powys teaching health board confirmed minutes of … · 9 december 2015 status: approval page 1 of...

Board Minutes Meeting held on

9 December 2015 Status: Approval

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POWYS TEACHING HEALTH BOARD CONFIRMED

MINUTES OF THE MEETING OF THE BOARD HELD ON WEDNESDAY 9 DECEMBER 2015, AT 10AM

AT THE MEDIA RESOURCE CENTRE, LLANDRINDOD WELLS

Present:

Vivienne Harpwood (VH) Chair (Chair of Meeting) Carol Shillabeer (CS) Chief Executive

Melanie Davies (MD) Vice Chair Trish Buchan (TB) Independent Member

Mark Baird (MB) Independent Member Roger Eagle (RE) Independent Member

Paul Dummer (PD) Independent Member Owen James (OJ) Independent Member

Sara Williams (SW) Independent Member Matthew Dorrance (MJD) Independent Member

Tony Thomas (TT) Independent Member Veronica Jarman (VJ) Associate Member (Older People)

Alan Lawrie (AL) Director of Primary and Community Care

Julie Rowles (JR) Director of Workforce & OD Rhiannon Jones (RJ) Director of Nursing

Hayley Thomas (HT) Director of Planning & Performance Rebecca Richards (RR) Director of Finance

Catherine Woodward (CW) Director of Public Health Dr Stephen Edwards (SE) Medical Director

In Attendance:

Stephen Harrhy (SH) Chief Ambulance Services Commissioner (tHB/15/140 only)

Rosemarie Harris (RH) Chair (Powys Community Health Councils) (tHB/15/147 to tHB/15/168)

Jane Thornhill (JT) Deputy Chief Officer (Powys Community Health Councils)

Stephen Hayes (SH1) Portfolio Holder for Adult Social Care, Powys

County Council (PCC) Mandy Collins (MC) Interim Board Secretary

Sarah Murphy (SM) Corporate Governance Support Officer

Observers: There were 4 observers from the health board and local authority present.



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Public Attendance: There were no members of the public present.

Apologies:

David Adams (JDA) Chief Officer (Powys Community Health Councils)

Amanda Smith (AS) Director of Therapies & Health Sciences Amanda Lewis (AL1) Associate Member, Strategic Director of

People, PCC

tHB/15/145 WELCOME AND APOLOGIES FOR ABSENCE

The Chair welcomed everyone to the meeting and noted that

there was a quorum present.

Apologies for absence were received from David Adams, Chief Officer (Powys Community Health Councils); Amanda Smith,

Director of Therapies & Health Sciences and Amanda Lewis, Associate Member, Strategic Director of People, PCC.

tHB/15/146 DECLARATIONS OF INTEREST

The Chair INVITED members to declare any interests in relation to the items on the meeting agenda. There were no

declarations of interests made.

tHB/15/147 PATIENT EXPERIENCE PRESENTATION

RJ introduced the patient experience story, she explained that

the audio that was about to be heard was initiated by a recent complaint received by the Health Board. RJ confirmed that it

was a very current story and pertinent to the presentation due to be received later in the Board Meeting from the Emergency

Ambulance Services Committee.

RJ confirmed that the investigation into the matter was still ongoing (by WAST), and hence there was no accompanying

summary of findings, recommendations and improvements. RJ advised that the story brought to the fore the personal impact

that ambulance delays had on patients and their families.

In discussing the case:

it was confirmed that a root cause analysis is undertaken

whenever there is a delay in responding to calls that involved life threatening circumstances.

the importance of call handlers having clear, appropriate



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and robust protocols. it was agreed that the use of language used by call

handlers was incredibly important.

The Board NOTED the Patient experience presentation and AGREED to receiving a report outlining the findings of the

investigation at a later date. Action: Director of Nursing

tHB/15/148 PRESENTATION BY EMERGENCY AMBULANCE SERVICES ON THE NATIONAL COLLABORATIVE COMMISSIONING:

QUALITY AND DELIVERY FRAMEWORK

The Chair welcomed Stephen Harrhy (SH), Chief Ambulance Services Commissioner, to the meeting. SH delivered a

presentation on the scope and work undertaken by the Emergency Ambulance Services Committee (EASC).

The presentation covered: • The role of EASC

• The role of the Commissioner • The EASC’s future plans

• Key Issues and Risks

The presentation was welcomed by the Board. It was noted there was a need for a cultural shift away from what the patient

‘wants’ to what the patient ‘needs’.

