NATIONAL PLANNING FORUM

Transcription

1 Meeting: NoSPG Date: 24 th September 2014 Item: 62/14 NATIONAL PLANNING FORUM Date: Thursday, 26 June 2014 Time: :00 Venue: Scottish Health Service Centre, Edinburgh DRAFT NOTE OF MEETING Present Richard Carey Michael Kellet Jacqui Simpson Alex McMahon Caroline Selkirk Allan Gunning Mark O Donnell Janette Fraser Stephanie Phillips Donald Harley Catriona Renfrew Elizabeth Porterfield Chris Roberts Catherine Calderwood Donald Cameron Della Thomas Deirdre Evans Ian Ritchie Ed Clifton Irene McGonnigle Martin Bell Videoconference Graeme Smith Jim Cannon Sarah Taylor Donna Smith In attendance James Stevenson Clare Ruxton Chair, NHS Grampian Co-Chair, Scottish Government, The Quality Unit SEAT NHS Lothian NHS Tayside NHS Ayrshire & Arran Scottish Government The Quality Unit WoSPG Scottish Ambulance Service Scottish Partnership Forum Staffside NHS Greater Glasgow & Clyde Scottish Government The Quality Unit Scottish Government The Quality Unit Senior Medical Officer, Scottish Government NHS National Education for Scotland NHS Health Scotland NHS National Specialist & Screening Services Directorate Scottish Academy of Medical Royal Colleges Scottish Health Technologies Group NHS Fife NHS National Services Scotland NHS Grampian NoSPG NHS Shetland NHS Highland Executive Support to Board Chief Executives Executive Support to Board Chief Executives 1 WELCOME AND APOLOGIES 1. The Chair welcomed members to the meeting. Apologies have been received from: Sally Winning (Donald Harley deputising); Emelin Collier; Robin McNaught; Vicky Freeman; Justine Westwood; Heather Kenney (Stephanie Philips deputising); Calum Campbell; Harpreet Kohli; Graham Foster; Cath Denholm (Della Thomas deputising); Aileen Keel; Sara Davies; Deborah Jones (Donna Smith deputising).

2 2 MINUTES OF 16 APRIL MEETING Paper (14) Subject to the addition of Ian Ritchie to the attendance list, members were content that paper (14) 14, is an accurate record of the previous meeting held on 16 April. 3 CURRENT AND RECENT ISSUES 3.1 Update on work to move from open to laparoscopic prostatectomy 3. Regional Planning Directors had provided the requested updates on the move from open (ORP) to laparoscopic (LRP) radical prostatectomy in a few high-volume centres, presented in paper NPF (14) In SEAT, predominantly LRP is being carried out currently, though noting that in a very few cases, open surgery is required. Discussions are ongoing with colleagues in NHS Fife about phasing out open surgery, with patient activity expected to move to NHS Lothian s LRP service. 5. In the West of Scotland, options are being explored for the move to 1-2 LRP sites, from the current 5 ORP/1 LRP. Work is ongoing to try to understand the lower demand for radical prostatectomy in the West. There was some discussion on the pace of the change in the West. Experience from England suggested that around 3 years would be needed, but there were some concerns that this move should be carried out more swiftly, noting that there were already LRP trained surgeons in the West carrying out open procedures. 6. In the North of Scotland, three smaller units were operating single-handedly. Jim Cannon reported that clinicians did not have an appetite to move to a single site, though would consider if robotic surgery were to be introduced. Only small numbers of operations are undertaken in Inverness and clinicians were of the view that if the option of open surgery was removed (except where clinically indicated), patient choice was diminished. However, in light of the evidence the view of NPF was that the phasing out of open surgery (which has happened in the rest of the UK over the last 10 years, and in the US over 20 or so) the changes previously agreed need to go ahead in the interests of patients and improved experience/outcomes. The patient choice argument was challenged. It was appreciated that there may be concerns about sustainability of other services if ORP is removed and further work would be needed to support the clinicians and understand better why they are reticent, but the key driver for the change to LRP was improved outcomes for patients. 7. The view of the Cabinet Secretary was restated, that these changes should be achieved more rapidly. While it was important to support clinicians during transition, it was reiterated that the move to LRP was not a matter for debate, having been endorsed by NPF, Board Chief Executives and Cabinet Secretary. Action: Regional Planning Directors to provide written updates that set out plans for more rapid timescales to move from ORP to LRP. Issue to be revisited at each NPF meeting.

