NORTH OF SCOTLAND PLANNING GROUP Minute of meeting held on Wednesday 7 th September 2011 at 10.30am in Meeting room 5, Summerfield House, Aberdeen. Present: NORTH OF SCOTLAND PLANNING GROUP APPROVED Aberdeen: Mr Richard Carey, Chief Executive, NHS Grampian (Chair) Dr Roelf Dijkhuizen, Medical Director, NHS Grampian/Chair, NoS Medical Directors Group Dr Annie Ingram, Director of Regional Planning and Workforce Dev, NoSPG Mr Marthinus Roos, Medical Director, NHS Orkney Mr Gordon Stephen, Employee Director, NHS Grampian Mrs Rhoda Walker, Director of Nursing and Allied Health Professions, NHS Orkney/Chair, NoS Nurse Directors In attendance: Mr Peter Gent, Manager, Network Manager, NOSCAN (item 59/11) Mrs Martha Hay, PA Dir. Regional Planning & Workforce Dev, NoSPG Mr Ken Mitchell, Programme Manager, NoS Acute Services & Workforce Mr Neil Strachan, Programme Manager, NoS Child Health & CAMHS Dundee: In attendance: Inverness: In attendance: NSD Shetland: Orkney: Dr Sarah Taylor, Director of Public Health & Planning, NHS Shetland Mrs Hazel Scott, Commissioner for Older Peoples Services, NHS Tayside Ms Elaine Mead, Chief Executive, NHS Highland Mrs Pip Farman, Co-ordinator, NoSPHN Mrs Deirdre Evans, Director, NSD Mr Ralph Roberts, Chief Executive, NHS Shetland Mrs Cathie Cowan, Chief Executive, NHS Orkney Glasgow: Mrs Justine Westwood, Head of Planning, NHS 24 In Attendance: Mr James Ferguson, Clinical Lead, SCTT, NHS 24 Mrs Heather Kenney, Director of Strategy and Planning, Scottish Ambulance Service (item 58/11) Edinburgh, In attendance: Mr Robbie Pearson, Acting Deputy Director, Directorate of Health and Health Care Improvement, SGHD (item 57/11) Ms Jenny Long, Health and Healthcare Improvement Directorate, SGHD (item 57/11) 51/11 Apologies Action Mrs Anne Gent, Director of HR, NHS Highland; Mr Gordon Jamieson, Chief Executive, NHS Western Isles; Mr Gerry Marr, Chief Executive, NHS Tayside; Prof Gillian Needham, Post Graduate Dean, NHS Education for Scotland, North Deanery; Ms Caroline Selkirk, Deputy Chief Executive, NHS Tayside; Ms Carmel Sheriff, Performance Manager, Scottish Government; Mr Mark Sinclair, Director of HR, NHS Grampian; Ms Yvonne Summers, Performance Manager, Scottish Government; Ms Roseanne Urquhart, Head of Healthcare Strategy & Planning, NHS Highland; Mr Jim Ward, Medical Director, NHS Western Isles; Mr Milne Weir, General Manager (North), Scottish Ambulance Service; and Dr Lesley Wilkie, Director of Public Health - 1 -
& Planning, NHS Grampian. 52/11 Minute of the meeting held on 27 th April 2011 The minute of meeting held on 29 th June 2011 was approved as an accurate record of the meeting. 53/11 Matters Arising i) Action Points Dr Ingram confirmed that all the action points were complete or ongoing. ii) Emergency Care Network The minutes of the meeting of the Emergency Care Network group held on 11 th August were noted. Dr Dijkhuizen reported that the group had developed a workplan which identified four main areas of work: Primary care unscheduled care, inpatient environments, clinical decision support and logistics. He reported that there was good engagement form NHS Grampian, NHS Highland, NHS Orkney, NHS 24 and SAS and it remained the intention to submit a business case to NoSPG by 31st March 2012. RD/AKI Mr Roos advised that from a medical perspective NHS Orkney viewed this work positively and Mr Ferguson agreed that the command and control structure would support the aim of achieving better clinical support and improved patient outcomes. Dr Taylor advised that NHS Shetland would consider how this would work in Shetland once it was further developed, whilst Ms Mead reported that within NHS Highland, it was the intention that Raigmore would act as the hub for the emergency care requirements of the Highland RGHs, whilst linking with the wider ECN. Mr Carey emphasised that this had a huge significance around the sustainability of services for all Boards but particularly those with remote and rural services and said that it was important Boards supported the aims of this work and demonstrated organisational commitment to establishing the ECN. He continued by suggesting that focus on regional approaches would be important for Boards going forward and said that he expected non-executive directors to identify improved regional working as a theme at the NoSPG event in Nairn on 21 st September 201. He concluded that the engagement of Boards was encouraging and saw its importance and potential. BCE ALL iii) Reshaping Medical Workforce Dr Ingram reminded members that the Reshaping the Medical Workforce in Scotland consultation on speciality training numbers 2012 and beyond had been issued in July, for consultation by Scottish Government, with responses requested by 26 th August 2011. The NoSPG response had been approved by the Regional Reshaping Group and raised concerns regarding the veracity of the document, the lack of clarity on the impact for the region and the ability of the national project to deliver against the original timescales. The next National Reshaping Medical Workforce meeting is scheduled for 15 th September 2011 where all of the responses to the consultation from across the profession and the service will be considered in more detail. In the previous two years, a total of 50 and 49 posts respectively were agreed for disestablishment although the funding only becomes available when posts are vacated. This year, a reduction of 153 posts has been proposed, although no regional or Deanery split is yet available. - 2 -
