NATIONAL PLANNING FORUM

Transcription

1 Meeting: NoSPG Date: 17 th December 2014 NPF Item: 86/14 (i) NATIONAL PLANNING FORUM Date: Thursday, 25 September 2014 Time: :00 Venue: Scottish Health Service Centre, Edinburgh NOTE OF MEETING Present Michael Kellet Richard Carey Robert Stevenson Ian Ritchie Harpreet Kohli Allan Gunnin g Irene McGonnigle Janette Fraser Catriona Renfrew Deirdre Evans Rachel Green Catherine Calderwood Chris Roberts Craig Bell Vicky Freeman Elizabeth Porterfield Alex McMahon James Stevenson Colin Sloey Jacqui Simpson Jim Cannon Donna Smith Chair, Scottish Government The Quality Unit Co-chair, NHS Grampian / Board Chief Executives NHS Forth Valley Scottish Academy of Medical Royal Colleges NHS Lanarkshire / Directors of Public Health NHS Ayrshire & Arran NHS Fife West of Scotland Planning Group NHS Greater Glasgow & Clyde / Directors of Planning NHS National Specialist & Screening Services Directorate NHS GGC / Scottish Association of Medical Directors SG Senior Medical Officer SG Planning & Quality Division SG National Planning Manager NHS Dumfries & Galloway SG Head of Strategic Planning & Clinical Priorities NHS Lothian Executive Support to NHS Board Chief Executives Group NHS Lanarkshire South East And Tayside Regional Planning Group North of Scotland Planning Group NHS Highland Videoconference Brian Kelly Mark McEwan NHS Tayside NHS Grampian In attendance Frances Elliot SG Deputy Chief Medical Officer (for item 3.4) 1. WELCOME AND APOLOGIES Page 1 of 7

2 1. The chair welcomed members to the meeting. Apologies had been received from: Elaine Mead, Caroline Selkirk (Brian Kelly deputising), Sara Davies, Jennifer Armstrong (Rachel Green deputising), Maggie Waterston, and Susan Myles. 2. MINUTES OF 26 JUNE MEETING Paper (14) Subject to taking account of comments on robot-assisted surgery, members were content that paper (14) 21, was an accurate record of the meeting held on 26 June. REFERENDUM RESULT 3. The Chair noted the result in the referendum on independence, and the clear message from Scottish Ministers that the excellent work of the NHS should continue. Ministers considered that the result provided a strong mandate for change, and NPF would continue to work collectively to tackle the challenges going forward. 3 DISCUSSION ITEMS 3.1 Move from open to laparoscopic prostatectomy Paper (14) It had been a year since NHS Boards were asked to begin to plan the move from open to laparoscopic surgery, with the expectation being that the procedure would be delivered in a few high-volume centres (min. 50 cases per surgeon per year, and 2 surgeons per centre). 5. At the last NPF meeting in June, the rate of progress with the move from open to minimally invasive surgery for prostate cancer in each region was discussed. Reported progress in the West and North of Scotland had been a particular concern. The Cabinet Secretary had previously indicated that he wished to see faster progress in both regions. NPF agreed that the move was not a matter for debate, having previously been endorsed by NPF, Board Chief Executives and the Cabinet Secretary. It was recognised that open procedures may still be performed where clinically appropriate, though this was expected to be the exception rather than the norm. 6. In the West of Scotland, there had been two meetings of a regional group to consider this issue where there was consensus that minimally-invasive radical prostatectomy should be provided on a single site. Work was under way to explore what could be done to accelerate the 5 year timetable set out in paper NPF requested sight of a robust plan for a faster move to minimally-invasive radical prostatectomy in the West of Scotland for consideration at the next meeting in December. 7. In SEAT, work was under way to finalise pathways, and develop plans to meet projected demand for RP for the NHS Lothian based service, which would see patients being referred from across the region. A date for ceasing open radical prostatectomy (ORP) in the region was expected to be agreed soon. Page 2 of 7

