MSN for Neurosurgery Board Meeting 3rd October, 2014 10.30 12.30 Stirling Court Hotel MINUTES Website Present: Mr Calum Campbell (CC) Mr Eric Ballantyne (EB) Ms Diana Beard (DB) Mr Chris Barrett (CBa) Mr Craig Bell (CB) Mr Jonathan Best (JBe) (deputising for R Calderwood) Miss Jennifer Brown (JBr) Ms Claire Nicholl (CN) (deputising for R Carey) Ms Jacquie Campbell (JC) (deputising for T Davison) Mrs Candice Dillen (CD) Mr Laurence Dunn (LD) Dr Helen Gooday (HG) Mr Mark Hughes (MH) Mr Mahmoud Kamel (MK) Mr Imran Liaquat (IL) Ms Audrey Warden (AWa) (deputising for Ms Lesley McLay) Mrs Fiona MacAulay Ms Laura MacKinnon (LMacK) Dr Sue Midgely(SM) Ms Tanith Muller (TM) Mr Patrick Statham (PS) Ms Hester Niven (HN) Mr Andy Wynd (AWy) Apologies: Mr Tim Davison Mr Robert Calderwood Mr Richard Carey Dr John Greene Dr Aileen Keel Dr Andrew McIntyre Ms Lesley McLay Ms Paula Niven Mr Patrick Statham In attendance: Ms Susan Chambers (SC) Item 1 Welcome and apologies Action Apologies were received from those listed above. The Chairman welcomed Ms Jacquie Campbell (General Manager, NHS Lothian) deputising for Mr Tim Davison, Ms Claire Nicholl (Unit Operational Manager, NHS Grampian) deputising for Mr Richard Carey and Ms Audrey Warden (General Manager, NHS Tayside) deputising for Ms Lesley McLay. 2 Approval of the Minutes held on 27.06.14 The minutes of the meeting held on 27th June 2014 were approved. 3 Matters arising There were no matters arising that were not covered in the agenda. 4 Network Manager s Report DB reported on progress with achieving the MSN s business objectives for 2014/15 and was able to confirm that the outstanding objectives from previous years were now being addressed as a result of the appointment of new staff to the MSN. The Clinical Co-ordinator and Audit Facilitator posts are now filled and both are based in NHS GG&C. This is the first time the MSN has been fully staffed in 15 months. Although delays had been incurred in launching the national paediatric audit (as a result of staffing shortages), significant progress had been made over the last three months. The single objective that had not been progressed was an adult patient experience survey however the paediatric survey had been completed. Page 1 of 6
In summary, the activities of the MSN over the last three months have included: a comprehensive update of the website, national meetings of the Nurse Reference Group, the AHP group, the Neurosurgical Voices group and the National Consultants group. The Nurse Reference Group has elected a Chair and Vice Chair for the group: Ms Paola Niven (Senior Charge Nurse, NHS Tayside and Ms Laura MacKinnon (Senior Charge Nurse, NHS GG&C) respectively. The group are about to undertake a national audit of bed occupancy to examine issues related to boarding, delayed discharges and repatriation. The national AHP group has competed the next phase of the condition-specific standards audit and expects to be able to report results at the next Board meeting in December. The first national meeting of the Neurosurgical Voices groups was well-attended and resulted in prioritisation of the issues raised in the individual group meetings; these will be taken forward with the Nurse Reference Group. The Clinical Director gave a presentation on image guidance techniques and equipment and a newsletter about the day is about to be distributed. DB had attended a meeting with the Executive Group of the MSN for Children and Young People with Cancer. Areas of shared interest were discussed and the involvement of a neuro-oncologist in the design of the MSN Quality Performance Indicator for brain tumour had been noted. Miss Jennifer Brown will replace the Clinical Director at the biannual meeting of the MSN Executives. 5 Regionalisation of trauma services Following on from discussions at the last Board meeting, a draft letter to the Chair of the Major Trauma Oversight Group (MTOG) had been agreed at the National Consultants meeting on September 26 th. The letter highlights the Board s concerns in relation to the potential impact of regionalisation of trauma services on neurosurgery. It was agreed that the letter, subject to a minor modification, should be sent of behalf of the Board (see attached). The Chair acknowledged Miss Emer Campbell s contribution to the letter which was informed by the results of her audit of the impact of trauma regionalisation on the service in NHS GG&C. CB suggested it would be helpful if EB and LD could attend the next MTOG meeting to discuss