NORTH OF SCOTLAND PLANNING GROUP

NORTH OF SCOTLAND PLANNING GROUP Minute of meeting held on Thursday 13 th August 2009 at 10.00am in the Conference Room, Summerfield House, Eday Road, Aberdeen. NORTH OF SCOTLAND PLANNING GROUP Present: APPROVED Mr Richard Carey, Chief Executive, NHS Grampian (Chair) Mrs Deirdre Evans, Director, NSD Dr Roger Gibbins, Chief Executive, NHS Highland Dr Annie Ingram, Director of Regional Planning and Workforce Dev, NoSPG Mr David Piggott, Interim Chief Executive, NHS Orkney Mr Gordon Stephen, Employee Director, NHS Grampian Mr David Sullivan, Director of Corporate Planning, NHS Grampian Dr Sarah Taylor, Director of Public Health & Planning, NHS Shetland Mrs Roseanne Urquhart, Head of Healthcare Strategy & Planning, NHS Highland In attendance: Mr Gerry Donald, Physical Planning Manager, NHS Grampian (item 64/09) Mrs Betty Flynn, Regional Workforce Programme Manager, NoSPG Miss Sandra Hay, Corporate Services Manager, NoSPG Mr Nigel Hobson, Associate Director of Nursing, NHS Highland (representing NoS Nurse Directors) Mr Grant McIntyre, Lead Consultant NoS MCN for Orthodontics (until item 62/09) Mr Ken Mitchell, Programme Manager Child Health, NoSPG (until item 63/09) Mrs Helen Strachan, Regional Manager Oral Health, NoSPG (until item 62/09) Mr Richard Wootton, Director, Scottish Centre for Telehealth (item 62/09) In attendance by VC: Mrs Judith Catherwood, Associate Director (AHP), NHS Highland (item 67/09) Mr Brian Kelly, Strategy & Regional Projects Manager, NHS Tayside 59/09 Apologies Apologies were received from Dr Roelf Dijkhuizen, Medical Director, NHS Grampian; Mr Gordon Jamieson, Chief Executive, NHS Western Isles; Miss Sandra Laurenson, Chief Executive, NHS Shetland; Ms Heidi May, Director of Nursing, NHS Highland; Prof Gillian Needham, Post-graduate Dean, NHS Education for Scotland, North Deanery; Dr Marthinus Roos, Medical Director, NHS Orkney; Dr Sheila Scott, Director of Public Health & Planning, NHS Western Isles; Prof Tony Wells, Chief Executive, NHS Tayside and Dr Peter Williamson, Director of Planning, NHS Tayside. 60/09 Minute of the meeting held on 10 th June 2009 The minute of the meeting was approved as an accurate record. 61/09 Matters Arising i) Action Points Dr Ingram highlighted that the Terms of Reference for both the Breast Cancer Review and the Endoscopic Ultrasound Service had yet to be circulated to members. PG ii) CJA Dr Ingram reminded members that a health sub-group had been

