NORTH OF SCOTLAND PLANNING GROUP Minute of virtual meeting held on Wednesday 18 th April 2012 at 10.30am NORTH OF SCOTLAND PLANNING GROUP Present: Aberdeen: In attendance: Dundee: In attendance: Inverness: Shetland: Orkney: APPROVED Mr Richard Carey, Chief Executive, NHS Grampian (Chair) Dr Roelf Dijkhuizen, Medical Director, NHS Grampian/Chair, NoS Medical Directors Group Mr Peter Gent, Interim Director of Regional Planning and Workforce Dev, NoS Mr Graeme Smith, Head of Service Development, NHS Grampian Mrs Anne-Marie Pitt, Child Health Network Manager Mr Neil Strachan, Programme Manager, NoS Child Health & CAMHS Mrs Martha Hay, Executive Assistant, NoS Mr Brian Kelly, Strategy & Regional Planning Projects Manager, NHS Tayside Ms Roseanne Urquhart, Head of Healthcare Strategy & Planning, NHS Highland Mr Ralph Roberts, Chief Executive, NHS Shetland Dr Sarah Taylor, Director of Public Health & Planning, NHS Shetland Mr Marthinus Roos, Medical Director, NHS Orkney NHS 24: Mrs Justine Westwood, Head of Planning, NHS 24. NSD: Mrs Deirdre Evans, Director, NSD 15/12 Apologies Action Mrs Cathie Cowan, Chief Executive, NHS Orkney; Mrs Pip Farman, Network Coordinator, NoSPHN; Mrs Anne Gent, Director of HR, NHS Highland; Mr Gordon Jamieson, Chief Executive, NHS Western Isles; Mr Gerry Marr, Chief Executive, NHS Tayside; Ms Elaine Mead, Chief Executive, NHS Highland; 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; Ms Yvonne Summers, Performance Manager, Scottish Government; Mrs Rhoda Walker, Director of Nursing and Allied Health Professions, NHS Orkney/Chair, NoS Nurse Directors; Dr Jim Ward, Medical Director, NHS Western Isles; and Mr Milne Weir, General Manager (North), Scottish Ambulance Service. 16/12 Minute of the meeting held on 29 th February 2012 The minute of meeting held on 29 th February 2012 was approved as an accurate record of the meeting. 17/12 Matters Arising i) Action Points Mr Gent confirmed the action points were either complete or ongoing and that the March I meeting had been cancelled but the items to be raised at that meeting - 1 -
would be carried forward to the meeting scheduled for 16 May 2012. He also confirmed that Dr Ingram had written to Mr Chris Lyons, General Manager NHS Highland and Mrs Pauline Strachan, Chief Operating Officer, NHS Grampian more formal links for joint service planning between the two Boards. A paper will be presented locally to each of the Boards strategic teams. ii) NoS Weight Management Implementation Group Ms Urquhart reported the Weight Management Implementation Group was progressing well. The costing exercise for bariatric surgery was complete and will be in place as from 1 April 2012. The north will not progress the framework to capture data as this exercise is currently being undertaken by ISD. Mr Mitchell attended a meeting on 17 April 2012 with dieticians regarding the tier 2 and tier 3 services, and will feedback any relevant outcomes where appropriate. The pilot in NHS Highland is progressing very well and will be reported upon in due course. A sub group has been established to investigate a number of areas which will be discussed at the National Planning Forum (NPF) meeting scheduled for 20 April 2012, following which Good Practice Guidance, incorporating the criteria for surgery and the process for patients who no longer fall within the structure, will be issued to Board Chief Executives and Medical Directors. Mr Carey asked if the north Boards were able to meet the 12 week treatment guarantee, which will include patients within the bariatric pathway listed for bariatric surgery, and if there had been discussions around the risks? In response Ms Urquhart said that the national group have had discussions and the north will fall in line with their recommendations. She further said that whilst patients on the waiting list may have an expectation they will receive surgery, the reason they are on the waiting list is for a weight management service and the end result of their treatment is not necessarily surgery. Mr Carey was keen to have assurance that Boards are prepared, with no expected breaches for patients who have been clinically identified for surgery after going through the pathway and therefore said this should also be raised at the NPF. Mr Gent advised it was important to have local Waiting Time Managers involved in any waiting times definition issues to ensure consistency of performance measuring. RC In answer to Mr Roberts concern regarding ensuring there was no misconception with patients as to what they were on the waiting list for, Ms Urquhart said links had already been made with the communications team within