REPORT OF THE MEETING OF HIGHLAND NHS BOARD ON
TUESDAY 5th AUGUST 2008 IN INVERNESS
MINUTE OF MEETING OF MID HIGHLAND CHP COMMITTEE 4TH JULY 2008
The Board noted the minute and the results from the national Hand Hygiene Audit in May 2008,
which were excellent for Mid Highland Community Health Partnership (CHP).
The Board also noted the discussion regarding the Scottish Ambulance Service. Garry Coutts,
Chair of NHS Highland, reported on a very useful joint meeting between the Chairs and Chief
Executives of NHS Highland and the Scottish Ambulance Service. A number of areas for joint
work had been identified and a report back would be provided in due course.
The Board wished to record its thanks to the staff who had maintained the service to the people of
Acharacle under very difficult circumstances. Dr Rob Colebrook officially takes up his new
appointment at the practice on 1 September 2008.
MINUTE OF MEETING OF NORTH HIGHLAND CHP 17 JUNE 2008
The Board noted the minute. The formal opening of the new CT scanner for Caithness General
Hospital will take place on 25th August 2008. Garry Coutts indicated that he had been advised by
the Lord Lieutenant of Caithness that the CT Scan was co-invented by a Nobel prize winning son of
Caithness, Professor Allan Macleod Cormack.
MINUTE OF MEETING OF RAIGMORE GOVERNANCE COMMITTEE 16 JUNE 2008
The Board noted the minute and discussed the problems with enforcing the smoking policy at
Raigmore Hospital. Staff were complying with the policy but it was difficult to enforce with patients
and visitors. It was agreed that the enforcement of the Policy should be reviewed and staff
supported to enforce the Policy. The Board reaffirmed its policy was that all NHS Highland buildings
and grounds should be smoke free. A report on progress would be submitted to the Board in due
course.
MINUTE OF MEETING OF SOUTH EAST HIGHLAND CHP 10 JULY 2008
The Board noted the minute and in particular the CHP's discussions regarding integrating handwashing posts into Care Homes. Care Homes have standards on Infection Control as set by the
Care Commission. It was agreed that the issue of hand hygiene and control of infection should be
discussed at a future Board Development session.
ARGYLL & BUTE COMMUNITY HEALTH PARTNERSHIP
The CHP had had a recent useful meeting but the minutes were not yet available. Mr Brackenridge
highlighted the difficulties of ensuring that the Committee was quorate. It was agreed that it was
essential that that all the operational committees were quorate and that as many members as
possible attend. The positive partnership working with schools in A&B regarding hand hygiene was
noted.
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MINUTE OF MEETING OF HEALTH AND SAFETY COMMITTEE 22 MAY 2008
The Board noted the minute. The Board welcomed the appointment of Mr Bob Summers to the
post of Professional Head of Service – Health & Safety. An appointment had now also been made
to the senior Radiation Protection post discussed in the minute.
The Board discussed the issue of the Management of Occupational Road Risk (MORR), noting that
most occupational deaths occurred on the road. It was noted that the proposed transport and travel
policy would also apply to all board members. The Scottish Ambulance service had provided a
special driving course for its Non Executive Directors. Bill Brackenridge, Non Executive Director,
offered to arrange such training for Board members. Anne Gent, Director of Human Resources,
indicated that training was already available for staff and agreed to look at the provision of training
for board members.
CLINICAL PLANNING GROUP (SERVICE REDESIGN COMMITTEE) 9 JUNE 2008
The Board noted the minute and it was confirmed that all board members could attend the Clinical
Planning Group meetings if they wished.
The Board noted the discussion regarding Anticoagulation and a number of models that were being
considered for delivering this service across NHS Highland. Elaine Mead, Chief Operating Officer,
reported that a group was meeting to look at this in detail.
UPDATE ON MENTAL HEALTH SERVICE HEAT TARGETS AND COMMITMENTS
Dr Ken Proctor, Associate Medical Director (Primary Care), presented the report to the Board on
progress against the targets.
