CHILDREN AND YOUNG PEOPLE S HEALTH SUPPORT GROUP MINUTES OF MEETING: 21 MARCH 2007 CONFERENCE ROOMS D AND E, ST ANDREW S HOUSE, REGENT ROAD, EDINBURGH

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1 CHILDREN AND YOUNG PEOPLE S HEALTH SUPPORT GROUP MINUTES OF MEETING: 21 MARCH 2007 CONFERENCE ROOMS D AND E, ST ANDREW S HOUSE, REGENT ROAD, EDINBURGH Present: Children and Young People s Health Support Group (CYPHSG) Malcolm Wright, Chair, Chief Executive, NHS Education Scotland (NES) Mary Boyle, NHS Education Scotland (NES) Graham Bryce, Consultant Psychiatrist, NHS Glasgow Charles Clark, Chair, Child Health Commissioners Group Bronwen Cohen, Children in Scotland Zoë Dunhill, Patients Services Director and Community Paediatrician, Royal Hospital for Sick Children, Edinburgh Deirdre Evans, Director, National Services Division (NSD) Mo Grant, Allied Health Professionals Scotland Graham Haddock, Consultant Paediatric Surgeon, Royal Hospital for Sick Children, Yorkhill Hilary Hood, Head of Child Health Allied Health Professional Services, NHS Tayside Marion Marshall, Health Visitor and Staff Side Representative, Primary Care Services, Partnership Forum, Glasgow Don McGillivray, Head of Early Education and Childcare, Scottish Executive Health Department Ray Murphy, Association of Directors of Education in Scotland (ADES) Michael Van Beinum, Royal College of Psychiatrists Emma Witney, Head of Children and Young People s Health Team, NHS Health Scotland Scottish Executive Health Department (SEHD) Rory Farrelly, Nursing Officer, Women and Children John Froggatt, Head, Child and Maternal Health Division Rosie Ilett, Integrated Children s Services Morgan Jamieson, National Clinical Lead for Children and Young People s Health in Scotland Cathy Magee, National Demonstrations Project Officer, Health Improvement Chris Ridley, Integrated Children s Services, Child and Maternal Health Division Mary Sloan, Policy Officer, Child and Maternal Health Division Robert Stevenson, Head of Children and Young People s Specialist Services Team In Attendance: Kay Barton, Head of Health Improvement Strategy and Support, Scottish Executive Health Department Apologies: Children and Young People s Health Support Group Safaa Baxter, Association of Directors of Social Work Jennifer Bennison, Royal College of General Practitioners Mark Bevan, Community Care Providers Michael Bisset, Consultant Paediatrician, Royal Aberdeen Hospital for Sick Children Linda de Caestecker, Faculty of Public Health 1

2 Gavin Fergie, Professional Officer for Scotland, Community Practitioners and Health Visitors Association Stewart Forsyth, (Vice Chair), Medical Director, NHS Tayside Acute Services Division Annie Ingram, North of Scotland Planning Group Janice MacKenzie, Principal Nurse and Directorate Manager, Women, Children and Associated Services, NHS Lothian Adrian Margerison, Scottish Officer, Royal College of Paediatrics and Child Health Fiona Mercer, West of Scotland Regional Planning Group Julie Metcalfe, British Psychological Society Shirley Rogers, Scottish Ambulance Service Caroline Selkirk, Director of Innovation and Change, NHS Tayside Jan Warner, Director, Performance Assessment and Practice Development, NHS Quality Improvement Scotland (QIS) John Wilson, SEAT Regional Planning Group George Youngson, Consultant Paediatric Surgeon, NHS Grampian Scottish Executive Health Department (SEHD) Ian Bashford, Senior Medical Officer, Women and Children s Services Jacqui Lunday, Allied Health Professions Margaret McGuire, Nursing Officer, Women and Children s Services ITEM 1: WELCOME AND APOLOGIES 1. Malcolm Wright began by saying the meeting would begin with short presentations to update the Group on the progress of the current workstreams. The future workplan would be discussed with the aim of bringing forward a draft outline for discussion in June. Malcolm went on to welcome Kay Barton, Head of Health Improvement Strategy and Support of the Scottish Executive Health Department. He also welcomed John Froggatt who has taken over as Head of the Child and Maternal Health Division from Rosie Ilett, who will now be leading on the health aspects of integrated children s services. ITEM 2: PRESENTATIONS 2.1: Action Framework 2. Malcolm paid tribute to the huge amount of work undertaken to produce Delivering a Healthy Future, in particular to Robert Stevenson and Morgan Jamieson. He reminded the Group that this document contained the key deliverables for the children s workstream of Delivering for Health. He also reminded the meeting that the analysis report on the comments received during the consultation period were available on the Web. 3. Morgan confirmed Delivering a Healthy Future had been issued in February but said there may have been problems with the distribution and that would be investigated. He went on to say consideration must now be given on how to monitor implementation of the Action Framework. He would discuss this with the Child and Maternal Health Division perhaps the first step could be to ask for initial feedback from NHS Boards then set up monitoring systems with the Boards and Regions. 4. The meeting agreed delivery implementation was very important. 2

