He enquired if this was an opportunity for patients choosing to use a private sector provider to jump the queue. Carol McKenna and Mike Potts clarified the definition of this statement and explained how patient choice was offered. Dr Anderson explained that patients being referred to hospital for treatment now had a choice of five providers one of which should be a private sector provider. It was acknowledged that patients were not able to jump the queue by choosing a private sector provider. In addition it was emphasised the achievement of meeting the18 week waiting time target would reduce the need for patients to seek private treatment because of the length on NHS waiting lists. KPCT/07/196

Apologies for Absence Apologies for absence were received from Mehboob Khan, Nonexecutive, Sheila Dilks, Executive Director of Patient Care and Professions and Sarah Brackwell, Professional Executive Committee member.


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


Minutes of the meeting held 31 October 2007 The Minutes of the Trust Board meeting held on the 31 October 2007 were AGREED as a true and accurate record.


Matters Arising KPCT/07/177

Finance Report

Bryan Machin confirmed an update on the efficiency plan would be included in the December Finance Report to the Board. KPCT/07/178

Performance Report

Mike confirmed that he had spoken to Helen Thomson, Director of Nursing at Calderdale and Huddersfield NHS Foundation Trust, concerning the timely release of MRSA data from CHFT. Mike AGREED he would raise this again with Diane Whittingham, Chief Executive of CHFT. Carol McKenna confirmed that work had commenced on the Early Intervention in Psychosis service. It was noted there would be a caseload of 16 patients by the end of December. Page 2 of 14


Chief Executive’s Report Mike Potts presented his report to the Board highlighting the following: KPCT/07/200.1

Yorkshire and Humber PCT Collaborative – Director of Networking and Collaboration

Mandy Forrest will be taking up this post in the New Year and for the first instance; this will be a secondment arrangement for 12 months. KPCT/07/200.2

Assistant Director/Head of Information Analysis and Data Quality

Helen Bridges had been appointed to this role within the Performance and Information Directorate and took up her post on 19 November. KPCT/07/200.3

Patient and Public Involvement Forum

Pauline Cooper had resigned from her role as Chair of the PPI Forum due to ill health. David Thompson has taken over this role. The PCT sends best wishes to Pauline with grateful thanks for all the hard work and support she has given to the Board. KPCT/07/200.4

NHS Carol Service – York Minster, Wednesday 12 December 2007

The Carol Service is open to all employees within Yorkshire and the Humber and starts at 7.30pm. If you wish to attend, please contact Natalie Norma, KPCT/07/200.5

NHS Next Stage Review

An introductory film may be accessed on the Review website, or alternatively a copy is available from the Chief Executive’s office, if anyone wishes to see this film. Lord Darzi has also published his interim report which sets out a ten-year vision for the NHS, based on the views of the public, patients and staff. Staff are encouraged to feed in their views to the Review. KPCT/07/200.6

Kirklees PCT Headquarters – Update

A report will be presented to the December Board to approve the decision on the future location of the PCT’s headquarters. Page 3 of 14


Central Procurement Process

The Department has been undertaking a review of the remaining schemes in Part 2 of the central procurement process. This review is now complete and confirmation has been received that the North East Diagnostics Scheme and North East Yorkshire and North Lincolnshire Referral Assessment Diagnostics and Treatment Service, are not progressing and will be withdrawn from the central procurement process. The Department will work with the NHS to consider how best to move forward, including the wider options for working with the independent sector, to ensure that local services are accessible, effective and best meet local needs. The PET CT North Diagnostics will continue to move forward through the central procurement process. KPCT/07/200.8

National Survey to Local Health Services 2008

The Healthcare Commission will be co-ordinating a survey of local health services within the primary care sector in Spring 2008. This will be a repeat of the national surveys conducted in all PCTs in 2003, 2004 and 2005, although there will be some important updates to the questionnaire and methods to ensure that the survey reflects current issues. KPCT/07/200.9

NHS Litigation Authority (NHSLA) Assessment (previously CNST – Clinical Negligence Scheme for Trusts)

The PCT has been involved in a pilot scheme and undertook an assessment at the beginning of November 2007. Regrettably, at this time the PCT did not achieve the required standard. An action plan is now being developed and there will be a working group set up to make sure that the PCT is able to meet the required standard up to level 2, which is the standard required by the healthcare commission. However the PCT will have to achieve the level 1 standard before it is eligible to be assessed at level 2 standard. KPCT/07/200.10

Positive Practice

Two members of staff, who are health advisors within the Youth Offending Team, have been shortlisted for this award. The ceremony will take place on 17 December 2007 in London. The category entered by the YOT health advisors was “Health and Social Care in Criminal Justice”. The Board congratulated the health advisors.

