Paper J DRAFT UNCONFIRMED MINUTES OF THE TENTH MEETING OF THE GOVERNING BODY OF HEALTH EDUCATION EAST MIDLANDS (HEEM) (EAST MIDLANDS LOCAL EDUCATION AND TRAINING BOARD) HELD AT 1 MERE WAY, RUDDINGTON ON 28 JANUARY 2015 Ms Kaye Burnett (KB) Independent Chair of Governing Body Ms Lyn Bacon (LB) Mr David Farrelly (DF) Prof Simon Gregory (SG) Prof Ian Hall (IH) Mrs Jane Johnson (JJ) Prof Sheona MacLeod (SM) Mr Paul O’Connor (POC) Mrs Anne Marlow (AM) Mrs Sue Noyes (SN) Prof Rishabh Prasad (RP) Ms Amanda Rawlings Ms Karen Rutter (KR) Dr Sonia Swart (SS) Third Sector representative Local Director, HEEM Director of Education & Quality, (Midlands and East) Medical HEI representative Deputy Director of Workforce, Education and Quality, HEEM Post Graduate Dean, HEEM Chair, Nottinghamshire LETC Director for Innovation, HEEM Chief Executive, East Midlands Ambulance Service Director of Primary Care, HEEM Representing Derbyshire LETC Head of Finance (Midlands and East) Chair, Northamptonshire LETC Apologies: Mrs Sue James Ms Jane Lewington Dr Peter Miller Chair, Derbyshire LETC Chair, Lincolnshire LETC Chair, Leicestershire and Rutland LETC In attendance: Mrs Karen Adcock (KA) Mr Richard Ansell (RA) Mrs Carole Appleby (CA) Mrs Jackie Brocklehurst (JB) Ms Mary Elford Mr John Keenan (JK) Mrs Helen Smith (HS) Workforce Lead, Northamptonshire Workforce Team Workforce Lead, Leicestershire & Rutland Workforce Team Head of Marketing and Communications, HEEM Workforce Lead, Nottinghamshire Workforce Team Non Executive Director, HEE Interim Workforce Lead, Derbyshire Workforce Team Workforce Lead, Lincolnshire Workforce Team 01/15 Welcome The Chair welcomed the following to the Governing Body (GB) meeting:      Paul O’Connor, Chief Executive, Sherwood Forest Hospitals NHS Trust (new Nottinghamshire LETC Chair) Simon Gregory, Director of Education & Quality, (Midlands and East) Amanda Rawlings, Derbyshire Community Health Services NHS Trust (representing Derbyshire LETC) John Keenan, Interim Workforce Lead, Derbyshire Workforce Team Mary Elford, Non-Executive Director, Health Education England. 1 02/15 Declaration of interests No new declarations of interest were raised in connection with the items listed on the agenda. 03/15 Update from the Independent Chair Opening the meeting KB said that the GB meeting would take a slightly different approach to previous meetings and that agenda had been designed to enable GB members to start the year thinking about our forward plan and key priorities. This should help to provide clarity and a line of sight for performance and assurance conversations around the table. The ‘Shape of Caring’ Report was due to be published at the end of March; the expectation was that there would be a greater emphasis on mentoring/preceptorship for nurses. The HEEM Nursing and Midwifery Summit was planned for 6 February; HEE’s Chief Nurse, Lisa Bayliss-Pratt was a keynote speaker, alongside HEE’s National Director for Midlands and East, Janice Stevens (also a former nurse). The HEE Board (27 January) had agreed to continue to provide pre degree care experience opportunities for aspiring nurses to gain care experience before entering their studies. This route is seen as one of the ways to increase the pool of good quality candidates for nursing degrees, working in tandem with, as examples, values based recruitment, Talent for Care bands 1-4 progression, and widening participation initiatives. Opportunities to extend this to Allied Healthcare Professionals would also be explored. HEE had asked colleagues to pass on their thanks to everyone in the East Midlands who helped make the pilot project a success. In connection with the NHS ‘Five Year Forward View’ KB said that HEE’s Chief Executive, Ian Cumming would be chairing the newly established Workforce Advisory Board; this would bring together senior national figures in the NHS and would be a valuable opportunity for HEE to influence this agenda. KB also wished to congratulate the University of Nottingham’s School of Medicine for their result in the recent Research Excellence Framework, over 80% of their research was judged to be ‘world leading’ or ‘internationally excellent’. This was a significant improvement since the previous Research Assessment Exercise in 2008. 04/15 Review of Governing Body (GB) actions to date The status of actions was noted; a number of items with update reports appeared later in the agenda. 05/15 Report of the Local Director With regard to ‘Beyond Transition’ the formal consultation period had ended on 9 January. New structures had been developed to support the 20% running cost reduction across HEE. The structures were due to be released by 2 February following approval at the HEE Board meeting on 27 January. The impact of this on LETCs would be discussed with LETC Chairs in a follow up meeting; a timeline for implementation would also be shared. With regard to Primary Care, DF said that there had been a lot of activity at national level around three key areas: 2 (i) The Primary Care Workforce Commission (PCWC) had been established as an independent Commission to identify good examples of integrated, patient focused, primary care. In the East Midlands, Lakeside surgery/Corby Urgent Care Centre would be an area for review. The PCWC report will inform HEE priorities for education and training as well as future decisions