north of scotland planning group - nhs … · dr peter williamson, director of health ... both mr...

North of Scotland Regional Planning Group is a collaboration between NHS Grampian, NHS Highland, NHS Orkney, NHS Shetland, NHS Tayside and NHS Western Isles

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APPROVED 30/06/10 Present: Mr Richard Carey, Chief Executive, NHS Grampian (Chair)

Mrs Cathie Cowan, Chief Executive, NHS Orkney Mrs Deirdre Evans, Director, NSD Mrs Anne Gent, Director of HR, NHS Highland Dr Roger Gibbins, Chief Executive, NHS Highland Dr Annie Ingram, Director of Regional Planning and Workforce Dev, NoSPG Ms Heidi May, Nurse Director, NHS Highland (until item 27/10) Ms Carmel Sheriff, Performance Manager, Scottish Government Dr Sarah Taylor, Director of Public Health & Planning, NHS Shetland Ms Roseanne Urquhart, Head of Healthcare Strategy & Planning, NHS Highland

Dundee v/c: Prof Tony Wells, Chief Executive, NHS Tayside (until item 2724/10) Dr Peter Williamson, Director of Health Strategy, NHS Tayside (until item 27/10)

Aberdeen v/c: Dr Roelf Dijkhuizen, Medical Director, NHS Grampian (item 27/10) Dr Lesley Wilkie, Director of Public Health & Planning, NHS Grampian (until item 24/10) Prof. Gillian Needham, Post Graduate Dean, NHS Education for Scotland, North Deanery

Western Isles v/c: Dr Jim Ward, Medical Director, NHS Western Isles (until item 22/10)

In attendance: Dr Ian Bashford, Medical Director, NHS Highland (item 20/10 and 21/10) Mrs Betty Flynn, Regional Workforce Programme Manager, NoSPG Miss Sandra Hay, Corporate Services Manager, NoSPG Dr Andrew Russell, Medical Director, NHS Tayside (until item 27/10)

In attendance by VC:Mr Gerry Donald, Physical Planning Manager, NHS Grampian (item 26/10) Mr Matthew Toms, Unit Operational Manager, NHS Grampian (item 24/10) Mrs Jillian Evans, Head of Health Intelligence, NHS Grampian (from item 25/10 representing Dr Lesley Wilkie)

17/10 Apologies

Apologies were received from Mr Gordon Jamieson, Chief Executive, NHS Western Isles, Miss Sandra Laurenson, Chief Executive, NHS Shetland; Mr Marthinus Roos, Medical Director, NHS Orkney and Mr G Stephen, Employee Director, NHS Grampian.

Mr Carey introduced Dr Lesley Wilkie, Director of Public Health and Planning for NHS Grampian and explained that following Mr Sullivan’s retiral, Dr Wilkie had assumed the role of Director of Planning, in addition to her role as Director of Public Health and confirmed that Dr Wilkie would be the second Grampian representative on NoSPG.

Action

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18/10 Minute of the meeting held on 3 rd February 2010

The minute was accepted as an accurate record of the meeting, subject to the substitution of the word ‘retiral’ for the word ‘retrial’ on page 3, line 1. Dr Taylor, referring to item 08/10 (iv), asked whether the text on bariatric and stroke had been muddled, as stoke was not on the workplan and Bariatric was. Dr Ingram confirmed that the wording was accurate but explained that following the meeting of the NoS Chairs and Chief Executives, stroke had been deleted from the workplan. Bariatric had been added to the workplan in 2009/10 and remained on the current plan. AKI

NORTH OF SCOTLAND PLANNING GROUP

NORTH OF SCOTLAND PLANNING GROUP

Minute of meeting held on Wednesday 14 th April 2010 at 10.30am in the Board Room, Assynt House, Inverness.

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Board Meeting 03 08 10 Open Session Item 8.8


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19/10 Matters Arising

i) Action Points

Dr Ingram apologised for the absence of the traffic light coding on the action points but confirmed that there were no red items, with most either green or amber. Dr Gibbins asked for an update on the cardiac services event and the proposed regional delivery plan and it was agreed that Dr Ingram should give an update at item 24/10.

ii) Neurology

Dr Ingram reported that the Medical Directors had agreed to recommend that neurology be removed from the workplan at their meeting on 17 th February 2010 and this was approved.

iii) EHealth

Dr Ingram reminded members that it had agreed that this would be a standing item on the agenda. Referring to the letter from Mr Feeley, Director of Healthcare Policy & Strategy, SGHD, she explained that this letter was a response to her letter of 18 th

December 2009 to Dr Woods, which had been prepared following earlier correspondence regarding required investment in eHealth across Scotland and in particular the North. Members were pleased to note the positive response received, although agreed with Dr Ingram’s observation that investment in videoconferencing equipment should be as a result of the current National pilot.

