Highland NHS Board6 December 2011

Item 2(a)

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HIGHLAND NHS BOARD

Assynt House

Beechwood Park

Inverness IV2 3BW

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www.nhshighland.scot.nhs.uk/

DRAFT MINUTE of MEETING of theBOARD

Board Room, Assynt House,Beechwood Park, Inverness

4 October 2011 – 8 30 am

Present Mr Garry Coutts, ChairMr Bill BrackenridgeMs Pam CourchaMr Robin CreelmanMr Mike EvansMr Ian GibsonDr Iain KennedyMrs Gillian McCreathMr Colin PunlerDr Vivian ShelleyMr Ray StewartMs Sarah WedgwoodMs Elaine Mead, Chief ExecutiveDr Ian Bashford, Board Medical DirectorMrs Anne Gent, Director of Human ResourcesMs Heidi May, Board Nurse DirectorDr Margaret Somerville, Director of Public Health & Health Policy

Also present Mrs Jan Baird, Transitions Director (Item 140)Mr David Garden, Interim Director of FinanceMs Chrissie Lane, Cancer Nurse Consultant (Item 139)Mr Derek Leslie, General Manager, Argyll & Bute CHP (Item 128)Mr Kenny Oliver, Acting Board SecretaryMrs Lorraine Power, Board Services AssistantMr David Ritchie, Communications ManagerMr Simon Steer, Head of Community Care (Item 138)Ms Maimie Thompson, Head of Public Relations and EngagementAbhayadevi Tissington, Nurse Consultant Health Protection (Item 131)

Apologies – Apologies were received from Cllr Margaret Davidson, Mr Okain McLennan and CllrElaine Robertson.

105 Declarations of Interest

Board members declared the following interests: Garry Coutts – Scottish Social Services Council, University of the Highlands and Islands Pam Courcha – Ms Courcha is a carer David Garden – Health & Happiness Ian Gibson – CLIC Sargent (Item 139) Iain Kennedy – GP at Riverside Medical Practice, Inverness Ray Stewart – Member of Unite and Staffside Chair

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The Board

a Noted the Declarations of Interest.

106 Welcome

The Chair welcomed Dr Iain Kennedy to his first Board meeting as the Chair of the Area ClinicalForum and Mr David Garden, Interim Director of Finance.

Mr Quentin Cox – The Chair acknowledged the Board’s appreciation of the work done by theprevious Chair of the Area Clinical Forum, Mr Quentin Cox, over the last four years and advisedthat he had been a good contributor to discussions and a regular attendee at Board meetings. TheChair confirmed that he would write formally to Mr Cox on behalf of the Board.

Director of Finance – It was noted that interviews had recently been held for the post of Director ofFinance. Mr Nick Kenton who was currently the Director of Finance for NHS Shetland had verballyaccepted the position. It was anticipated that Mr Kenton would take up post in January 2012.

107 NHS Highland Annual Review – 3 October 2011

The Chair updated on the NHS Highland Annual Review, which had been held the previous day.The Review had been undertaken by Michael Matheson, Minister for Public Health and on thewhole had been successful, although formal feedback was still awaited. The Chair thanked all thestaff involved in preparing the self-assessment documentation for submission to ScottishGovernment. The Chair felt that NHS Highland had provided a good level of assurance although afew areas, which were challenging were identified. One of these areas related to Children andAdolescent Mental Health Services (CAMHs) where it was difficult to recruit to more specialisedposts and there were a number of vacancies across NHS Highland. The Chair asked thatCHP/Raigmore Chairs should consider this issue in their area and ensure that recruitment isongoing to fill any vacancies. Another area in relation to CAMHs related to inpatient services and itwas noted that a report for on proposals by the North of Scotland Planning Group to upgrade theclinic in Dundee would be submitted to the next meeting of the Board in December.

The Chair offered congratulations regarding the various public health indicators, including AlcoholBrief Interventions, Healthy Weight and Breastfeeding although it was recognised that measuringthese was challenging. He asked that CHP/Raigmore Chairs ensure that these issues were ontheir governance committee agendas.

The Board

a Noted the update on the NHS Highland Annual Review.

b Thanked all staff involved in the preparation for the event.

c Remitted to CHP/Raigmore Chairs to ensure the issues raised are progressed within theiroperational units.

108 Minute of Meeting of 9 August 2011

The minute of 9 August 2011 was approved, subject to the following amendments:

Declaration of interest by Pam Courcha to read “Ms Courcha is a carer and supervises GPand voluntary organisation councillors.

Page 54, item 89 – Health and Safety Committee – the last sentence to read “…in relationto secondary employment”.

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The Board

a Approved the Minute of Meeting held on 9 August 2011.

109 Matters Arising

Board Papers – Bill Brackenridge referred to the change in the way the Board papers had beenissued, in sets for parts 1, 2 and 3 with consecutive numbering of all pages at the top of each page.He felt that it would also be useful to indicate on the agenda the pages of each item. The ChiefExecutive explained that the change to the way papers were issued was as a result of an ongoingLEAN project and due to features available on a new photocopying machine. This method saved alot of time in the collation of papers. The Chair advised that it was the intention to make papersavailable in an electronic format with each item book marked, in the move towards using lesspaper at meetings. This was currently work in progress.

Savings Plan – Ms Wedgwood referred to item 93 on pages 56 and 57 of the minute of the lastmeeting and asked when the Board might see the summary of the savings plan referred to. MrGarden confirmed that it had been agreed that the Director of Finance would circulate this outwiththe meeting and it was hoped that this would be available later this week for issue to Boardmembers.

Managing Access for Patients – Dr Shelley referred to the action on page 2 of the Board RollingAction plan in relation to Managing Access for Patients, which was being progressed through thePatient Travel Bench Project. The Director of Human Resources advised that this was anotherLEAN project and this work had been completed. This work had been reported to the SeniorManagement Team and Mrs Gent confirmed that she would give Dr Shelley a copy of the relevantslides for information.

Patient / Public Representatives on Committees – Mr Gibson asked about progress in relationto appointing patient and public representatives on governance committees. It was noted that thiswas work in progress and Mr Gibson asked that this be added as an action to the Board RollingAction Plan.

The Board

a Noted the Board Rolling Action Plan and the updates.

b Noted that the summary of the Savings Plan would be circulated to Board membersoutwith the meeting.

c Remitted to the Director of Human Resources to provide Dr Shelley with a copy of therelevant slides.

d Agreed that an action should be added to the Board Rolling Action Plan in relation toappointing patient and public representatives to governance committees.