One of the HEAT Targets (the core set of targets for NHS Scotland) is to reduce the suicide rate
between 2002 and 2013 by 20%, supported by 50% of key frontline staff in mental health and
substance misuse services, primary care, and accident and emergency being educated and trained
in using suicide assessment tools/suicide prevention training programmes by (2010/2013). The
rate in the NHS Highland area has reduced from 19.4/100,000 in 2002 to 16.6/100,000 in 2006, a
reduction of 14%. There is substantial variation in rates from year to year and it is important that the
NHS continues to contribute fully to multi-agency working in this area.
CHPs already have trainers within their existing staff complement in most instances, although not
all types of training are yet available in all CHPs. Highland Council has supported financially the
appointment of a training co-ordinator for one year, who will be based within NHS mental health
services.
Another HEAT Target is that we will reduce the number of readmissions (within one year) for those
that have had a hospital admission of over 7 days by 10% (by the end of December 2009). Some
people suffering from mental illness experience long and complex illnesses, with repeated relapse.
If this happens, it is essential that a range of services, including psychiatric hospital admission, are
available. There is no suggestion that all psychiatric hospital re-admission can, or should, be
prevented. NHS Highland had 321 re-admissions in patients discharged in 2004, the baseline year
for the target. A 10% reduction in admissions requires no more than 293 re-admissions in 2008-09.
For people discharged in April 2006 – March 2007, there were 226 readmissions, which exceeds
the required reduction. Continued work to maintain this performance will be required. There are
approximately 97 patients at risk of readmission. The work will be looking at what can be done to
support them and to prevent admission.
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A further HEAT Target is to reduce the annual rate of increase of defined daily dose per capita of
antidepressants to zero by 2009/10 and put in place the required support framework to achieve a
10% reduction in future years (2009/10) . NHS Highland is among the lower prescribers of antidepressants, so this is a particularly challenging target for the area. Highland has made some
progress towards this target and in the last available period, the calendar year 2007, the percentage
increase in prescribing was 0.87 percent, compared to a national increase of 1.6 percent. The
main likelihood of reducing prescribing lies in two areas – rational prescribing at a lower severity of
illness, and alternatives to prescribing. These are interlinked.
The HEAT Target relating to dementia is that each NHS Board will achieve agreed improvements in
the early diagnosis and management of patients with a dementia (March 2011). The two main
actions planned for this target are to increase consistency of recording, and to improve services
aimed at providing an early, accurate, diagnosis, treatment and support. In the baseline year 2007,
epidemiological estimates suggest that almost 4,000 people in the NHS Highland area will have had
a dementia. Practice QOF registers for this period included 1,925 people, just over 50% of the
expected total prevalence. By 2007/08, identified prevalence had increased to 53.5%. In order to
increase early diagnosis, it is important to make this straightforward, and to provide as far as
possible a streamlined process for diagnosis and treatment. Dr Chris MacGregor is leading a
Working Group looking at services for this group of people, and the group will report to the Mental
Health Network on their recommendations on service changes required to meet the HEAT target. It
was agreed that support for carers was very important.
The Board agreed it was a very positive report. It was agreed that the Voluntary Sector should be
invited to work with NHS Highland on this at an early stage in any redesign work. It was also agreed
that it was important to disaggregate these measures so that CHPs can proactively monitor
progress against each of the targets in their area..
It was also agreed that exercise prescriptions played an important role in mental health.
It was agreed that clinical advice would be sought on the feedback to be given to the Scottish
Government about the appropriate levels of prescribing. An update on progress would be provided
at the end of the year.
HEALTHY WEIGHT STRATEGY
The Board noted the Report by Fiona Clarke, Senior Health Promotion Specialist which outlines
developments in the implementation of the Healthy Weight Strategy since it was endorsed by the
Board in February 2008.
