Ayrshire and Arran NHS BoardMinutes of a public meeting on Monday 18 May 2015Greenwood Conference Centre, Dreghorn

NHS, tI

'IAyrshire&Arran

Present: Dr Martin Cheyne (Chair)Non-Executive Members:Mrs Lesley BowieMr John Callaghan

l Dr Kirsty Darwent (Vice Chair)Cllr Willie GibsonCllr Hugh HunterDr Janet McKayMr Stephen McKenzieMr Alistair McKieMiss Lisa TennantMr Ian Welsh _

Executive Members:Mr John BurnsDr Carol DavidsonDr Alison GrahamDr Allan Gunning

Mr Derek Lindsay

(Chief Executive)(Director of Public Health)(Medical Director)(Director for Strategic Planning, Policy andPerformance)(Director of Finance)

Board Advisors/Ex-OfficiosMs lona Colvin (Director of Health and Social Care, North Ayrshire)Mr Tim Eltringham (Director of Health and Social Care, South Ayrshire)Mr Eddie Fraser (Director of Health and Social Care, East Ayrshire)Mrs Ann Gow (Interim Nurse Director)Mrs Patricia Leiser (Human Resources Director)Mrs Liz Moore (Director for Acute Services)

In attendance. Mrs Vicki Campbell (Corporate Business Manager)Mr Billy McClean (Associate Director .for Allied Health Professions)Mrs Angela O'Mahony (Committee Secretary) minutesMrs Miriam Porte (Communications Manager)

1. Apologies

Apologies were noted from Mr Bob Martin, Councillor Douglas Reid and Mr JohnWright.

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3.

4.

Declaration of interests

There were no declarations noted.

Minutes of the meeting of the NHS Board held on 30 March 2015

The minutes were approved as an accurate record of discussions.

Matters arising

(056/2015)

(057/2015)

(058/2015)

Paper 2 - Action LogThe Board action log was circulated to Board Members in advance of the meetingand all actions were noted.

5. Chairman and Chief Executive's report

5.1 Chief Executive's report (059/2015)

• The Chief Executive reported that he had recently visited staff and carried out aleadership walkround on Cumbrae and Arran. Both visits had demonstrated theimportance of building and developing integrated working. On Cumbrae he wasable to see the impact of Advanced Nurse Practitioners (ANPs) on the out-of-hours services. Whilst there have been challenges in implementing this service, itis embedding well and staff and patients are now seeing the benefits of thiseffective model of working. Board Members welcomed this progress andrecognised the significant work done by the organisation and the widercommunity in re-designing the model of care.

• Paul Gray, Director General of Health and Social Care and Chief Executive ofNHS Scotland, is visiting NHS Ayrshire & Arran on 21 May. Mr Gray will join theearly morning Crosshouse huddle and then visit the North West Kilmarnock AreaCentre where he will meet staff and hear more about the progress andchallenges in Ayrshire in terms of integration. He will then take part in theScottish Patient Safety Mental Health event in the afternoon.

• A Board workshop will take place on 23 June, following the NHS Board AnnualAccounts meeting, to consider the Board's strategic direction over the coming 10-15 years. The Chairman underlined the importance of this workshop and heencouraged full attendance.

5.2 Chairman's report (060/2015)

• The Chairman reported that interviews for the two Non-Executive Board Memberpositions have taken place and nominations have been submitted to the CabinetSecretary. An update will be provided at the next Board meeting.

• He advised that the national Chairs' meeting continues to meet on a regular basisand is taking forward a number of issues.

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6. Quality

6.1 Gender Based Violence (GBV) (061/2015)

The interim Nurse Director introduced the patient story which came from a serviceuser who had attended the Addictions Unit and, through routine enquiry, was able toshare her experience of gender based violence. GBV is an all population healthissue with significant financial and human costs which requires to be handled verysensitively by staff. The story recognises the strength and value of routine enquiry inencouraging disclosure of abuse and providing more appropriate interventions. Staffrequire to be trained and supported to work in this difficult area. The programmeworks very closely with the health and social care partnerships, third sectorcolleagues, Women's Aid and the police.