proposed to improve the representation of local issues in the CJA plan and improve communication between the CJA and local systems. The first meeting of the group had been scheduled for 17 th September 2009 and would discuss how to improve links. iii) ehealth Dr Ingram reminded members that ehealth had been a longstanding issue for NoSPG and that following the views expressed by Board ehealth leads that a NoS ehealth group was not required, given existing national structures, Bill Reid, Head of ehealth in NHS Highland had been tasked by Dr Gibbins to identify the issues and gaps in the infrastructure to allow a response to the letter received from Dr Woods to be prepared. Although Mr Reid s paper recommended that this work should be taken forward within existing structures, Dr Ingram suggested that it did not provide the required information to allow a response to Dr Woods to be drafted. Dr Gibbins commented that NoSPG need an articulation of the clinical impact of the infrastructure issues, for example, PACS within RGHs, and a discussion with clinical leads was required to be clear around this. Dr Taylor agreed that the response should focus on the clinical impact. She added that common issues within remote and rural areas, such as connectivity within the islands, was understood and may require to be solved nationally although this was not evident in the paper. Links to the national remote and rural policy were also not highlighted within the paper. Dr Ingram confirmed that a discussion had been scheduled for the 2 nd September 2009 and would highlight the issues of current delivery and future sustainability. It was suggested that following this meeting, a letter should be prepared in response to Dr Woods s letter. iv) CAMHS Dr Ingram advised members that the Initial Agreement for the reprovision of the inpatient facility for young people, within the context of a regional network had been approved by the Scottish Government Capital Investment Group at its meeting on 30 th June 2009 and NoS partners will now move to development of an Outline Business Case. She added that the project structure is being reviewed and will be circulated for comment soon. 62/09 NoS Oral Health and Dentistry Project i) NoS MCN for Orthodontics Mrs Strachan introduced Mr Grant McIntyre, Lead Consultant for the NoS MCN and Prof Richard Wootton, Director, SCT who had been working closely with her to build the Orthodontics Strategy, including e- Orthodontics, and who would give a presentation on progress to date. Mr McIntyre outlined the current position for Orthodontics, which consists of General Dental Practitioners/Community Dental Officers who deal with simple cases and those with additional skills treat some more complex cases; Specialist Practitioners who deal with complex cases involving a variety of treatment modalities; and Hospital Consultants who deal with complex and multi-disciplinary cases. He advised that there are current linkages between Grampian, Orkney and Shetland; Highland and the Western Isles; and Tayside as a stand alone local network.

Mr McIntyre advised that a regional MCN would add value in terms of inequalities, waiting time pressures, quality assurance, education & training, difficulties in recruitment and partnership working. The regional network would share pathways and protocols with a view to achieving an agreed standard across the North. The service would be delivered locally, however, required to be equitable across all areas. This may include the redistribution of patients to the most appropriate care provider. Mr McIntyre also advised that waiting times targets in Orthodontics currently apply to secondary care but not primary care and there was an opportunity to develop co-ordinated referral and treatment protocols. In terms of quality assurance, Mr McIntyre stated that audit is currently undertaken, however, not in a co-ordinated manner and a regional approach would avoid duplication of effort and use resources more appropriately. The regional MCN would also provide opportunities to train Dentists with Special Interests (DwSI) to increase service capacity, although a lack of long-term support was noted for current DwSI staff. This support would be delivered using ehealth. Mr McIntyre also highlighted opportunities for orthodontic therapists and other dental care professionals to increase service capacity in high volume settings. Mr McIntyre went on to highlight the key stages in the e-orthodontics project: Stage I e-triage Stage II treatment planning & advice Stage III training and education Stage IV Electronic Data Interchange (EDI) in primary care The objectives of the project were to provide a means of tracking referrals; to improve the quality of captured information; to provide a single electronic source of patient information relevant to e-orthodontics; the production of personalised documentation; to provide a means fo capturing media items (i.e. pictures or x-rays); to provide enhanced reporting capabilities; and to provide greater information security. Mr McIntyre presented examples of the screens that had been developed to date. Prof Wootton stated that there were three principles to be mindful of in any ehealth project: 1. keep it simple i.e. minimum dataset; 2. pilot mode to start; and 3. evaluation is useful to get clinical buy-in. Mrs Strachan advised that for the proposed pilot, a capital outlay of 58k (non-recurring) would be required for Stage I, II and evaluation. She asked members if they supported this in principle and would be prepared to fund the pilot. Dr Ingram added that a small amount of slippage monies had been used to develop the specification document. In response to a question from Dr Gibbins, Mr McIntyre confirmed that the services would remain integral to each board, with no cross cover between boards but that the Boards would come together in the context of the network to improve services through consistency of approach. He added that Stage I of the e-orthodontics pilot would involve 5/6 sites for up to two months and would involve cross board movement of data in relation to the small number of patients involved. Stage II would look at board services. He noted that Western Isles patients were referred to RW / Boards