the MSN s concerns. Action: CB to ask the Chair of the MTOG to invite EB and LD to the next meeting. CB 6 Paediatric Service 6.1 Selective Dorsal Rhizotomy (SDR) The SDR sub group had completed a detailed pathway and costs for SDR and had submitted these to the National Services Division (NSD) of NHS National Services Scotland. It was confirmed that SDR was not a suitable case for national service designation however NSD was asked to write to the Boards to raise awareness of the pathway and also to ask Boards to identify the number of children who are eligible for the procedure or who are awaiting assessment of their eligibilty. NHS Lothian and NHS GG&C had been sighted on the proposal in advance of the Board meeting and both provider boards confirmed that subject to certain caveats, there was agreement in principal that the SDR service could be provided in both units. The caveats were: central funding should be made available to purchase the necessary equipment, the three regional planning groups agree to risk sharing for the additional staff appointments by the provider Boards (two physiotherapists and a part-time MDT co-ordinator). The Board was reminded that referring boards must be in a position to commit resource to the intensive and prolonged physiotherapy (~200 hours over two years) required in the community before referring children to the service. DB had been informed there were at least 12 children who were confirmed as eligible for SDR and a further 15 children thought likely to be eligible. Best estimates based on activity in NHS England indicated that there would be around 20 children a year who would fulfil the criteria for surgery. Page 2 of 6
The Chair asked both provider Boards to confirm the cost of the procedure and to indicate the date at which they would be ready to accept referrals. The Chair will then write to Boards to inform them of the referral process, the cost of the service, the importance of community physiotherapy provision and the training that can be provided by the in-patient physiotherapists. Action: JBe and JC to write to the MSN confirming the above. The Chair will write to Boards advising them about the service. JBe, JC CC 6.2 National Paediatric Audit JBr provided an update on activities related to the national paediatric audit: the nine national standards are complete and are available for consultation on the MSN website, the two quality performance indicators are in final stage development prior to starting the pilot study and the patient/parent experience survey is now complete and is also available on the website. Informal visits to each of the units to discuss the audit had been well-received and engagement with the MSN had been encouraging. The plan for the formal audit review visits in 2015 will be made available in November. 6.3 Categories of surgery The informal visits to the units highlighted the need to agree appropriate categories of surgery that could be safely undertaken in the various centres (see attached). Consultation around the country and at the National Consultants meeting had generated a categorisation of paediatric surgical procedures: Category 1 work that needs to be provided in all four units because of the potential to present emergently and require immediate surgical intervention Category 2 work that can safely be provided by adult colleagues with a stated interest in Paediatric Neurosurgery and that provides a critical mass of practice that helps to support skills required in emergent situations. Category 3 work that benefits from transfer to a unit with defined 24/7 paediatric subspecialty cover and or access to Paediatric ITU Discussion ensued about the need for flexibility and succession planning in the delivery of the paediatric neurosurgery service and the proposed categorisation was agreed. 7 Centre Updates It had been intended that the reports from each centre would be circulated in advance of the meeting however not all reports had been received. Centre updates will be collated into a single document and circulated at a later date. 7.1 NHS Grampian 7.2 NHS Tayside 7.3 NHS Lothian 7.4 NHS GG&C Page 3 of 6