3 8. The North of Scotland, expected to be able to provide laparoscopic radical prostatectomy (LRP) for all suitable patients from across the region in Aberdeen by March There was some discussion of whether all patients would be willing to travel to Aberdeen. It was made clear that all patients should be given an informed choice, including being made aware that open radical prostatectomy (ORP) is considered suboptimal treatment. Discussions about how best to promote treatment options were ongoing with NoS clinicians. 9. The Chair welcomed the progress that had been made to date with these issues. The West and North Regions were requested to provide robust plans for their moves to minimally-invasive surgery, for the December NPF meeting. Plans should make it clear how each region would deliver LRP, including the minimum number of cases of 50 per surgeon and 2 surgeons per centre, as well as the timescales associated with phasing out ORP. Action 1: North and West Regional Planning Directors to provide robust plans on the move from ORP to LRP for December NPF meeting which take account of the need for faster progress and the need for a minimum of 40 to 50 LRP cases per surgeon. 10. Ian Ritchie suggested that, following discussions with Sam McClinton (Grampian) and Craig McElhinney (Forth Valley) the Royal College of Surgeons Edinburgh would be willing to host a meeting to bring together clinicians and lay people to discuss the issues around the move from ORP to LRP. There was agreement that this would be useful. Action 2: Ian Ritchie to arrange an RCSE meeting for clinicians and lay people to discuss the merits of providing patients with an informed choice regarding LRP vs. ORP. 3.2 Robot-Assisted Surgery 11. Catherine Calderwood confirmed that on 19 August, the Cabinet Secretary had announced that Scottish Government would provide funds (of up to 1m) to help purchase a robot, to help establish a robot assisted surgery service in NHS Scotland. The first robot would be located in Aberdeen, with a second robot planned for somewhere in the central belt within 3 years. 12. There was some discussion of the decision to locate the first robot in Aberdeen. It was confirmed that UCAN, the North-East urological cancer charity, had raised significant funds to help purchase a robot assisted surgery system to be based in Aberdeen. 13. A group was being established to develop and implement plans for this new service and to ensure optimal use of the robot(s). The first meeting would take place on 10 October. The group would consider the procurement process, the development of appropriate pathways and referral criteria, training issues and equity of access, to maximise benefit from this new technology for patients from across Scotland. It was not intended that the group revisit the decision to site the first robot in Aberdeen, but the group would be expected to recommend the location of the second robot for the central belt. 14. Initially, robot-assisted surgery would be for prostate cancer, recognising that this was where the evidence was strongest, however,should there be extra capacity, then use of the robot for other procedures might be considered. Page 3 of 7

4 15. There had also been good progress with the development of a research proposal that seeks to build the evidence base for robot assisted surgery. The NPF Robotic Surgery Research Group s proposal had been approved by the Chief Scientist Office (CSO) and would receive 225,000 funding. The research would compare laparoscopic with robotassisted laparoscopic prostatectomy outcomes, including longer term outcomes, including quality of life data collected through patient questionnaires. The research was expected to take 2 years to complete and the new NPF Robot Assisted Surgery Implementation Group (RSIP), would keep track of how the research was progressing. 3.3 Forensic Child and Adolescent Mental Health Services National secure CAMHS facility update 16. Catriona Renfrew confirmed the membership of the implementation group for a national secure CAMHS facility had been established, with meeting due in October Update on Regional CAMHS Work 17. Regional Planning Directors provided an update. In the West, a range of work within the West of Scotland CAMHS network was being taken forward (as set out in paper 14-23). 18. North of Scotland was in a good position with little change from the position reported in June. A new inpatient unit was expected to open next year, and advice was in place for tier 3 and tier 4 CAMHS services. 19. In SEAT, the situation with IPCU care was as reported in June, and this was incorporated in the plan for the new Sick Kids hospital. In terms of specialist advice and support, a regional group was considering this, including what could be learned from experience in England and Wales, with a further meeting planned for end of October. 20. It was agreed that ongoing work on national/regional forensic CAMHS/specialist CAMHS advice should be taken forward by the Directors of Planning Group in collaboration with the Regional Planning Directors. NPF should revisit this work once solutions had been developed. Action 3: Catriona Renfrew/Regional Planning Directors to bring forward solutions on national/regional forensic CAMHS/specialist CAMHS service issues in due course. 3.4 Vaginal Mesh Care Pathways Paper (14) Dr Frances Elliot introduced work carried out to date by the Expert Group on Vaginal Mesh issues (paper 14-24). This issue had received significant media and ministerial attention. The paper proposed a new model of care for those women affected by complications, including the development of regional services, and a specialist national service for certain low-volume mesh procedures. It was noted that consideration was also being given to implementing unique device IDs, to aid in the reporting/management of adverse events. 22. The proposed model required further workup, and it was considered that planning input from NHS boards would be beneficial in developing the model. Page 4 of 7

