NORTH OF SCOTLAND PLANNING GROUP Minute of virtual meeting held on Wednesday 18 th September 2013 at 09.30 am Present: NORTH OF SCOTLAND PLANNING GROUP APPROVED Highland: In Attendance: New Craigs: Ms Elaine Mead, Chief Executive, NHS Highland (Chair) Mr Jim Cannon, Director of Regional Planning, NoSPG Mrs Pip Farman, Network Co-ordinator, NoSPHN Dr Ian Bashford, Medical Director, NHS Highland Mrs Martha Hay, Executive Assistant, NoSPG Mr Bill Reid, Head of ehealth, NHS Highland Grampian: Summerfield In Attendance: Rosehill Annexe: Orkney: Shetland: In attendance: Tayside: In attendance: NSD: Mr Richard Carey, Chief Executive, NHS Grampian Mr Peter Gent, Network Manager, NOSCAN Mr Mark McEwan, Service Planning Lead, NHS Grampian Prof Gillian Needham, Post Graduate Dean, NHS Education for Scotland, North Deanery Mrs Cathie Cowan, Chief Executive, NHS Orkney/NoSPG Vice Chair Ms Suzanne Lawrence, Employee Director, NHS Orkney Mr Ralph Roberts, Chief Executive, NHS Shetland Dr Sarah Taylor, Director of Public Health & Planning, NHS Shetland (part-time) Mr Keith Farrer, Programme Manager, NoSPG Mr James Crichton, Director Mental Health Services, NHS Tayside Dr Stuart Doig, Consultant Forensic Psychiatrist, NHS Tayside Mr Neil Fraser, Strategy and Performance Manager, NHS Tayside Mrs Marie Gardiner, Clinical Faciliatotor, NoS Neonatal MCNs Mrs Barbara Wilson, Service Manager, Secure Care, NHS Tayside Mrs Deirdre Evans, Director, NSD 32/13 Apologies Apologies were received from: Mr Alan Gray, Director of Finance, NHS Grampian; Ms Alison Hawkins, General Manager, ehealth, NHS Grampian; Mr Gordon Jamieson, Chief Executive, NHS Western Isles; Mr Gerry Marr, Chief Executive, NHS Tayside; Mr Marthinus Roos, Medical Director, NHS Orkney; Ms Caroline Selkirk, Deputy Chief Executive, NHS Tayside; Ms Carmel Sheriff, Performance Manager, Scottish Government; Mr Graeme Smith, Director of Modernisation, NHS Grampian; Ms Yvonne Summers, Performance Manager, Scottish Government; Ms Roseanne Urquhart, Head of Healthcare Strategy & Planning, NHS Highland; Dr Jim Ward, Medical Director, NHS Western Isles; Mr Milne Weir, General Manager (North), Scottish Ambulance Service; and Mrs Justine Westwood, Head of Planning and Performance, NHS 24. - 1 -
33/13 Minute of the meeting held on 19 th June 2013 The minute of the meeting held on 19 th June 2013 was accepted as an accurate record of the meeting. 34/13 Matters Arising / Action Points The progress on the Action sheet from the meeting held on 19 th June 2013 was noted. An update paper was also circulated on the Scottish Hyperbaric Medical Service Strategic Context and Overview; and an interim report on the Review of Service Sustainability across NoS Specialist Oncology Centres. Hyperbarics Mr McEwan informed members that a paper had been submitted to Mr David Steel, Programme Director, NSD who was combining this with the paper submitted by Ms Catriona Renfrew, Director Corporate Planning and Policy, NHS Greater Glasgow & Clyde, to progress through the NSCC process and to inform the NHS Board Chief Executives of the preferred options. The joint paper will be submitted to the National Directors of Planning meeting on 26 th September 2013 then a recommendation will be made to the NHS Board Chief Executives group. There will be three options contained within the paper: i) the regional recommendation which was that there should be a designated centre to include Aberdeen, one in the west and one in Orkney; ii) the provision of the service from Orkney and Aberdeen; and iii) de-designation. It was noted if the outcome was for de-designation the outstanding monies would be returned to Health Boards according to their NRAC share and it would then be the responsibility for individual Health Boards to procure the service for their population. De-designation would need ministerial approval. However, Mr Carey said de-designation would have consequences as NHS Grampian would be unable to fund the service itself therefore the service would cease to exist resulting in no hyperbaric service being available in Scotland. NoSPG approved the recommendations within the paper for submission to Mr Steele. MMc Oncology Workforce Issues Mr Gent spoke to the Interim Report carried out following site visits undertaken in the process of the review of service sustainability across NoS specialist oncology centres. Following the NoSPG meeting on 19 th June 2013 Mr Gent convened a group to undertake these site visits across each NoS cancer centre in response to a critical workforce issue. The team involved were Mr Sami Shimi, Cancer Clinical Lead, NHS Tayside and Mr Malcolm Loudon, Cancer Clinical Lead, NHS Grampian. He also further advised that the situation had worsened as a further member of staff had gone off in Aberdeen, further reducing capacity within key areas of the service.. The site visits were well attended by all colleagues across the north and the feedback across Boards was that it was helpful, valuable and had provided an opportunity to look critically at each part of oncology services and identify those at most risk. The report outlined twelve recommendations: four strategic; and eight operational. The service now had almost 50% vacant oncology positions as a result of maternity leave, sick leave and vacancies being recruited into, with short term locums in place. It was noted that staff shortages within oncology were more widespread - 2 -
