1

Subject: Key Messages from the SCIN Annual Event File ref: K:\07 Health Support Ser\Specialist & Screening\NMCNs &

NMDNs\Networks\NMDN SCIN\Events\SCIN Annual Event 2016\Mins Author: Liam Anderson Date of meeting: Thursday 21 April 2016 INTRODUCTION

The Scottish Clinical Imaging Network (SCIN) facilitated its second annual event annual event at the Golden Jubilee Conference Hotel. Dr Anne Marie Sinclair, SCIN Lead Clinician welcomed delegates from the imaging communality and other colleagues with a vested interest in imaging.

Dr Sinclair began the event by presenting delegates with an over view of SCIN; “SCIN is linked groups of health professionals and organisations from primary, secondary and tertiary care, working in a co-ordinated manner, unconstrained by existing professional and Health Board boundaries, to ensure equitable provision of high quality clinically effective services throughout Scotland.” Dr Sinclair informed the delegates of SCIN achievements from the previous year, SCIN current work plan which was presented in more detail from the presentations that followed. Dr Sinclair concluded here presentation by introducing and informing delegates that the SCIN annual afternoon event would focus on NHS Scotland’s Shared Services Health Portfolio Board in Imaging.

MORNING PRESENTATIONS

Dr Raj Burgul and Mr Jamie Gray presented delegates with the work that SCIN had undertaken to date in facilitating the collection of national imaging data.

Dr Burgal demonstrated the dashboard which he created for use in NHS Forth Valley & had been piloted in NHS Greater Glasgow and Clyde. Dr Burgul informed delegates that the dashboard enables SCIN and health Boards to see what clinical specialities were requesting imaging test, which provides data on whether there are similarities or differences with requesting rates between health boards. This would provide a national picture of the requests for imaging requesting. Dr Burgul emphasised that using live, real time data was the way for SCIN to understand the demands and pressures of imaging requesting which would enable SCIN to assist health boards to effectively manage demand.

Mr Jamie Gray, Principal Info Development Manager, National Services Scotland presented delegates with “The Art of Possible” the tableau visualisation software that can provides approved users with access to a range of comparative information to support performance and quality improvement. Indicators within the NSS Discovery tool can be viewed by NHS Board by treatment or residence. The information within NSS Discovery assists NHS Boards

Key messages v1.0

Area 062 Gyle Square 1 South Gyle Crescent Edinburgh EH12 9EB Telephone 0131 275 6575 Fax 0131 275 7614 www.nsd.scot.nhs.uk

2

to review performance, benchmark against peers as well as identify areas where resources can be targeted to address local health and care needs.

Dr Ian Robertson presented delegates with the outcomes from the SCIN short life Interventional Radiology working group discussion document that had been developed by representativeness of General Interventional Radiologists. Dr Robertson presentation provided delegates with information on the significant challenges experienced in providing a comprehensive 24 hour elective and emergency Interventional Radiology services across Scotland due to the way that the acute services are currently configured. Dr Robertson explained that many hospitals did not have robust on call interventional radiology services with no formal arrangements between health boards for the transfer of sick patients who could access emergency Interventional Radiology Services out with their health board Dr Robertson sited that the SCIN Interventional Radiology discussion document has focused on opportunities to improve equity of access to Interventional Radiology services by identifying and developing a shared services model across traditional health boards, which also addresses improving the training model for Interventional Radiology within Scotland to support the sustainability of the workforce in order to improve patient outcomes. The morning presentations were concluded with Dr David Stirling, Director of Health Care Science, National Services Scotland, who presented delegates with the work of the Scottish Governments National Demand Optimisation from a laboratory perspective. Dr Stirling informed participants of NHS healthcare science leads, who work in health boards stakeholders to develop local improvement plans to reduce unnecessary testing across primary and secondary care. In order to free-up capacity to address rising demand and deliver testing that positively affects the patient pathway, supports primary care preventive measures and reduces hospital referrals and admissions. Delegates were then provided with an opportunity to discuss the work of SCIN (Appendix 1)