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Creation of a Single Postgraduate Deanery for Yorkshire and the Humber

Over the last year, options have been examined for the configuration of the postgraduate deaneries and related workforce development arrangements. Following consultation, the SHA Board received a recommendation that a single deanery be established on 1 April 2008 to form part of the Workforce Directorate at the SHA. A summary document has been offered to stakeholders for comment by the end of November 2007. KPCT/07/200.12

“Putting Commissioning into Practice”

Anyone wishing 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/07/200.13

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, has 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. The PCT is to arrange a Comprehensive Area Assessment development session. KPCT/07/200.14

General Medical Council – Dr Dutt Case

The GMC have removed Dr Dutt from the Medical Register following a fitness to practice hearing. Dr Dutt has 28 days to appeal against this decision. KPCT/07/200.15

‘Route to a Solution’

This first of three meetings in the ‘Route to a Solution’ process to formulate policy in relation to district nurse provision is to be held today involving representatives from all practices in Kirklees along with district nurses. The Board would receive regular updates with regard to this process. The Board RECEIVED and NOTED the contents of the Chief Executive’s Report. Page 5 of 14


PEC Chair’s Report David Anderson presented his report to the Board highlighting the following: All PEC members have had their lead areas allocated and are meeting with relevant managers to identify how to progress the clinical role. The PEC is also discussing how to enable discussion between frontline clinicians and the consortia and the PEC to ensure the widest participation in the development of the strategic direction of the PCT. An advertisement has been placed in the weekly job bulletin to appoint a number of clinical champions. Interviews have been arranged for 11 December 2007. The PEC covered the following three major areas at the last meeting:  

Draft Mental Health Strategy and endorsed the work done to date and the direction of travel. Report re infection control in particular C Difficile – The PEC was assured by the work to date that the issues were being dealt with in an appropriate manner and is subject to a separate Board report. Report re proposed developments in Dentistry where the PEC reflected on the need to address inequalities to direct investment decisions.

The Board RECEIVED and NOTED the contents of the PEC Chair’s Report. KPCT/07/202

Finance Report Bryan Machin presented the Finance Report which updated the Board on the current financial position. He advised the Board that the PCT is still forecasting a surplus of £2.7m for 2007/08. This is based on the assumptions that the contingency reserve currently held by the PCT is utilized within the financial year. Should the balance in the contingency reserve not be required this financial year the PCT would achieve £5.1m surplus. It was noted that following a financial review meeting with the SHA the PCT has increased its Strategic Reserve contribution for 2007/08 by £800k bringing the overall balance in the Strategic Reserve fund to £19.8m. It was acknowledged that this is non recurrent funding and will be available to the PCT to withdraw as required.

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This reduces the contingency reserve held by the PCT from £3.4m to £2.6m. A further £150k has been used from the contingency fund to cover non recurrent budget increases; this reduces the contingency fund available to the PCT from £2.6m to £2.4m. In addition it was noted there were some significant changes to financial forecasts which mean there is no requirement for the PCT to use any of the £2.4m contingency fund: These include;  

A reduction in the forecast prescribing expenditure (£1.5m). A reduction in the expenditure forecast on the Leeds SLA (0.6m)

There had also been; 

An increase in expenditure forecast on the Mid Yorkshire NHS Trust SLA (£0.8m).

Bryan explained the background to the reduction in prescribing expenditure. Concerning this it was noted that there had been an unexpected national price change. Bryan also summarised the significant financial variances in 5.1 of the report. The Board noted that there had been press coverage of the level of surplus in the NHS as a whole and the possible risk to carrying forward surpluses. The Board noted that the PCT’s potential surplus was only 0.9% of its allocation and was as planned at the start of the year if the contingency was not required. Finally, Bryan explained there was a risk on the PCT’s capital position, as to date there had only been £1.8m of the £4.4m capital resource limit spent. The PCT has advised the SHA that it would like to carry forward the remaining £2.6m but no decision concerning this had been made to date. Bryan confirmed that some of the uncommitted capital had been invested in the PCT’s Estates Strategy. It was recognised that the PCT would need to up capacity to deliver schemes timely and effectively to ensure best value for money. The Board NOTED:  

The income and expenditure position of the PCT and the associated risks; and Forecast performance against the PCT’s other key financial duties/targets.

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Corporate Performance Report Peter Flynn presented the Corporate Performance Report to the Board. He explained that the report highlighted current performance against high priority targets and where appropriate, identified action being taken to improve performance. The Board reviewed performance against the six service priority areas and other performance indicators set out in the Operating Framework. Peter summarised performance against the breach report. It was recognised there had been no further breaches since those reported in November. It was AGREED future reports would include a graph for performance against Clostridium Difficile. Robert Flack provided an update on the recruitment of the Community Matrons. He confirmed 3.5 Whole Time Equivalent (WTE) Community Matrons had been appointed. The successful candidates were due to take up their appointments early February. It was recognised that alternative recruitment opportunities were being explored to appoint to the remaining 2.5 WTE posts. It was recognised that the trajectory for Infant Mortality was challenging. The PCT was exploring developing a revised local trajectory which is more achievable. Finally there was a discussion regarding performance against Mental Health. Carol McKenna clarified the position and provided assurance that performance was on target for the Early Intervention in Psychosis service. The Board RECEIVED and NOTED the Corporate Performance Report.