MJD asked for clarification in relation to the routing of 999 calls. He enquired as to whether there was an intention to consider

using West Midlands Ambulance services as they may, in some cases, be better located to provide Powys residents with a

timely response. SH explained that it was important to get the

basics right first within Wales before tackling the cross border issues. He confirmed that there were discussions underway

with the English Ambulance Commissioners however, at present, Welsh Ambulance Services NHS Trust (WAST) had a

different model.

The Board asked for an explanation as to why the air ambulance could not fly at night. SH believed the reason for

this was the receiving hospitals not being able to land the helicopters at night due to some regulatory issue.

There was some discussion in relation to the expansion of the

remit of EASC to cover the Non-Emergency Patient Transport Service (NEPTS). SH explained EASC had recommended to the



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Minister that steps should be taken to look at commissioning NEPTS. He advised that it was hoped that WAST would be the

main provider with a mixed model capability. CS confirmed that it was important that the NEPTS was responsive to patient

needs.

CS reflected on the significant progress made by EASC and WAST in respect to response times, addressing gridlocks in

flow, and improving public confidence. The success of the

advanced paramedic role was discussed and its positive contribution to the Golden Hour (i.e. the hour that offers the

biggest difference to patient outcome).

There was a discussion in relation to the steps being taken by WAST to improve the efficiency of the services they provide and

the need to shift resources. It was acknowledged that in the past WAST had been overly reliant on staff working overtime

and the use of private ambulances. SH advised that the recruitment of more staff and effective rostering should help to

reduce the pay bill.

The Board was assured that the Trade Unions had been involved with the changes that had taken place, and that the

staff side had been engaged. SH confirmed that WAST staff

could see that the new model worked, and now it was important to focus on the education of the public. It was felt important

that performance was allowed to improve further before a public information campaign was initiated.

The Chair suggested that the arrangements for who to call out

of hours for community patients was shared with WAST. SH agreed this would be extremely useful and stated these

arrangements would be included in the Directory of Services currently being produced. This should be followed up by the

Director of Primary and Community Care. Action: Director of Primary & Community Care

The Board NOTED the presentation from EASC.

tHB/15/149 UNCONFIRMED MINUTES OF THE MEETING HELD: 21 OCTOBER 2015

The minutes of the previous meeting held on the 21 October

2015 were RECEIVED and AGREED as being a true and accurate record, subject to the following amendments being

made:-



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tHB/15/131 Heart Disease Delivery Plan: Annual Report It was confirmed that the fourth paragraph should be amended

to read “The Board noted the potential discrepancy in position for apparently lower cardiovascular but higher stroke rates

presented in the two annual reports. CW suggested this was potentially due to a number of factors, including age-

standardisation and the recording of incident events. In terms of GP registers, CW went on to suggest the figures could

possibly prove to be a distraction and that the focus should be

on how the registers were being used to drive clinical management at practice level.”

tHB/15/138 Financial Performance Report

The fifth paragraph should be amended to read “It was noted the most pressing and likely risks to the current reported

position have been quantified at £0.4M and are in respect of:

Continuing NHS healthcare retrospective claims, currently estimated at £0.3M subject to final conclusion. This is

currently being explored with Welsh Government £0.6M of commissioned services risks which relate to

approaches by 2 health boards to rebase their contracts to reflect the cost of delivering care. These continue to be

discussed but conclusions suggest settlement will be the

likely outcome Potential underspend on Pharmacy and Dental (£0.5M).”

tHB/15/150 MATTERS ARISING

There was one matter arising:

tHB/15/140 One Plan: Annual Report

HT advised the Board that the comments made in the last

Board Meeting had been forwarded to the Strategic Planning and Performance Department of Powys County Council.

tHB/15/151 ACTION LOG

The Board RECEIVED and NOTED the action log. Further

updates were provided as follows:

tHB/15/113 Patient Experience Presentation - DoTHS It was confirmed that this had not been actioned.

tHB/15/113 Patient Experience Presentation – DoPCC AL advised this work was still in progress. He advised that there

were difficulties in progressing it as there was no Care Transfer



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Coordinator established for UHW.

tHB/15/113 Patient Experience Presentation – DoF It was confirmed that this would be discussed as part of the ICT

Report on the Agenda.

tHB/15/118 Chair’s Report It was confirmed that action was complete.

tHB/15/122 Joint Committee Assurance Reports Emergency Ambulance Services Committee (EASC)

AL advised this was due to be completed shortly.

tHB/15/122 Joint Committee Assurance Reports Welsh Health Specialised Services Committee (WHSSC)

It was noted the report was to be taken though the Quality and Safety (Q&S) Committee.

tHB/15/123 Community Health Council (CHC) Update - CEO

CS advised this was to be signed off shortly.