Dr Ingram reported that there had also been concerns regarding the fill-rate for August 2011 and the impact this has had on service delivery, particularly within the RGHs, who rely on GPST doctors and within the larger centres, where vacancies to programmes have had a significant impact on the ability to deliver core services. In relation to general practice, where there were 14 vacancies in August in both the North and the west, a new national rural-track GPST programme has been proposed and a Consultation paper is currently with Medical Directors and Directors of Medical Education (DMEs) for comment. Dr Ingram referred to the discussions that have taken place at the Chief Executives meetings regarding the underlying assumption of the Reshaping Project that speciality doctors would be available to undertake the majority (60%) of those roles that would require to be staffed by a doctor, but that the supply of these doctors had not materialised, either because doctors had chose to go to posts outwith Scotland or because the run-through nature of some programmes meant that there was no route to create Specialty Doctors. Dr Ingram said that there was also a sense that in some areas the necessary redesign had yet to take place and this meant that services could be at risk. Dr Dijkhuizen agreed with Dr Ingram and that services within Boards were at risk and the change in national leadership had not helped. He continued that the process was complicated and suggested that it was important that Boards identify the future model and concentrated on growing the appropriate clinicians to run future services. Referring to the recently established programme for Physicians Assistants in the North, Dr Dijkhuizen suggested that this would be one among a number of possible solutions for the future and suggested that a national approach was required for some of these roles. Dr Ingram reminded members that previously there had previously been a national approach but this had only had limited success. Dr Ingram suggested that the uni-disciplinary approach was an issue and suggested that the approach should be to consider what the service required and redesign the workforce to meet these needs and there was a general agreement with this view. Ms Mead reported that NHS Highland were in a better position than they were at this time last year, but issues remained in the provision of sustainable medical cover in Wick which was creating a significant pressure in the RGH. She also said that within NHS Highland a mixed economy solution, with local redesign around a menu of options including the GP hybrid and physician assistants but, noted that none of these individually could provide a final solution. She also suggested that the emergency care network, on its own would not be the complete solution, as there needed to be a whole set of options to ensure that services are covered and she suggested that this required all Boards to work together to take this forward. Mr Roos indicated that those coming out of the remote and rural fellowships did not match up with the number of vacancies. He advised that he was in discussion with the deanery to consider a post CCT fellowship, which would allow a doctor to be appointed to a vacancy, and subsequently undertake the fellowship which should resolve the difficulty in matching candidates and jobs. Dr Ingram suggested that in addition, Boards might wish to consider setting up a regional medical bank, appointing newly qualified doctors in a similar way to the flying start schemes and developing a programme that would allow doctors to gain experience in each of the RGH hospitals and as part of the solution would get people employed, assist with cover and allow Boards to address the financial issues. Mr Carey as chair of the national Medical Bank Implementation Group advised that - 3 -
a lot of work was being done around HR and IT issues and was confident a solution around a national medical locum bank would be established, which might provide part of the solution. Mr Roberts echoed the suggestion of a mixed economy and asked if NoSPG were confident there was a structure and process in place to move this forward across the Boards. Mr Carey advised that this was covered by the NoS Medical Directors Group and the ECN group and admitted a reluctance to set up something new. Whilst members understood the reluctance to set up a new group, it was evident from the discussions that NoSPG did not have one group that could undertake the range of roles required. Dr Ingram suggested that the work required would need a group with a role akin to that of the Remote and Rural Implementation Group. Following further debate, it was agreed that Dr Dijkhuizen and Dr Ingram should submit a paper to the next NoSPG meeting that described a forum that would bring the different groups together to focus on the NoS redesign challenge and the implications of this for both service and workforce design. Mr Carey cautioned that the agenda should be manageable, would need to maintain a degree of focus, and the priorities would need to be identified. It was also important that the relevant people were engaged and that it would benefit a regional approach, but