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MINUTES

Attendees: (P) Present (A) Apology (Ab) Absent

BOARD MEMBERS

The Hon. Peter Collins, AM QC (Chair)

P Mr Greg Allchin (Deputy Chair) (via PEXIP)

P

Mr Murray Austin (via PEXIP) P Dr Linda McQueen (via PEXIP) P

Mr Gary Smith (via PEXIP) P Mr Joseph Grassi (via PEXIP) P

Professor Ian Seppelt (via PEXIP) P Mr Colin Lenton (via PEXIP) P

Ms Kath Skinner (via PEXIP) P Professor Jennifer Reath (via

PEXIP)

P

Mr Clarke Scott (via PEXIP) P Associate Professor Stephen Fuller (via PEXIP)

P

Dr Peta Seaton, AM P

NBMLHD EXECUTIVE & STAFF

Ms Kay Hyman, Chief Executive P Ms Clair Ramsden, Executive Director Operations (via PEXIP)

P

Ms Jacqui Clark, Executive Director People & Culture (via PEXIP)

A Ms Julie Williams, Executive Director Nursing & Midwifery (via

PEXIP) P

Ms Rebecca Beech, Executive Director Finance & Corporate Services (via PEXIP)

A Ms Karen Arblaster, A/Director Allied & Population Health (via

PEXIP) P

Ms Rasha Kisswani, Director Planning (via PEXIP)

P Ms Debbie Wyburd, Executive Director Clinical Governance (via

PEXIP) P

Mr Paul Grocott, A/Director Media & Communications (via PEXIP)

A Mr Greg Driver, A/Executive Director People & Culture

P

MEDICAL STAFF COUNCIL & JUNIOR MEDICAL STAFF REPRESENTATIVES

Dr Nhi Nguyen, Chair, Nepean Medical Staff Council

P Dr Jim Kalantar, Chair Blue Mountains Medical Staff Council (via PEXIP)

A

Dr A Babajanyan, Blue Mountains Medical Staff Council (via PEXIP)

P

WENTWORTH HEALTHCARE LIMITED (Primary Health Network)

Ms Lizz Reay (via PEXIP) A

Nepean Blue Mountains Local Health District

Board Meeting DATE: 16 September 2020 TIME: 4.00pm – 6.30 pm

VENUE: Virtual meeting via PEXIP

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1. OPENING AND ACKNOWLEDGEMENT OF COUNTRY

The Chair welcomed attendees to the Nepean Blue Mountains Local Health District (NBMLHD) Board meeting and opened with an acknowledgment to country. Apologies were noted. The Chair welcomed Dr Peta Seaton, AM, new Board member to the Nepean Blue Mountains Local Health District Board. The Chair noted that Dr Seaton is the Chair of Hearing Australia, President of the Near Eastern Archaeology Foundation, and a non-executive director of the Menzies Research Centre. Dr Seaton expressed her appreciation to the Chair and the Chief Executive for their warm welcome. 2. DECLARATION OF CONFLICTS OF INTEREST The Chair asked members to advise any changes to the conflicts of interest register. No changes were advised. 3. MINUTES OF PREVIOUS MINUTES Minutes of the meeting on Wednesday, 19 August 2020 were a true and accurate record of the meeting. Moved: Mr Lenton Seconded: Mr Austin Action: Endorsed by the NBMLHD Board. Mr Allchin asked for clarification on last month’s discussion regarding planning funding for the One Hospital in the Blue Mountains. The Chair stated that the new single hospital in the Blue Mountains is estimated at $400M and an additional $15M for planning. Members noted that Health Infrastructure NSW have been advised that the One Hospital in the Blue Mountains is a priority for the District. Action: Chief Executive to provide an update at the October Board meeting. Update by Dr James Branley The Chair thanked Dr Branley for his dedication and support of the Nepean Blue Mountains Local Health District community and staff during the pandemic. The Chair highlighted that the NSW Premier, NSW Minister for Health and Secretary NSW Health have noted Dr Branley’s professional dedication. The Chair stated that there was discussion at the August Board meeting on the use of personal protective equipment (PPE), in particular use of N95 face masks. Dr Branley advised Members that the Clinical Excellence Commission’s Infection Prevention and Control Application of PPE during COVID-19 guidelines are adhered to by the District plus the use of N95 masks in ED, ICU and locations where aerosol generating procedures are conducted. Members were advised that education for staff on the application of PPE continues to be of a high standard. Dr Branley noted that social distancing can be a challenge within staff areas of hospitals and noted that actions have been taken to identify capacity of staff areas and to

