NORTH OF SCOTLAND PLANNING GROUP

Transcription

1 NORTH OF SCOTLAND PLANNING GROUP Annual Report Version 3 1

2 NoSPG ANNUAL REPORT CONTENTS Introduction... 4 Background... 6 Aim... 7 Context... 7 Regional Team Update... 7 Child Health... 8 North of Scotland Public Health Network (NoSPHN)... 8 Regional Workforce Group... 9 Workforce Planning Learning and Development Network... 9 National Delivery Plan funding for Specialist Children s Services Director of Regional Planning - Specific Work Regional Networks Managed Clinical Network for Specialist Paediatric Child Protection Paediatric High Dependency Care Network General Surgery for Childhood Network Child & Adolescent Mental Health Network North of Scotland Oral and Dental Health North of Scotland Paediatric Gastroenterology, Hepatology and Nutrition Network (NOSPGHANN) North East Scotland Child & Adolescent Neurology Network (NeSCANN) North of Scotland Paediatric Respiratory Network Neonatal Network North of Scotland Cancer Network (NOSCAN) North of Scotland Public Health Network (NoSPHN) Regional Services Cardiothoracic Regional Service Regional Mohs micrographic surgery service Managed Clinical Network for Eating Disorders (North Scotland) Regional Medium Secure Care Services, Rohallion clinic Regional Projects Single Vascular Service A96 Corridor (Paediatric services) Regional Sustainability Programme Neuromuscular

3 Regional / National Projects Paediatric Unscheduled Care (PUC) pilot project Safe and Sustainable Secondary Transfer and Retrieval in the North of Scotland.. 54 A Geospatial Evaluation of Systems (GEOS) of Trauma Care for Scotland Radiology Priorities for Finance Appendices North of Scotland Planning Group Executive Appendix II New (Substantive) Team Structure Appendix III Workstream Contacts

4 Introduction The last year has been a testing one for the NHS in Scotland as we saw increasing levels of activity and challenges in recruitment, particularly in the north. Against this background the North of Scotland Regional Planning Group has made significant progress in refreshing the way we plan collaborative services and also in developing the Intelligent Region themes to ensure we reduce the time spent carrying out that planning where possible. The small regional planning team has now been restructured to reflect changing needs of the north and in the coming year will regain the capacity which has been lacking for some time now. The team have supported a number of work areas over the past year and worked in different ways with constituent boards to drive forward collaborative working within the north, but also across regions, and Scotland as a whole, where that makes sense clinically. During the past year we have seen the departure of several Clinical Leads and core staff and also the addition of others to fill those vacancies. I would like to thank those who have left, for their valuable contributions and welcome our new team members whether in temporary rotational roles or in permanent ones. This year also saw the recruitment of Dr Michael Bisset as our first Regional Medical Director. Mike has worked in Regional roles for a number of years and brings a wealth of experience to this new post. This post will be central to developing a consistent approach to clinical governance across boundaries as well as providing a structured support framework for the range of clinical leads across the north. This is a first for Regional Planning in Scotland, and a testament to the commitment we have in the north, to this way of working. Work continues apace on existing networks and agreed projects, however significant progress has been made in some key areas across the region: Development of the Regional Oncology Clinical Board Agreement to establish a networked Vascular Surgery service across NHS Grampian and NHS Highland, supporting NHS Orkney and NHS Shetland with links to NHS Western Isles Completion of the CAMHS in patient unit and establishment of the CAMHS network to support patient pathways upstream and downstream from the unit. The Sustainability programme has delivered on infrastructure work streams, as part of implementing the Intelligent Region, working closely with colleagues in the North of Scotland Public Health Network. This programme is central to the renewed focus and move towards the team becoming more involved with longer term planning. 4

5 Latterly NoSPG has endorsed the development of a Regional Clinical Strategy to augment national work, which will see a higher level national strategy emerging during 2015 / This will reaffirm regional planning firmly within relevant high priority areas and focussed on work which will help sustain high quality services delivered as close to home as possible. The Regional Medical Director will support this work directly, helping to identify clinical priorities and critical codependencies as we move towards an increasing number of shared and networked services to ensure sustainability. I commend this report to you as a testament to the hard work, and record of the outputs from, the regional team, as they support us in initiatives across the North Boards. I am pleased to continue chairing NoSPG for a further year and look forward to reporting further progress during 2015 / Elaine Mead CEO NHS Highland Chair North of Scotland Planning Group 5