than the north. The majority of risks across the north are low resilience in the sense that if one individual goes down the service would have no cover. In the immediate term the treatment for head and neck patients was being sourced out with the north, with other tumour sites likely to follow as short to medium term, measures. One of the recommendations within the report was that each of the centres, as a matter of urgency, would review its caseload to ascertain what they were capable of providing safely and which services should be offered as a national mutual contingency approach. Another issue which needed to be addressed was that there was no formal escalation or contingency planning in place at local, regional or national levels. PG Ms Mead referred to page 3 where it stated independently operating cancer centres in the NoS appears to have become unsustainable... and goes on later in the paper to suggest clinical colleagues say there needs to be a much more collaborative approach, therefore it was unclear if a collaborative approach referred to across the three regional centres in the north or collaboratively across the whole of Scotland. Mr Gent said there was unanimous agreement around the three north centres that the only way forward was working nationally at a collaborative stage. Mr Carey said there would be issues where sustainability will depend on closer working relationships within the national network but there were more things which could be done more effectively on a regional basis and referred to the report by Dr Shami Shimi around the HPB service and agreement on a collaborative service across the north. In terms of the national level discussion we should take the opportunity to combine regional approaches and consider ourselves a virtual cancer outfit in Scotland, operating across three regional centres. Mr Gent explained that although this had been escalated to national level this was still in the hands of the NoS Boards at this time. This piece of work was commissioned by NoSPG although members of SGHD have been brokering different meetings and have requested sight of the review paper, which had not been distributed wider than this group. All options within the report need to be explored and one of those could be for a Managed Service approach for the three cancer centres in the north. Prof. Needham said there was a critical gap in training doctors if there was a 45-50% consultant shortage and referred to recommendation 7. relating to trainees and the perceived disproportion of trainees in the north and she said that both these training programmes are national programmes and Boards need to understand why the Scotland National programme trainees are not being produced in the right Boards or they do not choose to come to these positions or whether this was about recruitment or retention, would like to explore issue around supply. Ms Mead said the vacancies were due to the current model of delivery which was a longer term piece of work to be undertaken. It was noted there was a national UK shortage of oncology positions and trainees are opting to go south. Mr Cannon said there was an immediate piece of work required which needed national support and clinicians require a clear mandate from Chief Executives before they enter into these discussions. Also, regionally need to ascertain what capacity there was in each tumour group area. Mr Gent said it was disappointing that this had not been brought to the attention of RCAF earlier and that there has been a collective failing which could possibly be because there was no formally agreed escalation process in place around these services. Ms Mead summarised the discussions by saying there were a number of prongs which needed to be pursued: the most critical for NOSCAN was the provision and - 3 -
sustainability of service, ideally delivered locally; a number of clinical colleagues were looking pragmatically at what can be done now with current expertise and support; and at the same time look at links nationally and improved escalation plans. Mr Carey said there was a two stage process: recognise what can be done regionally in the short term; and strategy recommendations which need to bring to national forum. This should be raised at the Scottish Cancer Taskforce group as there needed to be a national action around this. The report should be circulated to colleagues nationally and used as the vehicle for further debate nationally. Mr Gent had been asked by NHS Grampian to support a call for support - from the centres in Edinburgh and Glasgow - for head, neck and lung. Ms Mead was comfortable asking for support from the larger cancer centres but wanted to see this happening in a staged manner as need was identified. Mr Gent and Mr Cannon have prepared a next steps paper and would discuss this being submitted to the Scottish Cancer Taskforce group as part of regular regional updates. More dialogue was also needed between clinicians about what specifically they can do, mapping out what capacity and what that capacity was capable of delivering, identifying what gaps and what can be covered regionally or nationally. Longer term could look at model of care and addressing the training issues. Ms Mead confirmed there was chief executive support behind this and was keen that clinical colleagues were aware of this support. Mr Carey agreed to bring together a meeting with clinicians to obtain a NoS position, ahead of any nationally led discussions. It was also only a matter of time before the public were aware of the level of vacancies and the impact on the oncology service. It was agreed Ms Mead and Mr Carey would have a discussion out with the meeting, with their respective Communications departments, as to how to this should be managed. Ms