AFTERNOON PRESENTATIONS

Dr Brian Montgomery led the afternoon presentation by introducing the NHS Scotland Shared Services Health Portfolio Board. Dr Montgomery informed delegates that the National Health Service (NHS) National Services Scotland (NSS) Programme Management Services (PgMS) had been commissioned by the Guiding Coalition (now Senior Leaders Forum), made up of Board Chairs and Chief Executives in 2015 to take forward the NHS Scotland Shared Services: to deliver sustainable, efficient services which will ultimately improve service user experience. The Health Portfolio work stream was set up to consider a “Best for Scotland” approach for some of the functions within Diagnostics (Laboratories and Radiology), Medical Physics, Pharmacy Aseptic Dispensing and Public Health.

Dr Montgomery explained that NHS Board Chief Executives had tasked the NHS Scotland Shared Services Health Portfolio Board to develop a sustainable model for radiology services in Scotland whereby there was an agreed national data set for imaging and a way of reporting imagining nationally. Dr Montgomery advised that he had been tasked along with the imaging profession to explore how to achieve a robust, sustainable future radiology service for Scotland out with the existing health board constraints.

3

Dr Hamish McRitchie concluded the afternoon presentations by introducing himself as NHS Scotland Shared Services Health Portfolio Board Subject matter expert (SME). Dr McRitchie informed delegates that the three core elements of his role were; providing leadership, engaging

stakeholders and supporting the programme delivery. Dr McRitchie informed the group that the outputs from the first visioning workshop included; specifying the IT requirements necessary to support a national radiology service; identifying a national approach to radiography reporting; a coordinated approach to out of hours services & support for remote and rural boards mapping activity to identify demand; capacity which included staffing and equipments Delegates were then provided with an opportunity to discuss shared services in imaging (Appendix 2)

EVALUATION Delegates were provided with an evaluation form and invited to share their thoughts on the event the results from the post event evaluation have been assessed in Appendix 3.

4

APPENDIX 1 MORNING FACILITATED ROUND TABLE DISCUSSIONS Delegates were invited to participate in round table discussions on the following topics:

1. Discuss the relevance of the SCIN working group, is SCIN tackling the right issues in its working groups? What should the SCIN Horizon group focus on?

2. What should the SCIN Horizon Scanning Group be focussing on? 3. How could SCIN effectively communicate with the wider Imaging community and its

stakeholders? 4. Are there any other issues SCIN should focus on?

Collated responses from the round table facilitated discussion are detailed below.

Discuss the relevance of the SCIN working group, is SCIN tackling the right issues in its working groups? What should the SCIN Horizon group focus on?

Has any of the work carried out by the sub groups actually been implemented- feedback to the imaging community would be appreciated

What feedback has SCIN had from the Scottish Government? IT in Scotland fails; no cross communication – How do we get all of the Health

Boards to communicate with one another? How can this be mandated? How can the current RIUS system be integrated, acknowledging that RIS has progressed, how can this be taken forward?

Additional Group- out of hours radiology reporting o What is the demand/activity/ capacity o Identify Variation

Primary care utilisation of imaging, how by international standards? o Risk standardisation, increased utilisation o National standards for primary care – CT/ MRI access

SCIN QI DNA – a focus on admin ( Reminders) o Time spent on o Cost?

Extra costs missed- Where doe the costs come from? Admin Staff o DNA data: Standardisation

Quality Improvement o Need accessible data o Need for forward projection data o Comparable data = data definitions

Horizon scanning o Some overlap with shared services and demand optimisation o Issue with how group reports o More focus on “Scanning of the Horizon”

Demand optimisation Group ( standardisation of imaging) o Referrers don’t share out vision o Pessimistic

Issues compared with names o “procurement of imaging” = “procurement of reporting”

Horizon Scanning? = Technology

5

How could SCIN effectively communicate with the wider Imaging community and its stakeholders?

Communication- real time reporting, what’s been and is happening to ensure that health Board Representatives feedback from SCIN to their respective Health Board.

Steering group- should be more outward looking o Interacting with other non- imaging groups

More interaction with other Networks o i.e. cancer networks

Are there any other issues SCIN should focus on?

