NORTH OF SCOTLAND PLANNING GROUP Cardiac Services Sub Group Minute of virtual meeting held on 11 th September 2012. NORTH OF SCOTLAND PLANNING GROUP APPROVED Aberdeen: Ninewells: Inverness: Orkney: NoSPG: Mr Hussein El Shafei, Consultant Cardiothoracic Surgeon, NHS Grampian (Chair) Mr Deepak Garg, Consultant Cardiologist, NHS Grampian Ms Sandra Hay, Regional Project Manager, North of Scotland Planning Group Mr Malcolm Metcalfe, Consultant Cardiologist, NHS Grampian Ms Claire Nicholl, Unit Operational Manager (Cardiothoracic and Cardiology), NHS Grampian Ms Vanessa Turner, Finance Manager, NHS Grampian Ms Jillian Galloway, Clinical Services Manager Urgent Care, NHS Tayside Prof Stuart Pringle, Consultant Cardiologist/Clinical Lead, NHS Tayside (from item xx/12) Mr Charles Bloe, Lead Nurse, NHS Highland Mr Peter Clarkson, Consultant Cardiologist, NHS Highland Ms Morag McLeay, (title), NHS Highland Mrs Sue Menzies, Long Term Conditions Manager, NHS Highland Ms Amanda Manson, Heart Failure Specialist Nurse, NHS Orkney Michelle Manzie, Primary Care Manager, NHS Orkney Mrs Karen Wing, Team Secretary, North of Scotland Planning Group 11/12 Apologies Apologies were received from Ms Elaine Garman, Public Health Lead, Cardiac Sub Group, NHS Highland; Mr Mark Houliston, MCN Clinical Lead, NHS Grampian; Mr Ken Mitchell, Programme Manager, North of Scotland Planning Group; Mr Allan Reid, Head of A&E Services, Scottish Ambulance Service; and Ms Roseanne Urquhart, Head of Healthcare Strategy, NHS Highland. Dr Yacoub, NHS Shetland was unable to join the meeting due to technical difficulties. 12/12 Minute of the meeting held on 6 th March 2012 The minute was accepted as an accurate record of the meeting. 13/12 Matters Arising i) Membership and Role and Remit Miss Hay reminded members that the draft document had been agreed in principle at the previous meeting and that the relevant amendments had been made. She asked for any further comments prior to getting this signed off by the North of Scotland Integrated Planning Group (IPG) and NoSPG Executive. Ms Galloway suggested and it was agreed that the remit, para 3 bullet point 1, should include provision of managerial advice. It was also noted that there was no finance representative on the group. Although Mr Norton had previously represented the NoS, members felt that finance representation was required from each Board. Ms Turner agreed to write to Boards requesting nominations. VT ii) Website Development
Miss Hay advised that the NoSPG website was currently being reviewed and that Cardiac pages would be included as part of the revamp. She said that the site was public facing and would provide information for both patients and staff. Members were asked to comment on what they would want to see on the site. Suggestions included: Information and guidance on available services across the region; Staffing profiles; A repository for minutes, activity, population and financial information (password protected); Links to local cardiology/local MCN websites; and Link to NHS Highland educational resource. Any further suggestions should be submitted to Miss Hay. ALL 14/12 Optimal Reperfusion Therapy (ORT) i) Pathways progress Dr Clarkson commented that some progress had been made within NHS Highland in relation to the PPCI process. He said that there were two interventionalists providing a Mon Fri 9 5 service and that this would not be likely to expand in the near future. He went on to say that whilst there may be capacity for west Moray patient, this would depend on laboratory capacity and financial flow from NHS Grampian. In general, he reported that the Highland service was going well and was of a high quality. Dr Garg asked whether it may be possible to trial contact with Raigmore for patients taken to Dr Grays where it was too late to thrombolyse. Dr Clarkson cautioned that management buy in and financial flows required to be in place first. Ms Galloway said that cardiology activity as a whole had increased within NHS Tayside and in turn, an increase had been seen in PPCI. She added that the service was going extremely well but that there was no spare capacity to consider taking patients from other areas. Ms Manson explained that the Orkney thrombolysis pathway was over ten years old and that she had asked Dr Metcalfe to assist in the updating. Dr Metcalfe said that a drip and ship policy was the optimal way to treat island patients and that there were approximately six per year. Dr Garg agreed to update the policy and liaise with Ms Manson. It was noted that discussion would be required with the Scottish Ambulance Service regarding transport, given that air ambulance was one of the biggest issues for NHS Orkney. DG Dr Metcalfe suggested that a similar policy should be implemented within NHS Shetland. ii) West Moray position Mr El Shafei said that a meeting had taken place in Elgin in May 2012 to begin to discuss ORT in relation to west Moray patients. Dr Garg said that he had drafted a paper although further discussion was required with colleagues in NHS Highland regarding the current and future service for Moray patients. Demand was estimated at 15 patients per year. The need for a robust pathway was noted. The need to reinforce thrombolysis for paramedics in the area was noted as a
few patients were still being taken to Dr Grays. Paramedics within Highland thrombolyse much more. iii) SIGN 93 revision 15/12 Workplan Mr El Shafei said that Dr Hannah was part of the working group and had advised that guidance would be published within the next few weeks. i) SACCS Update Dr Clarkson said that a third Consultant had been appointed for the national service in Glasgow and this would provide for 24/7 on call. He added that the service were keen to re establish outreach clinics and that agreement had been reached with NHS Highland to provide twice yearly clinics (approximately 40 patients per year). Dr Metcalfe said that NHS Grampian had plans in place for a member of staff to undertake training to level one in Canada for two years. This person would then take over from Dr Walton upon his retiral. A link to Glasgow would still be required for the more complex cases. It was noted that a meeting had been scheduled for end September. Ms Galloway said that no meeting had yet been scheduled with NHS Tayside. Prof Pringle advised that Dr Peter Currie and Dr Adele Dawson provided the local adult service in Perth and Dundee respectively. In response to