tHB/15/123 Community Health Council (CHC) Update – DWOD JR advised the offer of help had been accepted, and a mutually

convenient date was being identified.

tHB/15/127 Communications Strategy

JR advised that the strategy had been updated and the action complete.

tHB/15/130 Stroke Services Delivery Plan: Annual Report –

DOPCC/DoTHS AL advised this was being picked up under the revised

unscheduled care plan for 2016-17.

tHB/15/130 Stroke Services Delivery Plan: Annual Report – DoTHS

It was confirmed that this would be resolved as part of the refresh of national delivery plans.

tHB/15/130 Stroke Services Delivery Plan: Annual Report – DoTHS

It was noted that work was on-going.

tHB/15/131 Heart Disease Delivery Plan: Annual Report CS advised that a meeting with the Chief Executable Officer of

Public Health Wales had been arranged for January 2016.



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tHB/15/132 Future Fit - DoPP It was confirmed that action was ongoing.

tHB/15/140 One Plan: Annual Report

It was confirmed that action was complete.

tHB/15/152 PROGRAMME OF BOARD BUSINESS

The Committee RECEIVED and NOTED the 2015/16

programme of board business.

tHB/15/153 CHAIR’S REPORT

The Board RECEIVED and NOTED the Chairs report, which

focused on the following areas: Integration of Services with Powys County Council

Progress on the Mid Wales Collaborative Staff Matters

Independent Members Working with Partners

Further Commitments

tHB/15/154 VICE CHAIR’S REPORT

The Board RECEIVED and NOTED the Vice Chair’s report,

which focused on the following issues: Mental Health

Ministerial Meeting Other Undertakings

MD informed the Board that a meeting of the Mental Health

Services Committee had taken place in November, however due to the cycle of papers, the Assurance Report would be

presented at the next Board Meeting. She also advised that following the interviews for the post of Consultant Child and

Adolescent Psychiatrist held on 4th December, they had appointed, and were waiting to hear about acceptance.

The Board discussed taking forward the opportunity of joint work involving the HB, Powys Armed and Ex-Armed Forces

Forum and Powys County Council’s Armed Forces Community Covenant. RH offered to liaise between organisations to

progress this opportunity.

tHB/15/155 CHIEF EXECUTIVE’S REPORT

The Board RECEIVED and NOTED the Chief Executive’s report,



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which provided an update in relation to: Strategic Planning & Developments

o Social Services and Wellbeing Act o Integrated Medium Term Plan

o Strategic Change Programmes o Mid Wales Collaborative Board

o Wales Health Collaborative Board o Integrated working with Powys County Council

Engagement and Communication

o Key Stakeholders o Communication

o Social Media Training o Newtown ShropDoc Development

o Board briefing o Flu Campaign

o Reduction in teenage pregnancy rates in Powys o Branding

o Intranet o Powys News

Performance Achievements & Challenges o Joint Executive Team

o National Outcomes Framework Innovation & Development

o Public services conference

o RCN Nurse of the Year Awards

CS noted that since writing her report, the following matters had occurred:

The successful transfer of Abertawe Bro Morgannwg University Health Board and Betsi Cadwaladr University

Health Board Mental Health staff took place on 1st December. It was noted there was to be a rephasing of the Aneurin

Bevan University Health Board, which was being managed jointly through a Transition Board. Betsi Cadwaladr

University Health Board had managed to recruit sufficient maternity staff from overseas, and were therefore in a

position to sustain three units. CS confirmed that discussions were ongoing with BCUHB to ensure Powys

patient safety.

MJD sought clarity around the Shropdoc arrangements in

Newtown. CS explained that the service was put in place to support the Practice in the absence of a GP during working

hours. The Board felt that these arrangements should be clearly set out, as Shopdoc was synonymous with the out of

hour’s service. It was confirmed that the involvement of Shopdoc in this capacity had worked very well in Machynlleth,



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and it was agreed AL would bring an update to the next Board Meeting of how the arrangement was progressing in Newtown.

Action: Director of Primary & Community Care

tHB/15/156 BOARD COMMITTEE ASSURANCE REPORTS

The Board RECEIVED and NOTED the summary of Board

Committee activity that took place during October and November 2015.

Finance and Performance Committee

The Chair of the Finance and Performance Committee (MJD)

advised the Board that, due to the delay in papers reaching the Independent Members (IMs) of the Committee, an unanimous

decision had been taken by the IM’s to defer the 1st December 2015 Committee Meeting. This would enable better scrutiny of

the papers at the reconvened meeting on 16th December 2015.