6 Background Regional work in the North covers a number of service and infrastructure areas and different types of activity, which can broadly be categorised into Networks, Services and Projects. These categories are simply a means to make sense of the broad agenda for the reader and are listed in Appendix III. In some cases activity bridges two or more categories; for example some of the NoS Paediatric and Dental Health Networks deliver service across Health Board boundaries and have funded Clinical Lead and Managerial support, and although defined here as Managed Clinical Networks were set up to deliver service more akin to Service Networks. This does not remove traditional MCN responsibilities such as facilitation of education, and continuous improvement work, which they also fulfil. There are other regional network arrangements which are light touch, carrying only minimal resource implications from the NoSPG team (admin support), however deliver an important function in terms of improvement and redesign support for the boards within the region. Regional services have in some instances been agreed and hosted directly within a board and don t necessarily form part of the regional planning teams work plan. This report serves as a means of reporting, to regional partners, for these services. Regional Projects are generally time limited pieces of work with specific objectives. They are sometimes funded separately and in other cases under the umbrella of the work plan for the Regional Planning team, executed within existing resources. The Regional Planning team remains a small and nimble function, in relative terms, which acts as an agent of the NoS Boards collectively, able to respond to the needs of the service by supporting cross boundary collaborations in a variety of ways. Over the past 18 months the team has undergone significant changes as it was formally restructured to include the North of Scotland Cancer Network (NOSCAN) staff and to better reflect the needs of the north boards. Appendix II shows the new team structure and lists new, substantive team members. 6

7 Aim This report aims to provide a vehicle to report on all regional work, in recognition of the breadth and depth of cross boundary collaboration, for the benefit of patients in the north. Regional collaborations are necessarily varied, with different levels of input from the regional team. This report aims to describe progress in each area, as well as briefly describe the input from the regional team, as an indicator of added value to the NoS Boards. Context Regional Team Update The core regional team saw a sustained reduction in capacity during 2014, as a result of staff leaving for promoted posts and secondments. Vacancies were unable to be filled because of the ongoing organisational change process which was facilitating the team restructure. This limited the progress of some regional projects and reduced the amount of new work possible. During 2014 / 2015 NOSCAN staff was incorporated into the single regional team and office functions were brought closer together, allowing skills to be shared, maximising capacity and increasing sustainability of regional functions. The newly restructured team will see more emphasis on planning functions, with slightly less input to secondary care and operational work, where more reliance will be placed on operational and other colleagues within Boards, to progress projects. Although this creates some tension to release capacity within boards the regional team will continue to be flexible and act in different capacities, depending on the piece of work, recognising the need for board ownership of projects. During Q / 2015 the two programme managers supporting the SOSNOS programme (Sustaining Oncology Services in the North of Scotland; Ms Lesley Forsyth and Mrs Grace Ball) had their 1 year secondments extended for a further year; one from regional under spend and the other with match funding from the Scottish Government. Also in Q4 Ms Kerry Russell (temporary Programme Manager on the Sustainability programme) was successful in her application to the post of Associate Director of Regional Planning. During 2013 a temporary Clinical leadership post was agreed (2 years part time) in recognition of the importance of clinical input to strategic planning and redesign across boundaries. This post will specifically support the clinical aspects of current and emerging regional work and play an important and central role in the regional sustainability work. This post was recruited to during 2014 with Dr Michael Bisset taking up post in April

8 The new team structure was delivered at no additional cost to the NoS Boards and is detailed in Appendix II. Child Health A significant amount of regional work has been generated by central funding, as part of the National Delivery Plan (NDP) for children s services. As a result we have an overall Child Health Clinical Lead (Dr Mike Bisset, Consultant Paediatrician, and NHS Grampian) who chairs the regional Child Health Clinical Planning Group (CHCPG) and oversees a number of work areas, providing strategic guidance and support to Network Managers and Lead Clinicians across the whole Child Health agenda. The Child Health programme of work has continued to focus on supporting and developing regional networks where required, and projects that have developed from the recommendations in the North of Scotland Paediatric Sustainability Review. These projects are: Continued exploration and description of an obligate network for Child Health in NoS. Following a workshop held by the CHCPG in May 2014 which focused on the concept of the obligate network. An Obligate Framework for Child Health in the North of Scotland was agreed at the CHCPG meeting in February Delivery, evaluation and implementation of learning from the pilot Paediatric Unscheduled Care Project offering a single point of contact to rural practitioners (described later in the report). Establishing transport requirements for children requiring high dependency care or specialist clinical escort, where care needs do not require transfer to Paediatric Intensive Care units (described later in the report). North of Scotland Public Health Network (NoSPHN) The core NoSPG team continues to work in close collaboration with NoSPHN across a number of areas of work. NoSPHN provides ongoing advice and support to NoSPG work programmes through Public Health colleagues who sit on the regional networks (for example: NOSCAN; the Cardiac Network and the Dental Health Network) and through direct engagement with NoSPG work. Public Health colleagues have been engaged in supporting NoSPG in relation to review activities e.g. the NoS Integrated Planning Group and the NoSPG annual event. In addition NoSPHN has provided support to work programmes through for example use of Public Health related tools developed from the NoSPG horizon scanning work, the intelligent region, and evaluation tools for example logic modelling. 8