Glasgow and Tayside received referrals from south Grampian. Mr Piggott supported the concept of a network, the benefit of all boards progressing at the same rate and learning from each other, and the potential for making posts more attractive. Mr Carey added that this would address the professional isolation issues. Mrs Strachan advised that NES had noted an interest in this work and had asked if Remote & Rural Fellows be involved in the pilot at an early stage to assess the value. This work was also being watched by the national Task & Finish Group, who had asked that it be presented at the March 2010 event, to showcase the methodology, way of working and evaluation as good practice. In response to a question from Dr Gibbins around engagement, Mr McIntyre confirmed that any significant concerns had been addressed and a uniform view had been reached with all clinicians on board. Dr Gibbins welcomed the MCN approach, however, commented that funding of the e-orthodontics pilot would require further discussion. He questioned whether SCT could sponsor this given their support for the project and whether there were any further options. Prof Wootton replied that SCT funding had been frozen, pending the outcome of the national review underway. Members agreed to pursue this avenue and also to ask boards to identify any available funding. Dr Taylor commented that as waiting times were a driver, a shift in current patterns would be required and she questioned how quickly this would be evident. Mr McIntyre confirmed that clinical pathways were in development and that he was hopeful that ownership of these would change traditional models of referral. He added that it would be beneficial to have more Public Health support. Mr Carey said this was a genuine attempt to work together with a view to ensuring the capacity is used to effect and the skills and complexity of work is carried out at the appropriate level. This is consistent with other specialties and should be supported and encouraged. Dr Ingram added that the electronic approach will help improve skills and would support a shift in the balance of care, by developing an intermediate tier for Oral Health, that does not currently exist. It may also support recruitment gaps and help to address pressures in partner boards through time. She suggested that it may be prudent to encourage the availability of national funding for SCT through the Task & Finish Group and it was agreed that this should be investigated. ii) Restorative Dentistry Mrs Strachan reported that this work was further behind and that action had been taken to address the lack of data regarding current services. She noted that there were issues in all areas in relation to achievement of the 18 week RTT target but, that the clinicians had agreed a collaborative approach to planning future services. A collaborative event involving all Boards had been scheduled for 24 th November 2009 and may be hosted at the new Aberdeen Dental School. iii) OMFS & Oral Surgery Mrs Strachan advised members that since agreement had been given to appoint 2 OMFS Consultants in NHS Highland, the posts had been advertised and interviews scheduled for 31 st August 2009. Mrs Strachan

also mentioned that she had met with Mr Renny, NHS Grampian to agree and prioritise the workplan which would concentrate on training (DwSI), referral criteria and care pathways, particularly for Head & Neck Cancer and Trauma. Mr Carey advised members that significant progress had been made with the agenda both individually and collectively and that boards were better placed than previously to provide a sustainable service model for the 18 week pathway, although there were still some issues to overcome. He added that the two appointments would make a significant difference, as would the new Aberdeen Dental School, to recruitment and retention within the region. iv) NoS Dental Event 63/09 NoS Child Health Mrs Strachan advised that the event would be held on 24 th November 2009 in Aberdeen, potentially at the new Aberdeen Dental School. Members agreed that the event would help build the network across the North. i) Obligate Network Mr Mitchell advised that initially, further development of the existing networks for Paediatric Neurology and Paediatric Gastroenterology would take priority although there was value in developing one Child Health Obligate Network which included a number of specialties, rather than several individual networks. He added that there was also a degree of willingness around Respiratory Medicine. Dr Ingram confirmed that General Surgery had agreed that a network would be the way forward despite issues. Dr Gibbins commented that one network was a helpful approach and should be supported although he raised concerns in relation to the risk around the continuation of national funding. Mr Piggott confirmed his support for the approach and asked that Psychiatry and Psychology in terms of Child Protection be taken into account in year 3. Dr Ingram advised that the CHCP remit had been amended to include child protection following the April meeting of NoSPG and the CHCP still required to define what elements of child protection would be taken forward regionally. KM Mr Carey summarised the discussion, highlighting that this work was progressing well, and that obligate networks were supported despite the issues around funding risks. He asked that progress reports be submitted. ii) NDP year 3 Bid Mr Mitchell reminded members that this was the final bid against the year 3 allocation of 32m for specialist children s services. He advised that the logic model developed by NoSPHN would be used to structure the NoS bid and a toolkit was also being developed to support the use of the model by clinicians and managers. Mr Mitchell confirmed that a project group had been established to coordinate the development of year 3 plans and that a clinical reference group was also being established to enhance communication and ensure consistency between regional and national discussions.