of commissioners and regulators. (ii) New Primary Care infrastructure bids: This new fund announced by the Government in December will lead to a four year investment programme targeted at increasing capacity in primary care to enable better access to GP and its associated community services, improving services for the frail and elderly and hence reducing unnecessary demands on urgent care services, as well as building the foundations for more integrated care to be delivered in community settings. HEEM would be staying close to this in order to optimise opportunities for education and training in the East Midlands. (iii) 10 point GP plan published earlier in the week: NHS England, HEE, Royal College of General Practice and the BMA GPs committee were working closely to ensure a skilled, trained and motivated GP workforce. The plan addressed immediate issues, and set out initial steps in building the workforce for the future and new models of care. It is part of the implementation of the Five Year Forward View and the New Deal for Primary Care, which set out a specific commitment to tackle workforce issues, alongside a range of other proposals. There are three key strands to this work: improving recruitment into general practice; retaining doctors within general practice and supporting those who wish to return to general practice. Publication of the 10 point GP plan generated high profile national media coverage, including an interview on BBC Radio 4’s World at One with HEE Director of Education and Quality, Wendy Reid and HEEM PG Dean, Sheona MacLeod, along with GP trainees from the East Midlands. Locally, a video had been made by HEEM to raise the profile of the East Midlands and in particular highlight GP as a great career choice. http://em.hee.nhs.uk/workforce/gp-training-in-the-east-midlands-video/ This was shown to GB members who commented positively on it. With regard to the paramedic workforce: HEEM would be taking a lead role on the national programme and will facilitate the work streams supported by national funding. In November 2014 HEEM worked with the East Midlands Leadership Academy and East Midlands Academic Health Science Network to host the event “Leading Innovation in Healthcare.” The collaboration has reported on the event, its outcomes and the next steps. Slides from the event and a copy of the report including recommendations and next steps here: http://www.leadershipeastmidlands.nhs.uk/events/leading-innovation-healthcareconference-king-power-stadium Action (a) To receive the report of the Local Director. (b) To provide GB members with a hyperlink to the new HEEM video about GP recruitment and the recording of the BBC Radio 4 ‘World at One’ item on the same topic (CA); (c) To provide GB members with a hyperlink to the ‘Leading Innovation in Healthcare’ Conference. 3 06/15 Addendum to Governing Body Constitution This paper proposed an addendum to the current HEEM Governing Body Constitution (approved 17 April 2013, reviewed January 2014) due to staff changes resulting from ‘Beyond Transition’. The proposal reflected a transitional position to 31 March 2015. Action (a) to adopt the arrangements proposed in paragraph 1 for the period 28 January to 31 March 2015 noting that the role of LETB Post Graduate Dean continues to remain in place but that the Director of Education and Quality (DEQ) remit of this role is now undertaken by the Geographic DEQ, with the PG Dean continuing in this role through to 31st March 2015. (For clarity, voting rights are retained in association with the LETB Post Graduate Dean role.) (b) to set in place arrangements for suitable appointment of GB members to fulfil the legislative requirements of becoming a NDPB in April 2015 (Chair). 07/15 Priorities and forward plan for the year ahead DF set the scene with a number of slides based on the NHS Five Year forward view, pulling out some thought provoking themes pertinent to workforce, education and training. RP welcomed the national focus on primary care and actions being taken to address current issues however the current issue needed a solution now not in two to three years’ time. LB made the point that the majority of the transformational work was happening not at the LETB or in LETCS, but among providers, because this was where the actual transformation was needed in order to meet patients and service needs. What was necessary was a flexible workforce. In her view it was about actively getting on the ground and seeking to influence through primary care groups. In order to accelerate transformation she felt it was vital to be clear about the LETB’s remit (what is ‘in’ and what is ‘out’ and where the true influence lay). AR said that she currently led across two units of planning around the integrated care workforce. One of the challenges was that 51% was already committed leaving little scope to change things. We need to ensure we have an ability to make things happen quickly and to take speedy decisions to change things. The way we have set up our systems hinders our ability to deliver change. SS said that in Northamptonshire, she and colleagues had been trying to reconfigure services for some time. Success had been limited by a lack of clarity about roles and entrenchment in existing roles. In reality there was commonality about the things that needed to change but it was vital to get staff