CS advised the Board that going forward it was intended to

improve the support for Committees by ensuring the right items were included on the Agendas at the right times, that the

timings for the papers would be reviewed, and the quality of the papers improved. CS acknowledged there was a very busy

Board Committee infrastructure. MC added that she would be undertaking a review of the meeting schedules to ensure that

there was sufficient time built into the paper submission cycle for quality checks and timely distribution.

The Board NOTED the Finance & Performance Committee

activity.

Workforce and OD Committee

VH presented the previously circulated paper providing the

Board with an update on the key issues discussed and any decisions made by the Workforce and OD Committee at its

meeting in October 2015.

The paper covered: Workforce Performance Report

PDR Trajectories Bank and Agency Use

Joint Leadership and Management Framework Communications Action Plan: Update

Local Partnership Forum Report Statutory and Mandatory Training



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Health Visiting and Flying Start Performance Nursing Revalidation

Corporate Health Standard Presentation

VH highlighted the typographical errors throughout the paper.

PD asked why the Statutory and Mandatory training target was only 80%, when by its nature should be 100%. It was

explained the target took into account staff turnover and staff

who are not on active duty (i.e. maternity leave etc). It was recommended that the target should be 100% of available staff.

There was discussion around the compliance mechanisms in

place. It was noted the PADR process was now holding the line managers and individuals more accountable for completing the

Statutory and Mandatory training.

The Board NOTED the Workforce & OD Committee Chair’s report.

Audit Committee

TT verbally updated the Board on the activity of the Audit

Committee, which met in November 2015. TT stated the

Committee had suggested that targets should be made explicit within the Audit Recommendations Update report made to the

Committee and advised that the appropriate Lead Director should be held to account by the Committee if areas were not

being closed off in a timely manner. It was noted that these targets needed to be set as part of management response to

Audit Recommendations.

TT acknowledged the timely and comprehensive responses on Audit reports by RJ & JR.

The Board NOTED the Audit Committee Chair’s Report.

Quality & Safety Committee

RE presented the previously circulated paper providing the Board with an update on the key issues discussed and any

decisions made by the Quality and Safety Committee at its meeting in October 2015.

The paper covered:

Key Performance Indicators for Quality

Improvement Plan: Putting Things Right



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Health & Care Standards: All Wales Metrics Approach to Internal Inspections (including approach 15

steps challenge) Welsh Risk Pool: Maternity Services

The Flynn Review Safeguarding Adults Report

Perinatal Review Mortality Report

Clinical Audit Progress Report

Estates Compliance Primary Care Quality Assurance Framework

Closed session

RE highlighted the typographical errors throughout the paper.

The Board flagged the achievement by the ward in Ystradgynlais of 12 months without a hospital-acquired

pressure ulcer, and asked what the HB had done to acknowledge this. The Board was informed both the Chief

Executive and Director of Nursing had written to the staff to congratulate them. Furthermore, the learning around the

robust use of the skin bundle was being presented to the Sister’s Forum. The Board also wanted to take the opportunity

to formally congratulate the staff in Ystradgynlais on this

significant achievement.

The Board NOTED the Quality & Safety Committee Chair’s report.

tHB/15/157 JOINT COMMITTEE ASSURANCE REPORTS

The Board RECEIVED and NOTED the report that provided a

summary of Joint Committee activity during October and

November 2015.

Emergency Ambulance Services Committee (EASC)

CS acknowledged the significant the progress that had been made by EASC & Welsh Ambulance Services Trust (WAST)

during the year, appreciating the upcoming winter period would put pressure on the system.

The Board NOTED the Emergency Ambulance Services

Committee activity.

Welsh Health Specialised Services Committee (WHSSC)



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The Board NOTED the minutes of the last meeting held by WHSSC. CS stated the Governance Report would be scrutinised

once it was published.

The Board was informed that Quality and Safety Committees of both the HB and WHSSC were now collaborating.

CS noted there would be further work for both organisations in

respect of an Integrated Commissioning Plan.

The Board requested that the Chief Executive of WHSSC was

invited to present to the Board, once a permanent appointment was made.

Action: Board Secretary

The Board NOTED the Welsh Health Specialised Services Committee activity.

NHS Wales Shared Services Partnership Committee (NWSSP)

RR informed the Board the NWSSP Committee meeting had just

taken place and, therefore, the minutes could not be shared at this time. . It was requested the minutes be circulated upon

receipt.