it was important all Boards were actively involved if sustainability is to be achieved. RD/AKI iv) Hub Procurement virtual Finance Team Dr Ingram reminded members that at the previous meeting it had been agreed to develop in-house expertise across the NoS and that a meeting had been held on 26 th August 2011 with the finance team. At that meeting it was agreed a workshop should be organised to focus on financing NHS Hub projects and the Directors of Finance will be invited. AKI v) NoS Cardiothoracic Surgery Service Mr Carey advised that NHS Grampian had received a letter from a clinician in Inverness intimating their intention to change the referral pattern for thoracic surgery from Aberdeen to Glasgow and Edinburgh. Mr Carey reminded members that there is an extant SLA for these services and suggested that outwith this meeting there should be an urgent meeting with all the relevant parties to discuss this issue and how it could be moved forward. Ms Mead advised that whilst she recognised the impact this will have on NHS Grampian services, this was not a decision the clinicians took lightly and agreed that an early meeting should be arranged to discuss the issue further. vi) CAMHS Mr Carey reported that it was also his intention to convene an urgent meeting in relation to the interim arrangements for adolescents with mental health issues, following a critical incident. Dr Ingram reported that the meeting was being arranged as a priority. 54/11 RGH Paediatric Unscheduled Care Project AKI AKI Mr Ferguson reported that NHS 24 had established the Paediatric Unscheduled Care workstream, within SCTT, chaired by Dr Ingram following the RRIG July 2010 event to revise the model for the RGH. He intimated that sustainable paediatric care was an important aspect of the SCTT workplan and that unscheduled care for children, within local environments, supported by Clinical Decision Support had been identified as a key deliverable. The project aims to develop a single point of contact between the six RGHs and the relevant receiving centres, including the four teaching hospitals and through the - 4 -
use videoconference to provide specialist clinical decision support, advice on the appropriateness of local management, with support if necessary or the need for transfer, ensuring that all relevant services, including the transport provider and the receiving centre are involved in the decision. Mr Ferguson said that services are currently organised in such a way that the default decision is to admit and from remote hospitals this often means a transfer, particularly when the doctor in the receiving hospital is a junior doctor. He referred to the recent High Dependency care audit, which highlighted that in 50-60% of transfers of children, these patients were discharged within 12 hours and a significant proportion of these patients were being transferred just in case. He also gave a recent example of a clinician within an RGH, who recently had to make 27 separate phone calls to get the right advice, before transferring the patient and suggested that there must be a better way to organise these services. He suggested that the balance needs to be redressed and through a command and control process, with a focus on patients, more patients could be retained and treated locally. This requires robust clinical support to support the remote and rural practitioners, including readily available clinical advice; a system which would allow use of videoconferencing within the clinical area and access to clinical data; and logistical support, including the availability of a senior clinician to act as the conduit between the RGH and the receiving centre. The proposal is that the Scottish Centre for Telehealth and Telecare (SCTT) should pilot this model in an RGH, noting that the RGH has a relatively defined population and, if successful would be rolled out across remote and rural areas. The intention would be that if an ill child was admitted to an RGH, the local clinician would telephone a single point of contact, probably within NHS 24, who would connect the clinician to the senior paediatrician on-call for this service, NHS 24 would also be able, at the same time, to pull records down and following examination by the paediatrician on-call, via videoconference, he/she would determine whether the patient could be safely managed in the local environment or require transfer. For those patients who do not require transfer, the paediatrician would work with the local practitioner to provide the support required, including call-back and handover the following day. Mr Ferguson said that in general RGHs were supportive of the concept, but work is required to identify how the decision support role will be staffed. A business plan will be developed but it was planned pilot the proposal from December 2011. It was intended that the project would not only improve the quality of care but also reduce unnecessary transfers. Mr Ferguson cautioned that it was unlikely that there would be a significant reduction in transfers initially until the relationships have been built up. Dr Ingram said that this pilot would dovetail with the Emergency Care Network, providing the pathway for children and that it was not intended that the pilot would interrupt current patient pathways. In response to a question from Mr Carey, Dr Ingram reported that she chaired the Project Board, supported by Mr Ferguson, Mrs Westwood, Ms Hazel Archer and Mrs Marcia Rankin, with good clinical representation from the RGHs and from Aberdeen, Inverness, Yorkhill and Edinburgh. The Paediatric transport teams and SAS were also represented. Ms Mead endorsed the plan to reduce the number of transfers, particularly, if it was not required but added this had implications for Raigmore and wanted to ensure that the links between Argyll and Bute and Yorkhill were also recognised. Dr Ingram provided reassurance regarding the links with Yorkhill but added there were some issue with engagement of Raigmore, despite enthusiasm of the RGHs and this might need to be addressed. EM - 5 -