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encourage staff to take breaks outside. Dr Branley confirmed that N95 masks are available to all staff as required. Prof Reath brought attention to recent research from the University of Sydney looking at behaviours which included fatigue and social isolation. The research highlights that these behaviours can contribute toward a second wave of COVID-19. Dr Branley advised that his view is that COVID-19 will continue to return over the next 1-2 years. It is therefore imperative that we support staff through continued high levels of communication and education. 4. CHAIRMAN’S REPORT The Chair reported on his attendance at the Council of Board Chair’s meeting held on Monday, 7 September 2020. Lithgow MRI The Chair brought attention to the proposal for the Lithgow MRI. Members were reminded that it is the Commonwealth’s expectation that the District manage the license of the MRI service at Lithgow with implementation as soon as possible, with the aim of mid-2021. Dr McQueen brought attention to the District’s obligation to ensure that the Lithgow community are provided with a quality health service. Members were reminded that an Enquiry into Rural and Regional Health Services is occurring shortly. 5. CHIEF EXECUTIVE REPORT Members noted the Chief Executive Report for the month of September 2020 and the following items were highlighted: Health People & Communities COVID-19 Update The Chief Executive reported on the active cases for NBMLHD, noting that clinic screening times in the Blue Mountains has been extended to manage increased demand following local cases. Residential Aged Care Facilities (RACF) The Chief Executive advised that the district is engaging with all RACFs to understand their level of preparedness to manage an outbreak and offer support where required. Members were advised that surge staffing is a concern for all RACFs. NSW Health have developed a short 3-4 week training program for a new role with the working title of Bed Side Assistants who would be available to work in RACFs as required across NSW. This will ensure the RACF have a backup staffing plan in place for any additional staff if required. The Chief Executive reported that the Aged Care Quality and Safety Commission are making unannounced visits to RACFs focusing on their COVID-19 preparedness. Elective Surgery The Chief Executive reported that elective surgery continues at 100% of pre-COVID-19 activity within NBMLHD facilities. Additional cases are also being performed in the private sector.

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Members were advised that staff have continue to work incredibly hard and the District is actively considering how to manage staff who are working to capacity and are unable to take leave. Funding to Support Mental Health Activities relating to COVID-19 The Chief Executive reported that NBMLHD (and other LHDs across NSW) have received additional funding to support Mental Health activities which have continued at pre-COVID-19 volumes and are expected to increase in the months to come. NSW Health - Future Health Strategy The Chief Executive reported on the consultation process regarding Future Health Strategy – the Ministry’s strategic plan for the next 10 years. Member were advised that there will be three consultation sessions for NBMLHD staff - Board Members, Executive, medical staff, nursing staff and all staff across the District. Talented, Happy and Engaged Workforce Assistant in Medicine The Chief Executive reported on the Assistant in Medicine (AIM) role that has been created as a result of COVID-19 to provide final year medical students with a six week employment opportunity and clinical experience. Dr Georgina King, ORL Surgeon is the local program Director. The Director provides support for the AIMs and facilitates their role within the hospital, liaises with supervisors and the University. Members were advised that local feedback has been very positive. There will be a formal evaluation of the program across NSW. Prof Fuller also acknowledged that the program has been very well received. NBMLHD deployed to Victoria The Chief Executive advised three staff members who were deployed to Victoria (Royal Melbourne Hospital) have now returned. The Chief Executive thanked the staff of People & Culture Directorate for the support they provided to deployed staff prior to, during and after their time in Melbourne. NSW Nursing and Midwifery Awards The Chief Executive reported that NBMLHD has finalists in two categories of this year’s NSW Health Nursing and Midwifery Awards:

P Lambert in the Registered Nurse of the Year

C Partridge in the Midwife of the Year

Winners will be announced at a COVID-19 safe virtual ceremony on 26 November 2020. Hub for Research and Innovation Research and Innovation The Chief Executive reported that Prof Maclean and Prof Tang have reached another milestone for their research with a commercial organisation SpeeDx, who have been awarded a Biomedical Translational Bridge program grant to support commercialisation of their gene expression biomarker test.