9 NoSPHN collaborations have been particularly valuable during 2014/15 as we work towards a redefined focus, building on previous work ( Intelligent Region ) to deliver on a wider and more holistic planning function, which focuses more on strategic planning for sustainable services in the north. Pip Farman (NoSPHN Network Coordinator) continues to provide direct support alongside public health colleagues from across the region. This support is at times advisory and at others as a core part of the project team. A separate summary of work is provided later in this report under Regional Networks. Regional Workforce Group Chair: NoSPG support: Ralph Roberts (CEO, NHS Shetland) Kerry Russell (Associate Director, NoSPG) This new group was convened early in 2015, in response to a variety of workforce issues. It has close links to the medical workforce agenda, currently being led By Dr Annie Ingram on behalf of the NoS boards, and also the Workforce Planning Learning and Development Network. Proposed work streams include collaborative work on: Workforce intelligence Recruitment / retention Regional Clinical Strategy workforce implications Remote and Rural workforce models Workforce Planning Learning and Development Network The Workforce Planning Learning Network continues to meet bi-monthly to enable sharing of knowledge and ideas across the region. Specific sharing has included the development of the Physician Associate role including placements as part of their course, providing data and information in relation to specific parts of the workforce and the work RRHEAL has supported around the development of competencies for a generic Health and Care Support Worker role. The network has provided a consistent, collective approach to workforce planning using the 6 Steps methodology across the North of Scotland, has supported workforce sustainability, ensuring the provision of a safe and affordable workforce and consistent delivery of safe standards of patient care. The network has also initiated the development of an agreed data set based on Big Questions such as is recruitment truly more challenging in the North of Scotland compared to other 9

10 regions? Further work this year has been in reviewing and updating the Network s Terms of Reference. National Delivery Plan funding for Specialist Children s Services National Delivery Plan (NDP) funding for Specialist Children s Services was introduced in 2008 for 3 years. NDP funding provided significant investment to develop and sustain tertiary and secondary paediatric services. The funding was confirmed as permanent and recurring by the Scottish Government in the summer of Over the course of the past 4 years, there has been a modest build-up of NDP funds which were allocated to the North (due to delays in recruiting to posts or services that were agreed). During early 2014 NoSPG agreed that this non-recurring money should be available to allow for one-off applications for funding. The North of Scotland Child Health Clinical Planning Group (CHCPG) developed and agreed a process whereby staff from the NoS Health Boards were invited to submit bids for projects or temporary posts that reflected the principles of the NDP and showed collaboration amongst Health Boards. Seventeen bids were developed by staff, with support from the NoSPG team, and then considered by an independent panel based on the criteria agreed by NoSPG. The panel made recommendations to the CHCPG as to which bids should be funded and were presented to NoSPG in December However, due to financial constraints experienced by Health Boards a number of questions were raised relating to how these bids compared to Health Board priorities and whether there were more pressing causes. The outcome of further discussion with the NoSPG Executive resulted in the NDP under spend being distributed back to Health Boards rather than funding the bids submitted. Director of Regional Planning - Specific Work During 2014/15 the Director of Regional Planning (DRP) undertook specific national work as part of his remit. This included representing the north, and the Directors of Planning on a number of groups, in particular where there is an imperative for the north: 2020 Vision Capital and Facilities Change Management Plan Programme Board National Patient, Public & Professional Reference Group National Planning Forum Scottish Health Technologies Group National Managed Network Service Project Board National Clinical Decision Support Steering Group Sustainability and 7 Day Services Taskforce Radiotherapy working Group Major Trauma Oversight Group 10

11 Children and Young People s Health Support Group The North DRP continues to work closely with his counterparts from the other 2 regions, meeting on a monthly basis to explore common areas of work and areas where inter regional collaboration might add value. This informal networking reduces duplication and maximises effort for the benefit of all boards in Scotland. 11

12 Regional Networks Managed Clinical Network for Specialist Paediatric Child Protection Clinical Lead: NoSPG support: Dr Joy Mires (Designated Doctor, NHS Tayside) Mrs Anne-Marie Pitt (Child Health Network Manager) Introduction Dr Joy Mires has continued to provide clinical leadership to the network on secondment for 2 PAs per week but reduced to 1 PA for a further two years from December The network has involved all the North of Scotland Health Boards except for NHS Western Isles, who link in with the West of Scotland Child Protection MCN. The availability of clinical leadership has allowed the network to develop into a fully functioning MCN which is multi-disciplinary and includes partner organisations. The first formal MCN Steering Group was held in February 2015, chaired by Dr Mike Bisset, which in the future will include NHS Western Isles in further collaboration as part of the network. Activity Activity on child protection cases and medical examinations has historically been collected differently throughout the region. However the network has agreed a minimum data set for medical examination activity, which has been collected manually by all Health Boards from July 2014 and the following results indicate activity and outcomes of child protection medical examinations within each Health Board. The data (figure 1) shows examination activity for a six month period; data from the last quarter is still being verified. It should be noted that all of NHS Orkney child protection medical examinations are currently carried out by the specialist service within NHS Grampian. Similarly child sexual abuse forensic examinations for NHS Shetland are carried out in NHS Grampian. The two other regional MCNs are awaiting the results of this data collection to consider the benefits of establishing a similar minimum data set across Scotland. 12

13 Figure 1 Numbers of referrals for examination by Board July December Q2 Q3 Q2 Q3 Q2 Q3 Q2 Q3 Grampian Highland Tayside Shetland 48 Number of Single Doctor Examinations by Board Q2 Q3 Q2 Q3 Q2 Q3 Grampian Highland Tayside Total numbers of Joint Paediatric Forensic Medical Examinations 37 Q2 Q paeds 1 paed & 1 FP 2 paeds 1 paed & 1 FP 2 paeds 1 paed & 1 FP In hours Out of hours week Out of hours weekends Total numbers of outcomes of examinations Q2 Q Expenditure 13