Dr Gibbins observed that the letter to Dr Woods had included a reference to further communication once the remote and rural requirements were more fully described and Dr Ingram confirmed that a number of strands were still progressing which would provide the information that would be required to conclude this issue. Mr Carey noted that the Highlands and Islands Enterprise had identified investment in the digital economy and had planned a conference for May 2010. Dr Gibbins confirmed that this had been planned, although he had concerns that the right people from health were not being involved. He continued that he was due to meet HIE tomorrow and he would raise this with them. It was agreed that Dr Ingram should try to attend.

iv) Child Health – NDP

Dr Ingram reported that no decision had been made by SGHD in relation to the year 3 bid but that the funds from years 1 and 2 were recurring. She said that there was some concern that not all of the year 3 bid would be funded and Child Health colleagues were reviewing the bid to identify where economies might be made if required.

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20/10 Oral Health & Dentistry

Dr Bashford joined the meeting for this item.

Mr Carey reminded colleagues that it had been agreed that a regional network for surgery would be established and asked for a progress report on the appointment to the second Highland post. Dr Bashford reported that the second consultant post had been advertised together with the Consultant orthodontist post but no applications had been received and he had now agreed to write to all 22 of those due to attain CCT in OMFS, following completion of Specialist Training, with a view to a further advert in two months time. If this was unsuccessful, Dr Bashford reported that he would consider whether appointment of an oral surgeon would be considered but that this would meet with resistance form the OMFS consultants. Both Mr Carey and Dr Bashford observed that a positive and supportive approach by the NHS Grampian


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clinicians would aid this process.

Dr Ingram reminded colleagues that the surgical workstream was but one aspect of the project, which had overshadowed other parts of the project and had led to confusion over the project objectives and deliverables. She referred to the discussion at the last meeting, where members had asked for a review of the remaining workplan, in order to determine the commitment to the continuation of the project. The appendix to the paper provided detail on the outstanding work within the three subspecialty areas of surgery, orthodontics and restorative dentistry, together with cross cutting issues and suggested that the challenges in meeting the 18 week RTT in the other subspecialty areas were as challenging, if not more so than the issues around surgery.

Ms Sheriff asked for clarification regarding the comment on page 2 regarding the scepticism of the restorative dentistry clinicians to Board commitment and the issue of the need for facilitation. Dr Ingram replied that the clinicians were sceptical because the issues in restorative dentistry were longstanding and explained that the project had been supported by a funded project manager but that this funding was no longer available. Mr Carey said that in the absence of agreed funding, he had decided that the current Project Manager would continue in post, funded by NHS Grampian.

In summarising the discussion, Mr Carey said that all Boards had agreed that the Project as described in the paper, albeit with some qualification, and that Dr Bashford, Dr Ingram and himself, together with the Project Manager would now progress the project, including revising the Project Board arrangements, as set out in his letter of 4 th

March 2010.

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21/10 Reshaping the Medical Workforce – challenges and risks

Dr Dijkhuizen referred to the letter sent to Board Chief Executives and Medical Directors on 9 th March 2010, which outlined a proposal to consider a regional solution for the out of hours services in small rural hospitals at night, built on the principle of integration of community out of hours services with hospital at night and augmented by decision support from the larger centres in Inverness, Aberdeen and Dundee. He reminded colleagues that the letter had invited Board Executive teams to debate the appetite within individual Boards to progress this proposal.

He reminded members that the proposal had been developed following debate at the NoS Medical Directors Group in light of the regional CEL 28 (2009) submission and in response to the debate at the last NoSPG meeting. He observed that the CEL highlighted a number of issues for all Boards, including affordability of the proposed workforce models that will be required to replace the reducing number of doctors in training and suggested that attractiveness of remaining training posts within the North and East deanery areas and the availability of an alternative workforce were perhaps even greater challenges.

He suggested that the sustainability of the RGHs and small DGHs, like Elgin, required a radically different approach, if services, particularly out of hours, were to continue to be available and suggested that through appropriate upskilling of locally based staff, particularly General Practitioners and Nursing staff; the development of clinical networks between community and hospital services in the local area and with the tertiary centres, and wider networks with NHS 24 and the ambulance service; it may be possible to develop a coordinated approach to out of hours. Such an approach would require appropriate and agreed clinical decision support, supported by an eHealth approach.