Action: Director of Finance

Joint Partnership Board

CS explained that the JPB had not met recently, however progress was being made in relation to strengthening the

integration agenda.

tHB/15/158 COMMUNITY HEALTH COUNCIL (CHC) UPDATE

The Board RECEIVED the Community Health Council’s update

report. JT talked the Board through the paper, which covered:

CHC Members Inspection Reports Oder People’s Mental Health Units in Powys

Mental Health Services in Powys Llanidloes and District War Memorial Hospital

Head of Nursing (South Powys) Teaching Health Board Website

New Chair for the CHC Board

JT advised the Board that the visit to Llanidloes Hospital referred to in the report did not take place at the beginning of



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December as planned, due to flooding, which prevented travel. JT apologised for any inconvenience caused by the change in

plan.

RH advised the Board that the CHC Wales Board met for two days, and had agreed five National Priorities:

Care of the elderly Adult Mental Health

CAMHS

Dementia Ophthalmology

RH informed the Board that, together with Tony Rucinsk, the

CEO of the CHC, she had visited a number of the providers from whom the Health Board commissioned services to establish the

impact of the challenges they face on Powys residents.

CS thanked the CHC for their hard work in producing the flowchart, which was a really useful tool. She suggested the

CHC Wales priorities should be brought to the Services Planning Committee for discussion.

It was noted that CS and Chair were also meeting with the

CEO’s and Chairs of the providers, and it was suggested it

would be useful to share intelligence.

MD acknowledged the work conducted by the CHC in relation to Mental Health Committee, and suggested this be picked up

through the Mental Health Services Assurances Committee.

The Board NOTED the CHC update.

tHB/15/159 INVESTMENT PROPOSAL TO ACCELERATE INTEGRATION

OF HEALTH & SOCIAL CARE

The Board RECEIVED the paper which sought support to undertake an appraisal of the options for the integration of

health and social care services.

CS confirmed that an initial review of the possibility of integration had highlighted a number of key benefits, including:

Seamless service user care; Value for money;

Stemming growth; Joined up approach welcomed by staff and the people of

Powys.



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CS acknowledged the significant input of Julia Toy, Programme Manager, in producing the paper.

In discussing the paper a number of points were raised by the

Board, including:

the need to consider the political instability that may be caused by the forthcoming election period.

the fact that the paper did not refer to consultation;

the need for the paper to be more explicit in relation to how the services or care would be delivered;

there were some significant stakeholders who did not appear to have been consultees in the preparation of the

paper (Independent Members of the Board, CHC, Scrutiny Committee of PCC etc);

the lack of engagement with the Trade Unions; the capacity of Powys THB to take forward such

substantial change and the significant risks aligned to the change programmes already being taken forward.

It was noted that there were Independent Members on the

Board who were also elected members of Powys County Council, which may present a conflict of interest in the future.

CS acknowledged the points raised, stressing that the paper was a request for the Board’s approval to undertake exploratory

work, not to go ahead with an integration plan or merger. She confirmed that the Board was being asked to agree to the

undertaking of an options appraisal to identify the pros and cons of the various integration options.

CS advised that a lot of the concerns raised would be addressed

by the options appraisal stage. She advised that it was fully acknowledged that no service change could be undertaken

without Trade Union engagement. CS recognised the capacity issue, and assured the Board that should this proposal (to

undertake an options appraisal) be supported, focus for the day to day business of the HB would remain a priority.

MC advised the work on developing the Board’s Risk Appetite and Assurance Framework would start to identify any capacity

and capability issues.

The Board sought assurance that other options than just integration with PCC would be considered as part of the options

appraisal. This was clarified to be the case. CS also stressed the proposal was only able to go ahead if funding from Welsh



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Government was made available. She emphasised that the Board was not being asked to sign up to integration with PCC, it

was purely being asked to agree to a full options appraisal being undertaken.

The Board discussed the process that would occur should the paper be endorsed. It was clarified the HB would prepare a

Strategic Outline Case following the Five Case Model, including

a full options appraisal, should this be the direction of travel. It was recommended a forensic cost analysis should be

undertaken of whatever option was decided upon. The Board ENDORSED the proposal to undertake a full options

appraisal subject to the receipt of funding from the Welsh

Government.

tHB/15/160 BOARD COMMITTEE MEMBERSHIP & BOARD CHAMPIONS

The Board RECEIVED a paper, providing the Board with an

overview of the Independent Membership of the Board’s Committees, and Board Champion arrangements.

TT advised that he was unable to be the Health Board’s

representative on the Local Service Board as he was an elected member of Powys CC. It was agreed that RE would take on this

role instead.