3 3.2 Robotic Surgery Research Group 8. Dr Catherine Calderwood outlined progress with the robotic surgery research proposal which is now undergoing peer review through Chief Scientist Office (CSO) funding pathway. Study will compare functional outcomes of two cohorts, one 800 laparoscopic RPs (Scotland) and the second 300 laparoscopic/500 robotically assisted (London) cases. If successful, the research is expected to start in October this year and complete/publish within 18 months/ 2 years. 9. Prostate cancer charities UCAN and Prostate Scotland are both raising funds for robotic surgery, with UCAN forecasting they may have the funds as early as the end of this year; Prostate Scotland estimates around months for raising the funds required. There is therefore recognition of the likelihood of introducing robotic surgery to Scotland at some point in the near future. 10. It was noted by Professor Ritchie that a recent College paper had noted that robotic assisted surgery is the future, e.g. in colorectal surgery. He also noted that while the picture in USA had changed somewhat arising from earlier mistakes following the introduction of robotically assisted surgery, it would be important to ensure appropriate follow up/consideration of complications. 11. The Cabinet Secretary wishes to see robotically assisted surgery in Scotland as soon as possible and has therefore asked that NPF sets up a new subgroup to plan for the introduction of robot(s). There were clear implications for NHS Grampian and other Boards to work together to achieve a pragmatic approach taking into account also research interests, for example in Tayside, which were not inconsiderable with the potential income for Scotland far outweighing the potential costs of robot(s) themselves. It was noted that the evidence for use in areas other than prostatectomy had been weaker but it would be important to check that is still the case. 12. The work to move from ORP to LRP is clearly linked in terms of planning, with and without robots, including the training and resources required which will also be a matter for the planning subgroup. 13. This move was endorsed by Directors of Planning colleagues, who recognise that it is reasonable to plan these things collectively. It was noted that, should for example a robot be introduced into NHS Grampian through UCAN funding, it would be important to have considered appropriate patient flows from elsewhere in the country to allow the use of the robot to be maximised and to ensure appropriate volume to maintain skills/expertise. Action: Catherine Calderwood / Secretariat to establish group to plan for the introduction of robotic surgery to NHSScotland. 3.3 Forensic Child and Adolescent Mental Health Services National secure CAMHS facility update; Catriona Renfrew 14. Catriona Renfrew confirmed that the membership of the group being established to consider a national secure CAMHS facility is nearing completion, with a first meeting scheduled for this summer. Action: Catriona Renfrew to report progress to NPF at September meeting.

4 3.3.2 Update on Regional CAMHS Work 15. In the West of Scotland, challenges around accommodation for the inpatient service were being worked through. There may be a need in a few instances for adolescents to make use of adult facilities, where this was appropriate in terms of individual patient circumstances. 16. Lothian CAMHS is well advanced down the route of planning for an intensive CAMHS nursing facility in the new RHSC which would, when required, provide IPCU-type accommodation for adolescents. The SEAT Tier 4 CAMHS Consortium will consider the most effective way to incorporate forensic CAMHS expertise into the regional model, including consideration of community forensic CAMHS models developed in England. A paper outlining options will be produced over the summer to be considered by SEAT regional planning group. 17. In the North, it was noted that the new facility in Tayside will provide inpatient beds, though these would not directly equate to IPCU beds. As in the West, it is envisaged that there may still be some instances where it is appropriate for adolescents to be cared for in adult facilities. Action: Regional Planning Directors to provide an update on regional CAMHS IPCU, and regional specialist advice service, to September NPF. 3.4 Strategic Planning 18. Michael Kellet noted that work is ongoing, with NHS and Local Authority Chief Executives, to develop the strategic planning landscape. This includes work being taken forward by Geoff Huggins in discussion with NHS Board Chairs to develop revised arrangements. 19. In terms of the discussion at the last NPF, particularly with a focus on LDP planning, Richard Carey hoped that a seminar would be held in August he would follow up with Paul Gray. Action: Richard Carey to speak with Paul Gray re above. 20. It was confirmed that NPF will continue within its existing remit pending emergence of any greater clarity. 4 WRITTEN UPDATES 4.1 Stocktake of Adult Critical Care 21. A questionnaire has been developed, and will shortly be sent to NHS Boards for completion. It is anticipated that much of the detail requested via the questionnaire will be readily available from the critical care IT system. The questionnaires will also be precompleted as far as possible, and should therefore be relatively straightforward for Boards to complete quite quickly. 4.2 Major Trauma