Since 2008, routine enquiry of abuse has been introduced in maternity services,community mental health teams, substance misuse services, community nursing andsexual health services to positive effect. A pilot has also taken place in a GPpractice in North Ayrshire and the outcome will inform further work within PrimaryCare. It is proposed that routine enquiry be further extended to include accident andemergency departments, occupational health, staff care and the learning disabilityservice. There are challenges in terms of routine data collection to demonstrate thebenefits of routine enquiry and work is taking place to address these issues.

Outcome: The Board noted the progress to date and welcomed the furtherplanned roll-out of routine enquiry.

6.2 Healthcare Associated Infection (HAl) report (062/2015)

The Medical Director presented the latest HAl data to the end of March 2015. It wasnoted that there were 126 Staphylococcus aureus bacteraemia (SAB) cases, 42above the target for this period. Of these 41% were hospital acquired and 59% werecommunity acquired or community onsetlhealthcare associated. The primary focusfor further SAB reductions continues to target those associated with vascular accessand good progress is being made in this area. Each SAB case is now reviewed bythe clinical team, a microbiologist and Infection Control.

Board members noted that there were 134 Clostridium difficile infection (COl) cases,14 above the target for this period. While above the target, this is a reduction of 9%on last year's figures. Further reductions in COl rates are linked to reductions in theoverall level of antimicrobial prescribing and it is important to remain vigilant in thisarea.

The MRSA screening rate target is 90% compliance against the national MRSAclinical risk assessment. The Board's rate was 82%, which is 8% below the target.Improvement work is taking place and the Infection Control Team now input to thedaily hospital huddle as required.

There have been nine confirmed Norovirus outbreaks since 29 September 2014 andthese were successfully rT)anaged with only short term closure and no spread toother areas.

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Outcome: Board Members considered and noted the HAl data and wereencouraged by the ongoing work within the organisation toreduce HAl rates.

6.3. Report on Patient Experience (063/2015)

The interim Nurse Director presented a report on organisational activity in respect offeedback recorded through the Board's feedback and complaints processes. Anintegral part of the delivery of the person-centred health and care programme locallyhas been the establishment of a real-time patient experience programme acrosshospital sites, including University Hospitals Ayr and Crosshouse, Ayrshire Central,Ailsa and Biggart Hospitals. The programme provides rapid feedback on patientexperience to drive further improvements. Since the start of the programme inFebruary 2014, the review team has interviewed an average of 48 in-patients permonth, within 49 inpatient wards. A number of further developments are planned for2015, including the possibility of using independent volunteers to deliver theprogramme. Board members supported this approach which should promote honestand meaningful feedback.

The Board continued to demonstrate a strong performance in achieving the nationaltarget of 95% of patients having a positive healthcare experience. However, therewas a dip in performance in December 2014 (82%), with winter pressures in acutewards being a significant factor.

Outcome: Board Members noted the ~pdate report and supported theplanned developments for 2015.

6.4 Scottish Patient Safety Programme - Maternity Services (064/2015)

The interim Nurse Director reported that the Maternal and Children's QualityImprovement Collaborative (MCQIC) was launched in March 2013, coveringmaternity, neonatal and paediatric safety work, each at different stages of progress.The programme aims to improve outcomes and reduce inequalities by providing asafe, high quality care experience for all women, babies and children and familiesacross all care settings in Scotland.

The maternity workstream is currently reporting nationally on 24 out of 27 agreedmeasures within t~e Maternity Care Measurement matrix. A number ofimprovements have been made relating to the safety culture and team working inmaternity services which were recognised by Healthcare Improvement Scotlandduring a recent visit. The workstream aims to achieve overall compliance by the endof the programme. Board Members were encouraged by the work taking placewithin maternity services.