REPORTS BY GOVERNANCE COMMITTEES

110 Argyll & Bute CHP Committee – Draft Minute of Meeting held on 31 August 2011

Bill Brackenridge, Chair of Argyll & Bute CHP updated on items discussed at the meeting. Henoted that once again he had not received a copy of the draft minute of the August Board meetingwhen the A&B CHP Committee met three weeks after the August Board. The Chair confirmed thatthe draft minutes were still being produced within the two-week standard and the delay had been in

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the checking of the draft minutes by the Chair and Chief Executive. The Chair confirmed that theywould aim to ensure that this was done in time for the next CHP Committee meeting.

Mr Brackenridge highlighted the discussion on the financial position in Argyll & Bute CHP includingthe summary of financial risks and advised that the position was challenging. Mrs Gent, Director ofHuman Resources congratulated Argyll & Bute CHP on the significant improvement in sicknessabsence figures and confirmed that a report would be shared with other operational units tohighlight the significant work done in this area.

Ms Wedgwood referred to the discussion on pressure ulcers and to the recruitment of a Preventionof Violence and Aggression Advisor. In relation to the new post, she asked how learning in thisarea would be monitored. Mr Brackenridge was unsure how this would be monitored, but advisedthat he would check how this would be progressed in the CHP. Mrs Gent advised that this was aredesigned post and part of a team and there was ongoing monitoring on the numbers of violentand aggressive incidents. Ms Wedgwood confirmed that as Chair of the Clinical GovernanceCommittee she would ensure this remained on the Clinical Governance agenda.

Mr Brackenridge referred to item 12.1 in the minute regarding the Vale of Leven Monitoring Groupand advised that a number of lay members of the Group had resigned as they believed that NHSGreater Glasgow & Clyde were not listening to their views. Mr Brackenridge wished to record histhanks to those members for their time and commitment and confirmed that he would welcomenew lay members on the Group.

111 Mid Highland CHP Committee – Draft Minute of Meeting held on 19 August 2011

In the absence of Mr McLennan, Chair of Mid Highland CHP, Sarah Wedgwood updated on issuesdiscussed at the meeting. Dr Shelley highlighted the issues around staff capacity in relation tomeeting public health targets. Dr Somerville, Director of Public Health and Health Policy confirmedthat there had been some concerns and it had been particularly difficult to recruit in these areas,however she congratulated staff involved for their work in these areas. She confirmed that progresswas being made and it was hoped that with more integrated services in the future that theseservices should be more sustainable. Reference was made to a Joint Advisory Group visit toMacKinnon Memorial Hospital on Gastrointestinal Endoscopy. Dr Bashford, Board Medical Directoradvised that an interim verbal report had been received which was favourable and the written reportwas still awaited.

Mrs Gent referred to the discussion on the HR Report at item 10.1 in the minute and advised thatthe HEAT target in relation to eKSF had not been “removed” but had been “achieved” and askedthat this be reflected in the minute. It was also noted that the Board required to achieve 100%compliance for the current year.

The Chair referred to item 4.2 on the discussion on West Ardnamurchan Unscheduled Care andadvised that a joint proposal had been put forward to the local community regarding emergency outof hours services and unscheduled care. This had not yet been agreed and a counter proposal hadbeen put forward by the community. A further meeting would be held later this week and then apublic meeting was scheduled for 26 October. The Chief Executive advised that similar discussionswere ongoing in relation to services in Glenelg and Arnisdale.

112 North Highland CHP Committee – Draft Minute of Meeting held on 16 August 2011

Colin Punler, Chair of North Highland CHP, updated on issues discussed by North Highland CHPCommittee, including Dental Services, West Caithness Redesign Project and the Financial Positionin North Highland CHP. Dr Shelley referred to the discussion on the West Caithness RedesignProject, highlighting the number of members of the public who had attended the meeting and thefact that one had requested to speak to the meeting. Mr Punler advised that the North HighlandCHP meeting was a meeting held in public rather than a public meeting and advised that it hadbeen recognised that an opportunity should be given for the public to express their views on the

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proposal and Mr Punler advised Cllr Mackay that if he identified someone prior to the meeting topresent the public views at the meeting then they would be heard, but no-one had been identified.The Chair supported Mr Punler in the way he had managed the situation at the meeting. The ChiefExecutive asked if the members of the public had been asked to submit their questions in writing.Mr Punler advised that this had not been possible as they had all left the meeting with 2 localcouncillors while the meeting was ongoing.

113 Raigmore Hospital Committee – Draft Minute of Meeting held on 15 August 2011

Mike Evans, Chair of Raigmore Hospital Committee updated on the last meeting of the RaigmoreCommittee. He advised that it had been a challenging meeting in relation to issues around HEATtargets and the financial position, which had been exacerbated by issues around attendance andthe quality of papers presented. However, the meeting had been attended by Dr Somerville, MsWedgwood, Ms McCreath, and Dr Smith who were attending to represent the Board and providesupport to today’s meeting. Mr Evans recorded his thanks to the Non-executive and Executivecolleagues for their support. It was noted that the Raigmore Management Team had soughtassistance from the Senior Management Team and the Chief Executive had agreed that DavidGarden, Linda Kirkland and Margaret Brown would assist the Raigmore Management Team torealise the necessary savings. The Chair highlighted the need for an Action Plan to be put in placedetailing how break even would be achieved and expected that this would be in place by the nextmeeting of the Raigmore Hospital Committee and the Board. Mr Evans confirmed that an ActionPlan would be submitted to the next meeting of the Committee. Heidi May, Board Nurse Directorreferred to the Infection Control Report to the Committee which needed to be clearer andconfirmed that she would provided appropriate support to Una Lyon, Lead Nurse at RaigmoreHospital to produce a report which is on a par with that produced by Argyll & Bute CHP.

Mr Evans confirmed that he had been asked to Chair the Group in relation to the Children’s Wardand the work of the Archie Foundation. The Chair welcomed this and asked that the ArchieFoundation be supported in this work.

The Chief Executive noted that Jan Baird, Transitions Director had attended the last meeting of theRaigmore Committee to update on Planning for Integration and that this item had not beendiscussed due to time constraints. Ms Mead highlighted the importance of this item and asked thatit be discussed at the next meeting of the Committee.

The Chair noted that Chris Lyons, Raigmore General Manager, had been on leave when the lastmeeting of the Raigmore Hospital Committee had taken place and advised that he felt thatGovernance Committee meetings should be prioritised in Lead Executive’s diaries. He asked thatall Chairs of Governance Committees should speak with the Lead Executive for their committeeregarding their role in leading these committees. He confirmed that there would be exceptions, butin general he would expect Lead Executives to be in attendance. The Chief Executive confirmedthat all the Lead Executives were line managed by her and she would expect them to discuss withher any exceptional circumstances which arose.