NHS Review Update Mike Potts provided a brief verbal update on the progress with the NHS Review.


Business Planning Update The Board received an update on the status of the business planning process since August 2007, when the planning process was presented to the Board. Peter Flynn explained the purpose of the HIT teams and highlighted the proposed planning framework and the progress made to date. Page 8 of 14

It was recognised that the HIT framework needs to be developed in conjunction with the business planning process. The updated strategic planning timeline was discussed and noted by the Board. There was concern among Board members how addressing health inequalities would be captured in the process. Judith Hooper AGREED to bring more information for discussion at the joint Board/PEC timeout on 29 November 2007. It was noted that Board members would appreciate the opportunity to be involved in the business planning process at an earlier stage than the end of January sign off. The PCT would be mindful of this in future planning. The Board NOTED the proposed planning framework and the progress made to date. KPCT/07/206

Holme Valley Memorial Hospital: In Patient Development Robert Flack presented the Holme Valley Memorial Hospital: In Patient Development Report to the Board. He explained that following an option appraisal carried out by a design team the costs of the upgrade had increased from the estimates given to the Board previously. This was due to the need to bring the potential inpatient facility up to the specific regulatory requirements including HTM and HBN compliance. The following three options were proposed: Option One This would provide 20 beds within the existing layout. Work would be undertaken to replace floor and decorative finishes, undertake any external repairs, and to bring the ward up to the standard to meet basic statutory requirements. It does not upgrade to HTM or HBN standard. Option Two This option would provide a 20 bed unit that is HTM and HBN compliant but does not meet the new standard for bed spacing. Option Three There is a possibility the number of beds may have to be reduced to 17 for the ward to become fully compliant with HTM and HBN compliance including bed spacing. Page 9 of 14

The Board was concerned to ensure equality of access across the local health economy. Following discussion it was recognised there would be equality across the patch given the context of the wider Community Hospital Bid. It was acknowledged this was subject to wider discussion in the future. Following discussion it was recognised there was an urgent requirement to address short-term infection control issues. Concerning this it was noted that an action plan had been developed to address the issues. It was AGREED that Jane O’Donnell would be asked to provide the detail of the infection control issues to Bryan Machin so that these could also be considered as part of the wider Estates Strategy. There was a debate about the preferred option. Following discussion Option three was AGREED. The rationale being that the hospital is ‘fit for purpose’ and fully compliant with the required regulations. In addition it was recognised that a full business case would be required to obtain Strategic Health Authority approval. It was therefore AGREED the development of a full business case is prepared which sits within the Community Hospital Bid. It was AGREED this would be presented to the Board for approval in March 2008. KPCT/07/207

Update on the Local Area Agreement (LAA) Julie Fothergill provided the Board with an update on the first draft of the LAA which included:  

background information on Kirklees which is to be developed further the priorities arising from the consultation carried out during September and October and agreed by the Kirklees Partnership Executive and Kirklees Council Cabinet on 9 November performance indicators to measure the priorities

Julie highlighted the priority indicators which were reviewed by the Board. It was recognised that lead officers were looking at what could be achieved against the expected outcomes. It was noted that work would be carried out between now and the formal sign off in June 2008 to confirm the priorities, performance indicators and targets. Page 10 of 14


The Board RECEIVED and AGREED the priorities within the LAA. Human Resources Policies Review Sue Ellis introduced the Human Resources Policies Review to the Board. She explained the purpose of the review and summarised the specific changes for each of the policies reviewed. A query was raised whether these Policies and Procedures should have been reviewed by another Committee prior to be being presented to the Board. It was recognised that these policies had been reviewed by the Senior Management Team and the Staff Partnership Forum. Helena Corder confirmed a review of Committee structures had been undertaken and AGREED to provide a Report on the outcome of the review at the next meeting. In addition it was recognised that in future an equality impact assessment should be undertaken on all polices prior to be being approved. The Board NOTED the changes and APPROVED the following policies:    


Grievance Policy and Procedure Maternity, Adoption and Paternity Guidelines Career Break Policy and Procedure Policy and Procedure/Guidance for the arrangement of Secondments

Healthcare Associated Infection Dr Judith Hooper presented the Healthcare Associated Infection Report to the Board. She explained the background of incidence of MRSA bacteraemia and Clostridium Difficile (C.difficile) within Mid Yorkshire Hospitals NHS Trust (MHYT), Calderdale and Huddersfield Foundation Trust (CHFT) and PCT Provider Services. Judith explained the four principles in preventing MRSA and C. Difficile:    

Prompt diagnosis Isolation Meticulous hand/personal hygiene and cleanliness Reducing inappropriate antibiotic prescribing

It was recognised that MYHT is working extremely comprehensively in terms of reducing the incidence of MRSA and other healthcare associated infection.