A number of working groups have been established to develop proposals for priority areas and work will be complete by the end of September to allow for development of the regional bid during October and November. Mr Mitchell advised that although the timescales for submission had been changed to January 2010, the NoS bid would be submitted to NoSPG at its November meeting as planned. Mr Mitchell advised that year 2 plans are currently being implemented and a monitoring template was being developed in partnership with other regional planning groups. He highlighted that there was an issue in some boards where vacancy control procedures were hindering recruitment to posts. It was agreed that a report on the current status should be prepared. KM Dr Ingram stated that year 1 allocations would be recurring, as would year 2 if posts had been filled, however, she was less sure of the recurring nature of year 3 bids. Mr Carey said it was prudent to assume that year 3 funding would not be available. Dr Ingram advised that she believed that there would be funding for posts to support the model announced for children s cancer services. iii) High Dependency Care Audit Mr Mitchell reminded members that following a presentation at the April meeting, NoSPG had tasked the Child Health Clinical Planning Group (CHCP) to progress the work, linked to the critical care audit and report back on the deliverable outcomes. Mr Mitchell advised that a working group would be established, with links to local Emergency Care Framework Implementation Groups, to progress the recommendations highlighted for regions as detailed in the paper. The proposal was approved. KM 64/09 HUB Initiative Mr Donald, referring to the briefing paper, advised that the two awareness sessions for the public and private sectors during June had been well attended. He added that this was the first time the Scottish Framework had been in the public domain. Mr Donald advised that the South East partnership had published an advert for private sector bids in the OJEU and a significant level of interest had been expressed, however, the North advert had been postponed until mid September. He added that exclusivity arrangements, detailed in the letter from Mr John Matheson (attached), meant that Hub Co will take precedence over the Framework Scotland for participants, as the default model for the delivery of new build primary health care and community based premises. Framework Scotland will apply to new build in acute service developments. The minimum level of capital costs of a project to which the exclusivity should apply has been set at 750,000 for all territories. Delegated authority is now in place for all partners with the exception of Aberdeen City council. Mr Donald raised concern at the non-engagement of NHS Western Isles and he reported that he was liaising with Mr Jamieson. GD An Interim Programme Director, Michelle Gallagher, has been appointed and the position will be advertised as a fixed term secondment into NHS Grampian

soon. The next Board meeting is due to be held on 24 th August 2009. In response to a question from Mr Carey, Mr Donald clarified that at this stage, the North Territory are selecting a private sector partner, not assigning capital projects, however, an indication of likely projects will be identified within the information pack developed. He added that the 17 partners provided a wider range of potential customers but projects were likely to be independent. Mr Sullivan questioned how real the 30m SGHD funding was, given the current financial climate. Mr Donald replied that he believed that the capital would be available but he continued that the funding covered the 5 territories within Scotland, although only 2 were currently being worked up. He added that guidance had been received on the bidding process and bids were in development. Although funding mechanisms suggested a share of approximately 6m for the North, the territory would overbid in an effort to maximise its share. Mr Sullivan commented that this could be used as a substitution for capital clawed back elsewhere. Mr Donald confirmed that no legal commitment had been made to date and that this would not happen until Easter 2010 when the Hub partnership is signed. 65/09 NoS Bariatric Surgery & Obesity Management Services Mr Sullivan advised that he had convened a Short Life Working Group (SLWG), which had met on 8 th July 2009. The crude figures contained within the minute of the meeting needed to be tested and this would require Public Health input into the demand and capacity analysis. A further meeting had been scheduled for 8 th September to discuss the wider obesity care pathway, although that date may require to be changed. Recommendations would be brought back to NoSPG at its November meeting. DS It was noted that this issue had been discussed at the National Planning Forum and it had been agreed that the national position would be reviewed, with a report submitted by early 2010. Ms Urquhart, who had attended the meeting as north representative, advised that capacity issues had been highlighted across Scotland and included the number of trained surgeons. The potential to dis-invest had been discussed. David Cline had proposed that the review should look at clinical effectiveness, best practice, cost effectiveness and resource implications. The Scottish Health Technologies Group would assist this work in relation to effectiveness of treatment. Dr Taylor commented that bariatric surgery had been demonstrated to be effective on a small number of patients but that the NIHCE guidelines were quite wide. She continued that successful outcomes required robust weight management programmes within the pathway.