Deep Brain Stimulation (DBS) It was confirmed that the DBS application had been submitted to NSD for review at the NPPPRG meeting on October 14 th and subsequent consideration at the National Specialist Services meeting on November 19th. Discussion ensued in relation to the proposal. It had been understood that the bid would include existing patients (~120) as well as the estimated 30 new patients per year. This is not the case. It was agreed that the NHS GG&C proposal should be submitted as it stands and that the MSN would work with the three other units to determine how best to develop and deliver a service for existing patients in other regions. This service will be developed in collaboration with NHS GG&C to ensure there is equitable access across the country. The importance of meeting the needs of existing patients was emphasised and the need for communication with patients via the specialist nurses was agreed. JBe agreed to circulation of the DBS proposal as submitted to NSD (circulated under separate cover). Action: EB to co-ordinate the plan for service provision for existing patients and report to the next MSN Board meeting. DB to circulate the GG&C proposal and collate comments. EB DB 8 National Consultants meeting The second National Consultants meeting was held on September 26 th. Topics under discussion were the SBNS plan to publish named consultant outcome data in NHS England (at a charge of 50,000 per unit), mapping of sub specialty interest in Scotland and the role of NSD in sub specialty development. It was agreed that accurate outcome data was difficult to source from routinely collected data however the focus in Scotland would be to improve the accuracy of the data and in the first instance ensure patients were correctly attributed to their respective surgeons. ISD had replicated the dataset that is used in NHS England for one of the surgeons so the technical skills exist in Scotland and the Board questioned the need to pay to submit Scottish data to the SBNS for reporting. It had been agreed that DB would visit each surgeon to review their data and update the MSN register of sub specialty interests. In relation to the role of NSD in sub specialty development, it was agreed that proposals for new services should be submitted to NSD but reconfiguration of existing services would be determined by the MSN Board. It was suggested it would be helpful if the Chair were to write to the Boards to provide clarity about the MSN s role in sub specialty development and service delivery. Action: the Chair is to write to the Board CEOs CC 9 Update on national compliance with NICE IPG 196 guidance re vcjd Responses in relation to instrument costs and timelines had been received from thee of the four Boards: NHS Grampian: 491,204; NHS Tayside: 283,310; NHS Lothian: not received; and NHS GG&C: 1,227,680. It was noted that NHS GG&C had included the cost of replacement of a Leica operating microscope with which there was a reported issue of potential lens contamination because of a faulty lens cover. The Board considered that sourcing a new lens cover would be the preferred course of action. The stress testing of the colour coating should be completed by the end of October. Instrument manufacturers could deliver the new instruments within three months of order placement. There was further discussion around the operational difficulties of instrument tracking and it was noted that costs listed above did not include the cost of colour coding, engraving or disposable instruments. Note: EB has since informed by Paul Hornby of National Procurement that national procurement is not possible because of the diverse nature of the instruments and suppliers. It is likely that provider Boards will be asked to individually order and finance the instruments then recoup the cost through an appropriate increase in their charges to non-provider Boards. Page 4 of 6
Actions: EB to circulate the instrument lists and associated costs for each centre to the General Managers. CB to inform the CMO of the likely costs and request a decision on instructing Boards to purchase. EB CB 10 Spinal Surgery achieving the 12 week treatment time guarantee EB presented information on compliance with the back pain pathway which showed that only three boards had fully implemented the pathway and the remainder had achieved partial implementation. The importance of the pathway in ensuring the appropriate patients are referred to the surgeons was discussed and the failure to implement it was having an effect on achieving the 12 week treatment time guarantee (TTG). Although only one patient was shown to have breached the TTG at end of June, the reality in Tayside for example was that 200 patients had been sent to the private sector because of resource issues and those patients who did not meet the 18 week waiting time guarantee did not get as far