The national neonatal programme is currently undergoing coordinated testing acrossall the units in Scotland with individual neonatal units selecting specific measures totest. Data is currently being collated and tested on six elements. A total of 14 newelements from the national programme have been agreed and these will beimplemented in a staged process following their launch. A number of localimprovement projects have also been identified by the neonatal quality improvementgroup to address important local issues.

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The paediatric workstream, is currently reporting measures in relation to thenationally agreed serious harm index. Data is being collated in terms of serioussafety events, unplanned admission to paediatric intensive care unit and medicinesharm.

Overall, NHS Ayrshire & Arran is making steady progress towards reaching theMCQIC measures and sustainability is improving due to the number of staff involvedin using the improvement science methodology.

Outcome:

7. Service

Board Members noted the progress to date, acknowledged thatfinancial constraints in the 2015/16 budget may impact on thepace of the programme moving forward and endorsed thecommitment of the multidisciplinary team across all three workstrands.

7.1 Child and Adolescent Mental Health Service (06~/2015)

The Director of Health and Social Care (North Ayrshire) provided an update onprogress in meeting referral to treatment times for specialist Child and AdolescentMental Health Services (CAMHS). The Scottish Government HEAT target is that nochild will wait longer than 18 weeks from referral to treatment for CAMHS services.Considerable work has been undertaken by the CAMHS Clinical Service Managerand his team over the past six months to develop quality and capacity within theservice. Since December 2014, NHS Ayrshire & Arran has consistently met thetarget of 90%, a significant achievement. CAMHS will continue to review keyresources and priorities in an integrated way to target high risk children and youngpeople.

Outcome: Board Members commended the progress made by the CAMHSteam in achieving the national waiting times targets andsupported the proposed future areas of work as outlined in thereport.

(066/2015)7.2 Progress towards Psychological Therapies Government HEATTarget

The Director of Health and Social Care (North Ayrshire) provided a report outliningprogress in the delivery of the HEAT target from December 2014. The ScottishGovernment's HEAT target is that no-one will wait longer tlJan 18 weeks fromreferral to treatment for psychological therapies.

NHS Ayrshire & Arran met the 90% target in December. However, this level has notbeen maintained and it is currently sitting at 15%. Over the past year, there hasbeen a signiffcant increase in the number of referrals received by psychologicaltherapies. There are variations between specialties and some long waits may bemasked due to the way data was collected in December 2014.

The report highlights the significant risks for Psychological Services Specialitiesarea-wide and for Primary Care Mental Health Teams.

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Three factors have been identified as crucial in improving, maintaining and reportingon the standard in future in relation to data and business intelligence, flexible use ofPsychological Therapy staff across specialities and localities, and review of themodel for delivery of psychological therapies across mental health services.

Outcome: Board Members noted progress towards the delivery of the HEATtarget from December 2014, acknowledged the associatedchallenges and risks and supported work being taken forward toachieve the target.

Board Members requested that a progress update should beprovided at the meeting on 1 February 2016.

7.3 Improving Collaboration between Primary and Secondary Care (067/2015)

The Medical Director provided a progress update on the Primary and SecondaryCare Interface Programme Board which was set up in June 2014 in order toenhance collaborative working between primary and secondary care. An action planhas been developed and progress has been made in a number of areas, includingout of hours general medical services, development of new contract models, newmedicines, workforce plan for general medical services, support for maternity,paternity, adoption and sick leave, embedding patient safety and improvingcommunication.

The new Head of Primary Care and Out of Hours Services, Pamela Milliken, isworking with Clinical Directors in the Health and Social Care Partnerships to ensurethere are effective GP and other professional stakeholder support arrangementswithin the Partnerships. The Board would receive a report on medical workforceissues at a future meeting.

Outcome: Board Members noted and welcomed the progress being made toimprove collaboration between Primary and Secondary Care.