3 2.2 National Steering Group For Specialist Children s Services 5. Malcolm reported that this Steering Group was reviewing 20+ strands of work which would be fed into the National Delivery Plan, due for consultation in the autumn. He went on to say that Sub-Group leads had been asked to submit interim reports by the end of March and that they had been asked to include workforce, training and resources issues in these reports. It would be challenging to pull all these together in one coherent plan. Economic consequences, costs and sustainability of all the strands would be considered. A small group would meet in April to look at the interim reports and to start drafting the Delivery Plan an outline had been drawn up. 6. Malcolm went on to report the work of the sub-groups was progressing, at varying stages. The Cancer review was proving to be challenging: age appropriate care was progressing well: dermatology, haematology and rheumatology were not progressing quite so well. The strategy paper on Managed Clinical Networks was nearing completion and would be issued through a Health Department letter shortly. Although Telemedicine had been included on the Steering Group s workplan, the Centre for Telehealth had agreed to the setting up of a paediatric telemedicine Network, therefore the Steering Group would keep a watching brief on this. The Workforce Sub-Group was progressing slowly due to the lack of available data a questionnaire had been issued, the results of which would hopefully create a baseline of the specialist workforce. 7. The MCN for Metabolic Services had been approved and Malcolm thanked all concerned. Discussions on Paediatric Intensive Care were ongoing. It would be commissioned as a national service from April this year until 31 March It would then be delivered by Boards as a single service but on 2 sites. Regarding the Neurosciences review, Malcolm had spoken with its Chair, John Glennie, who was content for the National Steering Group to provide advice on child health aspects. There were concerns over the different timescales this review was working towards compared with the National Steering Group s timeline. Action: Malcolm Wright to meet with the Scottish Executive Health Department to consider how best to link the Neurosciences review work into the National Steering Group s work. 8. Robert Stevenson reported that a lot had been achieved since the Steering Group s first meeting in May A template for the interim reports had been identified which would show up any hotspots. Metabolic Services had been fast-tracked and a revised timescale had been drawn up for the cancer review work had been commissioned to underpin these reviews. Robert warned the Group should not underestimate the amount of work which was required but that it had a great opportunity to influence change and he looked forward to its continuing support. 9. The fairly imminent retiral of academic paediatricians in Aberdeen, Dundee and Edinburgh, and other senior academics who provided key specialist tertiary services was highlighted as a hotspot. Many specialist children s services rely on academically funded posts. Action: highlight this possible future problem to Annie Ingram. 3

4 10. Malcolm summed up by saying the Group should not underestimate the scale and complexity of planning sustainable services which had cost, political and workforce implications. 2.3 Integrated Children s Services 11. Rosie Ilett began by pointing out that the structural changes within the Scottish Executive Health Department s Child and Maternal Health Division would strengthen the focus on integrated children s services. She went on to remind the Group that Getting it Right for Every Child began as a review of the children s hearing system but that it had widened its remit to look at how best to provide more integrated services for all children. A Getting it Right implementation plan had been issued in Pathfinder pilot projects had been set up Highland was a geographical project: a Project Board was in place which was establishing new ways of working. Children would be linked into the system in April/May. 4 domestic abuse Pathfinders were in the early stages of being set up in Clydebank, Dumfries, Falkirk and Edinburgh. 12. Issues which had been raised included Information Technology and information sharing these were being looked at both nationally and locally. Key policy initiatives had to be linked in. The Education Department was funding a 2-year secondment, to be based in the Health Department, to support Getting it Right development in the Health Department and in the service. 13. Getting it Right was a natural progression of many policies. Rosie suggested the Group had a key role to support its implementation and to link in primary, secondary and tertiary care. She also suggested Getting it Right should be a standing item for the Group. 14. A draft Children s Services (Scotland) Bill consultation was taking place the closing date for comments was 30 March The comments received so far appeared to be generally supportive. 15. During discussion it was pointed out that: The draft Bill was good regarding the concept of well-being of which health was a strand but had too narrow a definition and it could be strengthened People must understand that NHS Boards have the legal duty to meet the requirements in a child s plan Engagement with a whole range of stakeholders would be required to highlight that this Bill was not just about youth justice Integrated Children s Assessment had not been abandoned Action: Members to submit any comments on the Bill they would like included in a CYPHSG response to Robert Stevenson: the closing date for commenting on the Bill was 30 March. ITEM 2.4: MENTAL HEALTH 16. Malcolm Wright reminded the meeting that Graham Bryce had provided a fairly comprehensive update of the work of HeadsUpScotland, the National Project for Children and Young People s Mental Health, at the last meeting. He had also circulated papers on Infant Mental Health and Primary Mental Health Work. 4