14 National Delivery Plan (NDP) revenue funding resources the network, a breakdown of this funding is provided in Table 1. As mentioned above only 1 PA a week of clinical lead time has been required from December Table 1 Post Year 3 Grade/ Band WTE PAs Regional Network Manager ,890 Lead Clinician 2 23,345 Admin support ,725 Sub - Total 55,960 Total 55,960 Quality The network continues to focus on priority areas which have been highlighted by individual Health Boards or indicated as high risks on the risk register. Particular significant developments in the work plan this year has been the collaboration between NHS Grampian and NHS Orkney to establish training in Orkney provided by the lead child protection doctor in NHS Grampian. This will deliver child protection support to clinicians in Orkney and establish closer working relationships that will allow some medical examinations to be carried out by GPs on the islands, thus allowing children and families to be cared for more locally than at present. In addition Health Boards have worked steadily towards manually collecting data in order to provide a regional understanding of child protection medical examinations as described above. Steps have also been taken to begin to address the outcome of a previous audit on the equity of service provision within the region and likewise on an audit on the storage of intimate images where a regional policy is being developed. Members of the network have also continued to engage nationally in the Scottish Government s initiative to review child protection medical services and the development of a national work plan to address sustainability and quality issues. As part of the solution to these issues the Clinical Lead and Network Manager have developed close working relationships and joint initiatives with the other regional child protection MCNs. Consequently a joint national training programme has been developed which includes training on the clinical assessment of child sexual abuse. Plans are in hand for other courses such as advanced court room skills; and national guidance for a number of areas such as the criteria for out of hours medical forensic examinations. As part of the concern for sustainability and quality the Child Protection Complex Cases Forum was established as a pilot collaboration between the two MCNs in NoSPG and SEAT regions. Due to 14

15 retirements throughout the country of very experienced specialists there was a lack of expertise to provide advice on complex cases. The Forum aims to address this problem with the lead specialist from each Health Board meeting virtually for an hour monthly, allowing the specialists to discuss with their peers current complex cases for advice and support. Alongside this a package of mentoring and support has been made available for Forum members. The pilot period ended in December 2014 and was consequently evaluated as very successful. It has consequently been established across the whole of Scotland. Paediatric High Dependency Care Network NoSPG support: Mrs Anne-Marie Pitt (Child Health Network Manager) Significant investment has been provided to support paediatric high dependency care throughout the region, via the National Development Plan for Children s Specialist Services funding (NDP). This has resulted in an increased capacity for children and young people to receive more locally provided care (e.g. establishment of high dependency care beds at Raigmore Hospital in Inverness). A regional network was established in 2012, when it was agreed that the highest priority for coordination through the network was the safe inter-hospital transfer of critically ill children across the north of Scotland. Agreement to include this type of transfer in the wider consideration of secondary transfer risks in the north of Scotland by Specialist Transport Service for Scotland Review (ScotSTAR) has been reached. The network carried out an audit of critical care transfer data during 6 months of 2014, to feed into the business solutions of the review. This data was supplemented with transfer data from a number of Rural General and Community Hospitals, gathered though the Paediatric Unscheduled Care (PuC) Pilot and independently by NHS Shetland who were not involved in the PuC Pilot. A further description of this work is reported further on in this document under Safe and Sustainable Transfer and Retrieval in the North of Scotland. In addition to regional networking there was increasing agreement that quality improvement and training and education in high dependency care should be co-ordinated across Scotland in respect to agreeing national audit, performance measurement indicators and organising training for staff. Consequently an Inter-Regional HDU Group has been established, where the three regional networks are working together to improve paediatric high dependency care in non-tertiary settings i.e. District General Hospitals and Rural General Hospitals. Representatives from the NoSPG network contribute and distribute information from this national group. 15

16 Activity Previously there was no nationally agreed definition of high dependency care and therefore the collection of data within each Health Board was not consistent and accurate activity across the region was unknown. The Inter-Regional Group during the year has agreed a Scottish definition of high dependency care and further work will be required to establish a minimum data set. Expenditure The allocation below show the resources invested in each Health Board from the NDP funding. Recurrent funding for staffing indicated: Table 2 Health Board Recurrent Staff NHS Grampian 95,037 2x Band 5 nurses 0.5WTE Band 6 nurse 0.4WTE Band 4 admin NHS Highland 83,363 2x Band 5 nurses 0.3WTE Band 6 nurse 0.2WTE Band 4 admin NHS Tayside 95,037 2x Band 5 nurses 0.5WTE Band 6 nurse 0.4WTE Band 4 admin NHS Shetland NHS Orkney NoSPG 17,333 NDP allocation previously held by NSD and reallocated in year to regions. Expenditure not confirmed at present. Quality The last national audit of high dependency care was carried out in The recommendations in the audit had previously been assessed within each of the region s Health Boards and learning points implemented. During the last year, however, the Inter-Regional Group has agreed a national audit of the five most common conditions requiring high dependency care. This is currently being carried out within the region and learning discussed when completed. General Surgery for Childhood Network NoSPG support Mrs Anne-Marie Pitt (Child Health Network Manager) NDP investment has been provided to support general surgery for childhood throughout the region via the provision of a paediatric surgeon at the Royal Aberdeen Children s Hospital and extra sessions for general surgeons at Raigmore Hospital. The regional general surgery for childhood network continues to provide services throughout the region and meet together to improve 16

