HIGHLAND NHS BOARD
DRAFT MINUTE of MEETING of the
NHS Highland Performance Review Group
Board Room, Assynt House
Assynt House
Beechwood Park
Inverness IV2 3BW
Tel: 01463 717123
Fax: 01463 235189
Textphone users can contact us via
Typetalk: Tel 0800 959598
www.nhshighland.scot.nhs.uk
Tuesday 5 February 2008 – 1.50 pm
Present:
Mr Garry Coutts, Chair
Dr David Alston, Chair, North Highland CHP
Dr Ian Bashford, Board Medical Director
Mrs Ann Bethune, Chair, Mid Highland CHP
Mr Bill Brackenridge, Chair, Argyll & Bute CHP
Ms Pam Courcha, Chair, SSU
Ms Susan Eddie, General Manager, SSU
Dr Roger Gibbins, Chief Executive, NHS Highland
Mr Ian Gibson, Vice Chair, NHS Highland
Mrs Gillian McCreath, Chair, South East Highland CHP
Mrs Gill McVicar, General Manager, Mid Highland CHP
Ms Elaine Mead, Chief Operating Officer
Mr Nigel Small, General Manager, South East Highland CHP
In Attendance:
Dr Eric Baijal, Director of Public Health
Ms Margaret Brown, Head of Service Planning
Mr Stuart Caldwell, Head of Service Redesign
Mr Stuart Denholm, Associate Medical Director
Mr Derek Leslie, Director of Planning & Performance
Dr Duncan McCormick, Specialist Registrar
Mrs Christine McIntosh, Cancer Network Manager
Ms Heidi May, Board Nurse Director
Dr Ken Oates, Consultant in Public Health Medicine
Ms Moira Paton, Head of Community & Health Improvement
Planning
Mr Bill Reid, Interim Head of eHealth
Mrs Cathy Steer, Health Improvement Manager
Mr Simon Steer, Head of Community Care Integration
Miss Irene Robertson, Board Committee Administrator
Apologies - Sheena Craig, Jan Baird
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MINUTE OF PREVIOUS MEETING
Reference item 3.5 SSU Recurrent Savings, the Recovery Plan was on track to meet the
targets for 2007/08 and not 2006/07 as stated in the Minute. Subject to this amendment the
Minute of Meeting held on 06/11/07 was approved.
Working with you to make Highland the healthy place to be
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2007/2008 BALANCED SCORECARD - OVERVIEW
Derek Leslie gave a brief overview of the current position, noting that the Absence target had
been changed to 2009. All the December 2007 areas were ‘Green’ and were being
sustained. There were no particular issues to bring to the Group’s attention that were not on
the agenda.
On behalf of the Board, the Chairman expressed appreciation of the considerable efforts
made by everyone to achieve the December targets.
The Group:

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Noted the position.
TOPICS FOR FOCUS
3.1(a) Delayed Discharges – North, Mid and South East Highland CHPs
Simon Steer spoke to his circulated report setting out the current position. In the submission
made to ISD as at 10/01/08 there were 17 clients waiting over 6 weeks. A significant factor
in the delays was the number of patients awaiting commencement or completion of a social
work assessment, other reasons for the delays included unavailability of funding and lack of
placement availability. Discussions were ongoing with Social Work partners to address the
delays. The concerns would also be raised at the forthcoming Joint NHS Highland/Highland
Council Leadership meeting with a view to seeking an assurance that the issues would be
resolved.
Mr Steer advised that the ISD return did not include people who were under the incapacity
code. There were also clients who were delayed through exercising their right to choose
their placement. Cognisance would need to be taken of these delays and their impact on
hospital services. It was noted that the Argyll and Bute CHP was exploring private sector
developments as a longer term solution to address the lack of availability of care home
places. On the matter of care at home packages, it was noted that at present there were no
clients assessed as requiring complex care packages whose return home had been delayed.
3.1(b) Delayed Discharges – Argyll and Bute CHP
Elaine Mead spoke to the circulated report from Josephine Bown which provided an update
on the current position in the Argyll and Bute CHP in respect of delayed discharges in short
stay beds and delayed discharges over 6 weeks. Good progress was being made against
the over 6 week target but the number of delayed discharges in short stay beds had of late
been increasing and local managers (Health and Social Work) were addressing the issues.
There were at present three clients coded 71X. The situation was being monitored and Ms
Mead was able to confirm that to date no clients had remained under this code for any length
of time.
The Group:

Agreed to receive a further update on the position at the next meeting, particularly
with regard to delays resulting from non-unavailability of public funding to purchase
care home places.
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3.2
MMR Update
In his circulated report, Dr Ken Oates indicated that during July – September 2007 (the latest
quarterly data available), MMR1 uptake in NHS Highland overall (including Argyll and Bute)
was over 93.1% by age 5 years, the highest ever local uptake for any given quarter. During
the same period, uptake of all other childhood vaccinations at age 2 years was also the
highest ever and well over the 95% target. This upward trend was expected to continue.
The report focused on work carried out over recent months to address a number of issues
raised by the Group at its September 2007 meeting.

The additional number of children who would need to be immunised each quarter in
order for NHS Highland to hit its target of 95% uptake at 5 years of age was between
1 and 15 children. The low numbers involved emphasised the importance of all
Practices ensuring the timeous submission of accurate data to the Child Health
Surveillance Team.

A review of the uptake data from Quarter 1 2005 to Quarter 3 2007 demonstrated that
there were no persistent outliers in the performance of any CHP or General Practice.

An audit had been carried out of all children aged 2 years or 5 years who were
recorded as not having had MMR during the quarter April to June 2007. The data
obtained so far indicated that there were various reasons why children were not
immunised, the most common being concern about the alleged link to autism, giving
three vaccine components at once (“vaccine overload”), and concern about allergies.
Data analysis was still ongoing but would be carried out over the next few weeks to
ensure that the findings of the audit fully informed future actions.
An action plan had been drawn up for 2008 – 2009 to further improve uptake. Efforts would
also continue to ensure accurate and complete uptake data. Dr Oates highlighted a
significant risk to data validation because of capacity issues within the child health
administration team. The target of a sustained uptake of over 95% by 2009 was particularly
challenging for Highland, given its low starting point, however a gradual steady increase in
uptake over the next few years was expected.
The Group:

3.3
Noted the ongoing and planned work to achieve the target and sustain the uptake
rate.
Cataract Update
The Group received Sheena Craig’s circulated report outlining the background to the
establishment of cataract surgery at Caithness General Hospital in March 2007. The
intention was to have a half day operating session once a month to provide local services for
those patients who wished to have their surgery locally rather than at Raigmore. It had been
estimated that approximately 50% of the patients would be treated at the Caithness General
Hospital. To meet the 50% target, it would be necessary to increase local theatre capacity
and discussions were ongoing as to how this might be achieved. It was noted that there was
some evidence, albeit anecdotal, that patients were choosing to wait to have their surgery
carried out in the Caithness General Hospital in preference to travelling to Raigmore.
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The Group:

3.4
Agreed to receive an update in six months’ time to ascertain the position with regard
to demand for the local service and whether theatre capacity had been increased.
Cancer
The Group considered the latest monitoring report up to and including the week ending
01/02/08. Good progress was being made with urgent GP referrals, however one breach
had occurred in the last week and the situation continued to be closely monitored.
The time of diagnosis to the time of treatment needed to be as short as possible. Stuart
Denholm reported that in Quarter 3 this had been reduced to 18 days for urgent referrals
while the time for non-urgent referrals in the same period stood at 30 days. He suggested
that work could perhaps be done in terms of capacity to try to improve the non-urgent referral
position. It was anticipated that the new cancer plan would require Boards to look at nonurgent referrals and work done on this now would assist NHS Highland in the future process.
The Group:


3.5
Noted the latest monitoring report on urgent GP referrals.
Agreed to have an update on the position in respect of non-urgent referrals in three
months’ time.
Smoking Cessation
Cathy Steer spoke to her circulated report in which she detailed the targets and their
implications for NHS Highland, and outlined capacity issues and the ongoing and planned
actions to move towards the delivery of the targets. An improvement in the quit rate during
2007 was noted. Mrs Steer highlighted the need to collect more robust data from all the
sources involved in providing services and not just the Smoking Cessation Advisers. There
was some work to be done around reducing DNAs and drop off rates. There was also a
need to review activity, looking at the Smoking Cessation Advisers’ case loads and case mix,
and to improve ways of measuring activity to provide an assurance that resources were
being maximised. Each CHP had developed an action plan on how to configure services
most effectively in order to achieve the targets. A review group had been established to
oversee this work and quarterly reports were now being produced from the CHP databases.
It was proposed that the CHP Committees should consider these quarterly reports to monitor
activity and take follow up action as appropriate, and that they should submit position reports
to the Performance Review Group.
The Group:


Agreed to recommend that the quarterly reports on CHP activity should be
considered by the CHP Committees and progress reports prepared for submission to
the Group.
Agreed that the latest available figures relating to the percentage of adults smoking
should be obtained from other Scottish Boards for comparison purposes.
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3.6
Outpatient Waiting
The Group noted from the circulated report that the 18 week waiting time target had been
achieved as at end of December 2007 and that work was now ongoing to ensure the target
was maintained. The next target was to reduce the wait to 15 weeks by March 2009,
accordingly a trajectory would be planned for its achievement.
The Group:


3.7
Noted the achievement of the 18 week waiting time target.
Agreed to receive a report on the planned trajectory for the March 2009 target at a
future meeting.
CHI
Bill Reid spoke to his circulated report in which he explained that for 2007-2008, CHI
Utilisation was a key performance indicator within the HEAT framework, and the specific
measured used for this purpose was utilisation of CHI on laboratory requests.
Mr Reid reported that the target (97%) had been met in December 2007. There was some
fluctuation in the figures, particularly during the summer months due to the influx of visitors to
the region. Mr Reid outlined the actions taken to keep awareness high among staff of the
need to include CHI, the laboratory statistics were also closely monitored.
The next phase would be to implement CHI utilisation in the community. The CHPs were
taking this work forward with the aim of achieving universal use of the CHI number on clinical
communications, thereby making a major contribution to clinical safety by ensuring positive
patient identification.
The Group:

3.8
Noted the achievement of the target as at December 2007 and the work ongoing to
implement universal use of the CHI number.
HAI
The Group received Heidi May’s report. Since 2003 NHS Highland had remained within the
predicted limits of MRSA infection with a 40% reduction achieved in 2005/06. The infection
was now low and this presented a significant challenge to NHS Highland in terms of
achieving the national target of a 30% reduction by 2010. Ms May advised that although
MRSA remained within predicted ranges, the figures were presently showing an upward
trend. She outlined the range of actions including extended screening for MRSA in the
Control of Infection Action Plan that had been developed to address not only the control and
reduction of MRSA bacteraemia but all infections including Clostridium difficile. There were
also other initiatives such as the Hand Hygiene Campaign and the Patient Safety
Programme which could lead to further reductions in MRSA bacteraemia.
During discussion it was pointed out that the HEAT target related to MRSA bacteraemia. As
bacteraemia could only be diagnosed in a positive blood culture, it was felt that more clarity
was required around the defined criteria for inclusion in the results.
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The Group:


3.9
Agreed that clarification would be sought on what was being counted as part of the
MRSA Bacteraemia HEAT target.
Noted that the next six monthly report on performance was due to be submitted to
the April Board and Agreed that any emerging issues would be considered by the
Group at its April meeting.
Healthy Working Lives
Cathy Steer spoke to her circulated report, noting that there was currently no target within the
Local Delivery Plan for Healthy Working Lives (HWL) and no national target had been issued
for the HWL Award Scheme. When the Scheme was launched in Highland in May 2007 the
aim was to have all NHS Highland workplaces achieve the HWL Award within three years.
Resources for the HWL advisers had been devolved to the CHPs/SSU who had developed
local action plans for progressing the initiative. The role of the advisers was to work with
employers to improve the health of their workforce initiatives on health promotion and health
and safety, recruit workplaces to register for the award scheme, provide them with advice
and support to achieve the award and assess them against the award criteria. The advisers’
remit extended beyond the NHS and they were currently mainly engaged in advising and
supporting non-NHS workplaces to assist them through the process.
The report provided a summary of NHS HWL registrations by CHP/SSU and also of nonNHS HWL registrations. It appeared from the figures that there were no community staff
registered with the exception of those in the North Highland CHP. Mrs Steer explained that
some community staff working in hospitals would be covered by their ward schemes but
added that work was being done to increase community staff registrations. With regard to
SSU, it was noted that Raigmore was shown as a single workplace with 100% registration.
For the purposes of recording achievement of the HWL Award, it was suggested that SSU be
broken down into smaller units, directorates for example.
The Group:


3.10
Agreed to receive progress reports from the CHPs and SSU on their action plans
towards achieving 100% coverage over the next two years.
Noted that there was no national target and Suggested that consideration might be
given at a future stage to developing a local target.
Teenage Pregnancy
Eric Baijal spoke to the circulated report, explaining that there were two HEAT targets
relating to teenage pregnancy in whole or in part, one being specifically to reduce the
pregnancy rate in 13 – 15 year olds while the second was included as part of a reduction in
health inequalities. Dr Baijal explained that the target for the 13 – 15 year old age group was
a challenging target to measure and that it would not be statistically sound practice to use
variations from the low numbers involved to draw any conclusions about trends. There had
been little change in the interventions in place under the Sexual Health Strategy. Sex
education programmes were evidence based and had remained constant over the period in
question. There was some concern that the more rigorous application of the new Child
Protection policies and practices that had been developed might deter teenagers from using
sexual health services because of concerns about confidentiality and could possibly lead to
increased rates of teenage pregnancy. In this connection a multi-agency working group had
developed draft protocols to provide greater clarity, both for young people and for the
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professionals working with them, as to the standards of confidentiality young people could
expect.
The Group noted that teenage pregnancy was to be dropped from the Local Delivery Plan
but agreed that the work currently underway to achieve a reduction in the rate should
continue and that the issues could be revisited, if required, within the wider context of health
inequalities. It was suggested that the term “teenage pregnancy” might be revised to reflect
that it was specifically the 13 – 15 year age group that was being targeted. It was also
suggested that numbers of terminations might be explored.
The Group:


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Noted that this target was to be dropped from the Local Delivery Plan.
Agreed that any issues arising could be considered within the wider context of Health
Inequalities and the Sexual Health Strategy.
EMERGING ISSUES/AGENDA TOPICS FOR NEXT MEETING
The following issues were agreed for inclusion on the agenda for the next meeting on
01/04/08:



HAI
Delayed discharge
Interim report on Healthy Weight
Emerging issues from the Local Delivery Plan
Topics for future meetings:





Cancer – non-urgent referrals update (June 2008 meeting)
Cataract update (September 2008 meeting)
Smoking Cessation Activity Update (September 2008 meeting)
Sexual Health Strategy Review
Outpatient Waiting – trajectory for 2009 target
Healthy Working Lives – progress report
The Group Agreed the topics for the next and future agendas as detailed above.
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NEXT MEETING
The next meeting of the Group would take place on Tuesday 1 April 2008 at 1.30pm in the
Board Room, Assynt House.
The meeting closed at 3.55pm
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