66/09 Workforce i) Workforce Event (15 th June 2009) Mrs Flynn reported that a regional workforce planning and development event had been held on the 15 th June 2009. The event had been arranged to identify how Boards could better support the NoS agenda in relation to workforce and to provide Board representatives with a better understanding of the work of NoSPG. The main themes raised at the event included communication, capacity, responsibility, accountability and workforce intelligence. The outcome of the day was a proposal to establish a multi-professional regional workforce group to re-focus and re-energise the agenda. Leadership would be required from Dr Ingram as Director and the group would provide support to the Integrated Planning Group. Mr Piggott commented on the seemingly ad-hoc approach to medical and wider workforce issues, especially in relation to recruitment and retention of GPs and other specialties. He added that there was an opportunity to branch out planning and do more in collaboration to ensure consistency and quality, particularly around remote & rural issues. Mr Carey said that reshaping of the workforce was happening at board level currently, especially with Working Time Regulations and access targets and suggested that the group needed to be clear about where a regional approach will add value. He questioned the need to create additional infrastructure. Dr Gibbins agreed, commenting that the previous workforce group had not been successful. Dr Ingram said that given the lack of knowledge of those who attended the event, in relation to what NoSPG do, she was unsure if the connection would be made with regional work and added value. She added that the event had shown a desire to work together and this was a change of approach. ii) Medical Workforce Event (3 rd July 2009) Dr Ingram reminded members that NoSPG had been clear with the Medical Directors Group that an event was required to define the strategic direction of a regional approach to medical workforce. She reported that an event, involving a range of clinical colleagues, had been held on the 3 rd July 2009 to develop a plan to support the Government policy requirement to reshape the medical workforce and identify areas where a regional approach would add value. It was agreed that the regional approach be concentrated in a few areas, namely, Rural General Hospitals, Paediatrics, development of planning assumptions and scoping of the potential for a medical bank. There had also been a proposal to look at diagnostics, particularly radiology, however, past experience suggested this would not be successful and therefore was not agreed. Mr Carey suggested that any problems that required a regional solution should be identified and a more focussed assessment of where a regional solution could help should be carried out. He asked if there was a mechanism to surface these priority areas from within Board structures. Dr Ingram suggested that this was for Boards to undertake, reminding members that all NoS workstreams included a workforce planning objective. Dr Taylor commented that there was duplication in that the CHCP were dealing with paediatrics and that the Medical Directors should deal with issues not picked up within specialty planning. Dr Ingram replied that it was the intention to involve both groups in the planned event, but, that both groups did have a legitimate interest in this area.