114 South East Highland CHP Committee – Draft Minute of Meeting held on 18 August2011

Gillian McCreath, Chair of South East Highland CHP Committee updated on issues discussed bythe Committee, including the financial position for the South East Highland CHP. It was noted thatthere was an update in the Chief Executive’s Report on Prison Healthcare and the Chair asked if areport could be brought as a substantive item to the next meeting of the Board in December.

The Board

a Noted the minutes.

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b Remitted to Bill Brackenridge to ascertain how learning in relation to violence andaggression would be monitored and used and report back to Sarah Wedgwood.

c Agreed that the Mid Highland CHP minute be amended as discussed.

d Remitted to Mike Evans, Chair of Raigmore Hospital Committee to ensure that Planningfor Integration was discussed at the next meeting of the Committee.

e Remitted to Chairs of Governance Committees to speak to Lead Executives regardingtheir role in the Committee.

f Agreed that a substantive report on Prison Healthcare should be submitted to theDecember meeting of the Board.

115 Audit Committee – Draft Minute of Meeting held on 13 September 2011

Ian Gibson, Chair of the Audit Committee updated on issues discussed by the Committee andhighlighted Planning for Integration, Risk Management and Audit Scotland Reports. He referred tothe Audit Scotland Review of Information Management Report which would be brought to theattention of the Clinical Governance Committee and the Senior Management Team. Mention wasmade to the request for clarification of the position relating to Para.40 of the GMS ContractGuidance Note and Community Health (HCH) Payments, Argyll and Bute CHP. It was noted thatthe Chief Executive had sent a letter to SGHD regarding this, and a response was still awaited.

116 Clinical Governance Committee Assurance Report and Draft Minute of Meeting heldon 16 August 2011

Sarah Wedgwood, Chair of the Clinical Governance Committee updated on the meeting includingusing case studies, Tissue Viability, surgical profiles and the new Quality Standard. Dr Somervilleadvised that there had been a discussion on clinical pathways at the last meeting of the SeniorManagement Team and this work would be reported to the next meeting of the ClinicalGovernance Committee. Dr Shelley referred to the Scottish Government eHealth Strategy 2011-17 and the need for eHealth aims to be aligned to quality. The Chief Executive confirmed that shehad discussed this with the Head of eHealth. During discussion on developing Dashboards, DrBashford, Board Medical Director confirmed that the Maternity Services Dashboard would be rolledout to Caithness General Hospital and community units. There was a need for a consistentDashboard across operational units. Mike Evans highlighted the need for committee members tounderstand the information produced. The Chair advised that he and the Chief Executive wereprogressing this as part of the Governance Review. Dr Kennedy felt that clinical dashboards weremore important for clinicians in improving quality and reducing variation. Ms Wedgwood confirmedthat there would be a presentation on Falls Prevention by Judith Catherwood at the next meeting ofthe Clinical Governance Committee. Ms May highlighted that this area was a good example ofwhat can be achieved when the relevant data is available.

117 Staff Governance Committee Assurance Report and Draft Minute of Meeting held on23 August 2011

Pam Courcha, Chair of the Staff Governance Committee updated on the meeting. It was notedthat revised role and remit for the Staff Governance Committee had not been agreed and would besubmitted to the next meeting of the Committee for further consideration. Mr Stewart referred tothe recent Recognising Excellent Awards and felt that it was appropriate for the Board to formallyrecord its congratulations to the winners and that the list of winners should be included in theminute. The Chair confirmed that the winners had already received congratulations from the Boardand agreed to record the list of winners in the Board minute. Accordingly a list is attached asAppendix 1 to the minute.

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There was some discussion around the Implementation of eKSF, the aim of which was that NHSHighland achieve eKSF review completion for 100% of eligible staff in 2011/2012. It was notedthat the current figure was rather low at 11%. Mrs Gent confirmed that the figure had since risen toaround 16-17% and acknowledged that a high number of reviews were historically due towards theend of the financial year. The Chief Executive agreed that she would raise this issue with GeneralManagers. Mrs Gent advised that the issue would also reported again at the next meeting of theStaff Governance Committee and should there be no further improvement then this would beescalated to the Improvement Committee.

118 Improvement Committee Assurance Report of 5 September 2011 and BalancedScorecard

The Board noted the Improvement Committee Assurance Report of 5 September 2011 andBalanced Scorecard.

119 Area Clinical Forum – Draft Minute of Meeting held on 4 August 2011

Dr Iain Kennedy, Chair of the Area Clinical Forum, updated on the meeting and the ACF and HPFmeeting with the Minister for Public Health which formed part of the NHS Highland Annual Review.He confirmed that the new Clinical Advisory Group had been received praise at the Forum andalso the recent Health Check newspaper was welcomed and clinicians had identified potentialfuture topics for inclusion within a future edition, including use of antibiotics, appropriate use of x-rays, use of A&E and directing members of the public towards self-help. The Chair welcomed thefeedback on the newspaper and engagement of clinicians.

Mr Stewart advised that Dr Ken Oates had recently attended a meeting of the Highland PartnershipForum to encourage staff uptake of the flu vaccination. Dr Somerville advised that this was moreof a priority for frontline staff working with patients.

120 Constitution – NHS Highland Area Healthcare Science Forum

Dr Iain Kennedy advised that following discussion of the Constitution for the Area HealthcareScience Forum at the meeting of the Area Clinical Forum last week that further work was requiredon the draft constitution and requested that the Board defer the item for consideration at a laterdate.

121 Health and Safety Committee – Draft Minute of Meeting of 18 August 2011

Mrs Anne Gent, Joint Chair updated on the last meeting of the Committee, including Safe and Wellat Work and Fire Safety. Mr Brackenridge advised that he had attended the meeting and was veryimpressed with the discussion on Occupational Road Risk Assessment for NHS Highland Vehiclesand Winter Preparedness. Ms Courcha suggested that NHS Highland should offer as muchsupport as possible to staff on this subject. The Chair advised that the risk assessment wascurrently under review.

122 Pharmacy Practices Committee – Minute of Meeting of 23 August 2011

The Board noted the minute of meeting of the Pharmacy Practices Committee held on 23 August2011 regarding an application by Cill Chuimein Dispensing Company Limited for the provision ofgeneral pharmaceutical services at Great Glen Trading Centre, Fort Augustus, PH32 4DD. MrBrackenridge advised that there had been no objections to the application and the new premisesshould be open within the next 6 months.

123 Pharmacy Practices Committee – Revised Role and Remit

Mr Bill Brackenridge, Chair of the Committee advised that following consideration of the role andremit at the last meeting of the Board that there had been further amendments to the membership.