Mrs Evans pointed out that it should be identified whether the paediatric specialties had the required time to take this on, but Mr Ferguson advised that it was not envisaged that this would alter the clinician s roles, as this was providing generalist support, not locally available. Ms Mead enquired whether the proposal from 1 st January was a 24 hour solution and Mr Ferguson advised that different models were being considered. Members were supportive of the project, noting that it would assure availability of appropriate and sustainable clinical advice and would compliment the ECN approach being taken forward by Dr Dijkhuizen. 55/11 National Telecare Programme Mrs Westwood reported that the National Telecare Development Programme (TDP) was established by the Scottish Government in 2006, and has been facilitated by the Joint Improvement Team (JIT) as a partnership support programme across health and social care. In the period up to end of March 2011, the TDP secured a total of 20m funding to drive the adoption of telecare by local partnerships (local authorities, health boards and community health partnerships, voluntary and independent sector) within service users homes and community based services. In February 2011, the Scottish Government s Health and Social Care Directorate, the national Telecare programme Board and the NHS 24 Board approved the transfer of the Telecare Development Programme from JIT into NHS 24, as an integral part of the Scottish Centre for Telehealth, which has now been renamed the Scottish Centre for Telehealth and Telecare (SCTT). The key activity is to develop a single integrated strategy telehealth and telecare, covering a three year period to ensure continuity, delivery and integration with the strategic framework of NHS 24, but be reviewed annually to ensure flexibility within a swiftly changing environment. It was agreed by the Scottish Government s Health and Social Care Directorate that NHS 24 would co-ordinate future engagement with the Technology Strategy Board (TSB) around DALLAS (Demonstrators of Assisted Lifestyle Living at Scale). Groupings including Scottish Government, the academic community and the enterprise companies are all committed to work together to develop a co-ordinated approach to the challenges presented by chronic disease, an ageing population with increasing number of frail vulnerable elderly and the additional challenges presented by dementia. Through this approach, in March 2011, the Scottish Government and the TSB announced the investment of 10 m over 2012-15 to develop the Scottish telehealthcare sector. The Scottish Assisted Living Programme Board has now been established, and is chaired by Dr George Crooks, Medical Director, NHS 24. Mr Carey acknowledged that this was a very exciting project and noted that this was still at a fairly early stage and would therefore be grateful for regular updates to NoSPG as things develop. JW 56/11 NoS Weight Management Implementation Group Mr Mitchell advised there had been several meetings of the NoS Weight Management Implementation Group, which has identified four work streams: Development of a Regional Pathway Model; Development of a Regional pricing Structure; Implementation Plan for Introducing the New Criteria; and Development of a Framework for the Capture of Data. - 6 -
Members of the Group have been involved with the national review of obesity services, commissioned by the National Planning Forum (NPF), which has made a number of recommendations, including: A regional approach should be taken to the planning, development and delivery of Tier 3 and Tier 4 services, informed by a national planning framework. Access to Tier 3 services should be available in all NHS Boards, recognising that differences in geography and workforce mean that there will be differences in the way services are delivered in different areas. The need for innovative approaches to delivery, e.g. the increased use of technology; was noted. Implementation of national criteria for bariatric surgery in order to focus the surgical service on those with the greatest capacity to benefit and to ensure a consistent and equitable approach to providing access to treatment. The criteria agreed was as follows: Age 18-44 years (due to increased surgical risk after 45 years); BMI 35-39; Recent (less than 5 years) onset of type 2 diabetes mellitus (clinical effectiveness evidence is stronger with recent onset). Whilst the above criteria are largely in line with that agreed by NoSPG, there is a small differential in respect of the age criteria and members agreed NoSPG would adjust their agreed criteria in line with that suggested by