Cowan advised that she would be supportive of what was being said. And Mr Cannon would communicate with Ms Jacqui Simpson prior to SEATs RCAG meeting on 20 th September 2013 in terms of engagement. JC/PG RC RC/EM JC 35/13 Rohallion Medium Secure Unit Dr Doig asked members to note the update paper submitted to make NoSPG aware of the current status of the options appraisal process being led by Scottish Government. He also wanted to make NoSPG aware of the national discussions which have been taking place over the past six months about the potential for reconfiguration of beds in Scotland. It was noted there was a crisis in the west of Scotland over bed availability in that there are was a large number of patients identified for transfer out of he State Hospital, for whom there were no beds, and there was a local requirement for them to meet timescales which were going to prove challenging. There have been solutions discussed and some of them have involved Rohallion taking on the national adult male Learning Disability (LD) service. The Rohallion unit had been open for a year and the Rohallion s position would be that it was too early to predict what spare capacity there would be. Mr Geoff Huggins, Health & Social Care Integration Directorate, SGHD had been hosting these national meetings and Dr Doig was keen to take forward a consensus from the north Chief Executives. There also needed to be clear agreement from the forensic services and a further meeting was scheduled for November. Members noted the paper and will await the outcome from the meeting being hosted by Mr Huggins and asked Mr Doig to raise again with NoSPG if there was a requirement for a regional view. Mr Cannon discussed the need for other options, which would better suit north regional needs, to be articulated to Geoff Huggins and asked if Dr Doig thought there was any hope of achieving consensus from the north around which option was preferable (as NHS Grampian have a differing view from NHS Highland and NHS Tayside on the needs for female beds across the - 4 -
region, which was impacting on the option choice). Dr Doig would have further discussions and see whether a north concensus was possible and also whether there were other options which could be put forward in advance of the next inter regional meeting. 36/13 Child Protection As discussed and agreed at NoSPG on 19 th June 2013 the three regional MCNs for child protection and child sexual abuse are developing an interim solution of providing national child protection tertiary advice and support on complex cases. There have been a number of discussions at various groups and a series of letters between the chairs of the regional planning groups, and Chief Executives from each of the groups support the development of this piece of work. Further agreement on plans and funding implications were to be brought back to this group later in the year. A letter from Mr Ian Ross, Chief Executive, NHS Lanarkshire & Chair of West of Scotland Regional Planning Group had also been circulated and was noted along with the response from Ms Mead. Members noted the content of the letter from Mr Ross and supported the position outlined in Ms mead s letter. 37/13 NoS Neonatal MCN Quality Framework Review Report Mrs Gardiner spoke to the paper submitted which updated members on implementation, of the national Neonatal quality Framework. She advised that each of the NoS Boards had developed an implementation plan describing actions required over a short, medium and longer term. The NoS Neonatal Network was supporting implementation and the identified actions will inform substantial parts of network activity over the coming years. NoSPG are asked to note the update and support ongoing implementation work at Board and regional levels. Mrs Gardiner said that the report identified a few gaps in the service and some of the risks have been identified with individual Boards. The timescale for implementation is 1-6 years and Boards have the option to look at capital planning. Ms Cowan advised that NHS Orkney have appointed two consultants who will take up post within the next two months which will mitigate some of the risks identified in the report and Mrs Gardiner will amend accordingly. MG Mr Cannon advised members that Mrs Gardiner had been successful in obtaining a two year secondment with the Scottish Ambulance Service, therefore implementation of the implementation plan will be managed differently. Members agreed the implementation could be submitted to SGHD subject to the amendment to NHS Orkney section. 38/13 Working Towards an Intelligent Region i) Update on Progress The aim of the Intelligent Region (IR) was to improve accessibility of information within the NoSPG system for all, ensuring NoSPG had access to the right information at the right time. An event was held on 27 th August 2013 with colleagues across the north to look at two pieces of work: a high level review of workforce data; and imaging and oncology data. - 5 -