5 22. Caroline Selkirk, Chair of the Major Trauma Oversight Group (MTOG), updated NPF on the group s progress. The Major Trauma Oversight Group met on 16 June. Good progress has been made in many areas. Key challenges to address in the immediate term are resourcing for the Scottish Trauma Audit Group, and the arrangements for triage of patients, including SAS development of the major trauma triage tool. 23. On triage, work has been undertaken by Jan Jansen of NHS Grampian to look at patterns of triage, applying an algorithm against existing data to establish what patients might be triaged to a Major Trauma Centre (MTC). There is the potential for a significant level of overtriage, though it is accepted that some overtriage is necessary. Members of MTOG plan to visit established major trauma centres in England, to see how these systems operate and manage triage/and patient flow. 24. Major Trauma rehabilitation is vital and the CMO specialty advisor is providing advice on the various issues. 25. Ian Ritchie noted the good progress being made. He noted the importance of clinical buy-in across the country, and offered that RCSE might host a half, or whole day meeting for which questions could be answered by the MTOG. Action: Caroline Selkirk to discuss with Ian Ritchie RCSE meeting on major trauma. 4.3 TAVI 26. The TAVI Review Group last met in May. In summary, there is currently no clear evidence of unmet demand for TAVI and therefore no strong grounds for a current expansion of the service. Work is underway to better understand referral patterns. SHTG are preparing to look at volume/outcome evidence, to inform the position on number of cases per centre. There was unanimous commendation at the TAVI Review Group for the work of the national TAVI service, led by Dr Neal Uren. The next TAVI Review Group meeting will be on 5 November. 4.4 SHTG Workplan 27. The most recent SHTG workplan, paper (14) 20, was noted. 5. HORIZON SCANNING Vaginal mesh implant care pathways 28. Acting CMO recently wrote to Boards, to ask them to consider suspending mesh implants at this time, following an appearance by Cabinet Secretary at the Scottish Parliament s Public Petitions Committee. 29. Catherine Calderwood noted that overall complication rates for mesh procedures were low. It was confirmed that, if appropriate patient information is provided, and consent given, then mesh procedures may be undertaken. This is a particularly important point as appropriate alternative treatment options are limited. Concerns of patients are being taken into account by the working group considering these issues, including the development of improved consent forms. Endometriosis

6 30. Following a recent meeting with the Cabinet Secretary, Endometriosis UK (or more specifically clinicians involved) intend to bring a paper to NPF in September, to make the case for change to the way endometriosis services are delivered. It is anticipated that this will focus first on the most specialised aspects of endometriosis care. Interventional Radiology 31. Arising from the Hepatology Specialty Advisor report for , a joint paper (SGHSCD/Boards) paper seeking NPF s agreement to review of interventional radiology service provision for TIPSS (Transjugular Intrahepatic PortoSystemic Shunts) across Scotland. A paper is expected for the September. 6 ANY OTHER BUSINESS 32. No other business was raised. 7 DATES OF NEXT MEETINGS 25 September 4 December All meetings start at 13:30, at Scottish Health Service Centre, Edinburgh. The Quality Unit July 2014