Radiographer reporting – benchmarking radiographer reporting against the rest of the UK

Workforce planning- including HR contracts to support this- STACK/ AFC

Stagnation, protected on-call supplemental Out of Hours/ On Call- to understand radiology outsourcing

How do we get traction to implement, we need to do this otherwise potential to disengage members

Where has everything gone? – the work of SCIN Role of the Scottish Government

Horizon scanning needs to be more specific o RIS/PACS etc

Change needs decision making, above board level Junior radiologists( Training perspective)

Breast Screening o Tomosynthesis (Adding a diagnostic tool to breast screening)- Cross network

collaboration ? Workforce

o More visibility o Addressed in all groups o Central focus would be good o Multidisciplinary o Link with Scottish Government and NES

Productivity for team

Communication

Horizon Group o Recruitment & Retention o Smaller sites/islands

Widening the membership of SCIN o GPs, clinicians or other medical professionals to participate in the meetings to

understand imaging pathways etc. Should there be other groups with broader remits

o Avoids stop/start while we await on responses

DIS- Investment? o Are there things we should stop doing to permit reinvestment?

6

APPENDIX 2 AFTERNOON FACILITATED ROUND TABLE DISCUSSIONS Delegates were invited to participate in round table discussions under the heading of “shared services in Imaging” on the following topics:

1. Nationally agreed Imaging pathways

2. A co-ordinated approach to out of hours services

3. Support for remote and rural Boards for in-hours Reporting

4. National approach to Radiography reporting

5. Mapping exercise to identify demand, capacity, staffing and equipment

6. Specify the IT requirements necessary to support a Radiology service for Scotland

Collated responses from the round table facilitated discussion are detailed below

National Agreed pathways

Barriers/ Agreement/ consensus = motivation to agree Should focus on certain modalities first with agreed pathways- get agreement on

common imaging examinations( i.e. top 4)

Quick wins first, priority when and where, should it be done, have confidence in shared services

Pick early battles where high volume but simple pathway e.g., MRIs Agreements between existing guidelines

o Board stakeholder engagement o Disease specific o Clinical leadership at board level required

(Barriers) o Discord between recommendations o Wide views

Education needed, culture change compared with GPs etc.

Need robust information/ data End of life cover, often no consideration to benefits

Comparison of referrals for each clinical can be affective

7

A coordinated approached to out of hours services

Appropriate infrastructure required

Need to strengthen by investment – if not and OOHs service will not work

Financial incentive from NHS to support out of hours Change on-call frequency- shared services would b an advantage

Working with Australia/ New Zealand

Commitment

Quality- local Infrastructure not in place to support in- hours presently

Understand local issues at board level

External reporting ( overseas) pressure on staff with increased turnover time

Understanding of out of hours services ( Factors which may impact on the service)

o Would a national model provide solutions to the different factors o What other staff are required to provide e out of hours?

DICTATE! CEO permission to fail

Maintenance of skills, an issue Compensatory rest (gain in capacity?)

Decreased % of on-call payments

Decreased variation in access and increase in equity National agreement on emergency of unexpected event protocol

Definitive benefits cross-site agreed

Cross –site of HIS approach can be helpful but must not lose local relationships compared with referring clinicians

May be extended to sonographers etc. ? use of reporting radiography and legalities around that within a governance

structure

Barriers)

Local access to opinion/relationships Local knowledge loss

Decrease risk stratification as a result of knowledge loss

Support for remote and rural boards for in hours reporting Sub-specialisation- different for Rural boards to provide/ deliver this

How does it fit in with job plans? How do you put this in practice?

Are there enough radiographer to support the work?

Getting the balance right – radiologist- radiographer - sonographer

In source before outsource Access to sub-specialist advice

Potential benefits from shared services

Resource issues discussed SCA required this can be difficult to administration

Barriers) o Capacity o IT solutions o Quality assurance /Governance

Clinical Peer review

8

National approach to radiographer reporting

Define what radiographer reporting is

Under shared services- is there potential to absorb some reporting demand?