The key to the IR process was engagement with Chief Executives on what information was required in the future in terms of pro-active planning. Mr Carey said NHS Grampian were doing similar work at Board level in Intelligent Board and there needed to be connectivity with the regional IR concept. Mrs Farman confirmed much of the work was informed by board work and that regional discussions had involved NHS Grampian colleagues who were working closely with the regional piece. Ms Mead supported the development of a new structure and model for information gathering and reporting, both at local and regional levels but that critical value would be by joining up the efforts which were already ongoing. Mr Cannon said that one of the common themes was that this was almost too big to pull together but if there was a common thread i.e. sustainability, this would be something to focus on. Members endorsed the continuation on the workforce data piece of work. He also said there were a lot of issues around imaging and it would be helpful to map out for decision on whether this was a viable piece of work to undergo under the IR concept. Ms Mead asked that the imaging data be worked up as a discussion paper for the next NoSPG in December. JC NoSPG Clinical Leadership The aim of the paper submitted was to describe the need for senior clinical leadership in NoSPG and to propose establishment of a temporary senior medical role. The NoSPG workplan currently references a significant number of clinical projects which have emerged from questions around sustainability. There was an urgent need to tackle issues of sustainability across a range of specialties, using a structured methodology. Clinical leadership will be a crucial part of this redesign process and it was proposed that NoSPG takes an approach which had dedicated strategic medical expertise. This role would help provide a hollistic approach to proactive planning at regional level. NoSPG members are asked to consider the concept of dedicated strategic medical resource for NoSPG and agree the recommendation to develop a detailed proposal for this role. Mr Cannon advised their had been discussions around the concept of having clinical leadership across the NoSPG agenda and proposed a half time Medical Director type of role dedicated to regional work, for a period of two years, to work with clinical interdependencies and also the complexity of cultural issues around this. Evaluation of the role would be considered as part of assessing the impact on regional initiatives and could inform objectives of the post. Ms Cowan whilst supportive asked about another clinical leadership role for nursing. Mr Cannon said there was specific work around medical teams but would be happy to consider a high level nursing role as part of this discussion. The new workforce models required to deliver services, to which Ms Cowan was alluding, would be less doctor heavy and so other clinical leadership in other areas would be important in developing and implementing those models. Dr Bashford advised that the Medical Directors group no longer meet, as one of the issues for meeting on a regular basis was capacity. He agreed regional working had worked, but questioned whether it was strictly medical leadership that was required and Nursing or AHPs could be considered for a senior clinical leadership role also. Prof Needham said it would be difficult to finesse and find the correct person and commented that with regard to doctors, nothing less than 2 PAs per week was untenable, for a clinician to consider stepping out of a clinical role. It was also a big ask for someone to cover all aspects i.e. Neonatal, cardiac etc. Mr Cannon - 6 -
commented that specialty advice could still be sought through existing network structures or from the service, and that generic strategic leadership is what is required to pull teams together across boundaries and approach issues in a structured way. Mr Cannon referred to Prof. Needham s email where she had raised the issue that Scottish government and NES were funding two Clinical Leadership Fellows to start as soon as possible and this proposed approach may allow a Fellow to link with some of the work of the NoSPG, and agreed to have a more detailed discussion out with the meeting. NoSPG agreed the recommendation for senior clinical leadership but consideration should be given to the methodology of obtaining this leadership. Mr Cannon to work up the proposal, considering different types of clinical leadership and the requirement for each. JC/GN JC 39/13 Invitation for nominations for Forensic and Healthcare Services for people in police care Network Board Mrs Evans advised of the establishment of a National Co-ordinating network to bring together NHS Scotland, Police Scotland, the Crown Office and Procurator Fiscal s office, Local Authority and other interests involved in the provision of healthcare and forensic services for people in the care of the police. A workshop on 30 th May 2013 brought together key stakeholders to agree initial priorities for the co-ordinating network, and it was also agreed that the network should have a small strategic oversight Board, along with a number of sub groups which would focus on particular areas. Mrs Evans was therefore seeking two nominations: one strategic; and one operational. After discussion it was agreed that Dr Taylor would be the strategic representative and Mr McEwan would have a dual role for the operational representative along with his role as Chair on the telemedicine and ehealth group. 40/13 Spinal Surgery Mr Farrer had been meeting with clinicians across the region and had compiled a paper which identified demand and capacity, and clear understanding how the gaps will be met and what cost implications will be for individual Boards between gap and demand. Mr Farrer said there was work to be done within secondary care around complex spinal procedures. Dr Taylor advised NoSPHN were undertaking a mapping exercise up to tier 4 level around chronic pain and would like to connect with the work undertaken by Mr Farrer on spinal surgery services. KF/PF Ms Mead shared the concern around this and how the surgical work was shared across the north. She also said it would be helpful if NHS Grampian and NHS Highland Executives could meet to discuss specific common issues across the two Boards, which would support some of this work. Mr Farrer will bring back more detail to the next meeting. KF 41/13 NoS Oral & Maxillofacial Surgery Services A brief paper was submitted to update members on the current position following the resignation of a consultant in Inverness from the NoS Oral & Maxillofacial network. NoSPG approved the establishment of the oral health and dentistry workstream in 2006, aimed at developing a sustainable model of service for oral and maxillofacial surgery, orthodontics and restorative dentistry and the view was to continue with - 7 -