7.4 Allied Health Professions Local Delivery Plan (LOP) (068/2015)

The Associate Director for AHPs provided an update on the status of the Ayrshire &Arran Allied Health Professions Local Delivery Plan 2013-15, which was launched inMarch 2013. There has been significant progress in achieving goals and deliveringmeaningful outputs across all 16 workstreams with many actions now complete.Improvement activity has been targeted on health and social care and on improvingaccess to AHP services. Moving forward, the plan will concentrate on embedding,sustaining and spreading these improvements across health and social care and thethird sector. Further consideration will be given to the planning of the next Plan.Aligned to the Strategic Plans for each of the HSCPs .and acute and the next AHPnational delivery plan, the local plan will set out improvement activities for 2015-2020.

The Director of Health and Social Care (South Ayrshire) advised that the IntegrationJoint Board (South) had approved proposed AHP leadership arrangements movingforw~rd. The Integration Joint Boards in North and East Ayrshire will also be askedto endorse these proposals.

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Outcome:

8. Performance

8.1 Waiting times

Board Members noted the progress made and supported thedirection of travel outlined in the report.

(069/2015)

The Director for Acute Services provided Board Members with an up-to-date positionon the Board's performance against the national waiting times and access targets.She noted that the Board was in discussion with the Scottish Government in terms ofthe additional resources required to meet waiting times targets. The Chief Executiveadvised that the Board is reflecting on last winter's challenges in order to informpreparations for next winter. '

Outcome: Board Members acknowledged the hard work being done by staffin working towards meeting :the national waiting times andaccess targets but recognised the financial and workforcechallenges moving forward.

8.2 Financial Management Report (070/2015)

The Director of Finance presented the financial management report for the period to31 March 2015 and reported an underspend of £0.3 million, with several lateallocations being carried forward to next year, putting the Board ahead of theplanned year-end position of break-even. He noted overspends in acute services,mainly relating to medical and nursing staffing and drug costs. The three Health andSocial Care Partnerships were overspent, mainly due to primary care prescribing.North Ayrshire had the most significant overspend (£2.7m), due to spending on adultacute mental health in-patient services. All Directorates have worked hard to containoverspends and maximise underspends in order to achieve this positive outcome.The Board will meet on 23 June 2015 to approve the statutory annual accounts.

Outcome: Board Members noted the financial position at 31 March 2015 andrecognised the efforts of all those involved in achieving thispositive outcome.

8.3 Local Delivery Plan (LOP) for 2015/16

The Director for Strategic Planning, Policy and Performance presented a letter fromScottish Government signing off the Board's Local Delivery Plan for 2015/16 whichwas submitted on 20 March 2015.

Outcome Board Members noted the response from the ScottishGovernment.

9. Decision/Approval

9.1 People Strategy (071/2015)

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The Human Resources Director presented the People Strategy, which incorporatesa number of other strategic documents and plans, and describes the Board'sambitions and commitments as an employer moving towards 2020. The People

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Strategy will be key in delivering the Board's purpose, commitments, values andstrategic and operational objectives. The Strategy will be performance managedusing a range of metrics and these will continue to be developed.

Outcome: Board Members endorsed the People Strategy, which would besubject to further engagement with services.

10. Corporate Governance

10.1 Audit Committee Annual Report 2014/15 (072/2015)

Mr Alistair McKie presented the Audit Committee's Annual Report. He highlightedan issue that had arisen in relation to the theft of medical equipment, which hadbeen addressed effectively. In 2015/16, the Audit Committee will develop scrutiny,risk management and self assessment arrangements in support of the Board'sGovernance Committees and Integration Joint Boards.

It was noted that the terms of reference in the annual report state there are five Non-. Executive Board Members when this should be six.

Outcome: Board Members considered and noted the Annual Report.

10.2 Performance Governance Committee Annual Report 2014/15 (073/2015)

The Director of Finance presented the Performance Governance Committee AnnualReport. The Committee had focused on high risk areas in relation to Health,Efficiency, Access and Treatment targets, as well as routine financial performing. MrBob Martin had taken over the role of Chair in January 2015. It was noted that theCommittee had achieved full attendance at meetings throughout the year.