to work in broader roles and in new ways, across health and social care and across hospital and community. The new NHS ‘Five Year Forward View’ would provide a lever to make change if it were correctly interpreted. The NHS seemed to be still ‘waiting to be given permission’. AR said that there was so much good practice around; what was urgently needed was better ways to share this across boundaries. IH expressed concerns about the remit of the HEEM GB; in his view this was to reflect the ‘best guess’ about what workforce, education and training are needed to deliver services, rather than actually redesign services per se. He felt that the current approach to short-term planning for education commissioning impacted hugely on HEIs. A recent example was the change in nurse commissions. This had consequences on HEIs in the medium to long term, There were also things nationally that added to this volatility e.g. ‘Shape of Training’, this 4 would have huge implications for medical education. He felt that locally we needed to come up with a more medium term plan. SS’s view was that the role of HEEM was both service Redesign and changing the workforce; the two were linked. It was possible to do both without destabilising current things. SG said that from a HEE perspective, LETBs provided an important link to a provider led system; it was vital not to lose sight of local stakeholder relationships. HEE and LETBs needed to consider what workforce might be needed, along with the training to support new models and the impact of any decisions to reconfigure training and service models. KB pointed out that LETBs were established as provider-led organisations at the very time that the NHS system changed to give money to commissioners around service change. Commissioner involvement was now taking place via the LETCs. The LETB focus was on the transformation programmes that are happening across the East Midlands’ health & social care communities. SN felt that the LETB’s role was twofold. Firstly, for future education provision and ‘here and now’ development leading to a reliable workforce and secondly around collaborative projects such as services for the frail elderly. LB felt that ‘doing the unthinkable’ should be the LETB watchword. In her view a new workforce was needed, thinking very differently. She challenged the GB to be transformational. There were exciting things happening outside the NHS. What level of risk was the GB and HEEM as an organisation prepared to inject to rise to this challenge? What is our level of ambition? RA commented that in Leicester, Leicestershire and Rutland (LLR), the LETC business over the last 12 months had seen a vastly changed agenda and membership, particularly primary care and CCG representatives. In his view, a key thing about the transformation was about being ‘brave’ and possibly pushing boundaries to spend some of the LETC allocation on new ‘brave’ and collaborative initiatives that supported this approach. KR underlined the importance of sharing good practice and making sure we only do things once. AM added that this was the rationale for the research and innovation network which was currently being established under HEE as part of the Beyond Transition improvements. The case studies that are currently available on the HEEM website (http://heeminnovation.co.uk/projects/) were the tip of a huge pyramid. HEE were also piloting use of the NHS England Innovation Exchange, an existing repository of best practice. She said that through the HEEM Innovation Team there were a number of ways of sharing best practice across the LETCS. KA was in favour of a governance structure that supported ‘bravery’; this would be the catalyst for change and transformation. The existing workforce planning process was very system driven but local creativity, such as that seen recently in Northamptonshire around the frail elderly work stream, had been a great lever for bringing people together to make a difference. SM highlighted the responsibility that HEEM has ensuring the continued delivery of high quality education and training, as well as our role as an enabler for transformation through workforce planning and education and training. It is important for the GB to understand the wider implications of any ‘slippage’ on the workforce plan, the resultant risks to service and transformation, and approve the agreed plans for mitigation. 5 KB summarised a number of emerging themes from the contributions made:  HEE becoming a Non-Departmental Public Body on 1 April would bring about a need to review the GB membership to ensure that this included a doctor, a nurse and an allied health professional  ‘Bravery is good’ around transformational leadership  Clarity needed about where we can move at speed and the ‘rules’ and expectations on the funding (‘what is in and what is out’)  Clear agreement and recognition on the advantages and benefits of doing things differently  A need to pay attention to wider workforce issues and how commissioners are engaged in conversations  Acknowledge that there is a crisis in primary care now and a need to move at speed  Awareness that while supporting transformation, HEEM must still ensure the effective delivery and quality management of the education and training we are responsible for. Action To take on board the above points and use these to influence future thinking and conversations. 