the National Planning Forum. Members also agreed that as of 1 st April 2012, or the date for implementation agreed by the NPF, which ever is the later, all patients on Tier 4 waiting lists who do not meet the new criteria will be discharged back to their GP for local management. The national criteria for bariatric surgery have been set within the context of a weight management pathway, with patients having to complete Tiers 1 to 3 before being referred to Tier 4 (surgery). The NoS criteria also recognised the importance of a weight management pathway, however, the provision of specialist weight management services (Tier 3) across the NoS is varied, with some Boards having no provision (north Highland) and others have some but not comprehensive provision (Tayside and Grampian). Mr Mitchell proposed, therefore, that NoS Boards prioritise the development of Tier 3 services to ensure that, as a minimum, plans are in place for access to sustainable Specialist Weight Management Services in time for the implementation of the new criteria. Members noted the challenge that the development of comprehensive Tier 3 services would bring and agreed and that the NoS Weight Management Group should seek to articulate both the challenges for Boards, together with the cost implications. Members agreed that there may be some opportunity for aspects of Tier 3 to be provided regionally. Mr Carey cautioned that Boards need to be mindful of the management issues created by the decision to refer patients already on the waiting list back to their GP, because they no longer meet the criteria, and suggested this needed careful handling. Mr Mitchell advised that he and Ms Urquhart had met with Health Scotland to seek public relations guidance, but suggested that part of the challenge will be to ensure consistency nationally. Mr Mitchell confirmed clinical colleagues are supportive of the criteria. Dr Ingram reminded members that when NoSPG approved the NoS criteria in February (item 05/11), members had agreed that no new referrals should be accepted onto the waiting lists, unless they met the new criteria, but despite the appropriate communication by Ms Urquhart, this had not happened. Following a RU/KM RU/KM - 7 -
proposal by Ms Mead, members agreed to ensure that GPs across NoS Boards were advised of the intention to introduce the new criteria from 2012, in order to manage the changing approach. BCE 57/11 Specialist Transport Review Mr Pearson gave a presentation on the Specialist Transport Review and the progress towards a single national specialist retrieval service for Scotland (ScotSTAR). He reminded members that NHS Scotland Chief Executives had requested that a review of specialist transport services take place to consider the opportunities to deliver a more integrated specialist transport service for NHS Scotland. He demonstrated the conceptual level of what the model would look like but advised that it would not be a single tier service and there will be a period of evolution over a period of time. The group had considered where the new service should be hosted and there were currently two options being actively considered, hosting by the Scottish Ambulance Service (SAS), which is the preferred option; or hosted by a territorial NHS Board. Mr Pearson advised that the challenge over the coming weeks is submitting an outline business case to the National Planning Forum and subsequently to the Board Chief Executives. The final decision would be for the Cabinet Secretary. It was confirmed there were links to paediatric unscheduled care. Ms Mead enquired about the period of time for evolution and Mr Pearson advised there were a number of phases: getting the right project management into a structure; developing the implementation Plan and developing the single point of contact and triage and tasking, in collaboration with the SAS. Mr Pearson noted that whilst there are opportunities for overlap between children and adults, the teams would not completely integrate and in the first instance the individual team would retain their discrete identities. Referring to the Neonatal Transport Service, Dr Ingram said that continuation of Variation Order for at least another year will be necessary but that the group were hopeful that work, ongoing with Glasgow Caledonian University, to develop a critical care paramedic would bring a more sustainable staffing model for the future. She stressed that there would continue to be a need for the discrete medical roles for the foreseeable future. Mr Pearson advised there were a number of options regarding the resources required to deliver the service and financial colleagues had been consulted to ensure an objective input and scrutiny. Mr Carey said that this had been discussed with Chief Executives and there was an expectation it would be within the existing resource envelope but with financial savings. There will also be efficiencies with the transfer of patients within a shorter period of time. Mr Roos referred to the Air Ambulance Reprocurement team who work with private companies to repatriate with a single team for all retrievals and questioned the need to have nodes for Neonatal and paediatrics. Mr Pearson replied that the critical care paramedic would have a more extensive training programme and whilst down south there was greater integration, there remained an issue with the skills and competencies required. He continued that geography was also a factor in the duration of transfers which did not impact on other services in the UK. Dr Ingram reminded members that the patients transferred by the specialist transport teams are 10% of the most vulnerable patients transferred across Scotland and that the augmented clinical teams are there because the patient s condition requires it. Referring to the neonatal transport team, Dr Ingram reported that the average cost of the clinical team is 2,000 per baby in transport, which when compared to the - 8 -