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The Biomedical Translation Bridge program is a Commonwealth funded programme which supports an organisation to fund and support early stage health and medical research ventures to reach proof of concept stage. With this support it is hoped that future ventures will have the potential to attract further capital and support. Responsible Governance and Financial Management August Result The Chief Executive reported that the August result was $3.669M unfavourable and $10.335M unfavourable year to date. These results include our COVID-19 expenditure ($6.7M) as this is yet to be reimbursed by NSW Health. Ministry of Health Purchasing and Governance Consulting Committee The Chief Executive advised that she is one of three Chief Executive members of this Committee. There are also Director of Finance and Director of Operations representatives. The Committee has been formed to provide advice to the Ministry with regard to proposed purchasing methodologies and governance with regard to LHD performance against Service Agreements. Hawkesbury District Health Clinical Services Review The Chief Executive reported that the Clinical Service Review is essentially completed with the final report expected mid-September. Greater Western Sydney Health Partnership The Chief Executive reported that despite COVID-19 related distractions the Greater Western Sydney Health Partnership has continued to meet with strong representation from clinicians from Nepean Blue Mountains, Western Sydney and South Western Sydney Local Health Districts. Members were provided with a summary of activities. Nepean Redevelopment Stage 1 Construction Update The Chief Executive reported that construction continues with topping out anticipated in October 2020. Members noted that the District will be developing options for celebrating this significant milestone with local politicians and councils, most likely virtually. Nepean Redevelopment Art workshops The Chief Executive highlighted that the Nepean Redevelopment is hosting two workshops at the Penrith Regional Gallery for NBMLHD staff and local community members to create artwork for Nepean Hospital’s new 14-storey tower. Stage 2 - Strategic Business Case The Chief Executive reported on the Strategic Business Case review for the Nepean Hospital Redevelopment Stage 2. Positive feedback was received from the three independent reviewers Child & Adolescent Mental Health Unit

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The Chief Executive reported on the Child and Adolescent Mental Health Unit (CAMHU). Members noted that CAMHU estimated operating costs are currently unfavourable by ~$3M per annum, which is essentially staff related cost. Members were advised that this results from a small bed base with a larger than usual square meterage required to accommodate educational and recreational activities and high staff requirements resulting from high levels of therapeutic interactions with the family and the need for education and recreational activities. The Chief Executive reported that Health Infrastructure NSW are currently looking for offsite accommodation options for 271 staff who will need to be relocated to enable the demolition of buildings to clear the CAMHU site. Private Developments The Chief Executive stated that discussion is being held with developers of private facilities in the area adjacent to the Nepean Hospital campus. Members were advised that developments have the potential to deliver services complementary to ours or may be able to support visitors to the area. Trauma Service The Chief Executive reported that the meeting time between our Director of Trauma - Alan Garner and NSW Ambulance staff has been scheduled. Members held discussion on recent media activity on Radio 2GB. This demonstrates the ongoing community concern about the current trauma status of Nepean Hospital. Hawkesbury Hospital Aboriginal Readmission Rates Members noted the readmission rates in 28 days for Aboriginal patients at Hawkesbury Hospital. The Chief Executive stated that Hawkesbury District Health Service have recently formed a focus group to review the provision of Aboriginal Health in the Hawkesbury community. Agency for Clinical Innovation (ACI) Grant Application Mr Allchin brought attention to Prof Emily Hibbert who has applied for an ACI grant for $30K to support Endocrinologist case conferencing with General Practitioners for patients with diabetes on elective surgery waiting lists to improve glycaemic control prior to admission. The Chief Executive reported that Prof Hibbert has submitted a very high quality application and if not successful the District will consider local funding. Section B - Appendices Elective Surgery: overdue cases and median waiting time by Local Health District For information. COVID-19 Testing Information For information. Funding for Mental Health COVID-19 related activities For information.