17 communication, the development of agreed patient pathways, regional guidelines and improved training. Activity The NDP investment has enabled the implementation of the following extra clinics and operating lists by paediatric surgeons thus allowing general surgery for childhood to be delivered as locally as possible: Outpatient clinic x 2 / month in Inverness Outpatient clinic x 1/ month in Elgin Outpatient clinic x 4 / year in Shetland Outpatient clinic x 4 / year in Orkney Outpatient urology clinic x 1 / month in Inverness Operative sessions x 2 / month in Inverness Operative sessions x 4 / year in Shetland Expenditure NDP investment in general surgery for childhood has been: Table 3 NHS Grampian NHS Highland Consultant Paediatric Surgeon 1 WTE 117,587 General Surgery for Childhood Sessions 0.4WTE 35,018 Administration 0.5WTE 11,707 Non-Pay 5,624 This revenue sits within boards and is not administered by the regional team. Quality The network organised a multi-disciplinary Education Day in June 2014 which covered discussion of common presentations, began to develop regional protocols and assess how to develop the network structure. The intention is to increase joint working between the visiting paediatric surgeons and local surgeons by encouraging joint clinics and operating lists as well as increasing the teaching from visiting surgeons locally. There is also the willingness to consider rural team members rotating through the Royal Aberdeen Children s Hospital (RACH) and ensuring referrals are made to local services whenever feasible, rather than directly to the RACH. The aim overall is to facilitate the development of local skills in anaesthetic and nursing staff, as well as surgeons, and ensure new appointments in all these disciplines are competent in providing a quality service to children and young people out with tertiary centres. 17

18 Child & Adolescent Mental Health Network Clinical Lead: Regional Network/Service Manager: Dr Sally Bonnar (Consultant, NHS Tayside) Mrs Ruth Masson (NHS Tayside) The key objectives of the Tier 4 Network are: year olds with Tier 4 mental health need receive appropriate and timely care that is equitable across boards, as local as possible as specialist as necessary; Continuity of care through step up and step down care; Peer support and training; and Governance and clinical pathway development in collaboration, as part of an obligate network. These will be achieved through the establishment of an Obligate Network consisting of a new regional 12 bedded inpatient unit (replacing the existing 6 bedded unit) and a Network Team as below: Regional CAMHS Network Manager (1wte) Network Support Officer (1wte temporary) funding for this post has now ended Network Liaison Nurse for Tayside (1wte) Network Liaison Nurse for Highland (1wte) Network Liaison Nurse for Grampian, Shetland and Orkney (1wte) Advanced Nurse Practitioner (1wte) Regional CAMHS Network Consultant (0.5) Recruitment to The Network Team was completed in September The new regional in-patient unit was finished on schedule with the keys being handed over on March 6th 2015 and existing patients transferring to the new premises on 7th April All staff has had the opportunity to be involved in team development, training and fitting out the new facility, in house training was completed on 8th May. The Network have been working across the North of Scotland to establish consistent data reporting for all Tier 4 patients as well as working nationally with SEAT and the West of Scotland to develop a national ISD database for Tier 4 patients. This work is driven by the Network Support Officer who has provided the following data: 18

19 Admission to the YPU for young people across the NoS: Table 4 INPATIENT UNIT TOTAL Admission YPU, Dundee 16 2 (498) a 1 (102) NHSG NHSH NHSO NHSS NHST TOTAL BED DAYS c 0 1 (53) 12 (1550) 2203 Adult MH Ward (571) 2 (15) 0 1 (16) (641) b YPU, Edinburgh 3 2 (5) (7) 12 Huntercombe 21 7 (715) 6 (1474) (455) 2644 Skye House (34) 34 Paediatric Ward 18 2 (6) 10 (120) 0 1 (24) 5 (59) 185 General Ward 11 7 (101) 2 (13) 1 (13) TOTAL (1896) 21 (1724) 1 (13) 3 (93) 40 (2746) 6448 a. The numbers displayed in ( ) are total bed days for the number of patients admitted. These figures are prior to the unit becoming a regional service. b. 422 bed days were due to two patients that had special arrangements due to their level of risk. c. To capture total bed days from 1st April st March 2015 the totals above include admissions that overlap and These figures were collected in order to compare number of patients admitted and length of bed days associated. There is evidence to suggest that where there are dedicated community Tier 4 services the length of admission is reduced. NHS Tayside has the largest dedicated Tier 4 community service, followed by NHS Grampian. NHS Highland has very limited Tier 4 community services. Shetland and Orkney manage their Tier 4 work within their generic CAMHS teams. It should be noted that areas with a large rural population are faced with additional challenges when developing Tier 4 community services and that all areas support Tier 4 community care within the generic CAMHS teams. 19