Radiologist o Security o Training o Mentoring

Ensuring everyone gets enough exposure o the work

Standardise support package Scope to extend range of work covered by RAD’s

Peer review/ audit better in larger groups

Perception of loss of activity to train radiologists

Service driven Need agreement about can be reported across Scotland

Believe generally under utilised

Funding requirement if desire to roll out further

Could be useful cross-health board Data needed to understand the requirement

Audit of reporting practice

(Barriers) o Radiologist support o Political barriers o Change to team dynamics o Decreased scope of images

Mapping exercise to indentify demand, capacity and IT equipment

RAD report mind-shift Dashboard activity

More in-depth data collection

Barriers) o Difficulty defining data sets

Specify the IT requirements necessary to support a radiology service for Scotland

National reporting lat form

? National RIS IT Infrastructure critical across Scotland

Ad Hoc Statements (No headings listed)

Lining remote re reporting

Radiogragher reporting Joint contacts

Split posts

SPA/DCC 9/1 split Radiologists Champions

Expenditure/ own time reporting increase 1

9

APPENDIX 3 Summary From Evaluation Forms. The SCIN annual event was facilitated for health care professionals and their stakeholders who work with or have an interest in clinical imaging. Similar to previous years the event was fully subscribed with 80 delegates. 67 (2 NNMS Staff) of the 80 registered attended on the day of the event. The chart below identifies the where each group of attendees came from. With a large number of attendees attending from NHS Greater Glasgow and Clyde, would suggest that future SCIN Annual Events be rotated around the country in order to give the imaging community more opportunity to attend.

The overall feedback from the event was very positive with delegates feeding back to staff verbally on the day, via email after the event and through the event evaluation forms. Each delegate was asked to complete a feedback questionnaire in order that SCIN can evaluate how the day went and make required improvements to the program for future years. Out of the 65 evaluations distributed 38 were completed and analyzed providing the following information.

10

2

2

4

3

11

13

26

12

12

24

21

20

10

14

How do you rate the relevance of this event to you professional role?

How do you rate the overall content and quality of this event

Please rate the presentations from today's event

Please rate the discussion on the work of SCIN

Please rate the discussion on shared services

Satisfaction Rating

Highly Relevant Mostly of relevance Fairly Relevant Not Relevant

47%

8%

18%

3%

24%

How did you hear about the event?

Mail Shot SCIN Website SCIN Newsletter Other Colleague

The majority of delegates had heard about the event via direct emails from SCIN email, via a colleague or from the SCIN Newsletter.

When asking delegates about how relevant the event was in relation to their professional role an average of 15 and 18 people answered that elemants of the day were either ‘mostly of relevance’ or ‘highly relevant’ respectivley.

11

1 1

11

23

Poor Neither/nor Good Very good

Rating of venue

The majority of the delegates stated that the venue was very good and met the needs and requirements of the event.

Delegates were asked to comment on specifics from the event. Comments have been captured below:

What did you like best about the event?

Excellent discussion

Networking, meeting other people to try and solve common issues Hear about progress on the SCIN agenda and what is happening next

Wide ranging discussion

Shared services – informative as not been in discussion locally

Live tableau demonstrations Good range of topics

Round Table discussion and Demand Optimisation Group

Good feedback from different work streams

Open forum to discuss current issues Sharing of national common issues

Knowledge regarding initiates and drivers for change

Very informative.

What did you like least about the event?

Round table discussions too time limited Lack of focus/ results

Duplication from round table feedback, perhaps 1 table feedback on a specific topic.

Poor sound quality

Too little time to debate issues and agree solutions Car parking

Too much to think about for one day event

12

What topics would you like to see SCIN cover at future event?

Out of Hours cover

Radiographer presentations Engagement of staff groups to include other allied health professional to broaden the

SCIN perspective and touch more stakeholders.

Workforce planning

Expansion of training programme, radiology matched to clinical expansion Role development; standardising protocols, links with other relevant network ( i.e.

other NMDNs)

Technology developments

Research and evidence Examples of success

Patient Experience

Workforce a s separate sub group

Shared services relevant at the moment but a wider range of topics would be useful. Radiographer reporting

Other comments

- Very well run - Very insightful - Use of roving mics - Not wide enough spectrum of attendees - Excellent day thank you