Remote and Rural Implementation Group Minute of meeting held on 3 rd March 2010 at 12:00 in the Board Room, Assynt House, Inverness. REMOTE AND RURAL IMPLEMENTATION GROUP Present: By Video Link: By telephone link: In attendance: UNAPPROVED Dr R Gibbins, Chief Executive, NHS Highland (Chair) Ms R Derham, Scottish Partnership Forum, RCN representative Prof J Farmer, Co Director, Centre for Rural Health, Policy and Research Mrs B Flynn, Regional Nursing Workforce and Workload Advisor/Workforce Programme Manager, NoSPG Dr A Ingram, Director of Regional Planning and Workforce Development, NoSPG (Project Director) Mr B McKerrow, RRIG Clinical Lead and ENT Consultant, NHS Highland Mrs P Nicoll, Programme Director, RRHEAL Ms S Adamson, Head of Acute Planning GG&C Mrs J Flynn, Head of Primary Care, Perth & Kinross CHP, NHS Tayside Dr S Hearns, Lead Clinician, EMRS, NHS Greater Glasgow and Clyde Mrs G MacVicar, General Manager, Mid Highland CHP, NHS Highland Mrs E Porterfield, Head of Strategy & Planning Team, Scottish Government Prof A Sim, Consultant Surgeon, NHS Western Isles Mrs J Vickerman, Assistant Director of Healthcare Strategy and Policy, SGHD Dr J Ward, Medical Director, NHS Western Isles Ms S Hammell, Communications Manager, SAS Mr J Morton, Corporate Affairs Department, SAS Ms J Stevenson, Project Manager, Mobile Clinical Skills Unit, NHS Education for Scotland Mr T Homer, Joint Improvement Team, Scottish Government Dr L Thom, Registrar, EMRS, NHS Greater Glasgow & Clyde (until item 04/10) 01/10 Apologies Apologies were received from:; Dr E Baijal, Director of Public Health, NHS Borders (representing the DPHs); Dr P Baxter, Associate Medical Director, NHS 24; Mrs A Burns, Locality Manager, NHS Dumfries and Galloway; Mr R Creelman, Chair Argyll and Bute Public Partnership Forum; Mrs K Collins, Nursing and Quality Advisor, NSD; Dr G Crooks, Medical Director, Scottish Ambulance Service; Dr R Dijkhuizen, Medical Director, NHS Grampian; Prof N Douglas, Chair Academy of Medical Royal Colleges; Mr A Fowlie, General Manager, Moray CHSCP; Mrs A Gent, Director of Human Resources, NHS Highland; Dr D Gorman, Consultant in Public Health Medicine, NHS Lothian; Mrs F Grant, Remote and Rural Programme Manager; Dr M Hall, Clinical Director, Argyll and Bute CHP; Mr I Hunter, General Manager, Scottish Centre for Telehealth; Ms H Knox, Director of Regional Planning, WoSPG; Mr I Leslie, Dean of Faculty of Health, UHI Millennium Institute; Ms S Dee Masson, Unison; Prof G Needham, Post Graduate Dean, North East Deanery, NES; Mr B Nicol, CHP General Manager, Perth & Kinross, NHS Tayside; Mrs S Rogers, Director of Human Resources, Scottish Ambulance Service; Mr M Roos, Medical Director, NHS Orkney; Dr L Ryan, Unscheduled Care Clinical Lead (Primary Care), NHS Borders; Mrs G Stillie, Director of Service Delivery, NHS 24; Dr S Taylor, Director of Public Health and Planning, NHS Shetland; Dr I Wallace, Associate Medical Director, NHS Greater Glasgow and Clyde; Dr M Whoriskey, Assistant Director of Joint Improvement Team, SGHD.