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Local Health District Performance against State Price For information. Greater Western Sydney Health Partnership – summary of activities For information.

Example of Internal Wall Treatments For information. Construction update For information. Invitation to Art Workshop For information.

Section C NBMLHD KPIs by Directorate For information. NBMLHD Emergency Department and Elective Surgery For information. Ministry of Health League Table – July 2020 For information. NBMLHD Media Report – August 2020 For information. Integrated Care Activities in conjunction with NBMPHN For information. 6. FEEDBACK FROM MEDICAL STAFF COUNCIL 6.1 Nepean Medical Staff Council Dr Nguyen reported on behalf of the Nepean Medical Staff Council and brought attention to the emerging Nepean Redevelopment Stage One tower. Dr Nguyen acknowledged staff during the busy time of COVID-19, the build of a new hospital and business as usual. 6.2 Blue Mountains Springwood Medical Staff Council Dr Babajanyan reported on behalf of the Blue Mountains Springwood Medical Staff Council and highlighted the following:

Special care nursery – working through recruitment and organising equipment.

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Emergency Department space – limitations with social distancing requirements. Mr Austin suggested Dr Branley review space in the BMDAMH Emergency Department. Dr Nguyen advised that an isolation hood has been developed which sits over the patient bed and extracts air to reduce airborne transmission. Dr Nguyen noted that this product has received FDA approval for use of COVID-19 patients. Action: Chief Executive to request Dr Branley to review and provide a suggestion/s for BMDAMH Emergency Department. Mental Health Medical Staff Council The Chief Executive reported on a request from the newly formed Mental Health Medical Staff Council to have a representative attend the NBMLHD Board meetings. The Chair stated that the Board would welcome their attendance. Action: Secretariat to extend invitation to Chair, Mental Health Medical Staff Council. 7. WENTWORTH HEALTHCARE LIMITED (PRIMARY HEALTH NETWORK) Nil report. 8. NBMLHD RESEARCH & EDUCATION FOUNDATION Mr Grassi reported that a meeting of the NBMLHD Research & Education Foundation Board will be held on Thursday, 17 September 2020. Mr Allchin reported that the Foundation will be showcasing South Block to number of potential local business investors on Friday, 25 September. 9. WORK, HEALTH & SAFETY

9.1 Board Members’ Advice to NBMLHD Executive Nil report. 9.2 NBMLHD Executives’ Advice to Board The Chief Executive brought attention to concern of organisational fatigue; resulting from the combination of business as usual, the Nepean Redevelopment and COVID-19. Members were advised that there has been significant discussion on how to better manage this across the organisation. The Chair stated that the additional pressure of the global pandemic is significant by itself. Mr Smith reported that as the Chair of the Work, Health & Safety Committee this will be a focus of discussion at the next sub-committee meeting. Members noted that the item will be listed on the Risk Register accordingly. Dr Seaton highlighted the new research that professional development time, even if short in during, can have beneficial effect.

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10. ACTION SHEET No outstanding actions. 11. CORRESPONDENCE IN 11.1 HPRM 20/28269 Complaint to NBMLHD Board regarding care to VT at Blue Mountains District ANZAC Memorial Hospital 11.2 NBMBRIEF20/1184 Update to Board complaint regarding the care of VT at Blue Mountains District ANZAC Memorial Hospital Dr McQueen noted that early involvement of GPs in the care of complex patients could make a positive difference. 12. CORRESPONDENCE OUT 12.1 HPRM 20/28594 Letter of acknowledgement to NT regarding care of VT at Blue Mountains District ANZAC Memorial Hospital 12.2 HPRM 20/30800 Letter of congratulations to Prof Maclean and Prof Tang regarding partnership with SpeeDX on NBMLHD patent for Federal Grant