Action: Board Secretary

The Board RATIFIED the Board Committee Membership and Board Champions subject to the change outlined above.

tHB/15/161 CHARITABLE FUNDS ANNUAL REPORT AND ACCOUNTS TO

31ST MARCH 2015

RR presented the paper, providing the Board with the Charitable Funds Annual Report and Accounts for the period to

31st March 2015. She also drew the Board’s attention to the

letter from the Wales Audit Office setting out the findings of their independent examination; which were positive.

The Board RECEIVED and APPROVED the Charitable Funds

Annual Report and Accounts. The findings of the Wales Audit Office independent examination were NOTED.

tHB/15/162 OLDER PEOPLE’S COMMISSIONING STRATEGY



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The Board RECEIVED the joint (Powys THB, Powys CC and Powys Association of Voluntary Organisations (PAVO) Older

People’s Commissioning Strategy and Plan for approval.

In presenting the Strategy and Plan, AL confirmed how services would be commissioned and delivered over the next

five years to ensure older people were supported to lead fulfilled lives within their communities and achieve the vision

set out in the paper, supported by key outcomes and measures.

JT expressed disappointment at the lack of involvement of the

CHC in the pre-engagement phase. HT agreed to work with the CHC to improve engagement processes (both continuous and

formal) to satisfy legislation requirements in respect to joint (and wider) projects.

Action: Director of Planning & Performance

The Board discussed whether the Health Board was in a position to provide the digital equipment and assistive technology

mentioned on page 14. It was acknowledged the Health Board was only part way there, and it was necessary to join up tele-

health, tele-consulting and mobile diagnostics.

The Board APPROVED the Older People’s Commissioning

Strategy and Plan.

tHB/15/163 SAFEGUARDING ANNUAL REPORT

The Board RECEIVED the Annual Safeguarding Report for 2014-15.

RJ presented the report, highlighting the main elements,

namely:

The national context for the provision and development of

safeguarding children, young people and vulnerable

adults;

The local context for the provision and development of

the safeguarding agenda;

The local issues in relation to guidance, including risks,

gaps and priorities;

Local data, where available, in relation to Child Protection,

Looked after Children, Domestic Abuse and Multi Agency

Public Protection Arrangements (MAPPA);

Training data in relation to Child Protection and Adult



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Protection;

Priorities for 2015/16 including action underway.

An omission was noted on page 7; it was confirmed that Melanie Davies, Vice Chair of the PtHB should have been

included as the Safeguarding Champion for the HB.

In discussing the paper it was noted that:

national data would be included in future iterations of the

report in order to facilitate benchmarking Adult protection referrals data since April was absent,

which is an issue and potential risk, as this may indicate that staff are not recognising safeguarding issues.

Training compliance remains an issue, particularly for Adult Safeguarding.

the Health Board has experienced difficulties in engaging with the regional safeguarding forum since it changed

Footprint. female genital mutilation was a growing area of concern

and the Health Board was engaged with Powys CC to actively tackle this agenda.

RJ noted there was a lot more work to be done in respect of

safeguarding, to include exploration of integration between

PTHB and PCC.

It was agreed that it was important to fully identify the risks, and to ensure that regional arrangements were robust.

Action: Director of Nursing

The Board APPROVED the Safeguarding Annual Report.

tHB/15/164 MINIMUM UNIT PRICING ALCOHOL

The Board RECEIVED a paper outlining the Health Board’s

response to the Consultation on the Draft Public Health (Minimum Price for Alcohol) Bill.

CW advised that the introduction of a minimum unit price had

significant potential to improve population health, reduce health inequalities and reduce NHS expenditure. She advised that the

Executive Team had approved a response to the Welsh Government’s consultation on 04 November 2015. CW

confirmed that the response supported proposals to introduce a minimum unit price for alcohol was approved by the Board of

Powys Teaching Health Board.



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The Board NOTED the Health Board’s response to the Welsh Governments consultation on the Draft Public Health (Minimum

Price for Alcohol) Bill.

tHB/15/165 CONCERNS POLICY

RJ presented a paper outlining the Health Board’s new policy for

the effective management and resolution of concerns.

It was noted the Policy was based on the principles of “Being Open” (NPSA 2009), and clearly outlined peoples’

responsibilities for effectively managing and resolving concerns. The policy is seen as an important part of the overarching plan

to improve the health boards’ management of concerns. It was noted the policy would be translated in to Welsh.

The Board sought assurance that the Health Board had the

capacity to deliver the policy and meet the timelines set

therein. RJ advised that once the backlog of concerns had been cleared there should be sufficient capacity. Additionally, the

policy clearly outlines responsibilities and this will reduce duplication.

It was agreed paragraph 5.2, last bullet point should be

reworded to make the information on concerns ‘accessible’ rather than being so specific.