02/10 Minute of the meeting held on 12 th December 2009 The minute was approved as an accurate record of the meeting. Dr Gibbins noted under item 38/09 on page 9, it had been reported that the revised workplan should be submitted to Scottish Government with the Performance Management Report. He advised that the workplan had been submitted but had not been taken as anticipated. 03/10 Matters Arising i) Actions note The actions were noted. Dr Ingram advised that a paper regarding the Anaesthetic and Surgical workforce had been submitted to the National Reshaping the Medical Workforce Project Board on 24 th February 2010 and although it contained some inaccuracies, had asked for sustained funding to be set aside for remote and rural posts. No feedback had been received to date. ii) Obligate Networks resource requirements and review of networks Mrs Porterfield advised that the National Planning Forum had approved that Obligate Networks would be included as part of the wider mapping exercise to be undertaken to review Networks. No timetable had been agreed to date. Dr Ingram said that with three months of the project left, clarity was required around who and how to take forward the tasks be to be completed post June 2010. This was agreed. EP iii) Strategic Options Framework a. National Launch It was noted that Dr Ingram had presented this at the National Directors of Planning Group in February 2010, to seek guidance on how the SOF should be launched. The group noted that ongoing responsibility for implementation lay with SAS and RRIG until May 2010 and proposed that progress should be monitored. There would however be a discussion in March between SGHD, Dr Gibbins, Mrs Howie from the ambulance service and Dr Ingram, following which it was to be considered whether a discussion at the Chief Executives Group would be helpful. JV b. SAS Timetable for Board reports The timetable had clearly slipped and discussion was required on how to deal with this post RRIG. Dr Ingram advised that SAS had been asked to schedule dates for engagement with NHS Boards however this had not yet been confirmed. She reported some anecdotal evidence that there were plans in some areas to progress this but did not have formal confirmation. Dr Ingram had now written to Board contacts asking for confirmation of progress with a view to establishing a formal position by the end of the month in order to decide how to take this forward in the future. Mrs J Flynn advised that a joint NHS Tayside/SAS paper had been JF
prepared for the NHS Tayside Board however had been held back to await the outcome of a meeting with the Health & Sports Committee. She agreed to share the paper with the group. Dr Ward said that nothing had been submitted to NHS WI Board to date, however, there was additional work to be done which he would expedite. Mrs MacVicar confirmed that a paper to NHS Highland Board had been delayed and would be discussed at the Board development session on 12 th April, with a final paper to the Board in June. GM 04/10 Emergency Medical Retrieval Service Dr Gibbins reported that the Cabinet Secretary had formally launched the continuation and roll out of the service on 2 nd March 2010. Mrs Vickerman confirmed that Scottish Government were in discussion with SAS regarding additional costs to SAS as this was an outstanding issue. She went on to advise that a multi agency meeting had been scheduled the following week with Dr Woods to begin to put in place the governance and project management required for implementation. The Cabinet Secretary had agreed a proposal to operationalise the service from October 2010. Dr Hearns said he was delighted by the decision and grateful to RRIG, particularly Dr Ingram and Dr Gibbins, for their help. He was confident that the service would be operational by October although had some concerns regarding the methodology and accuracy of SAS costings and was keen to help with any information held. Dr Gibbins formally noted appreciation to the Cabinet Secretary and SG colleagues for the speedy and positive response to this issue. Mr McKerrow commented that this service underpins the sustainability of the RGHs but questioned whether there were any concerns regarding recruitment. Dr Hearns replied that there were no concerns in relation to Consultant posts and a number had already expressed an interest, however, 6 full time trainees was ambitious and alternative staffing models would be considered. 05/10 JIT scoping work on integrated out of hours services Mr Homer reminded members that a report had been commissioned by the Joint Improvement Team and RRIG in May 2009 which considered the nature and extent of good practice and innovation in health and social care services in remote and rural areas. There were two areas where further work was required: (i) Out of hours home care and (ii) integrated posts. Out of hours home care Mr Homer advised that a final report would be available for the next meeting but that the main issue was the lack of funding which had an impact on the way in which emergency situations were responded to while on call. Integrated posts Mr Homer advised that the main focus of the work had been on establishing links with those involved in developing training and contacting all remote and rural NHS Boards and Local Authorities in an attempt to scope the extent to which integrated posts have been introduced and are delivering services. He said that although the initial scoping had received a limited response, two areas had been identified as having introduced these posts although others were interested and were making active plans. Although not clear how to take this forward, Mr