An action plan to improve diet, increase physical activity and tackle obesity (2008-2011) was
published by the Scottish Government in June 2008. It has three specific targets for Health Boards:

Improving the nutrition of women of childbearing age, pregnant women and children under 5
in disadvantaged areas - further guidance on this is expected, including what indicators will
be used to monitor progress.

HEAT H7: increase the proportion of newborn children who are exclusively breast fed at 6-8
weeks from 26.6% to 33.3%. Progress on this target will be monitored through the Child
Health Surveillance System which NHS Highland has recently signed up to.
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
HEAT H3: Achieve agreed completion rates for child healthy weight intervention programme
by 2010/11; 13.5% of all 5 – 15 year old overweight and obese children should complete a
family based healthy weight intervention during 2008 and 2011. Initial work to deliver H3 is
underway, and the following work has been progressed:
o communities where over weight and obese children/young people are likely to be
concentrated are being identified through a population survey of Body Mass Index
(BMI) in 5 year olds with the implementation of the School CHSS.
o a social marketing approach to the introduction of the interventions is being
developed to address any parental concerns that might arise.
o a variety of evidenced based interventions aimed at the whole family is being
developed, for delivery to both groups and individuals.
The Counterweight programme is an evidenced based weight management programme which
was part of the national pilot Keep Well anticipatory care programmes for urban areas. The
Scottish Government are now rolling this programme out across Scotland. Counterweight
provides a structured approach to managing weight in primary care. Counterweight is based on
specialist Weight Management Advisers who provide support, training and mentoring to develop
local expertise in providing treatment for overweight and obese clients. The programme for each
patient lasts a year with continuing follow up. Funding has been made available for two years to
develop this approach in Highland. It is hoped that around 40 GP practices in NHS Highland
will engage with the programme. Two part time (0.5wte) Counterweight Advisers have been
appointed in NHS Highland and will commence work in August to implement this approach.
The Board welcomed the report and noted the progress being made, particularly in relation to
promote a healthy weight environment. All sugary fizzy drinks from vending machines in Raigmore
Hospital and Assynt House have been removed and removal from other sites is planned. A catering
strategy for the whole of NHS Highland is being developed which will oversee developments to
increase fruit and vegetable sales in NHS premises and achievement of the national Healthy Living
award. The “Cycle to Work” scheme was introduced in March 2008 with over 260 staff purchasing
new bikes.
The Board discussed the current shortage of dieticians due to a large number of vacancies. It was
agreed that the health weight strategy should be embedded in the core work of CHPs and
Raigmore and that it was important to disaggregate this to CHP level to allow them to monitor this..
It was noted that there were good working partnerships already in place with schools on healthy
eating. It was agreed that active engagement should be undertaken with voluntary organisations at
an early stage.
INFECTION CONTROL ANNUAL WORK PLAN (2008 – 2009)
Heidi May, Director of Nursing, presented the Infection Control Annual Work Plan and highlighted
the progress being made in this area. She indicated that NHS Highland was doing well in respect
of low levels of Clostridium difficile infections. NHS Highland had responded immediately to the
Vale of Leven situation, in terms of the increased risks to the population in Argyll & Bute.
During discussion, it was agreed that it was important to standardise patient and staff information.
Information on Control of Infection was fed into local clinical governance and risk management
groups and a detailed action plan would be submitted to the next Clinical Governance Committee.
Heidi May also indicated that the role of Non Executive Directors in Control of Infection was very
helpful. It was agreed that the Control Of Infection Committee be chaired by a Non Executive
Director. Garry Coutts indicated that he would be inviting expressions of interest from Non
Executive Directors shortly.
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AREA FINANCE REPORT FOR THE PERIOD TO 30 JUNE 2008
The Board received a Report from Malcolm Iredale, Director of Finance outlining the financial
position. He highlighted that Facilities is forecasting a year end over spend of £762,000. This is
almost entirely due to the significant increases in the cost of energy. The exact impact of this is
impossible to accurately predict as this stage, particularly due to the fact that the national contracts
for gas and electricity come to an end on 30th September. In addition to electricity and gas, there
are considerable price increases in the cost of oil and road fuel. The current modelling suggests
that the impact in 2008/09 will be between £526,000 and £944,000 with a full year impact in
2009/10 within the range £0.8m to £1.6m. Energy conservation initiatives are being explored and a
report on this will be presented to the board at the next meeting. All staff can help to manage
energy expenditure in an effective and appropriate manner – such as control of lighting and heating
in our own working areas – just as we would do in our home situations.