5 Action 4: Frances Elliot, Catriona Renfrew and Jacqui Simpson to discuss and agree Planning representation/involvement in the work of the expert mesh group. Action 5: Frances Elliot to consider to link with NSD to consider national service development. 3.5 Endometriosis Paper (14) Catherine Calderwood introduced paper (14) 25, which had been prepared by Endometriosis UK and clinicians from NHS Lothian, following their discussions with the Cabinet Secretary - who had indicated his support in principle for the proposed approach. 24. It was noted that endometriosis could be extremely debilitating with loss of quality of life and infertility and was difficult to diagnose. The paper suggested there was increasing evidence that management of complex endometriosis was best managed within a multidisciplinary team (MDT) within a specialist endometriosis centre. Currently, one centre in Scotland had appropriate accreditation from the British Society for Gynaecological Endoscopy (BSGE). Given the volume of cases expected, of around 500 per year, it was proposed that around three additional centres might be needed to meet demand. 25. Deirdre Evans confirmed initial discussions had taken place on the proposal to develop a national managed clinical network for endometriosis and that NSSC was aware as part of its horizon scanning process. However NPF agreed to establish a group to explore the evidence in support of a specialist centre model, and the development of a National Managed Clinical Network (NMCN) for high quality endometriosis services. Catriona Renfrew agreed to canvas Directors of Planning for appropriate planning representation for the group. Action 6: Catherine Calderwood/Secretariat to establish an NPF subgroup to consider the case for the potential reorganisation of endometriosis services. Action 7: Catriona Renfrew to canvas DoPs to nominate a representative for the NPF endometriosis subgroup. 4 UPDATES 4.1 Stocktake of Adult Critical Care Paper (14) Progress with the critical care stocktake was set out in paper It was noted that there had been some delays in receiving returns from Boards, which had inhibited progress with analysis; however most of the data had now been received. It was agreed that outstanding data should be provided by Boards as a matter of urgency. The stocktake report was expected to be ready for discussion at the BCE and NPF meetings in December. Action 8: NHS Boards to provide outstanding critical care stocktake data to SG; and Secretariat to ensure that the stocktake findings are ready for discussion at NPF meeting in December. Page 5 of 7

6 4.2 Major Trauma 27. The Major Trauma Oversight Group had met on 8 September. Good progress had been made in a range of areas, with regional major trauma working groups now well established. Key challenges being addressed included work to : enhance the Scottish Trauma Audit Group audit to improve major trauma data, and inform service improvements, with a business case for developments having been considered by the Clinical Outcomes and Measures for Quality Improvement (COMQI) working group; develop a triage tool and bypass protocols; assess the impact of overtriage on services at major trauma centres to inform capacity planning; and, identify rehabilitation service issues with a view to implementing the agreed major trauma rehabilitation pathway. 4.3 SHTG Workplan Susan Myles Paper (14) The SHTG work plan was noted. 5. HORIZON SCANNING TAVI Year 2 Report from TAVI Review Group 29. The TAVI Review Group (TRG) was due to meet on 5 November to consider the first two years of the operation of the national TAVI service, based at Royal Infirmary Edinburgh. One of the key questions to be considered was whether there was sufficient demand to consider the establishment of a second TAVI centre. The TRG s recommendations would be discussed at NPF in December. Interventional Radiology/TIPSS 30. Through the Hepatology Specialty Advisor report for , Scottish Government had received a request to consider a review of interventional radiology service provision for TIPSS (Transjugular Intrahepatic PortoSystemic Shunts) across Scotland. This would likely include development of treatment pathways. A paper was expected to be ready for consideration at the December NPF meeting. TAGRA Developing the NRAC resource allocation formula 31. At the December meeting, SG Analytical Services Division would present their work on TAGRA, which would explain how the NRAC formula works, and the development work under way. Further presentations NSS-Discovery 32. It was suggested that a presentation on NSS Discovery (the successor to CHKS) would be welcome. Page 6 of 7

7 Action 9: Secretariat to ask ISD to deliver presentation on Discovery software at next NPF meeting in December. 6 ANY OTHER BUSINESS 33. There was no other business. 7 DATES OF NEXT MEETINGS 34. NPF 2014 meeting dates: Thursday 4 December. 35. NPF 2015 meeting dates: All Wednesdays 4 February, 22 April, 24 June, 23 September, 2 December. 36. All meetings start at 13:30, at Scottish Health Service Centre, Edinburgh. The Quality Unit October 2014 Page 7 of 7