Homer planned to re engage NHS Boards to discuss how the overall agenda should be progressed. Dr Gibbins questioned how the work would be disseminated and how partnerships would be expected to pick this up locally. Mr Homer said that the written report presented to RRIG would be made available on the JIT website. He was aware of the important role to play into the broader national work around older people and these aspects of service redesign he hoped would be incorporated into materials being circulated. He went on to say that there were lessons to be fed into the broader reshaping care agenda and the link to social care should be reflected in joint arrangements between Boards and Local authority partners. Dr Ward asked that the RRHEAL/NES work regarding the generic worker role be made clearly visible to Community Health & Care Partnerships. Mr Homer was not sure if this had been disseminated widely, however, there was an awareness of the work. Mrs Nicoll confirmed that NHS Western Isles were involved in the development of education for the generic health and social care worker role and that NES were working with other partners to develop this role generally, not specifically for remote and rural areas. 06/10 Clinical Skills Strategy Mobile Skills Unit Ms Jeanette Stevenson gave a short presentation on the background to the mobile unit and the first year of the pilot. The unit, as part of the Scottish strategy for clinical skills, was developed to address inequality in the provision of training and had now been operational for one year of the two year pilot. The unit was a lorry which contained a 25 square metre classroom and state of the art equipment which could be used to train a wide range of skills. The first year of the pilot had seen the unit visit 11 remote and rural areas and deliver over 110 courses to over 800 multi professional staff, trained in a variety of skills from emergency care to health promotion. Ms Stevenson went on to list the achievements to date, which included increased access to training/education, faculty development, value for money, locally led programmes to support service delivery and quality assured training materials. Evaluation had been positive and had shown evidence of the positive impact on patient care. Several challenges were identified, including the release of staff by Boards to attend, cancellation of visits by Boards, logistical issues such as powering of the unit, sustainability given limited short term funding, and trainers time. Ms Stevenson asked members to consider how to address the issue of staff not being released for training and also their view of longer term use of the facility. Dr Gibbins thanked Ms Stevenson for her presentation and opened discussion by asking what process was in place for determining where the unit went, what would be delivered, how staff were released for training and what the lead in time was. Ms Stevenson confirmed that hosts had been identified within each Board who put them in touch with potential trainers and made relevant arrangements. She went on to say that the lead in time was 6 months but that some visits were cancelled within two weeks of the training dates. In response to a question from Mr McKerrow about whether the defaulters were from any particular staff group or sector, Ms Stevenson confirmed that this was not evident, however, pressure of service delivery due to staff absence was the main reason given. Mr McKerrow expressed concern that other things were being prioritised ahead of this and suggested that a model which included protected
learning time, such as in primary care, was required. Dr Hearns commented that this was a fantastic facility and that 30 training courses had been held for EMRS over the last year, with the mobile unit on site for a number of these. He did however request that technical support on site who were familiar with the equipment would be beneficial. Ms Stevenson agreed to arrange a day to train trainers in the use of the unit. Mrs MacVicar said that feedback from Fort William had been very positive, extremely helpful and that this needed to be strengthened into the future. Dr Ward said that this was an interesting initiative and although he had had no direct feedback from users, saw the key benefit in training delivery in places where otherwise it would not take place, for example in the outer isles. He agreed that it needed senior management mandating. Mrs B Flynn said that she had heard positive feedback and echoed the points regarding release of staff for training. She went on to say that there was some duplication, for example around the emergency care framework and that links should be made to reduce the increasing demand. Mr McKerrow suggested that there was a huge opportunity here to shift the balance of care to self reliance and therefore deliver health promotion training to local communities. Dr Ingram expressed concern at the short term nature of funding available and commented that the long term future required planning and sustained funding. Ms Derham said that this needed senior support and commented that training budgets are always first to be cut and that nurses had never had protected CPD time. Mrs Vickerman was keen to mention the opportunity to Special Health Boards in connection to the Quality Strategy and the integration of messages relating to patient centred and quality care. Mrs Nicoll said that NES were looking to support NHS Boards in their top five education priorities and that this would include where use could be made of the mobile unit. Dr Gibbins said that there was no lack of enthusiasm or commitment for this and suggested that this may be being pitched at the wrong level within Boards. He suggested that Ms Stevenson write to Chief Executives giving an update on progress to date and future plans and seeking engagement at senior level to get corporate ownership. JS 07/10 Delivering for Remote and Rural Healthcare priorities for 2010 i) Workplan to June 2010 Dr Ingram advised that the workplan had been reviewed following the previous meeting and was submitted for approval, noting however that the Scottish Government had some concerns. Dr Gibbins asked that Dr Ingram Mrs Vickerman and Mrs Porterfield meet to refine the wording whilst not losing the integrity of what RRIG had asked for. Dr Ingram added that some dates may require to be amended. It was agreed that the final plan should be distributed to Boards. /JV/ EP ii) Exit Strategy Dr Gibbins said that the 2 years implementation was coming to a successful conclusion although there were some aspects of the work which would continue and this required discussion. He went on to say that the