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The Chair suggested that it might be helpful for the Board to receive a report detailing the supportavailable to new applicants, as the new way of working was very complex.

The Board

a Noted the Minutes.

b Noted the Clinical Governance Committee met on 16 August 2011. the Assurance Report and agreed actions resulting from the consideration of the

specific items detailed. the next meeting of the Clinical Governance Committee will be held on 8 November

2011.

c Noted the Staff Governance Committee met on 23 August 2011. the Minute of Meeting and the associated Assurance Report and agreed actions

resulting from consideration of the specific items. the next meeting of the Staff Governance Committee will be held on 22 November

2011.

d Remitted to the Chief Executive to highlight the need to improve on implementation ofeKSF to General Managers.

e Noted: that the Improvement Committee met on 5 September 2011. the Assurance Report and agreed actions resulting from the review of the specific

topics detailed and the Balanced Scorecard. that the next meeting of the Improvement Committee would be held on 31 October

2011.

f Noted the Minute of Meeting of the Pharmacy Practices Committee held on 23 August2011.

g Approved the revised Role and Remit of the Pharmacy Practices Committee.

h Recommended that a report be prepared for Board members detailing the supportavailable to new applicants.

Council/Highland NHS Board Joint Committees

124 Highland Council Partnership – Joint Committee on Children and Young People –Minute of Meeting of 12 August 2011

Ms Wedgwood updated on the meeting and advised that as there had been a subsequent meetingon 23 September that many of the actions had been progressed. Mr Garden highlighted that theJoint Committee for Children and Young People budget in the financial year 2010/11 had showedan underspend of £389,000 and advised that he would check the arrangements relating to this. MsCourcha referred to healthcare needs for Looked After Children Out of Area and sought assurancethat their needs were met when they returned to Highland. The Chair asked Ms May to respond tothis query outwith the meeting.

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125 Highland Council Partnership – Joint Leadership and Performance Group – Minute ofMeeting of 16 August 2011

The Board noted the Minute of meeting of the Joint Leadership and Performance Group held on 16August 2011.

The Board

a Noted the minutes.

b Remitted to David Garden to ascertain the position in relation to the underspend in the2010/11 budget for the Joint Committee for Children and Young People.

c Remitted to Heidi May to respond to the query from Pam Courcha regarding Looked AfterChildren returning to Highland.

The Board adjourned at 10.45 am and resumed at 11.00 am.

CORPORATE GOVERNANCE / ASSURANCE

126 NHS Board and Board Development Meeting Dates 2012 and NHS Highland Calendarof Meetings 2012

A list of dates for Board Meetings and Board Development Meetings had been drafted for approval,as well as a list of dates for NHS Highland Governance and Professional Advisory CommitteeMeetings for 2012.

It was noted that there was a clash on 11 December 2012 between the Audit Committee and theJoint Leadership and Performance Group and it was agreed that this would be resolved.

The Board

a Approved the dates for meetings of the NHS Board and Board Development Sessions for2012.

b Approved the calendar of meetings for the next year, subject to resolving the clashhighlighted on 11 December 2012.

127 Director of Public Health Annual Report 2011Report by Margaret Somerville, Director of Public Health & Health Policy

Dr Margaret Somerville, Director of Public Health and Health Policy presented the report to theBoard. The purpose of the report was to provide information and direction to service planning andto highlight the issues around Health Inequalities to a wide audience.

The main topic of this year’s Annual Report was health inequalities in the NHS Highland area, but italso reiterated the dangers of smoking, drinking and obesity, as highlighted in last year’s annualreport, and encouraged people to adopt a healthier lifestyle. It covered the causes of healthinequalities and highlighted that they affect people throughout their lives, eventually resulting ininequalities in life expectancy. We know that these issues need to be addressed to reduce existinginequalities and to prevent the gap widening still further. The Report explains that this is notstraightforward due to a number of factors, including financial constraints and difficulties inreaching the relevant groups. It also highlighted the need for services to be made as accessible aspossible.

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Another clear message was that NHS Highland is already working hard to address the inequalities,but it is not something that can be tackled by the NHS alone. NHS Highland, therefore, needs tocontinue to work with its partners and the communities involved. Tackling health inequalities alsorequires national and local policies that support the changes needed to the socio-economicenvironment to alleviate the underlying causes.

The Report identified the good points about living in the NHS Highland area, such as the sense ofcommunity and higher than average employment – the things that are good for our health - and thebad points, such as poverty, isolation and difficulty in accessing services, which can have anadverse effect on our health. Finally the report looked at the contribution of the Public HealthTeam to the excellent work that has been delivered over the last year. The presentation outlinedthe asset-based approach and highlighted ongoing projects in local areas.

During discussion a number of issues were raised, including:

Whether equality and diversity impact assessment was now embedded in NHS Highlanddecision making. Dr Somerville advised that this was progressing well. Mrs Gent indicatedthat she was happy to progress work to improve the health of employees.

Mr Stewart referred to the “stop press” on page 28 of the annual report and highlighted thatsome NHS Highland staff do not earn the rural living wage detailed in the report.

The Chair also highlighted that there were two communities with no GP surgeries in them. Dr Somerville advised that she could make copies of the slide presentation available to

Board members.

In noting the report and its recommendations, the Chair asked that CHP and RaigmoreCommittees consider the report and also that an Action Plan be produced based on therecommendations and what would be progressed in the short, medium and longer term. The ChiefExecutive highlighted the need for NHS Highland to take a different approach if we are to see thebenefit of the significant investment in public health.

The Board

a Noted the report and its recommendations.

b Remitted to CHP/Raigmore Chairs to ensure the report is considered by theCHP/Raigmore Committees.

c Remitted to the Director of Public Health and Health Policy to produce an Action Planbased on the recommendations in the report.

128 Oban Dental Centre – Argyll & Bute CHP – Standard Business CaseReport by Stephen Whiston, Head of Planning, Contracting and Performance Argylland Bute CHP on behalf of David Garden, Interim Director of Finance

Derek Leslie, General Manager, Argyll & Bute CHP spoke to the report. Argyll and Bute CHP hadbeen progressing its dental modernisation strategy for those localities which did not have adequatedental services (Oban, Campbeltown, Bute and Islay/Jura). The CHP was successful in obtainingfunding under the Scottish Government Primary Care Modernisation Programme (SGHD PCMP) toprogress the schemes in Campbeltown and Oban, with Campbeltown completed in November2010 and Oban planned to commence in April 2011.