as impacting on the 12 week treatment time guarantee. There was a discussion about the complexities of delivering the service and measuring its various components so it was agreed that the focus of the next MSN Board meeting (December 12 th 2014) would be a detailed presentation of all aspects of the spinal surgery service for the entire country. Action: DB and CC to liaise with Kate James and senior Board managers to collate the information. DB, CC 11 Interventional Neuroradiology DB asked the Board if there was agreement in principle to engaging with the Interventional Neuro- Radiologists (INR) in NHS Lothian and NHS GG&C. The MSN Board had entered into discussions with the INR service on two previous occasions but matters had not progressed and there were recommendations in the 2009 review of the service that have not been implemented. DB had been approached by the Lothian INR team to ask what support the MSN could offer to their case to have the third consultant post restored and to explore the possibility of the service moving from the diagnostic radiology service to the neuroscience directorate. DB has also met with the INR team in NHS GG&C who are currently working with a short-life working group which is reviewing the service. It was agreed that the MSN would engage with the teams to explore what level of support the MSN could reasonably offer. Action: DB to notify INR teams and liaise with senior management in each Board DB 12 AOCB National Epilepsy Forum DB informed the Board that the MSN team was no longer in a position to provide the level of support to the National Epilepsy Forum that had previously been provided. Administrative support was available but the management of the national database (data entry, analysis, reporting etc) and the co-ordination of clinical materials for case presentations could no longer be provided. It had been agreed that the sustainability of the service was predicated on the units themselves having adequately resourced services. The terms of the MSN s funding are such that it cannot provide a service to an individual Board when it is the Board s responsibility to fund the service. The national database has now been relocated from NHS Tayside to NHS Lothian. 12 Dates of next meeting: Friday12 th December 10.30-12.30 Stirling Court Hotel, University of Stirling, Stirling FK9 4LA Page 5 of 6
MSN Board Membership 03.10.14 Name Title Board 1 Mr Calum Campbell Chairman, MSN and, Non-provider Board NHS Borders 2 Mr Eric Ballantyne National Clinical Director and NHS Tayside MSN Lead NHS Tayside 3 Ms Diana Beard National Network Manager, MSN 4 Dr Aileen Keel Deputy Chief Medical Officer, Scottish Government Health Directorate 5 Mr Craig Bell National Planning Manager, Scottish Government Health Directorate 6 Mr Richard Carey Deputy: Ms Amanda Croft Acting General Manager for Acute Sector NHS Grampian NHS Grampian 7 Ms Lesley McLay NHS Tayside Deputy: 8 Mr Tim Davison Deputy: Mr Jim Crombie Director of Scheduled Care NHS Lothian NHS Lothian 9 Mr Robert Calderwood Deputy: Mr Jonathan Best Director Regional Services NHS GG&C NHS GG&C 10 Miss Jennifer Brown National Lead for Paediatric Neurosurgery NHS GG&C 11 Mr Mahmoud Kamel Consultant Neurosurgeon, Grampian MSN Lead NHS Grampian 12 Mr Imran Liaquat Consultant Neurosurgeon, Lothian MSN Lead NHS Lothian 13 Mr Chris Barrett Consultant Neurosurgeon, Greater Glasgow and Clyde MSN Lead NHS GG&C 14 Mr Laurence Dunn Specialty Advisor to the Chief Medical Officer NHS GG&C 15 Mr Patrick Statham Consultant Neurosurgeon NHS Lothian 16 Ms Paola Niven Chair, National Nurse Reference Group NHS Tayside 17 Ms Fiona MacAulay Chair, Allied Health Professionals Reference Group NHS Tayside 18 Mr Mark Hughes National Neurosurgery Trainees Representative NHS Lothian 19 Mr Andy Wynd, Scottish Spina Bifida Association Third Sector 20 Ms Candice Dillen National Co-ordinator, Neurological Alliance of Scotland Third Sector 21 Ms Tanith Muller Parliamentary and Campaigns Manager, Parkinson s UK Third Sector 22 Dr Andrew McIntyre Associate Medical Director, Scottish Ambulance Service 23 Dr Helen Gooday Consultant in Neuro-rehabilitation Medicine, National Representative NHS Grampian 24 Dr Sue Midgely Consultant, Neuro-anaesthesia, National Representative NHS Lothian 25 Dr John Greene Consultant, Neurology, National Representative NHS GG&C 26 Consultant, Neuro-radiology, National Representative 27 Care of the Elderly, National Representative 28 Primary Care, National Representative Page 6 of 6