5 17. Graham apologised if members felt he had inundated them with mental health documents but he thought Infant Mental Health was a very important issue. Practice guidance and policy discussion papers had been produced. Anne Clark from HeadsUpScotland had also produced a helpful position paper. The current issues facing children and young people s mental health stemmed from The Mental Health of Children and Young People: a Framework for Promotion, Prevention and Care and the existing health targets. The Executive was committed to implementing the Framework by 2015, HeadsUpScotland was helping local agencies to work together to deliver the Framework. Delivering for Mental Health, which was issued in December 2006, reinforced the commitment to implement the Framework by identifying 2 key delivery milestones that will track progress by 2008 and Many of the milestones in Delivering a Healthy Future also related to the planning and development process, progress against which will also be monitored. 18. Graham reported the current challenges were: Adapting to the new Mental Health Division operating environment since responsibility for child and adolescent mental health had moved there from the Child and Maternal Health Division. Since the last meeting, Graham had received volunteers to join the Steering Group. The role and functions of this Steering Group were being discussed and he hoped the Steering Group would be established before the next CYPHSG meeting in June. Arrangements must be put in place to implement the milestones in Delivering a Healthy Future and in the Delivery Plan for Mental Health to ensure progress of the whole Mental Health Framework to meet the 2015 deadline. Monitoring of implementation had still to be decided perhaps this could be done by the CYPHSG and the Mental Health Division? Maintaining momentum. Clinical services had an important role to play in early intervention. Partnership working with the voluntary sector eg Young Scotland in Mind - would be very important. Child and young people participation was well developed but more work was needed. Some progress had been made, eg on developing the national inpatient service, the regional adolescent service and training, but little headway on workforce. Although investment in the NHS had increased, investment in child and adolescent mental health services had decreased. Child health services are seen as a small specialist part of the mental health agenda, but they provide across-the-board services for 25% of the population. Equity of children and young people s services were needed within adult services. CAMHS needed a higher profile in Boards, regions and local authorities. Glasgow had made a real difference but other areas hadn t as yet. Delivering for Mental Health would draw these issues to the attention of Chief Executives. 19. Malcolm suggested the key points from Graham s presentation were: there had been a lot of progress around planning and commissioning with the publication of Delivering for Mental Health and Delivering a Healthy Future. These now had to be implemented but there were frustrations around workforce and NHS Boards views of CAMHS. 20. During discussion, the following points were raised: Implementation of Delivering for Mental Health and Delivering a Healthy Future would overlap liaison and coordination would be required 5