Outcome: Board Members considered and noted the Annual Report.

10.3 Healthcare Governance Committee Annual Report 2014/15 (074/2015)

Dr Kirsty Darwent presented the Healthcare Governance Committee Annual Report.The Committee has focused on areas of known clinical risk, scrutinising the actionstaken to deliver improvements and seeking assurances that there has beensustained focus on the implementation of learning.

Outcome: Board Members considered and noted the Annual Report.

10.4 Information Governance Committee Annual Report 2014/15 (075/2015)

Mrs Lesley Bowie presented the Information Governance Committee Annual Report.She advised that the Committee is still only a recently established Committee and iscurrently developing its approach and work plan. An Information Governanceframework document has now been agreed to outline strategic and operationalactivity.

Outcome:

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Board Members considered and noted the Annual Report.

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10.5 Staff Governance Committee Annual Report 2014/15 (076/2015)

Mr Ian Welsh presented the Staff Governance Committee Annual Report. TheCommittee has continued to focus on the five elements of the Staff GovernanceStandard. Discussion has also focused on the development of the People Strategyand on attendance monitoring.

Outcome: Board Members considered and noted the Annual Report.

10.6 Area Professional Committees Annual Report 2014/15 (077/2015)

Dr Janet McKay presented the Area Professional Committees Annual Report. TheProfessional Committees represent a wide range of Health professions within NHSAyrshire & Arran.

Outcome: Board Members considered and noted the Annual Reports.

10.7 Pharmacy Practices Committee Annual Report 2014/15 (078/2015)

The Medical Director presented the Pharmacy Practices Committee Annual Report.The Committee did not meet formally between 1 April 2014 and 31 March 2015, asthere were no formal hearings. The Chair of the Committee advised the' Board thatalthough the Committee have not met they have undertaken training.

Outcome: Board Members considered and noted the Annual Report.

10.8 Staff Governance Committee (079/2015)

Mr Ian Welsh presented the minute and a short update report from the meeting heldon 19 March 2015.

Outcome: Board members considered and noted the minute.

10.9 East Ayrshire Shadow Integration Board (080/2015)

The Director of Health and Social Care (East) presented the minute and a shortupdate report from the meeting held on 26 March 2015.

Outcome: Board members considered and the good progress of the Boardwas noted.

10.10 North Ayrshire Shadow Integration Board (081/2015)

Mr Stephen McKenzie presented the minute and a short update report fromthe meeting held on 1.2March 2015.

Outcome:

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Board members considered and the good progress of the Boardwas noted.

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10.11South Ayrshire Shadow Integration Board (082/2015)

Mr John Callaghan presented the minute and a short update report from the meetingheld on 26 March 2015.

Outcome: Board members considered and the good progress of the Boardwas noted.

11. For information

11.1 Board briefing (083/2015)

Members noted the content of the briefing. The Chairman congratulated NHSAyrshire & Arran staff on receiving Advancing Healthcare and the Royal College ofMidwives Midwifery Awards, and recognised the good work being done by staffacross the organisation.

11.2 East Ayrshire Integration Joint Bo"ard (084/2015)

Board Members noted the minute from the meeting of East Ayrshire Integration Joint"Board held on 2 April 2015.

Outcome: Board members noted the draft minute.

11.3 North Ayrshire Integration Joint Board (085/2015)

Board Members noted the minute from the meeting of North Ayrshire IntegrationJoint Board held on 2 April 2015.

Outcome: " Board members noted the draft minute.

11.4 South Ayrshire Integration Joint Board (086/2015)

Board Members noted the minute from the meeting of South Ayrshire IntegrationJoint Board held on 2 April 2015.

Outcome: Board members noted the draft minute.

12. Any other competent business

There was no other competent business.

13. Date of next meeting

(087/2015)

The next meeting of the NHS Ayrshire and Arran Board would take place at 11.00amon Tuesday, 23 June 2015, venue to be advised.

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