20 Waiting Times Tier 4 patients will have out-patient CAMHS professionals involved, due to the level of clinical need they will be prioritised for urgent appointments so do not have a lengthy wait for treatment. The in-patient unit is measured as part of the Medicine Directorate within NHS Tayside, which has a 12 week target of referral to treatment, which has not been breached over the last year. Budget Table 5 Actual Direct Costs 2014/2015 Young Persons Unit CAMHs Network Total Medical & Dental 155,196 71, ,949 Nursing & Midwifery 853, ,753 1,020,686 Allied Health Professionals 117, ,965 Other Therapeutic 40, ,609 Admin & Clerical 38,046 13,793 51,839 Total Pay 1,205, ,299 1,458,048 Drugs 4, ,859 Equipment ,020 Other Admin Supplies 1,847 14,383 16,230 Hotel Services Property Other Supplies ,224 90,869 Total Non Pay 8, , ,699 Income (273,087) Grand Total 1,214, ,170 1,298,660 The above details the total of direct costs incurred across the Young Persons' Unit & CAMHs Network. The income represents the share of costs recovered from other NoS Boards associated with the full cost of CAMHs network and the additional costs incurred in moving forward with the expansion of the existing YPU. Priorities for Developing the strategic role for the Network Team Embedding the governance strategy into the Network Enhancing the provision of consultation for Tier 4 patient across the Network Building enhanced working relationships with the new regional inpatient unit Reporting data collected from the Integrated Care Pathway Developing research relevant to the Network 20

21 Achievements The Network has developed monthly Clinical Governance meetings held in Tayside with representation from the multidisciplinary team and the Network Liaison Nurses, this Group has developed a reporting scorecard and action plan based around the benefits realisation and is gathering data to populate the documents. A paper outlining the structure for governance has been submitted to and agreed by the project board. Ongoing work between the Steering Group, the North of Scotland Planning Group and NHS Tayside will determine the process for assurance around governance. The consultant for the network has been working with the network staff to provide consultation and second opinions for patients referred to the inpatient unit. All network staff support outpatient services who work with young people with Tier 4 need. The role of the Network Liaison Nurses has developed over the last year, with the increase in beds for the NoS they have been focussing on education, prevention of admission and transitions into and out of hospital. During this Year 1 Network Liaison Nurse left the Network, the post was vacant from 1 st March till 10 th June. Data gathering has continued over this year and a report was presented at A PDP event for the North of Scotland on 25 th September The Network Support Officer post terminated in February, there is scope for the band 5 Admin manager to take up the data collection. However, they have been heavily involved in the setting up of new systems for the new unit and have been covering sickness which has hindered their ability to continue the data analysis. A proposal has been submitted to the Scottish Government for a part time data coordinator. The Consultant in the Network has a special interest in research and is developing a research group to take projects forward. They have recently taken on the role of Principal Investigator for the CostED study that is looking at the cost effectiveness of treatments for anorexia nervosa. 21

22 North of Scotland Oral and Dental Health Following the retirement of Ray Watkins the clinical leadership of this network now sits with Dr Jonathan Iloya, in his capacity as NHS Grampian's Consultant in Dental Public Health. The new Chair of the network is yet to be agreed. The project manager post supporting this network has remained vacant for the year but Keith Farrer, Programme Manager, has provided some support. The network consists of the following MCNs and groups: Orthodontics Restorative Dentistry Oral and Maxillofacial Surgery (OMFS) These networks aim to provide a single service across the north (excluding Tayside) by employing joint network posts, collecting robust standardised data and reducing variation of access. Orthodontic Network NoSPG support: Regional Project Manager - vacant Mr. Keith Farrer (Regional Programme Manager) Activity for Orthodontics has remains relatively static over the last 3 years throughout the North. Benchmarking across the region has shown that new activity for Orthodontics remains between 3 and 7 per 1000 population, which is broadly in line with previous year s activity and national benchmarking. Over the year the network has been progressing joint guidelines and referral guidance for primary care. Restorative Dentistry Network NoSPG support: Mr. Keith Farrer (Regional Programme Manager) The restorative dentistry service is in its 2nd year of existence. This year has seen successful recruitment to the 2nd North of Scotland Restorative Dentistry post. The network has also been developing training plans to support provision of community based restorative dentistry. There were significant challenges to aspects of restorative dentistry due to technical problems in relation to decontamination of equipment. This has now been resolved and allows the network to regain normal functions. 22