6 CAMHS was very central to all local commissioning, eg for Looked After Children, child protection, education, health promotion new networks should be developed to bring all this together Integrated CAMHS services are critical Perhaps Mental Health Division colleagues should attend CYPHSG meetings Mental Health Division are unsure as yet how to work with NSD HeadsUpScotland should play an important role but due to organisational and personnel changes, momentum and sustainability were an issue. HeadsUp Scotland is also only planned to run until 2008 HeadsUpScotland should play an important role in implementing Getting it Right for Every Child Action: Malcolm Wright to discuss with John Froggatt how the Child and Maternal Health Division, the CYPHSG and the Mental Health Division can work together. 21. Graham Bryce thanked the CYPHSG for its continued support and Malcolm thanked Graham for his leadership in this area. ITEM 2.5: HEALTH IMPROVEMENT 22. Emma Witney informed the meeting that the health improvement sub-group had been very productive. There had been strong consensus on the focus to be taken. The Sub-Group had been set up in November and had looked at the consultation responses to Delivering a Healthy Future, and had mapped the relevant policy streams using the WHO assessment tool. It had been an active group with intensive meetings and a lot of work done outside the meetings. 23. Task 1 had been to consider the health improvement issues raised in responses to the Delivering a Healthy Future consultation. These suggested the need for a holistic, multiagency approach to child health services with the child at the centre supported by parents and the wider community. The sub-group looked at the rich policy environment eg Delivering for Health, Hall 4, Getting it Right for Every Child etc. 24. Task 2 involved policy mapping which was an extensive and detailed process led by Scottish Executive colleagues. The Group had focused on the WHO priority areas which included mothers and neonates, nutrition, communicable diseases, physical environment, adolescent health, injuries and violence, psychosocial development and mental health. Gaps which had been identified included: identifying and supporting pregnant mothers who were abusing substances; youth facilitation in community health partnerships; confidential and accessible services for children and young people; and support for families with multiple problems. 25. Cathy Magee went on to report that the sub-group had produced a report which contained 3 key recommendations covering a life journey or pathway from pre-conception to early adulthood involving a multi-agency approach with the aim being to improve the mental health and wellbeing of the child and the parents. Recommendation 1: a cohesive approach or framework should be developed to ensure that mothers, fathers and care givers are supported and mentored from the pre-conception stage until the child is in early adulthood. 6

7 Recommendation 2: a framework is developed to improve accessibility to a range of relevant services for young people aged 12 onwards through active and ongoing engagement with them. Recommendation 3: the CYPHSG should engage with SAMH not only to explore the proposed approach to anti-bullying as developed by the Respectme service but also to look at the health improvement agenda for bullying and wider resilience that addresses issues around all inappropriate behaviours (eg domestic abuse, substance abuse, self harm). 26. The underpinning issue was the importance of robust performance management in the Scottish Executive and at Board level to ensure health improvement for children and young people and to ensure vulnerable groups are reached. NHS Health Scotland is reviewing health improvement management and HEAT targets these recommendations should be included in the review. 27. The child should be at the centre of all services, then the parents and carers with better access for vulnerable families to family, social and community support. The outcomes would be: better resilience in young people and a reduction in harmful behaviour eg taking drugs, smoking etc; better coping strategy; improved self-efficacy; improved nutrition. The recommendations could be taken forward by: an identified lead in child health planning; clear triggers for early intervention; core competencies for the workforce; and better engagement with parents. 28. Recommendation 2 puts the young person at the centre with access to support via, eg, friends, family, schools, internet. The recommendation could be taken forward by nominated facilitators to reduce barriers to accessing services. All 3 recommendations focused on a holistic, multi-agency approach and all 3 required further work by the Scottish Executive and the CYPHSG. 29. During discussion it was pointed out: Obesity, dental health etc had not been included in the report because there were already ongoing initiatives the report highlighted gaps in activity The Group looked at areas that needed to be strengthened It was questioned whether the report was strong enough to address the state of childhood in Scotland which had come out badly in the Growing Up in Scotland report Poor outcomes are inter-generational, the trajectory is set in early years so parenting issues are important but parenthood should remain a natural, healthy process there should not be too many policies Hall 4 encouraged Boards to develop a coherent, multi-agency, parenting strategy The Health Improvement Directorate is looking at getting smarter re performance management: it would consider short-term and long-term outcomes. Targets would be about processes rather than high level outcomes The measures/services that make the most difference should be identified The child should be at the centre of services Delivering a Healthy Future provided interesting discussion, it would be important to maintain the momentum Integration is not performance managed properly 7