Capital funding for the Oban dental project has been identified by the SGHD £1.286m for 2011/12and 2012/13. SGHD Capital Investment Group (CIG) has approved the Standard Business Case(SBC) NHS Highland had in anticipation incorporated this in its Local Delivery Plan (LDP). Giventimescales and slippage, the expected expenditure profile was:

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Capital Expenditure2011-12

£000s2012-13

£000sPCCPMP Oban 390 2,195

With regard to operational needs and suitability, there remained a pressing need for a modernisedDental facility in Oban for both community and independent services. The Argyll Square DentalPractice did not meet the requirements of the Disability Discrimination Act (DDA) or theDecontamination Guidelines that will take effect from 2012, nor could the building be feasiblyaltered to meet either DDA or the decontamination guidelines. As there was no long-term futurefor the building, grants would not be available to improve the facility, the current GDP has obtainedcommitted status and has indicated his interest in occupying surgeries in the new dental premisesdeveloped in Oban. This integration with the independent sector is one of the important factors inthe project and the CHP was in the process of formalising this involvement by advertising to theindependent dental sector to receive formal expressions of interest. Finally the location of the newfacility in the Lorn and Isles Hospital, meets the requirement of CEL(2010)32 to enhance NHSasset utilisation and is also a critical factor to the success of the project and approval by CIG.

The Board welcomed the Standard Business Case for the new Dental Centre in Lorn and IslandsHospital, Oban. During discussion Mr Garden highlighted the need to be mindful of the risk aroundnon-cash limited funding. Mr Punler referred to the arrangement with the independent sector andasked if there was a commitment to meet the needs of the NHS patients before private patients.Mr Leslie advised that there had been much discussion with the independent dentist in Obanregarding their commitment to work with NHS Highland.

The Board

a Approved the Standard Business Case (SBC) for a new Dental Centre in Lorn andIslands Hospital, Oban.

b Noted that the NHS Highland Capital Asset Group has approved and endorsed the SBCand approach at its meeting on 24 May 2011.

c Noted the CHP Management Team and Committee has approved and endorsed the SBCto SGHD CIG at its June meetings.

d Noted that due to timing issues re the approval process to the SGHD Capital InvestmentGroup, the SBC had to be submitted to CIG in July on the premise that the schemeshould be progressed under the Transition arrangements as specified in CEL 32 (2010).The CIG approved the SBC and confirmed capital funding for the scheme on 5 August2011.

e Noted the recommendation that the scheme be procured under the “Framework” processdue to the designation of capital funding carried forward from the PCMP allocation.

129 Infection Control ReportReport by Liz McClurg, Interim Infection Control Manager on behalf of Heidi May,Board Nurse Director & Executive Lead for Infection Control

Heidi May, Board Nurse Director updated on the Infection Control Report. The ExecutiveSummary, which summarised the key information in the report, is detailed below:

Staphylococcus aureusbacteraemia (SAB)

On course to meet target of 0.26.NHS Highland current rate June – August 2011 is 0.13.

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Clostridium difficile On course to meet target of 0.39.NHS Highland current rate June – August is 0.27.

Hand Hygiene Compliance with hand hygiene 94% in July and August2011.

Cleaning and the HealthcareEnvironment

Cleaning Compliance 92% in July and 93% in August2011.Estates Monitoring Compliance 94% in July and 95% inAugust 2011.

Good HEI Inspection report at Belford (2 requirements and3recommendations) and MacKinnon Memorial (2requirements and 5 recommendations).

Significant HAI incidents /outbreaks, emerging threats

1 Norovirus outbreak in Nairn Town & County in July.8 patients and 16 staff affected.

Antimicrobial Prescribing NHS Highland is one of only 3 Boards achievingcompliance with empiric prescribing measures in acutemedical admissions areas.

Surgical site infections Orthopaedic and caesarean section surgical site infectionsrates less than 1%.

The Chair referred to the SAB Chart on page 269 of the papers and highlighted the slight increasein July/August. The Board Nurse Director confirmed that this had been investigated and no singlefactor found. A query was raised regarding the cost implication of training staff in relation to SABs.Ms May advised that there was a greater cost impact related to the cost of having the infection andthe staff training costs were a sound investment. Dr Shelley referred to HEI Inspections andpolicies being past their review date. Ms May advised that there had been a national review ofinfection control policies and NHS Highland had agreed not to review our own policies until the newnational guidance was available. It was noted that Scottish Government had now released therevised policy and NHS Highland policies had been updated.

The Board

a Noted the contents of the Report.

130 Tissue Viability – Pressure Ulcer PreventionReport by Pat Tyrrell Lead Nurse, Argyll & Bute CHP on behalf of Heidi May, BoardNurse Director

Heidi May, Board Nurse Director updated on the report. In August 2010 NHS Highland introducedthe new Pressure Ulcer reporting system through Datix. Clinical staff in all care settings wererequired to report all new pressure ulcers through this system. Significant work had beenundertaken in each operational unit to ensure the correct information was being reported and toaddress areas of under and over reporting. The data for the year August 2010 to July 2011 wasillustrated in Table 1 of the report. During this time 144 patients had developed a pressure ulcerduring a hospital stay. At a recent meeting of the Senior Management Team it was agreed toadopt a zero tolerance approach and that this should not happen in our care. It was noted thatnational benchmarking data was still awaited.

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During discussion the benefits of preventing pressure ulcers were clear. There was also a need forclarity around the resource required to ensure all nurses undertake the relevant trainingprogramme. It was recognised that not all pressure ulcers occurred in hospital, some occurred athome and in nursing homes and Ms May confirmed that there were good working relationships inplace with local GPs and the extended community care team. Dr Kennedy confirmed that thereport had been discussed at the recent meeting of the Area Clinical Forum and they had fullyendorsed the proposals. He also confirmed that the expertise in this area was within the nursingprofession. The Chair felt that it would be useful for the Board Nurse Director to consider targetsand reporting mechanisms for the operational units and that further reports should be submitted tothe Clinical Governance Committee.

The Board

a Noted the current status of pressure ulcer incidence across NHS Highland and theactions in place to improve care.

b Remitted to the Board Nurse Director to consider targets and reporting mechanisms forthe operational units.

131 Infection Prevention and Control in the CommunityReport by Abhayadevi Tissington, Nurse Consultant Health Protection on behalf ofHeidi May, Director of Nursing

The Chair welcomed Abhayadevi Tissington, Nurse Consultant Health Protection to speak to thereport. National policy, guidance and supporting materials on Healthcare Associated Infection(HAI) produced in the last decade by the Scottish Government Health Directorate, NationalServices Scotland, and other stakeholders had focused primarily on acute care. The new HAITask Force Delivery Plan recognised that HAI is an important issue in all environments, not onlyacute ones. This was to be welcomed and specific projects and initiatives already beingundertaken in the community were detailed in the report. In relation to work in care homes, it wasnoted that this work linked with pressure ulcer prevention and the integration agenda.