approach proposed required clarity on progress prior to Scottish Government colleagues agreeing the way forward. Dr Ingram commented that the work to be taken forward would very much be about Boards and frameworks and needed to be fully agreed and detailed in the exit plan. Mrs Vickerman suggested that in finalising the workplan, more detail was required on the exit strategy and a mapping exercise undertaken to identify who is responsible for what. Prof Farmer expressed concern that there was not a group such as RRIG to bring the issues together and ensure strategic ongoing look at remote and rural issues. Dr Gibbins reminded members that RRIG was an advisory group, constituted to oversee implementation and therefore the project would end as planned. Mrs Vickerman suggested that a virtual network of expertise may be required and agreed that a discussion at the next meeting would be helpful. 08/10 Workstream Progress Reports i) Workforce and Education a. Workforce Summit Dr Ingram reminded members that the conclusion of the September 2009 event was that workforce remained the main issue to resolve, particularly the medical workforce model to support the RGH. She reported that plans were in place to host a Workforce summit, it was likely that the outcome would require work post RRIG. Since September, Dr Ingram advised that a small group had met to develop plans and that a multi method approach was proposed. Mrs B Flynn advised that the methods included: i) proposed observational studies of medical and some nursing roles within the 6 RGHs, however, due to cost and work involved, one study would be carried out and NHS WI had agreed to participate; ii) A focussed workshop undertaking a table top review of care pathways for top ten conditions admitted to RGHs; and iii) an event looking at the acute care workforce within community hospitals to identify what skills/competences are required. Dr Ingram advised that the outcome of the process would be a toolkit of frameworks for use in these areas. She added that the NoS Medical Directors Group had also identified scoping work to define how out of hours services are delivered and what skills would be required in the future. It was suggested and agreed that the 3 rd June 2010 be used for the Workforce Summit and the final meeting of RRIG held slightly later. BF/ Dr Ward confirmed that NHS WI were happy to work with Mrs Flynn to design, roll out and report on the observation studies. Dr Gibbins suggested that it would be helpful to capture the workstreams above in a short paper and distribute to Boards to ensure clarity on the way forward. He added that the outcome should be clear and that the Boards need to be aware what was expected of them and who should attend the event. This was agreed. BF Dr Gibbins went on to say that the event would take place prior to the next intake of junior doctors and therefore the recruitment situation would not be entirely clear. Dr Ward suggested that discussions within Boards needed to consider how to deliver services without reliance on junior doctors. Mrs MacVicar said that it was important to have the event and to
be honest and radical about what can be achieved, for example, advanced nurse practitioners, out of hours services and it would be really useful to understand how serious the position is. She added that there are obvious sensitivities around this however this is a national issue and RRIG sponsorship would help. b. Workforce Mrs Flynn advised that the audit of medical models work remained outstanding and was unclear how this should be taken forward. Dr Ingram said that NoSPHN had advised that Dr Baijal did not have capacity to take this forward. Following discussion, it was not clear whether the outcomes of the original work were still pertinent issues and it was agreed that a following the community hospital work mentioned above, NHS Orkney should be contacted to say that the group are unable to progress as intended and does the work still require to be undertaken. BF c. Education Mrs Nicoll advised that most actions were reaching completion within the 2010 timetable and that the focus was on providing quick access to educational solutions in all areas. ii) Service Models and Care Pathways Prof Sim advised that the January workshop scheduled to validate care pathways had been postponed and would take place on 8/9 March 2010. The workshop would also discuss where use of technology could mean working differently and would feed into the ehealth work. He went on to say that there was no similar pathways for community hospitals or primary care but perhaps this should be given thought. Dr Ingram suggested that the care pathways could be launched formally at the workforce event on 3 rd June 2010. She added that pathways could be discussed at the community hospital workshop. AS/ iii) Emergency Response and Transport a. SAS Board engagement process b. SAS Review of R&R PTS As members were unaware of SAS colleagues on the audio link due to technical difficulties, this item was deferred. iv) ehealth and Infrastructure Dr Ingram advised that this was now moving forward and referred to the care pathways work described above. Dr Ingram also advised that a national Videoconference pilot had been established in the North and that she chaired the Project Board. v) Obligate Networks It was noted that some Boards had begun to put networks in place. Dr Ingram agreed to take forward. 09/10 Any other Competent Business
No further items were raised. 10/10 Date(s) of Next Meeting The date of the next meeting will be confirmed in due course.