Before opening a general discussion, Mr Carey asked for the views of each Board and the views of NES and confirmed that following discussion with Grampian, the Board were supportive of the approach and intimated that in relation to Elgin, the Board


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were keen to actively progress the proposal within the Board and would prefer to do so with partners.

Dr Russell said that within NHS Tayside there were 2 acute receiving sites and there were current issues with the sustainability of both the surgical and medical rota’s on two sites. He said that whilst supportive of the principles outlined by Dr Dijkhuizen’s letter, the priority in Tayside was to address local issues but in principle were supportive of that approach, if it were complimentary and did not compromise local requirements. He expressed a concern regarding the proposal to use GPs to support local small hospital services and questioned whether that workforce would be available.

Dr Ward reflected that the letter described the issues currently being faced within NHS Western Isles, both in the needs of the smaller hospitals in the southern isles, where telemedicine support would support decision making and in the RGH where, as a result of the recruitment challenges, plans were in hand to integrate primary care doctors to support out of hours. He agreed that the development of other nonmedical staff with the appropriate skills and competencies will be required in the future. Dr Ward concluded that the letter was timely and agreed with the three specific objectives described in the letter.

Reflecting the comments, Mr Carey suggested that there may be a variety of redesign solutions necessary to suit local circumstances but there may be value in establishing an overarching group to support the process, take forward the three specific objectives, identify commonalities and deal with cross board issues that arose.

Dr Bashford agreed that an overarching regional group would be appropriate but highlighted that the issues within the RGHs were immediate pressures, which were unlikely to abate, and needed urgent action. Dr Bashford was sceptical of the value of a telemedicine approach, suggesting that the skills required to be available locally and throughout the 24 hours not just out of hours. He was concerned that the proposal would remove trainee doctors from RGHs, as this had the potential to make recruitment even more of a challenge and that GPs did not have either the skills or the inclination to provide out of hours support. Dr Gibbins said that from a Highland perspective, he could not fault the analysis of the problem or the logic of the solution but he would be concerned if the proposal was to have no doctors in the hospital overnight. He said that Highland would be supportive of exploring a pragmatic and practical approach to the issue being faced but would not support a direction of travel that could be construed as the Board supporting and promoting such an approach. Turning to the broader issues, Dr Gibbins said that Delivering for Remote and Rural Healthcare had established the RGHs and the supporting workforce models as Scottish Government policy and he was thoughtful of the implications that the project would have for this policy.

In relation to NHS Orkney, Mrs Cowan said that she found the paper helpful and was supportive of the proposal, as like others the problems were immediate concerns. She continued that she would be keen that the wider integration with NHS 24 and SAS were a feature of the approach.

Dr Taylor said that there has been some discussion within Shetland and would be keen that any regional approach, took cognisance of the differences in local systems. She said that there was no real buyin in Shetland from the GPs to support hospital services, except where the GP had trained within the local hospital prior to sub specialisation and shared the concerns that others expressed regarding any proposal that would remove doctors in training from the RGH. She suggested that an approach would be for each Board to work within local systems to determine future models and identify the barriers which might need to be overcome but to do so within the wider regional programme that is supportive but not too prescriptive.


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There was a discussion on the role of the clinical decision support and the need to protect the local consultant resource but to support the RGH or small DGH out of hours. Dr Dijkhuizen also stressed that he was not suggesting that there would be no doctors in training in the RGHs, but a mixed economy, which should offer a safer more sustainable service. He described the need for an obligate network between centres and Dr Gibbins said that this is already a policy requirement and reminded colleagues that he had frequently raised the need to establish such networks to support local systems. There was also a debate on whether the proposals would lead to safer systems, however, Dr Dijkhuizen said that whilst the model may be different, any successful solution would need to be safer and suggested that the project must start with the confidence that this would be one of the important outcomes required, together with improved quality of care.

Prof Needham reminded members that NES currently support 54 doctors in training across the six RGHs, who provide a single tier of 1 st line medical cover but that given the vacancy level, this is a highrisk strategy. She said that the requirements of the National Reshaping Medical Workforce to reduce the number of doctors in training across the North and East by 140 sits in counterpoint with the remote and rural policy, also promulgated by Government. She continued that the North programmes were deemed unattractive and suggested that there needed to be clearer definition of the requirements of the ‘rural track’ training programmes.