SGHD over the last 6 months to discuss this issue and that NHS Highland were further ahead than the other Boards due to the current pilot being undertaken as letters have already been sent to patients clearly identifying the process. The letters used within the pilot process could be used as a template for other Boards. Mr Carey thanked Ms Urquhart for her hard work on behalf of the north. iii) Paediatric Secondary Care Sustainability Review Mr Strachan updated members that following the NoS meeting on 29 February 2012 the Paediatric Secondary Care Sustainability Review report, carried out by Dr Zoe Dunhill, Independent Child Health Consultant has been circulated more widely and Mr Carey had also written to Boards seeking feedback in terms of their response to the report s recommendations. The responses are requested by 31 May 2012 to enable feedback to the NoS meeting on 13 June 2012. The report has also been discussed at the NoS Child Health Clinical Planning Group (NoS CHC) and there is a planning session scheduled for the NoS team on 19 April 2012 to prioritise the local and regional issues. Mr Roos confirmed discussions had taken place around the report within NHS Orkney, and progress against this would follow. Dr Taylor said that a process was - 2 -
in place within NHS Shetland to widen discussions with colleagues with the aim of bringing recommendations through the local committee structure. She said there were some elements which could be prioritised, there were others which NHS Shetland did not see the benefit of, but a summary on the outcomes would be submitted by the May deadline. Mr Kelly confirmed the report had been reviewed and the actions specific to NHS Tayside were being taken forward, with particular emphasis on the OOH service. NHS Tayside were also looking at the potential of inequality and if it exists how it will be addressed. Ms Urquhart said NHS Highland s views were being canvassed across the services and it is planned to schedule a meeting with clinical colleagues. Dr Dijkhuizen said discussions had taken place at the NoS Medical Director s group and forwarded to the Clinical Leads to take forward. He said he was concerned there may be ambivalence about the usefulness of the report to overcome. Mr Carey reiterated the importance of this work in terms of the network and encouraged regular updates and communication with colleagues on the progress. Members were happy to note the position and a more detailed discussion will be held at the next meeting. ALL iv) Child Protection Mrs Pitt reminded members of the discussion at NoS on 29 February 2012 regarding the resignation of Dr Liz Myerscough, NoS Clinical Lead for Child Protection and the risks this raised. A further discussion was consequently held had at the Chairs and Chief Executives meeting on 7 March 2012 in relation to the main reasons for this, options for the future and the risks associated with this. It was also noted at this meeting that Dr Myerscough had made it clear that her provision of expert tertiary advice and opinions to colleagues within the region will also cease as she saw this as part of the Lead Clinician s role, despite this not being a feature of the current Lead Clinician job description. The Chairs and Chief Executives were keen to ensure that the requirement for regional expert support was scoped but that this should be made available in the interim. They mandated the NoS CHC to determine the correct course of action and subsequent discussions were held on 14 March 2012. The CHC agreed that an interim service specification should be discussed with NHS Grampian for one session per week, which would state explicitly what the session would be expected to deliver including expert tertiary advice, peer review, the development of training and performance reporting to the CHC. The group also agreed there was still a requirement to develop an overall proposal for a NoS specialist child protection network, and a working group should be brought together to help capitalise on the work already done and develop the proposal to bring back to NoS. Dr Myerscough is planning to retire in April 2013, therefore there are sustainability issues. Dr Dijkhuizen informed members that Dr Myerscough was appointed on behalf of NoS to provide leadership, she was not appointed from NoS to provide training or provide the actual services. However, Dr Myerscough had been involved in providing such a service by being involved in patient cases. She was not appointed to provide a clinical service and he added this resulted in confusion because Boards will still have issues with training and education, still have their clinical cases to be handled and pathways have not changed, but it may be possible to make them better, Boards were looking for leadership to co-ordinate. A statement will be issued, via Medical Directors, around leadership, provision of clinical service and the training requirements across the NoS. The statement should also be clear about what can be delivered through regional specialist service AMP/NS - 3 -