The Board

a Noted the contents of the report on Infection Prevention and Control in the Community.

132 NHS Highland Financial Position as at 31 August 2011Report by David Garden, Interim Director of Finance

Mr Garden updated on the financial position to 31 August 2011, which continued to estimate arevenue break-even position for the financial year. However, similar to the August report, theoperational forecasted overspend remained higher than would be expected, albeit there was animprovement of almost £0.8million, at operational level, on the previous Board Report. With themid-point of the financial year approaching, there had been a robust review of all allocations, non-recurrent resource and any benefits accrued from prior years. The result of this had allowed forthe application of £1.5million of non-recurrent resource to the position and overall, this had result inthe forecasted overspend to reduce to just below £5.7million, an improvement of £2.2million on theprevious Board Report.

To a large degree, Unit’s forecasted overspends related, in the main, to their as yet unachievedsavings. However, this was not entirely the case and there were a number of cost pressureshaving to be managed within the service. Most of these have been reported in previous monthsand continue:

Medical Locums – locum costs remain a pressure in Argyll & Bute and the North CHP.

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Out of Hours – the overall expected overspend in out of hours is over £0.4 million and is apressure within all Units.

Theatres – in Raigmore, predominantly around the modular theatre and significant paypressures.

Whilst not being reported as a significant item as yet, GP Prescribing costs were also being closelymonitored as early indications give cause for some degree of caution. However, given the time lagin terms of prescribing information, it remains relatively early within the financial year to form arobust opinion on likely impact.

Detailed Financial positions for each Operational Unit are reported to the relevant GovernanceCommittees, who are in the best position to investigate and secure the necessary actions at locallevel to minimise the impact of such pressures. The most significant variance related to Raigmorewith £3.4m relating to unidentified savings and £1.0m in respect of cost/service pressures, mainlyin Theatres. This is an improvement of £0.3m on previous reports. The importance of the deliveryof key quality and performance targets within the hospital, together with the requirement to deliveryear end financial breakeven, was recognised and the Unit had requested support, from the SeniorManagement Team. It has been agreed that members of the Corporate and Executive teams willjoin the Core Management Team of Raigmore Hospital on a weekly basis to direct effort to ensurea successful outcome in the delivery of all objectives under an agreed terms of reference.Meetings have commenced and actions are being developed to ensure financial recovery.

The delivery of Efficiency Savings was detailed in Table 3, which highlighted performance byOperational Unit against the individual targets. In relation to Efficiency Savings, a wide range ofinitiatives were ongoing to help bring the forecast back in line.

Table 4 highlighted the capital spend against the CRL. Capital planning, prioritisation andexpenditure would be discussed in the more detailed report next on the agenda.

Dr Shelley referred to the management planned actions in relation to the £5.5m savings still to beidentified. The Chair advised that the activity being undertaken by the Interim Director of Finance,the Chief Executive and General Managers should be sufficient to achieve the necessary savingsover the year. Mr Gibson expressed concern around non-recurring savings and the need toensure savings were recurring. The Board recognised that future years would be just as difficultfinancially, if not more so.

The Board

a Noted the continued forecast of break-even in the current year.

b Noted the work on going to identify and deliver further savings.

c Noted the specific arrangements put in place for Raigmore Hospital to assist with thedelivery of targets.

133 NHS Highland Capital Plan 2011/12Report by Malcolm Iredale, Director of Finance

It was agreed at the last Board meeting that a detailed report on the Capital Plan would besubmitted to the next meeting of the Board. The Board’s Capital Plan was discussed at theFebruary 2011 Board meeting when the significant reduction in NHS capital resources was noted,together with the revised approach of capital allocations to NHS Boards. There was a movementaway from the previous methodology of formula allocation / specific scheme funding to one whichrecognised the legal carry forward commitments, with only a very limited sum beyond this for theBoard to allocate against its key capital priorities. There were a number of pressures within thesystem, including delivery of the previously envisaged capital plan, increasing property

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maintenance requirements and the replacement of equipment some of which had previously beenleased. These pressures were being managed in the current year through the Asset ManagementGroup (AMG), and application of an agreed prioritisation model, which has been developed in-house. This process and resultant programme were detailed in the report and highlighted in tables1-4 relating to:

Table 1 – Specific Capital Projects funded in 2011/12 Table 2 – Other Capital Projects Prioritised and Funded in 2011/12 Table 3 – Other Capital Projects Prioritised BUT NOT funded in 2011/12 Table 4 – Identified Capital Projects not included in the prioritisation process.

Table 4 highlighted that, due to the constraints on capital in the current year, it had not beenpossible to take forward all possible schemes. These will be included again within next year’sprioritisation process, along with any new schemes however, given the likely continued constraintson capital, it is unlikely that all of these schemes will be affordable in 2012/13 and there will need tobe managed through a combination of clinical prioritisation, service planning and the examinationof alternative financing models.

It was noted that the report was prepared on the basis of the current information on capitalallocations which related only to 2011/12. Information on potential future capital allocations shouldbe available after the Autumn announcement of the Scottish Comprehensive Spending Review(CSR), although detailed allocation will not be confirmed until after approval of the ScottishGovernment Budget in January 2012.

Mr Punler referred to section 8 of the report relating to impact assessment and asked if thisprocess included inequalities. Ms Mead did not think this was included in the scoring butconfirmed that she would check and advise Mr Punler outwith the meeting.

The Board

a Noted the capital resource available for 2011/12.

b Confirmed the 2011/12 projects underway, following prioritisation process and AssetManagement Group (AMG) approval.

c Agreed the process outlined to determine future capital plans.

d Noted the continued pressure on future capital plans.

e Remitted to the Chief Executive to check the query regarding impact assessment andadvise Mr Punler.

134 Better Together In-Patient Survey 2011Report by Mirian Morrison, Clinical Governance Development Manager on behalf ofHeidi May, Board Nurse Director

As part of the national Better Together Programme, 5388 in-patient questionnaires were sent topatients who had spent at least one night in a Highland Hospital in the period 1 October 2009 to 30September 2010. This survey excluded Mental Health, Maternity and Paediatrics. The overallresponse rate was 55%, similar to last year. The Highland wide results were shown in Appendix Ato the report.

Heidi May, Board Nurse Director updated on the report confirming that the survey had been fairlyposition, although there were still areas for improvement. Action Plans would be put in place foreach operational unit and Ms May confirmed that the CHP/Raigmore Chairs supported this workand confirmed that there would be regular updates to the Clinical Governance Committee.