Mr Carey asked whether SGHD were sighted on the issues and a number of members confirmed that the issues had been raised either individually or collectively, however there was shared concern that the issues were not fully appreciated nor understood. Ms Sheriff said that whilst the policy issues were important, it would be important to ensure that any initiative is described in a way that SGHD can work with the Boards, rather than acting as a block and suggested that early engagement would be important.

Dr Ingram suggested that the proposal was linked to much of the work of RRIG and might offer an opportunity to develop a sustainable model, particularly for the RGHs. She made a plea however, that this project and the work of RRIG were linked. She reminded members that within current RRIG workstreams there was ongoing work to review the workforce issues, including work to ensure the appropriate model, education and revalidation of GPs who have acute hospital responsibilities; an observation study of the whole clinical team (nurse and doctors) within NHS Western Isles, which will provide both tools and valuable information on roles; development of condition specific care pathways that describe whether a patient should be treated in an RGH or elsewhere; the guidance on the development of obligate networks and a plan to host a workforce summit later in the year. In relation to this summit, Dr Ingram observed that this might be linked with the proposal currently being considered.

Bringing the debate to a close, Mr Carey suggested that there was a need for Boards to work internally to develop redesign plans but these should be progressed in the context of the overarching group. He said that he was keen that the work was taken forward by one of the existing groups and proposals including the Medical Directors Group and RRIG were made. There was concern that the Medical Directors group would be uniprofessional in approach and that RRIG was due to be wound up in June. Dr Gibbins suggested that it might be helpful to split the work into two. The first is a requirement for work on immediate contingency arrangements and future staffing models to be progressed by Boards, in partnership with RRIG. Once Boards have completed a local review of requirements, there should a broader context discussion where the commonalities and areas for progression in partnership will be identified and this should be progressed by RRIG, perhaps within the Workforce Summit, proposed for June.

The second is the development of decision support arrangements, including clinical

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decision support; establishment of obligate networks; telehealth requirements and the supporting protocols and pathways. This should happen in parallel to the first workstream, led by the Medical Directors.

Dr Ingram suggested that a separate group may be required and suggested that a review of the North members of RRIG combined with a number of NoSPG members, together with Medical Director, Nurse Director colleagues could be established post RRIG, with appropriate representation from the Workforce group. She also suggested that the VC pilot could provide an opportunity to test the proof of concept and suggested that this group be involved in the development of the telehealth support aspect of the project.

NoSPG members were very careful to acknowledge that the Medical Directors proposal represented a pragmatic and practical approach to this issue, NoSPG were not promoting any change to the agreed policy for RGHs, but recognised that action was required. Mr Carey concluded that there was a clear mandate to progress this work as a priority and mandated Dr Ingram to develop a remit and proposed project group, in collaboration with Dr Dijkhuizen and others identified.

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22/10 NoS Workforce Planning & Development Group

i) Role & remit

Mrs Gent referred to the draft role and remit that was presented, noting that it required further refinement. She said that following a number of events, hosted by the HRDs, including a stocktake of the NoSPG workstreams, the proposed role and remit had been developed. The first formal meeting of the group would take place on the 6 th

May 2010, following which the role and remit would be presented for approval. It was noted that the draft identified one HRD as chair, however, NoSPG had previously approved Mrs Gent and Mr Sinclair as cochairs and this should be reflected in the role and remit, This was agreed.

Dr Gibbins suggested that the role and remit was quite inward looking and suggested that one of the roles of the group was to influence nationally on behalf of the North as a collective. He suggested that the role of members to act corporately on behalf of the North on national groups including MSG, the National Medical Reshaping Board was important and it was agreed that this should be included in the role and remit.

Mr Carey asked that any further comments be submitted to Mrs Gent directly and asked that the final role and remit be presented at the June 2010 meeting.

ii) Priorities for delivery

Mrs Gent reported that following the June 2009 event, the HRDs had sponsored a number of meetings and workshops to develop and refine the workplan. She reported that the group had identified work that it would sponsor and coordinate and work which would require direct input, particularly in relation to the NoSPG workstreams. She said that there was not a common understanding of the range of initiatives progressed by NoSPG and this had led to a stocktake of the workstreams, following which work had been taken forward, primarily by Lyn Marsland and Fiona Smith to identify the priorities for action. This would be presented in May to the Workforce Planning and Development Group, and to NoSPG in June.