23 Oral and Maxillofacial Surgery (OMFS) Network NoSPG support: Mr. Keith Farrer (Regional Programme Manager) The OMFS specialist service in the North (excluding Tayside) is provided through a network arrangement between NHS Highland and NHS Grampian. There remain acute workforce issues in relation to Consultant recruitment in both NHS Highland and NHS Grampian. Despite numerous recruitment attempts the North of Scotland has not attracted any interest in the vacant posts - this is compounded by a shortage of OMFS consultants nationally. Some patients requiring urgent complex surgery are being treated out with the North of Scotland and there is a growing waiting list for non-urgent cases. Due to the severity of the challenge of providing a OMFS surgical service in the North, there is a national group that has been set up to examine future service provision across Scotland. North of Scotland Paediatric Gastroenterology, Hepatology and Nutrition Network (NOSPGHANN) Clinical Lead: Dr. Michael Bisset (Consultant Gastroenterologist, NHS Grampian) NoSPG support: Mrs. Carolyn Duncan (Child Health Network Manager) The North of Scotland Paediatric Gastroenterology, Hepatology and Nutrition Network (NOSPGHANN) has been in existence since 2003 however the network was set up more formally over 4 years ago following investment from the National Delivery Plan from Clinicians support children and young people with problems of the gastrointestinal tract, the liver and complex nutritional issues across 5 North of Scotland Health Boards. Many of these children have complex health issues and rely on network clinicians to support them. Multi-disciplinary teams are based in Royal Aberdeen Children s Hospital, Tayside Children s Hospital, Dundee and Raigmore Hospital, Inverness. Staff work in a collaborative environment across health board boundaries and are proud of the excellent team working, communication and relationships that have been built up across the region over the past 11 years. They continue to drive up standards and to ensure they provide consistency of care across the North of Scotland whilst working in partnership with patients and families to enable them to better manage their conditions. Provision of a highly trained workforce continues to be very important and the network encourages staff training and education through formal and informal educational opportunities, case discussions and cross boundary working. The network has experienced a temporary reduction in staffing during the year in dietetics and psychology due to maternity leave absences however where possible partial cover has been provided. 23

24 The appointment of a third Consultant in RACH has proved a great benefit to the network and monthly clinics have also been undertaken in Elgin and twice yearly in Shetland and the new biologics and genetics and feeding clinics have been a very positive asset for patients and families. Another development which has proven very successful has been the appointment in August 2014 of a part-time Clinical Associate in Applied Psychology at Ninewells. Discussions over a period of months with the CAMHs service resulted in 1 day per week dedicated psychology funding for gastro from NDP being used to enable 1:1 direct clinical work with families and close liaison with the gastro team at a weekly clinic. Typical referral reasons include chronic pain, adjustment, anxiety and difficulties with adherence to their medical regimen. Due to numbers of chronically ill gastro & hepatology patients continuing to rise year on year (up to a 100% increase seen in Aberdeen, Dundee and Inverness over the last 5 years) many with Inflammatory Bowel Disease (IBD) are now on biologics therapies which are very time consuming for professionals to administer. There is an increasing need for endoscopy procedures, which are carried out in Aberdeen, Dundee and Inverness operating theatres. Numbers dictate that there is now a need to hold an additional theatre list per month in Ninewells and where theatre capacity allows, additional theatre sessions have been able to be undertaken by Consultant staff so that children do not have to travel out with their home Board. Strong links and collaboration with paediatric surgeon colleagues continues across the region meaning they can often carry out endoscopy or surgical procedures for network patients in Inverness and Shetland if urgently required. Endoscopy figures for procedures undertaken in 2014 are: Aberdeen 181 (an increase of 19%) Dundee 170 (an increase of 132%) Network staff worked hard to collect and submit data in the UK IBD audit during The first round of the UK IBD audit took place in 2006 and examined in-patient care of with Inflammatory Bowel Disease at each participating site and the organisation and structure of IBD services. Paediatric services were included in round 2, and the safe use of biological therapies and inpatient experiences were added in round 3. The audit has helped to improve IBD services and to deliver higher quality care nationally and locally. There remains a gap in having a fit-for-purpose data collection system for the network and for other North of Scotland child health networks however discussions are ongoing at the NoS e-health Leads. In the meantime a network data collection template was agreed in Spring 2015 and activity data will start to be collected from April

25 It has been an extremely busy year for the multi-disciplinary teams however the work has been carried out by a flexible workforce and the network is well positioned to take the network forward positively. The excellent team collaborations across the north of Scotland continue to ensure provision of safe and sustainable services for patients. North East Scotland Child & Adolescent Neurology Network (NeSCANN) Clinical Lead: Dr. Martin Kirkpatrick (Consultant Neurologist, NHS Tayside) NoSPG support: Mrs. Carolyn Duncan (Child Health Network Manager) Over the past year services have been delivered and enhanced by the dedication and collaboration of the network s multi-disciplinary teams of tertiary and secondary care clinicians across 5 north Health Board areas, supporting children with epilepsy, neurological and neurodisability conditions. The network is committed to ensuring the sustainability of the network in providing patients and families with patient-centred, safe, effective, efficient, timely equitable access to services. Clinicians collaborate across health board boundaries on a daily basis to deliver the best quality care as close to patients home as possible. Like NoSPGHANN (North of Scotland Paediatric Gastroenterology, Hepatology and Nutrition Network), NeSCANN has been in existence for the past 11 years and also received investment from the National Delivery Plan from Multi-disciplinary teams of clinicians involved in NeSCANN are based in Royal Aberdeen Children s Hospital, Tayside Children s Hospital, Dundee and Raigmore Hospital, Inverness. It is the aim of network staff to continually make improvements to the way care is delivered to patients and families so that standards and the best quality care are consistent across the region. At the same time clinicians from each of the centres work in partnership with families on a daily basis to enable them to better manage their child s condition. NeSCANN is committed to ensuring a highly skilled and trained workforce and again during the year a large number of learning and educational opportunities were provided. An excellent network study day incorporating topics on neurogenetics and neuromuscular conditions was held in September in Aberdeen. Professional support is regularly available by way of formal and informal training opportunities and case discussions. Monthly multi-disciplinary meetings take place in the 3 main centres providing teaching and education sessions, i.e. Brainwave (Ninewells) now available across the region by VC Neurology Open Day (Royal Aberdeen Children s Hospital) 25