VH requested the term ‘verbal’ be replace by ‘oral’ in section

4.5. Action: Director of Nursing

The Board APPROVED the Concerns Policy.

tHB/15/166 INTEGRATED PERFORMANCE REPORT

The Board RECEIVED the Integrated Performance Report, which set out the latest performance position in relation to the

delivery of the high level objectives included in the Annual Plan for 2015/16 and the national outcomes framework i.e. key

Welsh Government targets.

The Boards attention was drawn to the following: Areas where performance was not meeting target

• Health Care Acquired Infections: Rates of C.diff have

increased; the Health Board has had more cases, up to October 2015 of C.diff than in the same period 2014/15.

It must be noted that 14 C.diff cases are non-inpatient



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with only 1 case reported within Powys inpatients. (Page 15)

• Cancer: All targets for Cancer performance were missed in September by both English and Welsh providers,

although there has been an improvement under the 62 day target in England. In September Welsh providers

showed a total of 2 breaches but due to low patient numbers this pushes the percentage below target. (Page

20, 21)

• RTT: All Welsh providers except Powys have failed to meet the target of 95% patients treated within 26 weeks.

Of the English providers Robert Jones and Agnes Hunt have also failed to meet the target and we currently

continue not to report Wye Valley Performance due to ongoing data issues.(Page 22)

• Diagnostic & Therapies: Performance in this area has continued to fall with an increasing number of breaches.

Diagnostics non obstetric ultrasound continues to be a problem area. There is currently a capacity issue in Powys

with Adult Speech and Language Therapy with patients waiting still at 35+ weeks for treatment. We also have 7

breaches occurring under Paediatric Dietetics. (Page 23) • WAST: Welsh Ambulance performance in September fell

to 50% which is both below target (65%) and below the

Powys profile of 54%. (Page 25)

Areas where performance has improved • Flu Vaccination: Powys is above the all Wales average for

4-6 year olds (School age vaccinations) and Pregnant Women. (Page 10)

• Delayed Transfers of Care (DToC) Non Mental Health: For the last 3 months the Rolling 12 month DToC rate for non

mental health has continued to improve this is the first sustained improvement since January 2013. (Page 14)

• Clinical Coding Compliance: Powys clinical coding compliance has continued to meet and exceed the Welsh

Government set targets. (Page 18) • Referral to Treatment (RTT): Powys as a provider

consistently performs well above the 26 weeks wait target

of 95%. Powys Provider has not had an RTT patient waiting longer that 36 weeks since August 2013. (Page

22) • Sickness: The percentage of full time equivalent (FTE)

has progressively fallen and has continued to be below the target of 4.42%, the rate has continued to steadily

reduce throughout this financial year and now is at 4.19% (Page 26)



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HT emphasised WAST figures against the revised clinical model

had not been included in this report, but would be included when available in the future. It was noted that in future, the

Finance and Performance Committee would be scrutinising the IPR prior to presentation to the Board.

More detail in relation to Infection Control figures was

requested. RJ explained that the main issue in relation to C.diff

figures was antibiotic prescribing in the community. She confirmed that the Health Board was working with Aneurin

Bevin University Health Board to learn from their work in primary care.

RE asked if the Health Board would be able to get back to

target in the financial year in respect to RTT times. HT explained the HB as a provider was on target to meet the 95%

26week RTT target. Active discussions with the commissioners were taking place but it was unlikely that RTT targets would be

met across all providers by year end.

The Board NOTED the Integrated Performance Report, and the further work being undertaken.

tHB/15/167 TRANSFORMATION PROGRAMME HIGHLIGHT REPORT

The Board RECEIVED a paper, providing an update on progress in relation to the implementation of the Transformation

Programme.

It was noted that since the last report to Board in August 2015, a significant amount of work had been undertaken by the

Programme Management Office team to simplify and strengthen

the reporting arrangements. It was confirmed that monthly reporting to the Transformation Programme Board included:

• Reporting against programme objectives;

• At a glance programme status; • Programme headlines;

• Escalation to Transformation Programme Board; • Programme planning;

• Portfolio risks (by programme and category).

CS confirmed that the Executive Management Group had approved the Commissioning Framework, and commissioning

updates would be reported through the Finance and Performance Committee.



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HT highlighted further work would be completed during Q4 to

review the THB to reflect the updated 2016-19 IMTP.

The Board NOTED the Transformation Programme Highlight Report.

tHB/15/168 STRATEGIC PLANNING AND SERVICE CHANGE REPORT

The Board RECEIVED a paper providing an overview of work that will be undertaken to meet the requirements set for

national delivery plans by the end of the financial year.