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23/10 NSAG Bids 2010

Mrs Farman reminded members that the NSAG approval process included the requirement for regional planning groups to review the potential bids and that as part of the NoS process, NoSPHN undertook a review of the supporting evidence and presented a view, first to IPG, followed by the NoSPG Executive. This process ensured


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that each bid was considered on its own merits, following a public health review of clinical and cost effectiveness. She continued that in this year’s review, IPG once having considered the evidence also took a view on the appropriateness of supporting these bids for national designation, within the context of the other priorities within Boards and the current financial climate. The NSAG process required the views of the RPGs to be submitted by 10 th June 2010.

Mrs Farman said that there were seven bids this year, but that the seventh bid for Extracorporeal Membrane Oxygenation (ECMO) for adults was part of a UK wide process. She reported that NoSPHN had asked NSD for sight of the bid and Mrs Evans confirmed that this was with Scottish Government not NSD.

Turning to the six bids reviewed, Mrs Farman reported that IPG had reviewed each bid in detail, following the NoSPHN review and a number of supplementary questions had been submitted to NSD for clarification. She summarised the view of each bid, as follows:

1. MCN Adult & Paediatric Haemoglobinopathy +Transcranial Doppler Service, both Glasgow: NoSPHN concluded that the case for the MCN was not well made, with disproportionate management costs and whilst supportive of the introduction of the TCD services queried whether this could be provided on a cost per case basis and whether the service could be provided independent of the MCN. This was supported by the IPG. Mrs Evans said that the service required a sustainable critical mass of 40 cases per annum for QA purposes and the Board could not guarantee this without an agreed arrangement. She also noted that sickle cell was a growing issue across the UK including Scotland. She confirmed that the TCD service could be independent of the MCN.

2. Primary Ciliary Dyskinesia (PCD), Glasgow: This bid would establish the fourth UK centre, however, both NoSPHN and IPG concluded that the costs were high for a relatively small number of cases. IPG had questioned whether for the small number of cases economies of scale could be achieved within the Yorkhill lab service and rejected the bid. Mrs Evans advised that the costs represented £733/sample, compared to £3000 in an English unit and said that the proposal represented a quality issue.

3. LDL Apheresis Service, Edinburgh: NoSPHN concluded that the evidence to support this was not available and did not recommend approval, IPG agreed with NoSPHN.

4. Paediatric Epilepsy Surgery, Edinburgh: This bid involved the repatriation of cases from Great Ormond Street at greater cost and both NoSPHN and IPG had concerns regarding critical mass and patient safety and had sought clarification of this. The bid was not supported.

5. Histocompatibility & Immunogenetics Network, across 5 centres: This network would support organs for transplant. Mrs Farman reminded members that this was reviewed as a late submission last year and NoSPG had not supported it and asked for a number of clarifications, which had not been addressed in this new bid, although the costs had reduced. The bid was not recommended by either NoSPHN or IPG.

6. Extracorporeal Photopheresis (ECP) programme, Glasgow: This service currently exists in Glasgow, funded by SGHD, but is not available equally across Scotland. Mrs Farman reported that the bid proposes use of the treatment in 7 conditions but that NICE only approves 2 of these. There are questions relating to geographical relevance, but NoSPHN supported the bid in principle.

Mr Carey thanked Mrs Farman and NoSPHN colleagues for the extensive work undertaken to review the bids and Mrs Evans agreed that the process in the North was thorough. Dr Ingram said that following the review of the individual bids, IPG had considered whether, given the financial pressures within Boards, whether any of these bids should be supported and IPG had concluded that with this set of bids, at this time and giving due consideration to the financial situation of Boards, the recommendation


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to NoSPG should be that no bids should be supported for national designation in 2011, subject to the responses to the questions asked.

Members accepted the recommendation of IPG and agreed that unless any information is submitted that materially changes this view then that should be the view of the North boards submitted to NSAG.

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24/10 NoS Cardiac Services

Further to the question raised by Dr Gibbins in matters arising, Dr Ingram confirmed that the cardiac event had been held in February and that a revised Regional Delivery plan was in preparation. The following items will feature in the plan but these issues were more pressing a required to be addressed.

i) Cardiac Surgery

Mr Toms, Unit Operational Manager, for Cardiac Services reminded members that an SLA for cardiac surgery has existed across the North for some time but due to staffing difficulties caused by the changing nature of junior staffing and educational challenges for the junior doctors in place, a proposal to revise the staffing had been developed, which will provide better stability of the service and ensure that the doctors in training are able to fulfil their educational objectives. He highlighted that the proposal is £75k higher than the current budget but represents a reduction in spend in real terms, as the locum costs in the last year were £169k above budget. He reported that there would also be a need for transitional funding.