08/15 Business Intelligence and Performance Report The Business Intelligence and Performance Report provided assurance to the GB that HEEM was being effectively managed and updated members on the performance against key performance indicators and risks to achieving these. KR said that future Reports may look different in that a standardised approach would be implemented across HEE. KR highlighted:  RAG ratings were predominantly green apart from GP recruitment and finance. Health Visiting was on target locally and nationally.  Forecast outturn is £31.5m.  2015/16 LETB allocations were currently being worked out and she anticipated that draft figures should be available for the next GB meeting. LB asked whether HEEM had a Social Media Strategy with details of how social media might be optimised to position the East Midlands as an attractive place to train. DF explained that social media would become part of the HEE nationwide service and that the level of detail that this service would provide to LETBs was, at the moment, unclear. The new HEE Digital Team would be leading on social media strategy with effect from April 2015. Action: (a) To receive assurance from the Business Intelligence and Performance Report that HEEM is being managed effectively with action being taken to manage significant under performance. (b) To update the Governing Body on social media strategy post Beyond Transition (DF). 09/15 Strategic Risk Register A paper had been circulated describing top-line information regarding HEEM’s high-level risks. There were no emerging risks of any significance. KR explained that the biggest current risk were the structural changes across HEE in connection with ‘Beyond Transition’. She shared the concerns expressed by GB members around this. The Governance Team was currently in the process of becoming a nationwide team, alongside communications and HR and as such HEE were, in effect, reducing the capacity to manage risk. People at a local level would no longer be in place to help give us 6 the assurance that we have been getting to date. She did point out that LETCS have their own risk registers and that these that feed through to the overarching HEEM register. KB said that she had expressed concern at the level of support at LETB level for Governance and Communication and this concern had been shared by other Chairs at a recent national Chairs’ meeting. Action To understand and gain assurance that all risks are being identified and managed effectively by the functional area reporting and peer review process. 10/15 Minutes of the meeting of the Governing Body of Health Education East Midlands held on 19 November 2014 Resolution: These minutes were accepted as a correct record and signed by the Chair; there were no matters arising. 11/15 Minutes of meetings of Local Education and Training Councils Resolution: To receive, for assurance, the minutes of the following LETC meetings:      Derbyshire: 26 November 2014 Leicester, Leicestershire & Rutland: 10 November 2014 Lincolnshire: 25 November 2014 Northamptonshire: 14 November 2014 Nottinghamshire: 28 October; 3 December 2014 12/15 Items for information: The following items were received for information: (a) An update on the arrangements for ongoing quality management in HEEM (b) An update on the medical trainee redistribution project. The GB appreciated the work undertaken to deliver each of these aspects of business and thanked all those who had been involved in it. 13/15 Meeting evaluation GB members reflected on the meeting and provided the following feedback:  KR: Of the three LETB meetings I regularly attend across the Midlands and East geography, I prefer the format of this GB mtg. It flows well and is focused.  SG: The lack of commissioners around the table was different to other Midlands and East LETBs. The discussion was interesting and thought provoking. He felt that other LETB GBs could learn much from each other.  SG: After the issues raised by the Mid Staffs situation, I was surprised that the quality of care and training was not discussed. KB gave reassurances that today was not a typical GB meeting and that the GB had spent a lot of time on this in the past.  SS: Echoed that the quality of care and education and training are linked. This had been a topic of much debate at previous meetings. 7 14/15 Other business – resignation of Chair KB said that she would be standing down as Chair of Health Education East Midlands. It was with considerable sadness that she had reached this decision as she was still committed to HEEM and the vital contribution it makes to providing safe and sustainable services for patients and their families. However, other work commitments were making it increasingly difficult to give the role the time it requires. She felt optimistic about the future and that HEEM would be well placed to connect the national and local issues, as well as support the vital transformational agenda. HEE would now start the process to recruit a new Chair and this was likely to take until the end of March. 15/15 Date of next formal Governing Body meeting The next meeting of the Governing Body will be held on Wednesday 25 February 2015 at Ruddington. Post meeting note: The above meeting is postponed to 25 March 2015. Signed………………………………………… Ms Kaye Burnett, Independent Chair Date……………………….… 8