potential litigation costs of getting it wrong in such circumstances, did represent value for money. A progress report will be submitted to NoSPG at a future date. RP/JL 58/11 Scottish Ambulance Service Scheduled Care programme Mrs Kenney gave a presentation on the Scottish Ambulance Service Scheduled Care Programme established to reconfigure patient transport services to deliver a standardised and consistent service, operating from a technological platform. SAS board have committed 3-4m investment in technology to improve the infrastructure, which will be implemented next year. Mrs Kenney said that mobile technology will be installed in vehicles by Feb/March 2012 be and that the north Boards would be the first Boards to benefit from this. SAS will continue to work with Boards to manage the demands of patient transport and with other transport providers to develop an integrated approach. A dedicated call handling facility will be introduced, aimed at improving performance. At present the call handling standards are poor and inconsistent and a new suite of efficiency measures, together with an improvement plan will be implemented to improve the service outcomes. Ms Mead said that the PTS service often acts as compensation for deficiencies in remote and rural public transport and asked what planning had been put in place around communication of the changes to the service to patients. Mrs Kenney replied that a communication toolkit had been developed and SAS were working in partnership with local delivery teams to ensure effective communication. There would however be a safety net to prevent service gap or media issues during the transition. Dr Taylor was unsure of the connection back into the Islands and suggested data for Island activity would be helpful and that perhaps this could be a topic for further discussion. Mrs Kenney suggested that a separate meeting for the islands would be organised and she would ask Mr Weir, General Manager for the North to organise this. Mrs Farman asked if the criteria would be clear and Mrs Kenney advised the SAS have been working in partnership with patients for their view on how this might work. Once the eligibility criteria tool has been finalised, in October, Mrs Kenney will circulate to Boards. Mr Carey acknowledged this required a great deal of engagement going forward and requested NoSPG receive regular updates. HK HK HK 59/11 NOSCAN i) Breast Cancer Report 2010 At the last meeting members it had been reported that the NOSCAN Breast Cancer Report had largely been well received (item 47/11 (i)) but NHS Shetland had some outstanding issues, which Dr Taylor and Mr Gent had agreed to resolve outwith the meeting. Dr Taylor said that NHS Shetland did not agree with the recommendation that all patients should have their triple assessment at a one stop clinic in Grampian, as this was not the requirement of the QIS standards and there had been concern that the report had suggested that surgery should not continue to be provided locally. In relation to triple assessments, Dr Taylor reported that Shetland women do have - 9 -
access to triple assessments, but they are not all carried out on the Island or on a single day. Patients can choose to have an element of their assessment on the Island, as a preferred option to travelling the distance to Aberdeen, sometimes without the necessary support. All Shetland patients do receive triple assessment as required by the QIS standards, but these standards are outcome driven and do not require the assessments to be carried out in the same day. Mr Gent had clarified that the report recognised that it is appropriate for some surgery to happen on Island, as long as there is collaboration between the surgeon and specialist colleagues, outcomes are equivalent and quality of surgery on the Island is appropriate. Dr Taylor said that all the surgeons are part of the regional MDT with Aberdeen and as long as that continues, certain surgery can be provided locally. In response to a question from Ms Mead, Dr Taylor confirmed that both the mammogram and ultrasound were carried out in Aberdeen and that some biopsies were undertaken in Shetland. Mr Gent advised that the report had been harmonised to reflect NHS Shetland s concerns but noted that whilst some of the data contained within the report had been challenged, all the data had been approved, prior to submission, by the Board. In relation to progress against the recommendations of the Report in other Boards, Mr Gent reported that NHS Grampian, NHS Tayside and NHS Highland are engaged in service improvement initiatives aimed at reducing waiting times between surgery and post-operative radiotherapy/chemotherapy. NHS Orkney Area Medical Committee had supported the recommendations which are now going to the Area