Prof. Needham welcomed the proposals, highlighting that a recent internal quality management report of the training programme in cardiothoracic surgery had highlighted a number of issues. Referring to this proposal, she suggested that there may be the potential to appoint an advanced Medical Training Fellow, which is a post CCT fellow, who would work in the service, but that funding from this NES initiative may be available. It was agreed that Mr Toms should investigate the potential further with Prof Needham.

Dr Gibbins asked why the service had not considered a redesign of staffing within current costs and Mr Toms responded that differences in terms and conditions, particularly hours of work meant that replacement of junior doctor by a nonmedical practitioner meant that the replacement ratio was higher. In response to a question from Mr Carey, Mr Toms reported that the locum costs are not passed onto other Boards through the current SLA. Mr Carey responded that if this were the situation and invest to save could be demonstrated then he would approve this revised model from an NHS Grampian perspective but that the costs at this stage should not be passed on until the revision of the SLA, which would be included within the revised 3 year plan.

ii) TAVI

Dr Ingram referred to the paper jointly prepared by Dr Metcalfe and herself. She explained that this was presented, as a decision by NoSPG was needed, to allow this issue to be progressed nationally. The paper reflected, however, the outcome of the February meeting.

Dr Ingram reminded members that this intervention had previously been the subject of an unsuccessful NSAG bid but there was clinical pressure to develop a service for Scotland. She reported that the main beneficiaries of this intervention were people with heart failure, who were unsuitable for surgery and for whom there were few options other than palliative care. The numbers were projected, at this stage, to be small at 16pmp but there were expectations that the range of patients for whom this intervention was suitable would grow. The Scottish Health Technologies Group had commissioned a ‘Coverage with Evidence’ review from the University of Glasgow and it

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was expected that this would inform the decision on how and where this service should be provided in Scotland, if at all. She continued that it had been agreed that each region would take a view on how the service should be provided and feed this into a national process, which the National Planning Forum at the meeting of 1 st April had agreed that it would lead.

The number of patients, who meet the current criteria, across Scotland, is estimated at 80 per year, with an estimated 20 per year for the North Boards. The minimum recommended number for a centre is 50 and therefore it is recommended that:

i) NHS Scotland should await the outcome of the work commissioned by the Scottish Health Technologies Group from the University of Glasgow;

ii) Assuming that this supports the development of a service, NHS Scotland should develop a TAVI as a service for patients with Aortic stenosis, who are deemed unsuitable for surgery;

iii) This TAVI service should initially be developed in one centre, potentially through national designation;

iv) Any decision to extend this service, or to develop more TAVI centres within Scotland should be the subject of a detailed business case to be considered by Board Chief Executives, as a group;

v) Any extension of the service should be planned and managed; vi) Until all Boards agree to fund this service, it is proposed that patients in

Scotland should not be referred to England, however, as clinicians now find it unethical not to refer patients to centres in England for TAVI, an immediate interim agreement for funding should be considered based strictly on the above agreed referral criteria.

Referring to the final recommendation, Dr Ingram advised that in September 2009, it had been agreed not to make referrals to England but there were issues regarding communication of this and across the North there have been 9 referrals to England. She continued that from an ethical point of view Dr Metcalfe could not support a blanket refusal to offer an available treatment. Mr Carey asked whether these referrals have gone through the appropriate extraordinary referral process and Dr Ingram said that in Highland she understood this to be the case but it had been suggested that in Grampian, this was clinician to clinician. Mr Carey asked Dr Dijkhuizen to investigate this.

Dr Williamson commended the paper and confirmed that the National Planning Forum had agreed to progress but that he believed that the timetable needed to be clearer and the process needed to be a 2 stage process. He suggested that the commissioning decision required to be made, once all three regions had expressed a view and the SHTG evidence was available and that this commissioning decision should be supported by clear clinical criteria, if the decision is to commission a service for Scotland. Following this decision, there would be a further piece of work to consider where that service should be provided and when it should be provided in terms of priority.

Dr Gibbins said that the second recommendation assumes that if the evidence supports the introduction then it will be introduced and suggested that this needs to be amended to reflect the need to engage across Scotland to make that decision. In the interim the decision in relation to individual patients should sit within Board systems. Ms Urquhart said that she understood that the SHTG would review the evidence and provide advice but wouldn’t recommend whether the services should be introduced. Dr Williamson confirmed this was also his understanding. Ms Urquhart suggested that the North should suggest that the final decision regarding commissioning of service in Scotland should sit with the Board Chief Executives as a group and this was agreed.

