MINUTES OF THE CHILD HEALTH SUPPORT GROUP MEETING 22 APRIL 2004 AT 9.30 AM IN BOARD ROOM 2, DALIAN HOUSE, GLASGOW

Transcription

1 MINUTES OF THE CHILD HEALTH SUPPORT GROUP MEETING 22 APRIL 2004 AT 9.30 AM IN BOARD ROOM 2, DALIAN HOUSE, GLASGOW Present: Malcolm Wright, Chair, Chief Executive, NHS Education for Scotland Jonathan Best. Chief Executive, Yorkhill University Hospitals NHS Trust David Cumming, Director of Social Work, City of Glasgow Council Graham Bryce, Consultant Child and Adolescent Psychiatrist, Yorkhill Bronwen Cohen, Director, Children in Scotland Zoë Dunhill, Patient Services Director, Lothian University Hospitals NHS Trust Stewart Forsyth, Clinical Director of Paediatrics, Dundee Teaching Hospital NHS Trust Anna Murphy, Medical Directorate, Yorkhill NHS Trust Caroline Selkirk, Child Health Commissioner, Tayside NHS Brenda Townsend, Director of Nursing, Yorkhill NHS Trust Scottish Executive Ian Bashford, Senior Medical Officer, Scottish Executive Health Department Linda de Caestecker, Women and Children s Unit, Scottish Executive Health Department Mary Sloan, Women and Children s Unit, Scottish Executive Health Department Robert Stevenson, Women and Children s Unit, Scottish Executive Health Department Mags McGuire, Nursing Officer, Scottish Executive Health Department Lindsey Wright, Women and Children s Unit, Scottish Executive Health, Department Apologies: Douglas Bulloch, Chairman of the Scottish Children s Reporter, Administration Sally Harkness, GP, Inverurie, Grampian Primary Care, Margaret Kinsella, Integration Manager for Children s Services, Highland Council Anne-Marie Knox, Child Protection Adviser, Yorkhill NHS Division Shiona Mackie, Medical Director, Lanarkshire Primary Care Trust Bruce Robertson, Director of Education, Highland Council George Youngson, Professor of Paediatric Surgery, Grampian University Hospital NHS Trusts Fiona Page, Women and Children s Unit, Scottish Executive Health Department In Attendance: Derek Feeley, Head of National Planning Team, Scottish Executive Health Department Review of the NHS Fiona McManus, Professional Adviser, Scottish Executive Education Department, Child Protection Division ITEM 1: NATIONAL REVIEW OF THE NHS IN SCOTLAND 1. Derek Feeley presented the attached slides and made the following points: the review will be announced on Monday 26 or Tuesday 27 April. Scotland has an ageing and declining population which presents frightening challenges. the review aims to set out a vision for the direction partnerships for care should take. competing demands require to be reconciled. the trend should be away from hospital care to primary care. 1

2 both sides of the slide impact on the care provided, they are not direct opposites. It will be important to get the right balance. an Advisory Group meets for the first time on 27 April A project team has been put together comprising civil servants and secondees. (slide 9) a list of possible short life working groups. The downward arrows represent the core business of the NHS. child health services must be an integral part of national planning. Good practice examples of integration are available eg: unscheduled care, paediatric intensive care. the review team will work with regional planning coordinators. It is not envisaged that services will be centrally managed. The review report will provide guidance to Boards for their planning processes. The following points were raised during discussion: The UN Convention and the Kennedy Report on the Bristol Enquiry highlights the importance of children must be considered separately from adults: the review should consider children separately: many adult problems begin in childhood Children should be a third arrow (referring to slide 9): the child should be regarded in a holistic way and not as part of various specialisms Children are a priority for the Scottish Executive and Ministers this needs to be reflected in the NHS Problems in children s services are more acute than in adult services due to smaller numbers of staff spread over wider areas Sustainability will be important: the decline in population, in particular in rural areas, is worrying Workforce issues should be addressed: GMS contracts, less paediatric training available 6-12 consultants required for the rota for each specialism to provide 7/24 care impossible to provide in 3-4 sites: should there be a Scottish Great Ormond Street? Travelling long distances frequently for treatment would be unacceptable National, Regional planning and Managed Clinical Networks are the way forward: NSD has a key role in making this happen. Integrated services are very important: need more, better, local services The omission of multi-agency working is a potential difficulty as the review focuses on the NHS Health improvement has not been included in the review but the health improvement strategy will be taken into account The CHSG should feed into this planning exercise: the more it does, the higher priority will be given to children. The CHSG workplan should complement this exercise A child health colleague should be a member of the Review Advisory Group. Action: Derek Feeley and Linda de Caestecker to meet to discuss the mechanisms for the CHSG feeding into the Review. ITEM 2: FEEDBACK FROM JOINT CHSG/RCPCH MEETINGS: 10 AND 19 MARCH 2. Anna Murphy explained that when she took over as the Scottish Officer of the Royal College of Paediatrics and Child Health, she was aware children in Scotland had a low profile. The College believes there is a need for a national services framework and for a 2