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It was noted that policies and procedures were in place at CHFT to reduce healthcare associated infection however it was not clear how progress against the action plan was being monitored. It was acknowledged that the PCT would welcome some input into this. It was therefore recommended that the PCT has a weekly meeting with CHFT and key staff that mirrors the arrangements in place at MYHT. It was AGREED that Mike Potts would liaise with Diane Whittingham, Chief Executive of CHFT regarding this. Finally Judith explained the recommendations which need implementing to reduce healthcare associated infection for the PCT Provider Services. It was noted a robust action plan needed to put in place to tackle this issues at Holme Valley Memorial Hospital. It was also noted there were a number of issues concerning the uptake of infection control mandatory training which needed to be strengthened. The Board AGREED to:   

Support the action plan in place for MYHT, and implementation of Support the agreement and implementation of a robust recovery plan for CHFT Support the specific recommendations for the PCT Provider Services -


attendance at infection control training is undertaken by all staff ensure their clinicians undertake any RCAs, supported by infection control staff the Essential Steps to Safe Clean Care audit is undertaken and results published the estates issues regarding Holme Valley Memorial Hospital are urgently dealt with

Investors in People Standard Action Plan Sue Ellis introduced the report and explained that the report highlighted progress against the action plan towards achieving the Investors in People Standard. It was recognised that progress against the IIP action plan would be monitored by the Senior Management Team. The Board NOTED the progress against the IIP action plan.

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Joint Commissioning of Supported Housing for Substance Misusers Carol McKenna presented the Joint Commissioning of Supported Housing for Substance Misusers Report to the Board. She explained that the report highlighted progress made in commissioning housing support services for substance misusers by a range of partner agencies. It was acknowledged that Kirklees and Calderdale accessed £950k to jointly commission 12 units of abstinence based accommodation for people released from prison or leaving treatment. Kirklees Supporting People (Supported Housing Partnership) have provided the revenue funding for support workers and a tendering process will determine the support provider. It was recognised that the PCT is not providing any on-going revenue support to the project and there are no Capital Charge implications. The Board RECEIVED and NOTED the report and SUPPORTED the project.


Infection Control Annual Report 2006/07 The Board RECEIVED and NOTED the 2006/07 Infection Control Annual Report.


Minutes of the Professional Executive Committee held 17 October 2007 The Board RECEIVED and NOTED the minutes of the PEC meeting held on the 17 October 2007.


Minutes of the Finance and Performance Committee held 19 September 2007 The Board RECEIVED and NOTED the minutes of the Finance and Performance Committee held on the 19 September 2007.


Minutes of the Governance Committee held 10 October 2007 The Board RECEIVED and NOTED the minutes of the Governance Committee held on 10 October 2007.


Minutes of the Yorkshire and Humber Specialised Commissioning Group – North Meeting held 3 October 2007 The Board RECEIVED and NOTED the minutes of the Yorkshire and Humber Specialised Commissioning Group – North meeting held on 3 October 2007. Page 13 of 14


Minutes of the Estates Strategy Committee held 2 August 2007 The Board RECEIVED and NOTED the minutes of the Estates Strategy Committee held on 2 August 2007.


Minutes of the Audit Committee held 8 August 2007 The Board RECEIVED and NOTED the minutes of the Audit Committee held on 8 August 2007.


Minutes of the HR/OD Shared Service Governance Board Meeting held 19 March, 1 May and 9 July 2007 The Board RECEIVED and NOTED the minutes of the HR/OD Shared Service Governance Board meeting held on the 19 March, 1 May and 9 July 2007.


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 Kirklees PCT Trust Board would take place between 9.15am and 12.00 Noon on Wednesday 19 December 2007 in the Board Room at St Luke’s House, Huddersfield.

Questions from the Public The Chairman gave a final opportunity for members of the public to raise any further questions. Eugena Hayes stated that she could not envisage how any plan would eliminate the risk of MRSA and other healthcare associated infections from hospitals until sufficient procedures were put in place to ensure that standards of hygiene and cleanliness were adopted and strictly adhered to. Rob Napier thanked Eugena for the point she had made, and emphasised that strict hygiene and cleanliness procedures was fundamental to minimising the risks of healthcare associated infection.

Chairman’s Signature: ………………………………….

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Date: ………………