The recommendations of the report were agreed subject to the proposal that the final

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decision should sit with the Boards Chief Executives Group and greater clarity regarding the timetable, process and prioritisation process to be used by the NPF. Individual patient decisions would be subject to Board extraordinary referral processes.

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25/10 NoSPG Workplan

i) 2010/11 Workplan

Dr Ingram reported that at the NoS Chairs and Chief Executives group meeting on 17 th

March, the workplan had been approved subject to removal of stroke and neurology. NoSPG approved the workplan for 2010/11.

ii) NoSPG Annual Report

Members commended the Annual Report and approved for submission to Boards. Mrs Evans proposed that in the next Annual Report there should be a section for completion by Boards that outline the benefits to boards. Dr Ingram said that Boards would need to commit to provide this and Mr Carey asked that this be considered for next year.

Dr Ingram reminded members that the Annual Report, together with the approved workplan should now be presented to individual Boards and that she had a proposed schedule of dates. She said that this year the suite of papers would include the Annual Report, the workplan and the Compendium of Events, approved in February 2010. It was agreed that Dr Ingram should provide the schedule of dates to Board Chief executives and members agreed her plan to do as many reports by videoconference as possible.

iii) NoSPG Constitution

Dr Ingram said that the approval of the NoS Workforce Planning & Development Group required a change to the constitution and presented the revised version, which had changes to section 5.7 and Appendix 1. She noted, however, that following Mr Sullivan’s retiral and Miss May’s notice to resign as the Chair of the Nurse Directors group, the names were now inaccurate and Mr Carey suggested that job titles or regional role should be identified rather than individual names and this was agreed. It was agreed to revise and post to Chief Executives for signature.

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26/10 HUB Initiative

Mr Donald reported that in addition to Mr Innes, introduced at the last meeting, Mr Steve Homer had been appointed as the Project manager, funded by the Scottish Future Trust.

He reported that three consortia had been identified through the procurement process and the project had now moved into the competitive dialogue stage. The financial close was on target to be completed by December 2010.

Mr Donald provided a brief financial overview and highlighted a number of health projects under consideration.

27/10 Remote and Rural Implementation Group

i) Strategic Options Framework

Dr Gibbins reminded members that the development of robust and responsive local community emergency response systems was one of the most significant aspects of


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the work of RRIG. The Emergency Response and Transport workstream of RRIG had worked with SAS, NHS 24, the public and a number of other stakeholders to develop a Memorandum of Understanding between SAS and RRIG, on behalf of territorial Boards; standards for response and a range of models that might be appropriate to different remote and rural areas. There is an expectation that SGHD will endorse the SOF and Boards will implement recommendations.

In October 2009, Dr Gibbins reported that he and Mrs Howie, Chief Executive of SAS, had written to Boards to invite Boards to work with SAS to develop implementation plans, with a report to the March 2010 RRIG, following consideration of plans in the January/February cycle of Board meetings. There was little reported at RRIG by Boards and the paper presented represents a progress report prepared by Dr Ingram, following that meeting. It was noted that there were a number of Boards who had either not responded or plans were not yet in place, particularly across the North. Dr Gibbins encouraged territorial Boards to pursue this with SAS.

Mrs Cowan said that she had not been sighted on this and would pick it up and Dr Taylor said that following Dr Ingram’s request, Shetland had now met with SAS and had plans to progress. Dr Gibbins reported that Highland had met with the ambulance service but he remained concerned as to the level of commitment of SAS.

Mr Carey asked if the report required to be approved and Dr Ingram replied that the report had been prepared for RRIG and for submission to SGHD and noted that the plans were only the beginning of a process that was recognised would take time, as some of the potential models were not yet in place. Members noted the report and Mr Carey encouraged North Boards to push for progress within local areas.

ii) Progress Report

Dr Gibbins reported that there had been considerable progress across the other workstreams of the project and that most actions were on target to be completed by June 2010, or would have an agreed destination. He reported that there had been discussion with Government regarding an exit strategy and that Dr Ingram was undertaking a review of all workstreams to identify how the ongoing issues would be managed.