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There followed a detailed discussion on the report. It was noted that a number of surveys hadbeen sent to people who were deceased. Ms May advised that work was ongoing in this area tohelp prevent this happening in future. Information was broken down to hospital level, which wouldallow more detailed analysis locally. Ms Courcha noted that the survey excluded mental healthand highlighted the impact of being in hospital for people with learning difficulties, autism, dementiaetc.

The Board

a Noted the findings of the Better Together In-Patient Survey and the action being taken toaddress the findings.

135 Chief Executive’s and Directors’ Report – Emerging Issues and UpdatesReport by Elaine Mead, Chief Executive

This month’s report incorporated updates on:

Audit Scotland – Overview of NHS in Scotland Detect Cancer Early Implementation Plan Interim Director of Finance Nursing And Midwifery Council – Review of North of Scotland Local Supervising Authorities Regional Panning – NoSPG Report for NHS Board Annual Reviews Regional Planning – North of Scotland Planning Group and West of Scotland Planning

Group Strategic Framework – Updates on Communicating the Vision and Quality and Clinical

Pathways

Heidi May, Board Nurse Director highlighted the Review of North of Scotland Local SupervisingAuthorities and advised this had been a very positive visit. Elaine Mead, Chief Executivehighlighted the update on Communicating the Vision in relation to the distribution of the NHSHighland Newspaper. She confirmed that she had received feedback as had the Chair andMedical Director and they had all responded promptly to these. Overall feedback had been fairlypositive, with the items on patient stories rated highest. It was agreed that the full feedback reportwould be submitted to the December meeting of the Board.

The Board

a Noted the emerging issues and updates report.

b Agreed that a further more detailed report on the NHS Highland Newspaper would besubmitted to the December meeting of the Board.

136 NHS Highland Response to Mid Staffordshire NHS Foundation Trust ReportsReport by Mirian Morrison, Clinical Governance Development Manager on behalf ofDr Ian Bashford, Medical Director

Ian Bashford, Board Medical Director updated on the report. The Independent Inquiry into careprovided by Mid Staffordshire NHS Foundation Trust (‘The Francis Report’) was published inFebruary 2010. The Scottish Government Health Department asked for assurance that Boardshad considered the Mid Staffordshire reports and improvements were made to any shortcomingsidentified. In response to this the Board undertook a comprehensive review to identify the currentposition against the findings and recommendations in the reports. Overall, systems and processeswere in place across most areas however improvements could be made. After discussion, a fewareas were identified as areas of high risk as systems and process were not in place or not

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working sufficiently. These areas were identified as corporate priority areas for 2011/12 by theBoard Medical Director and Board Nurse Director. These were:-

Failure to conduct observations Implementation and compliance against guidelines and protocols Arrangement for venous thromboembolism prophylaxis Training programme for all staff Complaints management.

The initial review undertaken to identify the position within the Board found that, although theScottish Early Warning System (SEWS) was being used across all hospital sites compliance wasvariable. Two national programmes, the Scottish Patient Safety Programme (SPSP) andReleasing Time to Care Clinical Quality Indicators (CQIs) Programme monitor compliance againstSEWS. Over the last 12 months there is an indication that both programmes are leading toimproved patient care.

There was some discussion around the performance in different areas as detailed in the diagramswithin the report. Dr Shelley referred to the 20 day target for complaints and her understandingthat a gap analysis was still to be done. Dr Bashford advised that this had not been agreed,however Datix reporting was increasing and information was disaggregated to ward level. ElaineMead, Chief Executive advised that she sees the majority of complaints and highlighted theimportance of NHS Highland responding appropriately and investigating properly. It was alsoimportant to create a culture where people were comfortable to raise concerns, and that anymember of a team felt able to do this. The Chair emphasised the amount of data available, theneed to extract what we need for assurance and to ensure the quality of the data and suggestedthat we should review what we need to be looking at and avoid “information overload”.

The Board

a Noted the progress with the five priority areas for 2011/12, which were identified followinga detailed gap analysis against the Mid Staffordshire Reports.

The Board adjourned at 1.35 pm for lunch and resumed at 2.05 pm.

STRATEGY AND POLICY

137 NHS Highland Strategic Framework 2011/12 – WorkforceVerbal Update by Anne Gent, Director of Human Resources

Anne Gent, Director of Human Resources gave a verbal update to the Board on Workforce. TheWorkforce Plan had now been published on the intranet. This looked at the size, shape and costof the future workforce and considered quality, safety and the patient experience. It was noted thatthere would be some reduction in workforce and while the Board would not wish to reduce staffingit was acknowledged that approximately 70% of the NHS Highland budget related to staffing costs.There were currently reviews underway in Administrative Support Services and CorporateServices. Work was in progress in relation to reducing sickness absence, changes to skill mix andfacilities time. There was currently a policy of no compulsory redundancies in the NHS and whereneeded staff were being redeployed. It was recognised nationally that the Staff GovernanceStandard needed to be updated.

Mrs Gent highlighted the work of the Service Improvement Group which had been showcased atthe recent meeting of the Senior Management Team. The Chair thanked Mrs Gent for the detailedupdate and suggested that it would be useful for Board members to have a short note of therelevant points.

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Mr Stewart referred to the current situation regarding public sector pensions and advised that tradeunion members were being balloted for strike action to take place on 30 November. The Chairthanked him for the notification and advised that NHS Highland would deal with industrial action ifand when it arose.

The Board

a Noted the update.

138 The Highland Change PlanReport by Simon Steer, Head of Community Care on behalf of Elaine Mead, ChiefExecutive

The report described the initial development of the Highland and Argyll Change Plans and nowprovides members with the detail behind the high level plans agreed in March 2011, the LocalNorth Highland Plans agreed in July and August 2011, and the Mid Term Reports to the ScottishGovernment submitted in August 2011. Simon Steer, Head of Community Care spoke to thereport. Separate Plans were required for each Local Authority area, and weighted allocations of£3.4m (North Highland) and £1.7m (Argyll and Bute) apply to the respective plans. The aim of theChange Plans were to achieve a return of 3 times the investment, to help achieve savings and tohelp shift the balance of care. It was noted that there was no assumption that everything would bedelivered by the NHS and local authorities and there should be an interface with the third sector.

During discussion a question was raised in relation to “effectively mainstreaming” and “genuinestrategic commissioning”. Mr Steer advised that “effectively mainstreaming” meant finding financialsavings so that the plans would pay for themselves and “genuine strategic commissioning” relatedto working with all sectors throughout the process. In relation to self-directed support, it was hopedthat there would be more choice of options that were available at present.