It was noted there were a number of high level risks that were

associated with the strategic change programmes and included:

Engagement/Consultation Requirements

Affordability

Demand and Activity Assumptions

Commissioning

The Board discussed the very recent development in respect to

the contingency measures being consulted upon by the FutureFit Team, and the need to ensure the views of the public

of Powys were fed in. It was noted that neither the HB nor the CHC had been involved in the organisation of this. It was

agreed the Health Board should participate in the development of this work.

Action: Director of Planning & Performance

The Board sought assurance that the Programme Management Team had the capacity and capability to deliver the actions set

out in the paper. HT felt the recent organisational restructure of the Directorate would improve capacity, and advised that it

was now a priority to appoint to the vacant posts.

The Board NOTED the Strategic Planning and Service Change

Report.

tHB/15/169 FINANCIAL PERFORMANCE MONTH 07

The Board RECEIVED a report on the month 07 financial performance

It was noted that Month 07 presented essentially the same picture as that reported in Month 06. It was confirmed that



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there continued to be a number of financial risks which were being actively managed by the health board in respect of:

Use of agency Continuing NHS Healthcare

Prescribing Primary care – costs associated with the management of

a medical practice Performance within English NHS Trusts

Delivery of savings

The Board sought clarity over the decision to procure “at risk”

the works for the Llandrindod Wells development. It was explained that staff had been decanting from the building

required for works to be completed prior to the funding authority in order for the Health Board to be in a position to

meet the deadline of completing the birthing centre project prior to the end of the financial year. It was confirmed that the

delay in receipt of monies had been due to the Welsh Government requiring more detail before submitting the

proposal to the Minister for approval.

The Board NOTED the Financial Performance Reports for Month 07.

tHB/15/170 POWYS PANDEMIC INFLUENZA FRAMEWORK UPDATE

CW provided the Board with an update on the work completed in-year relating to the Powys Pandemic Influenza Framework.

It was confirmed that the Powys Pandemic Influenza Framework

remained current following Board approval in December 2014 and continues to provide an overarching framework for the

Powys THB response to an influenza pandemic.

CW advised that the Powys Pandemic Influenza Planning Group

(PPIPG) would continue to work in collaboration with key partners to ensure that the Framework was reviewed in January

2016 in line with the agreed timetable.

CW noted that going forward she would bring this report back to the Board as an annual report.

The Board NOTED the Powys Pandemic Influenza Framework

Update.

tHB/15/171 ICT STRATEGY IMPLEMENTATION UPDATE



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The Board RECEIVED the update on the joint ICT strategy and programme plans.

It was noted that progress was being made against

implementation of the plan approved by the board in August although there were some emerging issues of concern around

business as usual.

The Board discussed the progress in relation to electronic

discharges, with the Shrewsbury and Telford Hospital NHS Trust (SaTH) and NHS Wales Informatics Service (NWIS). It was

noted that this had been well received, and was now in use in 5 out of 6 Practices in the North.

MB stated it was imperative the Health Board reduced its

network performance issues prior to the WCCIS roll out. ACTION: Director of Finance

The Board NOTED the report on ICT Strategy Implementation

Update.

tHB/15/172 PRIMARY & COMMUNITY CARE UPDATE

The Board RECEIVED the paper and noted that there had been

a number of developments introduced since the last Board report. It was confirmed that these developments had been

deployed in order to increase the level of care available locally; reduce the number of referrals made to secondary care

providers and reduce the amount of time and distance that Powys residents have to travel to access care.

The Board felt it would be helpful to receive a briefing on any

new risks, as part of the Board Risk Register. It was agreed

this work would be picked up in the Risk Register due to Board in April 2016.

ACTION: Board Secretary

The Board NOTED the Primary & Community Care Update.

tHB/15/173 ANY OTHER BUSINESS

Mental Health NHS Management Arrangements

The Board RECEIVED a paper providing an update on the Adult

Mental Health NHS management arrangements and the re-phasing of the Aneurin Bevan University Health Board (ABUHB)

transfer.



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It was noted that a Joint Transition Board would be established

to drive forward the ABUHB transfer which was now expected to be achieved by the early summer 2016.

The Board NOTED the paper and expressed concern that the

issues that had led to the delay in the transfer of services back to Powys THB had been identified so late in the day.

tHB/15/174 DATE AND TIME OF NEXT MEETING

This was scheduled for Wednesday 24 February 2015, 10:30am - 4pm, Chamber, Powys County Council, Llandrindod Wells

powys teaching health board confirmed minutes of … · 9 december 2015 status: approval page 1 of...

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