Turning to the key outputs, Dr Gibbins reminded members that the EMRS service had formally been launched by the Cabinet Secretary on 2 March and plans were progressing to extend the current pilot to the northern isles and northern Highland. He reported that there had been a meeting with Kevin Woods, SAS, NSD and Greater Glasgow and Clyde on 11 March and a subsequent meeting of the Project Board and invited Dr Ingram to update members. Dr Ingram reminded members that the EMRS was one of the level 4 responses identified by the SoF and reported that SGHD had agreed to fund the service for a further year but at the meeting with SGHD, Dr Woods had made it clear that he expected the services to work together to implement the service, including identifying sustained funding and that he expected solutions not problems. One option being considered was national designation but further debate had suggested that this may not be the preferred option. A joint Operational Board was to be established, chaired jointly by SAS and NHS GG&C which would oversee the rollout and ongoing management of the service, although final membership, which would include users, was yet to be agreed. The plans for rollout were on track for the October implementation date, including arrangements to engage with the island Boards and the North Highland CHP.

Dr Ingram said that a number of other initiatives were also being progressed, particularly in relation to workforce. She reported that there had been a workshop on 26 th March with GPs who run acute facilities, including Orkney, Broadford, and Galloway. Medical Directors, the CD from Argyll and Bute, the deanery, RRHEAL and Basics Scotland also attended. This workshop had looked at the activity, required skills

Boards


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and competencies’, training requirements, appraisal and revalidation and a further workshop was planned for May. Other work included an observation study, being undertaken in the Western Isles, observing the clinical teams, including nurses and doctors, which would provide both tools for other Boards but also valuable information on the roles carried out. She suggested that this work could inform the work proposed by the Medical Directors. She also reported that work to plan a workforce summit for June had also been taken forward but the Medical Directors plans would have an impact on the final approach. In response to a question from Mrs Gent, Dr Ingram said she could not confirm that the 3 rd June event would go ahead until she had met with Dr Gibbins.

A care pathways event had also taken place at which the condition specific acute pathways for the RGHs, had been reviewed and agreed. The pathways were subsequently amended and will soon be launched in hard copy and on the web. This would also be an important link for the Medical Director work.

In terms of eHealth, the national VC pilot, involving all six Boards across the North, would address a number of the issues identified, through developing standards for VC, including naming and dialling conventions, speeds and requirements. It was hoped these would be adopted across Scotland. The pilot also intended to undertake work to agree with clinicians the minimum speed requirements for different clinical uses and she suggested that feedback from R&R clinicians was that these would need to be in place before clinicians would commit to extending the use of eHealth.

She reported that the use of obligate networks was still limited and suggested that the work proposed by the Medical Directors may serve to improve this. An audit would be concluded before June 2010.

Mr Carey asked that a detailed report be included in the minutes or a short briefing be prepared.

AKI

28/10 NoSPG Subgroups

i) Integrated Planning Group

The minutes of the meeting of 18 th March 2010 were noted.

ii) NoS Medical Directors

The minutes of the meeting of 17 th February 2010 were noted.

iii) NoS Nurse Directors

The minutes of the meeting of 23 rd November 2009 were noted and in Ms May’s absence, Dr Ingram reported that there were no significant issues to report, the group were still awaiting the appointment of a Chair and Ms may had confirmed that she would continue in the interim.

iv) NoS Public Health Network

The report was noted.

v) NOSCAN workplan 2009/10 update

The progress report was noted and Mr Carey proposed a more substantive discussion at the next meeting. In response to a question from Dr Ingram, he confirmed that the 2010 workplan was still in development.

29/10 National Update


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Mrs Evans noted that Scottish Ministers had approved two applications for national designation in 2010: pregnancy screening and sacral nerve urinary incontinence. She highlighted the review of existing services, highlighting the decision to dedesignate the sarcoma service and highlighting the implications for Boards.

Mr Carey highlighted the recent CEL issued in relation to the requirement to introduce an Abdominal Aortic Aneurysm screening programme within Boards or in partnership and confirmed that Grampian were progressing this and would include Orkney and Shetland. He noted that Highland had run the pilot and were well place to provide this, although Dr Gibbins highlighted that the pilot had operated in North Highland not Argyll and Bute.

30/10 National Planning Forum

Dr Ingram’s personal note and the minutes of the meeting of 27 th January 2010 were noted.

31/10 Any other Competent Business

There was no other business.

32/10 Date of Next Meeting

The next meeting will be held on 30 th June 2010 at 10:30am in the Aspen Room, NES, Forest Grove House, Aberdeen.

north of scotland planning group - nhs … · dr peter williamson, director of health ... both mr...

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