The overall position for NHS Highland was that there was a forecast overspend of £1m, which is
offset by further adjustments to achieve break even. This requires savings of £16m, of which £9.5m
is recurring savings.
During discussion it was agreed that it was important for Community Health Partnerships and
Raigmore to have robust plans in place to achieve the challenging savings programme.
PERFORMANCE REVIEW GROUP
Roger Gibbins, Chief Executive, introduced the new style of assurance report from the Performance
Review Group. The new format was welcomed and members were asked to forward any
comments on the presentation of the report to the Chief Executive. The effectiveness of the new
reporting style would be reviewed after a few months. It was agreed that a similar approach could
be considered for other Governance committees. The revised role and remit of Performance
Review Group would be submitted to the Board for approval.
CLINICAL GOVERNANCE & RISK MANAGEMENT PERFORMANCE REPORT
The Board noted this Report by Dr Lesley Anne Smith, Head of Clinical Governance & Risk
Management. It was noted that this would be the last of this type of report to the Board. In future
the report will be submitted to the Clinical Governance Committee who in turn will report to the
Board.
Lesley Anne Smith reported that the complaints department was piloting a new ISD complaints
database. This will be used nationally using common definitions. During discussion, it was noted
that biggest source of complaints is communication. It was agreed that it would be useful for the
Clinical Governance Committee to look at the communications issues, in relation to complaints, in
more detail.
The Board discussed the incidents involving disruptive, violent, or aggressive behaviour. These
had been discussed at the Health and Safety Committee and it was suggested that the Staff
Governance Committee also look at this in more detail, where the incidents involve staff. The
incidents involving access to treatment, fire, and staff availability were discussed. Lesley Anne
Smith agreed to ensure that these are examined, any problems investigated, and any anomalies
addressed.
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NHS HIGHLAND CAPITAL PLAN 2008/09 – 2012/13
David Blair, Head of Capital and Property Planning, presented a report on the Capital Plan. He
indicated that a number of significant capital pressures have emerged namely: upgrade of the
power supply to Raigmore Hospital, replacement Radiology equipment; and additional replacement
medical equipment. In addition design development work on the Raigmore Angiography//Catheter
Lab and Day Services Centre schemes has indicated the likely need to increase the funding for
these projects. There is also a need to reserve capital funds for anticipated Primary Care Premises
Developments.
These pressures required a re-profiling of the Capital Plan not only to achieve capital affordability
but also to ensure that the Plan continues to be affordable in terms of its supporting Capital
Charges Revenue budget. The changes proposed to the Plan were attached as Appendix 1 and
were approved.
David Blair confirmed that each of CHPs and Raigmore were looking at their plans over the longer
term and will produce prioritised bids for consideration. It was agreed that the process for capital
planning required further examination and that a paper would be submitted to the Board on this.
REPLACEMENT OF TAIN HEALTH CENTRE: OUTLINE BUSINESS CASE
The Board received a report from Gill McVicar, General Manager, Mid Highland Community Health
Partnership on the need to replace Tain Health Centre. Gill McVicar reminded the Board that
originally it was believed that the quickest and best option would be to lease the building and a
preferred developer was appointed. However since that time the environment has changed and the
lease option is no longer affordable nor value for money. The preferred option is now therefore to
build a new health centre including dental accommodation on a greenfield site using NHS capital
funding.