The Board welcomed the update and the Chief Executive highlighted the importance of getting areturn on the investment, with so much investment in the community there should be a reduction inbeds in the longer term.

The Board

a Noted the broad aims of the Plans. (Appendix 1 & 6). the method of allocation in North Highland (Not required due to co-terminosity in

Argyll and Bute). emerging local plans (Appendices 2, 3, 4 & 7). that further proposals are being developed in partnership with the Third and

Independent Sectors. the Mid Term Report Submitted to the Scottish Government in August

2011(Appendix 5 & 8).

139 Living & Dying Well – An Action Plan for Palliative and End of Life Care in Highland –Progress ReportReport by Chrissie Lane, Cancer Nurse Consultant-Project Lead for Living & DyingWell on behalf of Heidi May Executive Lead for Living & Dying Well

The Scottish Government published their intentions for improving palliative and end of life careacross Scotland in ‘Living & Dying Well – Improving Palliative & End of Life Care’ (2009). NHSHighland developed an improvement action plan, which set out to deliver consistently high qualitypalliative and end of life care to all those people who require it regardless of their age, diagnosis orplace of care.

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Chrissie Lane, Cancer Nurse Consultant spoke to the report which highlighted work over the lasttwo years. The Chief Executive noted that a lot of work had been done around Anticipatory CarePlans which had been very helpful. This work also linked with the Change Fund in supportingmore posts in the community to support people in their own home.

Mr Punler referred to Appendix 1 to the report which detailed the percentage of last 6 months oflife spent at home or in a community setting where NHS Highland was 3rd after NHS Grampianand NHS Lothian. He asked what made the difference. Ms Lane advised that this was downto skills, culture and use of Community Hospitals. The Chair asked for figures in relation toresidential homes, nursing homes, hospital etc. and Ms Lane confirmed that she could sendthis information to Board members following the meeting.

The Board

a Noted progress to date.

b Remitted to Chrissie Lane to send the relevant information to Board members.

140 Planning for Integration – Progress ReportReport by Jan Baird, Transitions Director, The Highland Partnership

Jan Baird, Transitions Director updated on the report. As reported previously to NHS HighlandBoard the programme of work known as Planning for Integration (P4I) is progressing towardsimplementation in April 2012. The update report seeks to inform Board members of progressagainst the deliverables previously reported, proposals that have been recently presented to theProgramme Board and to remind members of key dates on the timeline. It was noted that thecommission needed to be signed off in December to allow submission to the Council and theBoard prior to April 2012.

Ms Wedgwood referred to the Care Inspectorate and Mrs Baird confirmed that an early meetingwas arranged. Mrs McCreath asked if there were outstanding equal pay claims and it wasconfirmed that this related to Occupational Therapists employed by Highland Council who werekeen to address this. It was noted that the majority of services would transfer on 1 April 2012without redesign which would happen over time. There was some discussion around governancearrangements and complaints procedures which would still be overseen by the Public ServicesOmbudsman.

The Board

a Noted the progress in the programme of work – Planning for Integration.

b Noted the proposals put to the Programme Board on 27 September.

c Noted the emerging timelines.

141 Promoting Self-CareReport by NHS Highland CHP Lead Pharmacists on behalf of Elaine Mead, ChiefExecutive

Elaine Mead, Chief Executive, updated on the report which had been prepared by CHP LeadPharmacists. On 1 April 2011, NHS prescription charges were removed in Scotland. This has thepotential to increase pressure on GP practices to treat minor illnesses that patients would havepreviously self-managed. The potential result is increased inappropriate demand for GPappointments and increased prescribing cost, both in terms of the medicines themselves and thecosts associated with prescribing and dispensing.

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Prior to 1 April, practices were already reporting that a significant proportion of appointments arefor minor illnesses or requests for over the counter (OTC) medicines. Evidence also exists that asignificant number of consultations with Out of Hours Services and at Accident and EmergencyDepartments are for minor illnesses. These services could be relieved from such consultations toenable them to concentrate on more serious conditions. Therefore, the public requires informationand education about how to access treatment from the health professional most appropriate totheir needs. This paper outlined a number of proposed measures. The first section describesguidance on the prescribing of over the counter medicines. The second section proposes that NHSHighland adopts and expands upon the approach to self-care that has been recently piloted inNorth Highland CHP.

The Board welcomed the report and endorsed the approach being taken. It was suggested thathere should be some publicity around this initiative.

The Board

a Endorsed the introduction of guidance for the prescribing of over the counter (OTC)medicines.

b Endorsed the introduction of actions to promote self-care for minor, self-limitingillnesses.

142 AOCB – Patient Experience at Governance Committees

Colin Punler referred to a previous discussion on highlighting patient experiences at governancecommittees and whether this would also be done at Board meetings. The Chair advised that hewas mindful of the time available to discuss this at today’s meeting and confirmed that he wouldconsider this further.

143 Date of Next Meeting

The next meeting of the Board will be held on Tuesday 6 December 2011 at 8.30 am in the BoardRoom, Assynt House, Beechwood Park, Inverness.

The meeting concluded at 3.10 pm.

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APPENDIX 1NHS HIGHLAND RECOGNISING EXCELLENCE AWARDS 2011 – WINNERS

Categories: BH = Better Health; PCC = Person Centred Care; IQ = Improving Quality;V= Volunteering; BS = Behind the Scenes; GGE = Going Green for Efficiency;LA = Lifetime Achievement; ONR – Outstanding New Recruit

Ref No Nominee/s Role CHP Area

BH4 Donna Gough CPN SE CHP

PCC11 Dr Chris James GP, Dunvegan Health Centre Mid CHP

PCC12 Josie Johnson-Duff Nursing Assistant, Braeside, BenulaRoad, Inverness

SE CHP

PCC19 Florence Anderson Staff Nurse, Macmillan Suite, RaigmoreHospital

Raigmore

IQ3 Christine McArthur Falls Co-ordinator, Rothesay A&B CHP

IQ4 Broadford Hospital Team Mid CHP

V1 Mrs Alice Grant Volunteer, Scottish Ambulance CarService

NH CHP

BS1 South East CHP Community Equipment StoresDavid Sutherland, Raymond Harrison, Ali Munro, Richard Smith

SE CHP

BS9 Iris Mackenzie Administrative Assistant HealthProtection

Public Health

LA17 Dr James Douglas GP, Tweeddale Medical Practice Mid CHP

LA18 Dougie Montgomery Substance Misuse Co-ordinator / LeadNurse

Public Health

ONR1 Linda Fraser Administrative Support Officer,Pharmacy, Raigmore

Raigmore

GGE1 Lynn Lopez Secretarial Team Leader, Fort WilliamHC

Mid CHP