and what will be delivered through Boards. This will be in place until 31 March 2013 or until a proposal is approved for a regional Clinical Lead. Members noted the interim arrangements to establish expert tertiary child protection advice for the region; and noted the intention to develop a proposal for the NoS specialist child protection network to be further discussed at NoS in the following months. 18/12 NoS Interim Management Arrangements Mr Carey advised members that Mr Gent has been appointed to the role of Interim Director Regional Planning & Workforce Development following Dr Ingram s move to NHS Grampian. It is proposed this arrangement is for a 6 month period, which is the timeframe Mrs Vickerman has committed to undertake a review of regional planning and the National Planning Forum at national level. Notwithstanding Mrs Vickerman s view that this will be 6 months, members should be aware that this could potentially take longer. Mrs Vickerman has requested Mrs Knox, Director of Regional Planning, West of Scotland to lead this piece of work and it is important that Boards participate with this review process and give as much impetus to the importance to regional planning as possible. Mr Carey advised that it is not the intention that regional planning should be discontinued and that the thrust of a review is more likely to be how across the north it could be reinforced and there is a need to enhance the importance of regional planning and how it fits into the NPF. Mr Carey said that in discussion with Mr Derek Feeley, it was also his view that Boards need to work to make regional planning more of a success and take it to the next level. Mrs Evans informed that the Board Chief Executives had agreed the National Services Advisory Group should be replaced with different ways of working and different delegated authority, therefore the relationship between national strategy and regional planning is important and she would be happy to be included in the discussions. Mrs Evans agreed to provide feedback from the Board Chief Executives meeting and it was agreed Mrs Knox should be invited to attend a future meeting of NoS. Mr Kelly said he was unaware of any specific discussions around the review within NHS Tayside but he did not think there is a likelihood to be any major changes as NHS Tayside were still looking to work with both regional planning groups for service provision. 19/12 CAMHS Financial Risk Share Mr Strachan informed members that CAMHS Financial Risk Share had been subject to discussion during the process of the OBC going around the Boards. It had also been planned to submit a paper the I in March, but due to the cancellation of that meeting it was circulated around I members with a request for feedback on the preferred option. NHS Tayside, NHS Highland and NHS Orkney have responded and their preferred option is Option 1, which makes no difference between the risk share between Island or mainland Boards. Mr Carey confirmed Option 1 as NHS Grampian s preferred option as this reflects what already exits within the NoS Eating Disorders Unit in Aberdeen. This has also been discussed at the CAMHS project Finance sub group. Having had confirmation of a preferred option from most of the Boards, it was agreed to pursue Option 1. The principles around the risk share were contained in - 4 -
the OBC. Members confirmed their support of this option. Dr Taylor said that NHS Shetland were happy to support this but was unsure if the new Finance Director had sight of this, therefore it was agreed Mr Strachan would establish that. NS 20/12 NoS Workplan i) Progress Report 2012/13 The report was not gone through in detail as Mr Gent advised it was at an early stage. A more detailed update will be provided for the June NoS meeting following discussions with Mr Strachan and Mr Mitchell. Mr Carey suggested it would be helpful to have a colour tracker included in the workplan for ease of reference on progress status of projects. Members noted the workplan. 