a question regarding whether patients would travel to Glasgow for outpatient clinics, it was confirmed that some would for cardiac MRI or complex assessment, for example exercise tests. Overall, this was viewed as a positive development. ii) Cardiac Surgery SLA Review Mr El Shafei reminded members of the year on year reduction in the number of referrals to the unit in Aberdeen and added that a continuation would affect the viability of the unit. He said that a review of the original SLA was underway and that meetings had been held with colleagues in both NHS Highland and NHS Tayside to discuss areas for improvement. He also said that MDT meetings had been established in NHS Highland fortnightly and would be extended to Tayside by end September or October. It was noted that although communication had improved, there remained some issues to be resolved. Ms Galloway asked whether the referral pathway, contact numbers and waiting time information requested from Aberdeen would be distributed in due course. She also commented that the named Consultant referral for Aberdeen was contrary to that of NHS Lothian. Ms Nicholl agreed to liaise with Ms Galloway to progress. Miss Hay confirmed that the re costing of the original SLA had been delayed due to capacity issues in finance. She said that a revised document would be distributed for comment as soon as possible. Ms Turner advised that the draft SLA had been sent to finance colleagues within each Board for information. Mr El Shafei advised that Aberdeen would be undertaking a patient quality
survey during November 2012 and the results would be shared with the group in due course. iii) Electrophysiology Review Miss Hay said that a short life working group had been established and had met once to date. She added that in order to progress this work, a data collection exercise would be undertaken and a standard template would be issued to Boards in the next few weeks. Miss Hay also said that there was a need to understand the financial aspects of the service and a meeting with Mr Clark Paterson, NHS Grampian had been scheduled for later that day. There was a brief discussion about the value of the regional Consultant role. 16/12 Future Workplan Development i) Planning Event Mr El Shafei reminded members that the planning event had been scheduled for Tuesday 30 th October, Newton Hotel, Nairn. A draft programme had been distributed. Miss Hay advised that proposed attendance figures were low in some areas, particularly NHS Grampian and primary care across the region, and asked that members circulate the programme widely within their networks to encourage attendance. She also said that sponsorship had been obtained from Daiichi Sankyo and AstraZeneca to date, with Servier Labs and Pfizer also requesting further information. ii) Future Priorities Miss Hay suggested that if there were priority areas the group should be considering, that members email herself. iii) Event programme Miss Hay advised that the draft programme had been distributed but that comments were welcome and should be submitted to herself via email as soon as possible. 17/12 National Advisory Committee for Heart Disease i) Heart Failure Network Miss Hay said that Mark Petrie from the Golden Jubilee was keen to reinvigorate the network. She questioned whether this was an issue for the region and suggested that it may be appropriate to write to NSD regarding how the North engage and take this forward. Mr Metcalfe suggested that the network should be disbanded, particularly as it did not provide value for money. He went on to say that Aberdeen had ECMO and ELVAD, therefore if they bought an impellar through endowment funding, they could provide a regional service. Dr Clarkson shared this view, although suggested that national top slice funding may be difficult to disband. It was agreed that the regional view should be submitted to the National Advisory Committee for consideration. ii) Heart Disease Action Plan This item was not discussed.
18/12 AOCB iii) Applications for funding from Heart Disease Action Plan Implementation Fund Mr El Shafei said that information had been previously distributed to members regarding potential funding from the implementation fund. Miss Hay confirmed that 250k was available this year and that applications required to be submitted by 24 th September 2012 for consideration. She added that no bids from constituent Boards had been shared to date and questioned whether there was a regional proposal, for example training and education that could be worked up. Research & education and audit time were suggested areas to look at, however, it was agreed that a bid should be developed for funding to develop a NoS database for cardiac failure. It was agreed that Miss Hay would initiate an email discussion to collect the necessary information for the application. i) TAVI Mr Metcalfe advised members that as there had yet been no announcement from the Cabinet Secretary regarding the proposed national service, NHS Grampian had taken the decision to develop a service in Aberdeen and that this would commence late October 2012. He added that the cost of the procedure was 2k more than a single valve procedure and that the valves would be bought from an endowment fund set up by a private company in Aberdeen. Mr Metcalfe said that the logistics required further discussion. It was noted that any contact regarding the Aberdeen service should be directed to Mr Metcalfe. ii) Support for cardiac services to the islands Mr El Shafei reported that he was currently planning for a group of clinicians from Aberdeen and Highland to visit NHS Orkney. The aim was to hold a development session for GPs with an interest in cardiac services. Mr Metcalfe said that an additional Consultant had been appointed in Aberdeen and this would see an increase from six to eight clinics per year in Orkney, thereby the visiting service would be in balance with the number of referrals. He also said that VC links with the islands worked well, for example follow up clinics, and may be extended to cover Wick in the near future. Mr Metcalfe also advised that an IT imaging system was being developed which would enable ECHOs to be downloaded into the system and would link with SCI store to enable access to letters. 19/12 Date and time of next meeting The next meeting will be held on Tuesday 4th December at 10.30 in the Committee Room, Foresterhill House, Aberdeen. VC facilities will be available.