this model. Dr Bashford said this was an issue which could be discussed between NHS Highland and NHS Grampian. IB 42/13 NOSCAN Review Mr Cannon referred to the report on the NOSCAN Structure and Operating Framework Review and highlighted the detailed recommendations which allowed for closer alignment with NoSPG in terms of finance and the potential of amalgamation of data and audit systems across the region. Mr Carey sad that this was an excellent piece of work which was received within the timescales set for the review and he was keen to see the detailed recommendations taken forward to implementation plan. Members accepted the recommendations and Mr Cannon, Mr Gent and Mr King would work up an implementation plan based on the recommendations. There was also support from the three regional cancer centres and they all agreed to work collaboratively across the north. Mr Cannon commented that specific implementation plans may need NoSPG sign off but that most recommendations would be relatively simple to implement. 43/13 NoS Hepato Pancreatico Biliary (HPB)/Oesophago gastric (OG) Surgical Service Sustainability Review Mr Gent referred to the report by Mr Sami Shimi, Consultant Surgeon, NHS Tayside which had also been submitted and endorsed at the Regional Cancer Advisory Forum (RCAF) meeting on 9 th September 2013. Mr Shimi was nominated as Chair of an expert group, to identify and explore options for delivering these services in the north, which were in accord with the spirit of quality improvement in general, and the volume QPIs specifically. The recommendations of the report were largely for a collaborative approach across north and clinicians were keen to retain this service within the region. Ms Mead said that this was an excellent piece of work and was happy to support the recommendations. Mr Carey also supported the paper and wanted to highlight that it had been very well explained and there was a commonality of clinical management, job planning, and resource implications. He also suggested that this could be used as a template for future pieces of work and on how to manage cancer services as this was an opportunity to make this the norm across the region, linked to the previous discussion on cancer services but also sustainability in other specialties. Dr Bashford agreed that it would be useful to extract a template for other services across the north, but one caveat was volume, throughput and outcomes. Mrs Farman also advised that NoSPG planned to use this with the small volumes piece of work aligned to the Intelligent Region concept. 44/13 Mobile Skills Unit The paper circulated was intended to assist in raising the profile of the mobile skills unit, where the NES team were asking for services to locate sites where training using this model would be best suited. Colleagues were reminded of this useful training model and were asked to submit their suggestions of proposed sites to Mr Cannon or directly to the MSU contacts. 45/13 Reporting All - 8 -
The meeting had over-run the allotted timescale, therefore Ms Mead requested members to read the relevant reports and raise any specific issues with Mr Cannon. i) CAMHS ii) iii) Paediatric Sustainability (a) A96 Corridor project (b) Paediatric Unscheduled Care Critical Decision support Pilot Reshaping the Medical Workforce At the NoSPG meeting on 19 th June 2013 there had been a question regarding how medical workforce would be reported to NoSPG and with that in mind Dr Annie Ingram instigated the report circulated which she was happy to provide on a regular basis. 46/13 NoSPG Workplan Exception Report The NoSPG workplan and Exception report were noted. 47/13 NoSPG Sub Groups i) NoS Integrated Planning Group ii) NoS Public Health Network iii) NoS Medical Directors Group iv) NOSCAN Members noted the update reports circulated. 48/13 National Update Members noted the update report circulated. 49/13 National Planning Forum ii) iii) Verbal update on 25 th June 2013 meeting SHTG Robotic surgery for prostate cancer 50/13 Any Other Competent Business NoSPG Team Changes Mr Cannon informed members that within the NoSPG team there are now three members of staff on secondment and that he was proposing to develop a revised structure which included recruiting temporary roles. Any new structure would be within the same cost envelope and he sought agreement from NoSPG to this proposal. Members endorsed this proposal and Ms Mead requested she had an overview of the specifics of proposals. JC 51/13 Date of Next Meeting The next meeting will be a virtual meeting held on 4 th December 2013 at 2.00 pm. Proposed 2014 NoSPG meeting dates 19 th February 2014 28 th May 2014 24 th September 2014-9 -
17 th December 2014 Freedom of information notice: Board members should note that their names will be listed in the Minute which will be published on the public website. - 10 -