The Chair advised the correspondence is for noting. 13. COMMITTEE REPORTS 13.1 Aboriginal Health Mr Scott reported that the attached quadrant report is for information. Members noted that updated terms of reference will be forwarded for endorsement at the next meeting. Prof Reath noted the Coroner’s Report of a death at Tumut Hospital recommended 24/7 Aboriginal Liaison Officer (ALO) support in the hospital setting. Mr Scott highlighted that there has been a trial of extended ALO hours of operation and this was found to be unsuccessful. The Chief Executive reported that the District is looking at an extension of hours for particular services. 13.2 Audit & Risk Committee Mr Lenton reported that the attached quadrant report is for information. Mr Lenton brought attention to the Audit & Risk Committee concern with regard to information availability from the Information Communication Technology service. 13.2.1 HPRM 20/29778 NBMLHD Risk Appetite Statement 2020/21 Mr Lenton reported that the NBMLHD Risk Appetite Statement 2020/21 is submitted for the Board’s endorsement. Ms Skinner sought clarification with regard to Research and Research Ethics. Following discussion amended wording was agreed:

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Research and Research Ethics: NBMLHD has an appetite to support research activities including recognising that not all Research will be successful. There is a low appetite for any breach of research ethics.

Moved: Mr Lenton Seconded: Ms Skinner Action: Endorsed by the NBMLHD Board. 13.3 Clinical Services Strategic Development Prof Fuller reported that the attached quadrant report is provided for information. 13.4 Finance & Performance Members noted the next Finance & Performance Committee meeting is scheduled on Monday, 21 September 2020. 13.5 Health Care Quality Committee (HCQC) Prof Reath noted that discussion at HCQC included: performance in medication complications, hospital infections and respiratory complications, noting that there are ongoing activities relating to these issues. Prof Reath reported that Nepean Hospital have appointed a new Patient Safety and Quality Manager. Members were advised that the KPI for completion of RCAs reduces from 70 to 60 days. Members asked for further information. Action: Ms Wyburd to provide further details on the impact of the reduction to 60 days for RCA completion to the October meeting. 13.5.1 NBMBRIEF20/1173 Annual Attestation Statement and Clinical Governance Framework 2020 Prof Reath reported that the attached annual Attestation Statement and Clinical Governance Framework 2020 is submitted for endorsement. Moved: Prof Reath Seconded: Mr Allchin Action: Endorsed by the NBMLHD Board. 13.5.2 Health Care Quality Committee Sub Committee Report Ms Wyburd provided the annual update for Board Members on the roles and functions of the HCQC Sub-Committee. Members were advised of the following:

Role of the Health Care Quality Committee

Serious incident and investigation management

Root Cause Analysis and IMS+

Hospital Acquired Complications

Hospital associated infections

Hospital acquired pressure injuries

Fall related injuries in hospital

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Safety and Quality Account

Clinical Governance Framework

NBMLHD Accreditation

Members were advised that the NBMLHD Accreditation is due in November 2021 but surveys have been put on hold due to COVID-19, therefore our date could be delayed. Prof Reath acknowledged the work of the Clinical Governance Unit who monitor and manage the quality and safety of patients. 13.6 Medical & Dental Staff Appointments Advisory Committee (MDAAC) Mr Allchin reported that the Medical & Dental Staff Appointments Advisory Committee minutes for September are provided for information. Prof Reath inquired on the number of extensions to contracts. The Chief Executive noted that a number of recent contract extension relate to COVID-19 increases. Mr Allchin advised that the process for extensions and the number will be reviewed at the October MDAAC meeting. 13.7 Integrated Care Members noted that the Integrated Care Committee meeting is scheduled on 25 November. 13.8 Research Committee Members noted that the Research Committee meeting is scheduled on 21 September. 13.9 Workforce & Culture Members noted that the Workforce & Culture Committee meeting is scheduled on 27 October. 13.10 Work, Health & Safety Committee Members noted that the Workforce & Culture Committee meeting is scheduled on 27 October. 14 BUSINESS WITHOUT NOTICE The Chair advised there will be a return of face to face Board meetings from October 2020. Members were advised that appropriate social distancing guidelines will be met, hand hygiene and face masks will be provided to members. 15 FOR INFORMATION ONLY Nil report. The meeting closed at 6.15 pm

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16 NEXT MEETING

Date: Wednesday, 21 October 2020 Time: 4.00pm – 6.30pm Venue: To be confirmed

Nepean Blue Mountains Local Health Board Minutes 16 September 2020.

Date: / / The Hon. Peter Collins, AM, QC.