Following discussion, the Board approved the Outline Business Case (OBC) for the replacement
of Tain Health Centre, to include the two practices, a Dental suite and a Community wing. It was
agreed that the OBC be submitted to the Scottish Government for consideration and approval of
the additional Capital allocation to NHS Highland of £7.14M. If £7.14M is approved by the Scottish
Government, it was agreed to include the replacement of Tain Health Centre in the Board’s capital
programme for 2009/10 at an estimated £7.14M.
It was noted that as it would be a greenfield site, all opportunities to reduce energy costs through
solar power and other power sources should be explored.
NHS HIGHLAND WORKFORCE PLAN 2008/09 – EXECUTIVE SUMMARY
The Board noted the Report by Pamela Cremin, Workforce Planning & Development Manager,
outlining the Board’s current position and the further action to be taken forward to strengthen the
Board’s workforce planning function and underpin service planning and financial decision making.
This would be discussed further at the Staff Governance Committee.
The full version of NHS Highland Workforce Plan 2008/09 is available from:
http://www.nhshighland.scot.nhs.uk/Publications/Documents/Strategy/NHS%20Highland%20WORK
FORCE%20PLAN%202008_09.pdf
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PAY MODERNISATION BENEFITS REALISATION DELIVERY PLAN 2008/09 – EXECUTIVE
SUMMARY
The Board noted the Report by Pamela Cremin, Workforce Planning & Development Manager,
outlining the NHS Highland Pay Modernisation Benefits Realisation Delivery Plan 2008/09, and the
NHS Highland KSF Implementation Updated Project Implementation Plan 2008/09.
The Board noted the huge amount of work involved in implementation of Agenda for change. The
improved ability to recruit GPs was a significant benefit of the GMS contract. It was suggested that
there may be non-medical staff who work hours in excess of the European Working Time Directive.
It was agreed that the Staff Governance Committee undertake a piece of work on this.
NHS BOARD AND BOARD DEVELOPMENT MEETING DATES 2009
The Board agreed the following dates for meetings in 2009
MONTH
MEETING
DATE
January
No Board Development
February
Board Development
NHS Board
Monday 2 February 2009 at 1.30 pm
Tuesday 3 February 2009 at 9.30 am
March
Board Development (Strategy)
Tuesday 3 March 2009 at 9.30 am
April
Board Development
NHS Board
Monday 6 April 2009 at 1.30 pm
Tuesday 7 April 2009 at 9.30 am
May
Anticipated Public Holiday
Annual Board Development Event
Monday 4 May 2009
Tuesday 12 May 2009 at 9.30 am
June
Board Development
NHS Board
Monday 1 June 2009 at 1.30 pm
Tuesday 2 June 2009 at 9.30 am
August
Board Development
NHS Board
Monday 10 August 2009 at 1.30 pm
Tuesday 11 August 2009 at 9.30 am
September
Board Development (Strategy)
Tuesday 8 September 2009 at 9.30 am
October
Board Development
NHS Board
Monday 5 October 2009 at 1.30 pm
Tuesday 6 October 2009 at 9.30 am
November
Board Development (Strategy)
Tuesday 3 November 2009 at 9.30 am
December
Board Development
NHS Board
Monday 30 November 2009 at 1.30 pm
Tuesday 1 December 2009 at 9.30 am
It was agreed that an update on venues would be produced as soon as possible and that other
meetings which involved Non Executive Directors would be tied into these dates as much as
possible. The Committee dates would be agreed in September 2008.
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ANY OTHER COMPETENT BUSINESS
The Chair reported that he and Malcolm Iredale had been appointed to the national Technical
Advisory Group on Resource Allocation. The Group has been formed by the Scottish Government
Health Directorate in response to the Scottish Cabinet Secretary for Health and Wellbeing's
acceptance of the recommendations of the NHS Scotland Resource Allocation Committee (NRAC).
Chris Meecham
Board Secretary
6th August 2008
NB This report is intended as a summary of the meeting. A formal minute will be produced in due
course. All Board papers are available from the NHS Highland website at
http://www.nhshighland.scot.nhs.uk/Meetings/BoardsMeetings/Pages/welcome.aspx
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