8 The report needed an Action Plan to be led by the Executive with policy leads developing a coordinated process Action: The mapping exercise, CYPHSG report and recommendations to be written up and submitted to SEHD and WHO. Core Group to discuss the handling of the report and feed back to next meeting. ITEM 2.6: COMMUNITY CHILD HEALTH 30. Malcolm informed the meeting that community child health had been identified at the recent stakeholder events as an issue that required attention. He invited Zoë Dunhill to present to the Group. 31. Zoë began by pointing out that community child health services were affected by many planning policies, eg Delivering a Healthy Future, Hall 4, Getting it Right for Every Child, child protection, the Additional Support for Learning (ASL) Act, redesign of ehealth child health systems. She went on to say some of the problems facing community child health included: the patient journey work had not yet been done; workforce competency issues with joint inspections; young doctors were unwilling to do child protection work; the ASL Act had resulted in a reduced role for paediatricians; and it was difficult to redesign child health systems if the model of care was unknown % of child health services are delivered by community health partnerships. The focus of age appropriate care work is mainly on hospital settings but paediatricians can be treating patients with long term conditions up to the age of 30 transition issues must be addressed. 33. Zoë suggested the CYPHSG should think about: What should a child health service be offering? How should this be measured? What medical, nursing, AHP, other workforce was needed to deliver this model of care? The distribution of work across disciplines may have to change. 34. Regarding Models of Care, Zoë wondered where we were now and what were the drivers. A patient should have a seamless journey from, say, Yorkhill hospital to their home in the Western Isles. According to RCPCH consensus figures, there were 15.4 WTE staff per 100k children in Scotland compared to 16.3 WTE in the West Midlands. The average age of the workforce was around % of the children s community health workforce were women this could have an impact on willingness to do on call duty if they have children of their own. 35. Zoë wondered where child health services would be in 10 years time. Would professionals be answering s 24 hours a day? Would there be an increase in the number of children with complex needs and would there be an increase in the number of these children reaching adulthood? The focus should be on the child s journey in the community community professionals might know children for years. Proper training should be available for paediatricians with a special interest neurodisability paediatricians were in short supply in the UK. Workforce issues were paramount as was clarity on the model of care and standards. 8

9 36. Zoë also wondered if we could be sure that the new MMC trainees would have the right competencies. Experts on child development were needed, public health nursing only received a very small amount of training on this. Clinical psychologists with community paediatric training could pass on their knowledge to community nurses but this was an ageing workforce and this opportunity could be lost soon. 16 week paediatric training was not enough. Sensory disorders needed highly trained doctors. Community paediatricians experienced in behavioural disorders, working with CAMHS, were needed. National pathways for autism had been developed but they weren t yet being met. 37. Zoë suggested regional planning groups should set up networks of care and that a nationally agreed model of care for community child health services, to be used across all Health Board areas, should be developed. 38. During discussion the following points were made: Community paediatricians play an essential role in mental health services, in particular learning disability and Autistic Spectrum Disorder The role of the Allied Health Professionals was also critical but there were workforce pressures AHPs can t be encouraged to develop their role due to workload When planning for centralised specialist services is taking place, consideration must be given to colleagues who will be providing support outwith the centres Workforce planning should be child-centred MMC training is producing a very different product. There is increased pressure on paediatricians to do the work of surgeons, eg the first surgical diagnosis A multi professional workforce was needed In future, there may be no paediatricians with child protection skills Those with sensory impairment needed appropriate support The model of care needs to be explicit about children s nursing ITEM 2.7 PERFORMANCE MANAGEMENT 39. Robert Stevenson provided a summary of the key developments in performance management of children s health services. Delivering a Healthy Future An Action Framework for Children and Young People s Health in Scotland had been published and contained clear actions and milestones, indicating leads who should take these forward. It also emphasised the importance of inter-agency working. The Child and Maternal Health Division would now need to decide how best to ensure it was implemented. He reminded the meeting that the Hall 4 guidance, The Mental Health of Children and Young People: a Framework for Promotion, Prevention and Care and the Emergency Care Framework for Children and Young People in Scotland were also being implemented and should be performance managed. 40. He suggested visits made Boards look at what they were doing and how they were doing them. The first visits made by the Child Health Support Group had perhaps helped to increase investment in child health services. The CYPHSG had suggested that it could undertake further visits alongside QIS. 41. The Local Delivery Plan was the main NHS management tool. Targets must be measurable. The existing waiting time targets, to be implemented by the end of 2007, included: 9