3 national clinical director of child health services in Scotland. Child health services should be integrated and be aware of the holistic child. The College would like to partner other agencies in Scotland to develop child health services. To this end, Jackie McRae gave a useful talk to the College about the Women and Children s Unit (WCU); the College, representatives of the CHSG and the WCU met to explain their roles on 10 March; and on 19 March the College, the CHSG and the WCU met to hear of Al Aynsley-Green s experiences of the child health strategy in England and Wales. The College regarded these as helpful meetings. 3. During discussion, the meeting agreed a lot is being done in Scotland for children and child health services but that this wasn t well known, the Scottish Executive has a selling job to do. ITEM 3: NATIONAL STRATEGIC FRAMEWORK FOR CHILD HEALTH SERVICES 4. Malcolm reported the CHSG Template had been well received. It provided a map of combined and integrated services. The next stage forward might be to develop a National Strategic Framework. Malcolm had met with the Health Minister and with the Chief Medical Officer who were supportive of a Framework and of a national clinical leader. The meeting agreed a Framework would be useful to pull together existing strategies. The Framework should: Complement the Review being undertaken by Derek Feeley Be short, detailed and focused (not visionary) Be used as a benchmark, for use by a clinical leader and the service Set dates and (not too distant) timescales; what should be done by when Join up existing work, anticipate problems, identify gaps, and interface with local authority service planning, community plans Include a vision setting out what children s services should look like in 5-10 years time. 5. The Framework would have to be developed within existing resources and would therefore need to be limited. RCPCH may be able to help: Derek Feeley s Team could contribute to it. 6. It was agreed to take item 5 on the agenda next. ITEM 5: CLINICAL LEADERSHIP 7. The meeting was asked to think about what is clinical leadership. The CMO appeared to be supportive of a single clinical lead from a professional background and resources could be found for 2 sessions a week. The following elements were seen as being key in the role: provide independent advice and enhance dialogue with practitioners: someone to go to solve problems empower and coordinate what is happening develop and deliver the Framework raise the profile of child health in Scotland 3

4 8. The role need not be undertaken by just one person: the leads of the CHSG subgroups could be an example to follow. The person/people would require freed up time but would still create work for the WCU. 9. It was agreed the clinical leader role should work closely with the Chair of the Child Health Support Group and the Head of the Women and Children s Unit. The role would be complementary to these posts: ie the Head of the WCU commissions policy: the clinical leader would take it forward. Action: Linda de Caestecker to flesh out what the clinical leader role could look like. ITEM 4: HEALTH DEPARTMENT PAPER ON THE DEVELOPMENT OF CHILDREN S SERVICES IN SCOTLAND 10. Linda explained that following Malcolm s meeting with Trevor Jones, Malcolm had submitted his views on child health services in Scotland in writing to Trevor. This paper had been circulated among the Directors in the Health Department. Linda had been asked to summarise their responses and submit a paper to the Health Department Board. The draft paper was tabled. Action: the paper to be ed to CHSG members by Mary Sloan. Members to submit their comments to Linda by noon on Wednesday 28 April. ITEM 6: MINUTES OF THE MEETINGS HELD ON 22 AND 23 JANUARY Malcolm reported that the minutes of the 22 January meeting with NHS Lothian had been submitted to them for accuracy along with additional questions members had requested be put to Lothian. A reply was awaited. 12. He also reported that he had spoken to Stewart Bain who was agreeable to CAMHS being placed on the agenda of a monthly Chief Executives meetings with the Health Department. Action: Malcolm Wright to contact Stewart Bain and finalise arrangements. 13. The meeting agreed the CHSG should discuss the impact of Community Health Partnership on child health in more detail and submits views to the SEHD for inclusion in the guidance. Action: a small group to be convened by the WCU to be chaired by Zoë and Linda, hosted by Jonathan Best, to meet once to produce guidance. Caroline Selkirk, Anna Murphy, Brenda Townsend, David Cumming and Jonathan Best agreed to join this group. Zoë to invite a GP clinical director on to the group: funding for one GP session can be offered. 14. Caroline Selkirk reported that a small group had been formed to consider the Child Health Commissioner role: it had met twice. It had looked at, amended and developed the Template, looking particularly at strategic planning, joint working, quality assurance and PFPI. It had been agreed the critical success of the CHC role depended on dedicated time, the seniority of the postholder, independence and access to a support team. Action: Caroline to submit a draft paper to the CHSG at its next meeting on 23 July. Thereafter Boards will be asked to review their CHC role. 4