Mr Carey asked that a discussion with Chief Executives, Medical Directors, HR Directors and Workforce Planners be convened to discuss the current situation, the regional challenges and the priorities for action. This will be an outcomes focussed business meeting, chaired by Mr Carey. Dr Gibbins advised that in relation to RGHs, modelling work required to be progressed if the staffing of the RGHs was to be protected and the model sustained. Dr Ingram advised that a session on RGH medical workforce had been included in the R&R event on 1 st /2 nd September and that a further meeting had been planned for 28 th September. Dr Ingram added that there was an issue with understanding of remote and rural issues, particularly within Scottish Government, NES and the Management Steering Group (MSG) which she believed left the North disadvantaged. Mr Carey summarised the discussion, highlighting the agreement of the need to work regionally, the need to agree where regional approaches will add value, a meeting should be convened to agree 2/3 priority areas, the need to look for ways to influence the agenda nationally around remote sustainability. iii) Reshaping the Medical Workforce Project A national Reshaping Medical Workforce Project Board is to be established and as noted above, will include only 1 Regional Workforce Director. Regional Reshaping Boards are also required and it has been proposed that existing structures (Medical Directors Group and MMC Review Group) be used within the North and this was approved. RD/ 67/09 Regional AHP workplan Mrs Catherwood advised members that the National AHP Workforce and Workload Programme would come to an end in September 2009. She added that there were a range of priorities that Scottish Government were leading on for example, AHP bank, workforce data, Mental Health, Child health and Musculoskeletal which boards should be supporting and in which regional groups have a role to play. The NoS Nurse Directors Group had been asked by NoSPG at its February meeting to provide a view of the future priorities and work plan to support continuation of the AHP Strategic Alliance Group. Mrs Catherwood raised the issue of time and commitment from Board leads and asked that, if the proposals were approved, that NoSPG members re-assert Board commitment and mandate Board Lead AHPs to prioritise this. Mr Carey said that the challenge was to demonstrate that the work of the group added value on a regional basis and suggested that if people were not participating, this may reflect a perception that there is no added value. He added that the regional agenda could be supported through specific workstreams and that a separate group may not be required. Dr Gibbins commented that a workplan for the group would be helpful. Mrs Catherwood agreed to develop a plan, which identified who would take forward the work, outcomes and relevant timescales in collaboration with colleagues and submit for discussion at the November meeting. JC 68/09 NoSPG Workplan i) Workplan progress

Dr Ingram highlighted that the only area of concern was in relation to Neurology where there was no capacity to take this forward. She added that the Medical Directors had not met to discuss how to take this forward. RD The written report was noted. 69/09 NoSPG Sub-groups i) NoS Public Health Network Dr Taylor highlighted that there were problems with vacancy control and recruiting to posts within the Well North project where funding may be withdrawn if not used. ii) NOSCAN Dr Ingram questioned whether the workplan had been submitted for approval as NOSCAN was a sub-group of NoSPG. It was agreed that Dr Ingram should seek clarification from Mr Gent. It was noted that the Breast Cancer Review terms of reference had not been shared with members. Mrs Evans highlighted an interest in this area in relation to the NSD screening role. Mr Carey asked that Mrs Evans nominate a representative to attend future NOSCAN meetings and this was agreed. DE iii) NoS Nurse Directors The minute of the meeting held on 18 th May 2009 was noted. Dr Ingram reminded members that the role and remit of the Nurse Directors group had been raised at the April NoSPG meeting and was still outstanding. Mr Hobson agreed to liaise. NH 70/09 National Update Mrs Evans advised that the NSAG bids would be considered by Board Chief Executives at their meeting on 19 th August. 71/09 Any other Competent Business i) National Planning Forum It was agreed that feedback should be a substantive agenda item for future meetings. ii) Funding of future proposals All It was agreed that any future proposals should use NRAC as the basis for funding allocations. iii) Funding of OH&D Manager Dr Ingram asked if this could be discussed now that only NoSPG members remained. Mr Carey was supportive of continuing the funding for a further year, suggesting that without dedicated support the regional work would lose momentum. Dr Gibbins acknowledged the progress made but said that a more compelling case would be required if he were to persuade his Board to prioritise this and it was agreed Dr Ingram should prepare this

and circulate to Board Chief Executives outwith the meeting. iv) Convention of Highlands and Islands 72/09 Date(s) of Next Meeting The next joint meeting of NoSPG and Chairs will be held on 11 th November 2009 at 10:00am in the Board Room, Assynt House, Inverness. Lunch will be available at the end of the meeting. Please note video-conferencing is available. Video-conferencing number should be submitted to the NoSPG Admin team (nospg.admin@nhs.net) ahead of the meeting.