10 9 weeks for diagnostics achievable 18 weeks for outpatient appointment and day case/inpatient these have staffing and resource implications. 42. The aim should be to get children and young people s health services mainstreamed children and young people should be included in waiting time targets. Those waiting for very specialist services weren t included on waiting lists. Health improvement targets were being developed but what does the 10-week target for integrated assessment mean? 43. The joint inspections were throwing up a number of issues, although health issues didn t seem too bad. The key strategic areas being considered were: outcomes; meeting the needs of stakeholders; management; leadership; and capacity for improvement. 44. The key areas for the CYPHSG to consider were: Implementation of the Action Framework and delivery improvements What targets should be included in the Local Delivery Plan guidance? Clarity on the 10-week target for integrated assessment What the impact of joint inspections will be on local systems. 45. During discussion the following points were raised: The waiting time targets were interesting but what was most important for children the time lag to the first consultation or what happened afterwards? Waiting times guidance didn t take account of children s needs, especially those from vulnerable families Do not attends should not be struck off the waiting list the reasons for nonattendance should be investigated could be a child protection issue the general surgery visits were encouraging people who hadn t met before to get together to have a dialogue visits focused minds. Boards ensured everything was in place prior to the visit assessment of joint inspections was taking place some kind of self-assessment, care review could take place in each Board to ensure the Action Framework was implemented. Boards could initiate surveys, encouraging children/parents to take part the QIS inspection format was too long and detailed need to strike a happy medium. 46. Malcolm concluded by expressing the wish to get the joint visits with QIS organised. ITEM 3: FUTURE WORK PLAN 47. Robert Stevenson reminded the meeting that the Group had achieved a lot since the HDL had been issued in 2005: the target for developing the national CAMHS Framework had been met; the Emergency Care Framework had been issued as had Delivering a Healthy Future. The Group had contributed extensively to Delivering for Health including ensuring tertiary paediatrics and child and maternal health workstreams had been included. 48. Robert said future commitments for the Group, as identified in Delivering a Healthy Future, included How to strengthen Providing Care Locally Gearing Primary Care up to meet the needs of Getting it Right for Every Child 10

11 Age Appropriate Care, Hospital Care and Elective Surgery Involving Children and Young People Rolling out the Emergency Care Framework Performance Management and Quality Improvement - the Group had been asked to do specific tasks. Robert reminded the Group that the National Steering Group for Specialist Children s Services was taking forward 20 workstreams, the recommendations from which would be included in the National Delivery Plan. 49. A number of other service areas had been identified through the recent public engagement work as requiring attention: Orthopaedics, ophthalmology, specialist dentistry, Ear, Nose and Throat, Palliative Care Physical disability getting equipment quickly makes a big difference to a child s life Learning disability is CAMHS meeting the requirements for AHD? Community child health Neurodisability. 50. During discussion, the following points were raised: The key priority areas for the CYPHSG should be: implementation/delivery of Delivering a Healthy Future, the Emergency Care Framework and the Hall 4 guidance; CAMHS; integrated children s services; health improvement; community health; physical and learning disability; early years and supporting families CYPHSG workstreams should be re-badged to line up with Delivering for Health workstreams - using the same terminology as adult services would make it easier to access funding, eg call emergency care unplanned services Children s services were often planned at the end of adult service planning The Scottish Executive Health Department s Workforce Division had assisted the Group in looking at some services eg Paediatric Intensive Care which required 78 extra nurses to implement Phase 1 Crisis management was unavoidable but areas needing quick action could be identified. Managing Medical Careers can channel people into crisis areas The Interim Reports from the Specialist Children s Services work should include risk assessment taking into account impending retirals. Quick work can/should be done for physical/learning/neuro disability. 51. The Group also considered if there was an ongoing role for the CYPHSG. It was suggested that if the Group were to disband children could disappear from the agenda. The CYPHSG was a central Group to which other groups, eg the Child Health Commissioners, the Hall 4 Implementation Network, could feed into. It was also suggested the CYPHSG was useful in providing dialogue with Scottish Executive colleagues and with Scottish Ministers. The visits had been valued. 52. Malcolm summed up this item by saying it was good to get a range of experts together to discuss the future of child health services. Reporting to and advising Ministers gave it credibility. The CYPHSG had access to Ministers and was able to discuss issues with them as they arose. Malcolm suggested that the future work programme should focus on the 11

12 delivery of existing policies; provide peer support, influence/develop policies; connect with front-line staff and the Scottish Executive. Action: review this discussion and produce a concise work programme. ITEM 4: MINUTES OF PREVIOUS MEETING 53. The minutes of the previous meeting which took place on 10 November were agreed. ITEM 5: MATTERS ARISING 54. Mo Grant had undertaken to invite Allied Health Professional colleagues to join the Health Improvement sub-group this she had done. Charles Clark had undertaken to invite Public Health colleagues to join this sub-group too this had also been done. ITEM 6: DATE OF NEXT MEETING 55. The next meeting will take place on 18 June 2007, Conference Rooms C, D and E, St Andrew s House, Edinburgh. 12