5 ITEM 7: CHILD PROTECTION 15. Child protection services could be in crisis within 3-4 years due to medical staff retirements and newer consultants not expressing interest. The RCPCH is looking at child protection, including training, education and recruitment, but work is not yet progressing well. The proposed strategic child health framework could also include child protection. The national report It s Everyone s Job to make sure I m alright must be taken into account. Many issues regarding child sexual abuse must be addressed: eg where children can be examined. The delays in obtaining Disclosure Scotland clearance is presenting major problems. Action: Caroline Selkirk to seek the views of CHCs on the Disclosure Scotland delays and submit a paper to the CHSG: Bronwen Cohen to contact Disclosure Scotland. ITEM 8: UPDATES ON THE WORK OF THE CHILD HEALTH SUPPORT GROUP Promoting social justice through better integrated and high quality services 16. Bruce Robertson is concerned about the lack of clarity for his role: his sub-group has never been formally established. Issues to be addressed: Joint planning guidance will be issued in June should this guidance be circulated to the whole Group or establish separate sub-group? The Integrated Early Years Strategy and Hall 4 are closely linked Joint inspections for children s services is a separate sub-group required or should all members be consulted? Kathleen Marshall may address social justice issues Important to keep links with the Integrated Community Schools initiative and the Additional Support for Learning Bill. Action: Bruce to be invited to submit a paper on the issues he thinks his sub-group should address. Zoë to invite Bruce on to her Hall 4 reference group which is next due to meet at the end of June. Feedback from the Cabinet Delivery Group s Expert Reference Group to be a standing item on CHSG agendae. Review and Planning of Specialist Paediatric Services 17. The position statement of the Review of Tertiary Paediatric Services in Scotland which had been circulated was a first draft of a paper for the 11 June Conference. George s sub-group was to meet the next day to expand the paper. It was agreed George s workplan was very ambitious: clinicians don t have the capacity to undertake reviews, and would have less capacity once the consultants contract was in place. The pilot reviews are highlighting challenging issues there will be even greater pressures on services by NSD could be undertaking the reviews. MCNs could be the way forward. The Framework could include models of care. 18. It was reported that George had received letters from NSD seeking CHSG views on the Cleft Lip and Palate and Nephrology MCNs. It was thought it would be appropriate for George to respond. Action: George to respond to NSD letters re MCNs. 5

6 Strengthening Community-Based Child Health Services 19. A paper summarising the work of the Strengthening community-based child health services sub-group was tabled. Zoë reported: a medical colleague had been identified to undertake the groundwork in developing standards The workplan will go to the QIS Board in July The role of QIS in the joint child protection inspections needs clarification (a pilot joint inspection will take place in December 04) Implications of the ASN Bill: a small group has been set up The Hall 4 reference group will be reconvened to consider responses to the consultation exercise: the guidance included references to the Framework for School Nursing Action: Caroline Selkirk to pass to Zoë the Child Health Commissioners costings of the ASN Bill implementation. Champion and Develop CAMHS 20. Graham Bryce reported that the national conference on 31 March had gone well. Young people (aged 11-25) made a significant contribution. Delegates were placed in roundtable groups working through scenarios in the morning and problem solving in the afternoon. A young people s research group has been established to help in developing the CAMHS Template. The Template will be produced by the latter part of the year. A National Director of Mental Health, Ann Clarke, has been appointed and will work closely with Graham and the WCU. 21. Inpatient Units are proving a major problem Bruce Dickie is leading on this. Solutions are needed now. Inpatient Units are over the edge staff recruitment is a problem, adolescent commissioning arrangements are patchy. The development of models of care may help with recruitment. Bruce has produced a paper which could be put to the 3 Regional Heads. Action: CAMHS Template to be considered at next CHSG Meeting Delivering Patient Focus, Public Involvement for Children and Young People 22. Brenda reported: The reference group had met 3 times The task was more complex than first envisaged She had met with Hector MacKenzie and Charlie McMillan of the Scottish Executive Health Department s Involving People team Charlie McMillan is rolling out the Fair for All project The Fair for All project is being approached for funding to take forward a project to engage expertise and consult on the principles of involving children Boards which are already good at involving children will be asked to pilot the principles Systems must be put in place for different age groups 23. The meeting then commented: NHS Health Scotland might commission the principles 6

7 Save the Children has a toolkit for engaging young people The Young People s Research Group should be involved Zoë Dunhill could assist with this work. ITEM 9: CHSG FUTURE WORK PLAN 24. It was agreed: a national strategic framework should be developed an interim, limited framework could be developed within existing resources and could link in to the national review of the NHS to lobby for a clinical leader on a sessional basis: the job description to be based on the roles of the Chair of the CHSG and the Head of the Women and Children s Unit RCPCH, RCN, CMO, Ian Gordon, the Centre for Change and Innovation, and the Cabinet Office Modernising Government Fund could be approached for funding ITEM 10: DATE OF NEXT MEETING 25. Action: Mary Sloan to trawl for suitable date towards the end of June as many members would be unavailable on 23 July. [The next meeting has been arranged to take place on Tuesday 31 August at 10.30am in The Scottish Health Service Centre, Western General Hospital, Crewe Road, Edinburgh.] 7