Clinical Forum and NHS Shetland are progressing the recommendations via their Clinical Governance Committee but are expecting to support the report. ii) Progress Mr Carey advised members that in terms of governance NOSCAN is now a subgroup of NoSPG. NOSCAN manages the north of Scotland cancer issues on behalf of NoSPG. He continued that the Scottish Government had recently consulted a Detecting Cancer Early (DCE) initiative, which with 30m additional funding has the potential to be significant for all Boards. Dr Ingram said that she extremely disappointed that the document made no reference to children and asked that North colleagues on SCT ensured that this was fed in. This was agreed. PG NOSCAN continues to represent the NoS Boards on the Scottish Cancer Taskforce (SCT), leading on a number of national initiatives. Mr Marr is due to replace Mr Carey as the Chief Executive representative from the North on, whilst Mr Gent and Dr King will continue to be involved. Mr Gent reported that there had been positive feedback on the final NoS Gynaecology Cancer Report which is currently out for consultation with the clinical teams. The Report will be finalised in September and will be submitted to a future NoSPG meeting. Mr Gent advised that the next NOSCAN Review to be undertaken will be endocrine services, as Prof. Krukowski s retirement will have implications for the future configuration of services. A proposal will be brought to NoSPG in due course. PG PG The de-designation of the musculoskeletal Sarcoma service by NSAG was noted and Dr Ingram reported that this had raised two issue for the North: how services would be organised in future; and how NoSPG prepared Board Chief Executives ahead of decisions to de-designate, as this was the second such decision that had - 10 -
had regional service impacts which Chief Executives had not been sighted on. She continued that in relation to sarcoma there were funding and access issues, which might suggest a risk share was required and reported that she and Mr Gent were due to meet and a paper would be brought to a future meeting. Mr Gent referred to the Regional Oncology Efficiencies Group, chaired by Mr Marr, which had held their final meeting on 29 th August 2011, with a proposal that a report to guide Boards to the areas where cost savings could be made will be submitted to Boards by November 2011. The report will also be submitted to NoSPG. AKI/PG PG 60/11 NoSPG Business i) Workplan 2011/12 and Progress Report The 2011/12 workplan was noted. Mr Carey advised that he had a very positive meeting around oral health and dentistry on 30 th August 2011 and that progress was being made around this project. Dr Ingram advised that Dr Zoe Dunhill had produced an interim report around secondary care paediatrics and that following discussions with Medical Directors, would be submitted to NoSPG early 2012. ii) NoSPG Event 21 st September 2011 Dr Taylor advised members that a pre-planning event had been held on 17 th August 2011 where a summary of the horizon scanning review was discussed with a view to reaching agreement on the format of the event on 21 st September 2011. Details of the literature review will be posted onto the NoSPG website for reference. Mrs Farman advised that as well as undertaking the literature review, NoSPHN had also sought the views from programme managers and clinical leads. Dr Taylor advised there was a mixture of attendees which included executive and non-executive Directors of Boards, public health colleagues and Medical Directors. A copy of the attendance list will be circulated to members for information. Mr Carey said that he would expect the non-executive attendees will be challenging around what added value could be achieved from Boards working regionally. Dr Taylor acknowledged that whilst the event might present challenges, the response may not be straightforward but should provide the opportunity to agree how these might be addressed. Dr Ingram advised members that it would be the intention to submit a paper on the outcome of the event to the next joint NoSPG/Chief Executives and Chairs meeting on 30 th November 2011. PF AKI 61/11 NoSPG Sub-groups i) NoS Integrated Planning Group The minute of the meeting held on 17 th August 2011 was noted. ii) NoS Public Health Network Nothing further was discussed under this item, see item 60/11 (ii). 62/11 National Update Mrs Evans update report was noted. Mrs Farman reported that the NSAG - 11 -
application for Sleep Disorders was currently being considered by NoSPHN following which it would be discussed at the IPG meeting on 12 th October 2011. The NSAG meeting was prior to the next NoSPG meeting and sought approval that a response from IPG could be submitted to NSAG, with retrospective approval by NoSPG and this was agreed. PF 63/11 National Planning Forum The minute of the meeting held on 1 st July 2011 was noted. Mr Carey advised that the membership and format of the National Planning Forum was being reviewed. 64/11 Any other Competent Business There was no other competent business raised for discussion. 65/11 Date of Next Meeting The next meeting will be held on 30th November 2011 at 10:30 am in the Conference room, Summerfield House, Aberdeen, followed by a joint meeting of all members of the NoSPG Executive and NoS Chairs. 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. - 12 -