21/12 NoS Sub Groups i) NoS Integrated Planning Group Further to Dr Ingram s move to NHS Grampian a Chair for the NoS I Group was required. Mr Gent said that following discussions with Dr Ingram it was suggested that he assumed the role of Chair unless there were any other nominations. Members agreed to Mr Gent accepting the role of Chair. Mr Gent advised that following the cancellation of the March meeting of I he would collate a list of actions that were outstanding. ii) NoS Public Health Network The paper submitted was noted. iii) NOSCAN Mr Gent said that a process was in place for the handover of his NOSCAN duties within the team for the duration of his interim appointment. A significant priority for cancer is the soon to be published Systemic Anti-Cancer Therapies CEL, currently at final draft stage. The requirements specific to the region relate to regional protocols and clinical management guidelines which have not previously been developed jointly across the three NoS cancer centres. Mark Parsons has commenced work on this but it is likely that considerable support at MD level will be required to progress this important area of work. It was agreed this would be highlighted to the Medical Directors and Mr Gent will provide a written update for the June NoS meeting on the issues that require to be addressed. iv) NoS Medical Directors The Minute of the meeting held on Monday 19 March 2012 was submitted and Dr Dijkhuizen gave an overview on the following: NoS Thoracic Surgery Service By way of background, Mr Dijkhizen said that referrals to NHS Highland had been suspended due to clinical concerns regarding how patients had been managed by the Aberdeen Cardiothoracic Unit. Mr Keith Farrer has been assisting in bringing people together and has provided a report and - 5 -
a final meeting of the group has been planned between NHS Grampian and NHS Highland. Considerable progress has been made in addressing concerns. Spinal Services There had been discussions with clinicians regarding the national pathway and it was acknowledged NHS Tayside would work with NHS Fife and that NHS Highland and NHS Grampian favoured a network approach. TAVI There is a national discussion ongoing regarding how the service will be provided across Scotland. Remote & Rural Anaesthesia There have been a number of discussions around anaesthetics and the recruitment to remote and rural posts. An interesting point regarding joint appointments was raised whereby the mainland Board which has the vacancy could consider offering an appointment on the mainland but include a provision of work for 2 years in a remote and rural Board at the outset. Mr Carey said this was similar to what was highlighted in Canada and other countries where candidates are offered substantive posts but would have to commit for a period of time in a remote and rural area. Mr Roos said there were problems with attracting Consultants who are at the end of their careers, but Island Boards would also like to attract young people. Mr Gent advised that he has had previous involvement with NHS Orkney in relation to joint appointments and will have a separate discussion with Dr Dijkhuizen. Mr Roberts said he was pleased to see discussion around anaesthesia and that unless Boards look at solutions services will become unsustainable. Dr Dijkhuizen referred to the recent meeting held in NHS Orkney and said Mr Brian Stickle, Consultant Anaesthetist, NHS Grampian gained a better understanding for the role of the anaesthetist in an Island setting and was motivated to assist in taking things forward. Paediatric Secondary Care Sustainability Review - Dr Dijkhuizen said Boards should be advised if a review has been commissioned for a service, the recommendations of that review should be adhered to and not be altered or ignored unless there was a good enough reason to do so. Mr Carey will have a discussion with Ms Meade regarding NHS Highland s position in respect of the potential issues. Ms Urquhart confirmed that discussions are ongoing and that Highland colleagues were progressing discussions and would respond as per Mr Carey s letter. /RD RC Maxillofacial Surgery, Oral and Dental Health Further to the appointment of a second OMFS Consultant the north could now begin to develop a robust network model and meetings will be held with clinicians to define what this will mean for patients across the north. 22/12 National Update The paper submitted regarding the NPF review of National Services Advisory Group (NSAG) and efficiency of specialised services; and Service Reviews of existing national services was noted. 23/12 Any other Competent Business There was no other business raised for discussion. 24/12 Date of Next Meeting The next meeting will be a virtual meeting to be held at 10.30 am on 13 th June 2012. 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. - 6 -