26 Raigmore Hospital, Inverness lunchtime sessions alongside the visiting Consultant Neurologist clinics. In March, a CHaT (Childhood Headache Training) course run by the British Paediatric Neurology Association was held in the Suttie Centre, Aberdeen with several network clinicians providing the teaching. Network clinicians are also involved in teaching the Paediatric Epilepsy Training (PET) courses both in the UK and internationally. There continues to be close links by network clinicians with the Scottish Paediatric Epilepsy Network (SPEN) and the Scottish Muscle Network on topics such as education and training, audit, road shows and family days. Dr Kirkpatrick continues to attend the Scottish Paediatric Epilepsy Surgery MDT on behalf of NoS patients who are being discussed for potential surgery to improve their epilepsy. Good progress was made during the year on the network work plan. There have been positive developments in the delivery of epilepsy clinics in Dr Gray s Elgin, the ITB service (Intrathecal Baclofen), neuropsychology involvement in NHS standards for paediatric brain injury, care pathways and audits. A fit-for-purpose data collection system and accompanying data officer support remain as gaps for the network (as well as for other regional paediatric networks). It has been recognised for a number of years that there could be clinical governance issues at times regarding access to patient information and the ability to make clinical decisions on patients outwith their home Board. NeSCANN clinicians have continued to participate in the national Epilepsy 12 audit, second round - 3 audit units in Aberdeen, Dundee and Inverness have contributed. The results for the performance indicators demonstrate that NeSCANN fairs well in comparison to the rest of the UK and in many of the 12 performance indicators the network is at the top of the range of data results. The network has had another extremely busy year. Cross-boundary working brings many challenges however multi-disciplinary teams of conscientious, hardworking network staff continue to deliver the best quality care and service as close to patients homes as possible. NeSCANN will continue to develop services where practically possible, to ensure a highly skilled workforce and to build on the very good collaborative work that has been carried out across the region over the past 11 years. North of Scotland Paediatric Respiratory Network Clinical Lead: NoSPG support: Dr. Jonathan McCormick (Consultant in Paediatric Respiratory Medicine, NHS Tayside) Mrs Carolyn Duncan (Child Health Network Manager) 26

27 The North of Scotland Paediatric Respiratory Network delivers specialist inpatient and outpatient care including the diagnostic testing and monitoring of respiratory patients across the 5 NHS boards in the North of Scotland. Tertiary and secondary care multi-disciplinary clinicians work collaboratively to deliver, to develop, and to sustain services for children with respiratory conditions as close to their homes as possible. The NOSPRN has helped link the teams delivering these services with the aim of providing mutual support and further professional development for the benefit of patients. In 2014, the network continued collaborative working to harmonise patient protocols and patient information leaflets, with small groups of individuals tackling different projects. The possibility of developing a third Scottish paediatric ventilation initiation centre in Aberdeen was explored, but staff and patients in Dundee and Inverness were content with current service provision from Edinburgh and Glasgow. Specialist visiting clinics were run in Portree (CF only), Raigmore (CF and Respiratory), Orkney (Respiratory) and Shetland (Respiratory) with respiratory clinics continuing in Dundee, Aberdeen, Elgin and Perth. The network has endeavoured to maintain lay representation at meetings and now has input from British Lung Foundation Scotland. National Delivery Plan (NDP) recurring funding is embedded in existing paediatric services for complex respiratory and CF patients in Aberdeen, Dundee and Inverness. Staffing challenges were greater in 2014 than in previous years, due to absences and departures for career progression, sick leave, maternity leave, and difficulties recruiting to vacancies. There was additional pressure on CF teams with a significant increase in newly diagnosed babies through in all areas. However, we welcomed a number of new appointees to positions within the network in permanent and temporary positions, which helped maintain services for patients. The advantages of the NOSPRN include enhanced training opportunities for staff, more efficient use of resources, an increased capacity for service delivery, and the management of complex patients resulting in improved services for children with respiratory conditions. A successful CF Away Day was run in Aberdeen attended by the multidisciplinary teams from the three major centres. The integration of teams through shared working in clinics, or through collaborative peer educational initiatives via videoconference such as the Complex Respiratory Cases meeting, CF Annual Review meetings, or network respiratory teaching has helped to negate barriers and promote professional support amongst all grades of staff who might previously have worked in isolation. 27