SOUTH EAST AND TAYSIDE GROUP Minutes of the Meeting of the South East and Tayside Group held at 10.45am on 10 th September 2010 in the Seminar Room, NHS Tayside, Kings Cross Hospital, Dundee, DD3 8EA Present:- Borders Fife Forth Valley Mr Calum Campbell Mr George Brechin Ms Janette Fraser Dr Ross Cameron Mr Gavin Brown Lothian Tayside Dumfries & Galloway Professor James Barbour Dr Peter Williamson Dr Mary Harper (VC) (Chair) Mr Alex McMahon Regional Leads Directors of Finance Scottish Government Mr Derek Phillips Mr Robbie Pearson Ms Jan McClean Directors of Public Health Nurse Directors NES Dr Alison McCallum Ms Sheena Wright Professor Bill Reid NSD Scottish Ambulance Service Medical Director Mrs Deirdre Evans Ms Heather Kenney Dr Gordon Birnie HR Director NHS 24 In Attendance Mr Tom Hammond, LD MCN Manager Dr. Tracy Sanderson, Consultant Psychiatrist, Clinical Lead for the LD MCN Elaine Kwiatek, Project Manager for the LD MCN Ms Lynne Khindria on behalf of Mr A Boyter Ms Justine Westwood on behalf of Mr J Turner Minutes Mrs Caroline Caddell, PA, SEAT Apologies for absence were received from: Mr Alan Boyter, Ms Susan Goldsmith, Ms Jacqui Simpson, Professor Elizabeth Wilson, Ms Sonya Lam, Dr Brian Montgomery, Ms Yvonne Summers Item No. Section Action 1 Welcome James Barbour welcomed everyone to the meeting. He informed the group that Jacqui Simpson would not be in attendance at this meeting due to bereavement. The Group extended their sympathies and asked that their condolences were passed to 1
Jacqui. James Barbour advised that this was Gavin Brown s last SEAT meeting before his retiral in October. James thanked him for his significant and valued contribution to SEAT over the years and wished him well for his retirement. 2 Previous Meeting 2.1 Minutes of the Meeting held on 21 st May 2010 The minutes of the previous meeting were agreed as an accurate record. 2.2 Progress Against Action Note The progress against the action note was noted. 3 Matters Arising 3.1 TAVI Ross Cameron, chair of the national TAVI Group, provided an update for SEAT on progress. The first Steering Group meeting took place in August and the first of three evidence gathering sessions had taken place last week. The evidence sessions will be completed over the next month, with a draft report prepared in November and finalised by December 2010. 3.2 SEAT Away Day 12 th October 2010 In Jacqui Simpson s absence, Derek Phillips confirmed that the SEAT Away Day would take place on the 12 th October at the Vine Church in Dunfermline. An independent facilitator, Ken Jarrold from Dearden Consulting, has been engaged to facilitate the event and has now had telephone conversations with each of the core SEAT Board Chief Executives to agree the format and key objectives of the day. Jacqui Simpson was leading a sub-group of Directors of Planning and Finance in developing potential themes to be discussed at the event. Background papers and relevant information would be made available prior to the Away Day. It was agreed that outcomes should be deliverable in the required timescales, achievable, and relevant to 2 or more Boards. Derek Phillips advised that Chief Executives from the core SEAT Boards had been asked to nominate senior staff they would wish to attend from their respective Boards. It was highlighted that representatives from NHS Tayside and Forth Valley will be invited, with an expectation that they will be at a sufficiently senior level to make decisions on behalf of their Boards and commit to the themes agreed on the day. James Barbour confirmed that representatives from Special Boards would be invited, with further discussion to take place between SEAT and the Special Boards. JSimpson CExecs/ J Simpson 2
3.3 Optimal Reperfusion Therapy (ORT) Business Case in NHS Borders Calum Campbell confirmed that the regional ORT Business Case had been approved by NHS Borders Board and that the service will be operational in October. 3.4 Bariatric Surgery Gavin Brown reported that a group chaired by Dr E Coyle, Director of Public Health, NHS Fife, had been set up under the auspices of the National Planning Forum. There is emerging evidence of the efficacy of surgical procedures for morbidly obese patients particularly those suffering from diabetes. The Group has recognised the importance of striking a balance between local and regional provision of bariatric procedures, with the possibility of local hospitals providing the less complex procedures. An interim report is expected by October 2010. James Barbour emphasised that a key part of this work should be the accompanying development of protocols for bariatric procedures. 3.5 Abdominal Aortic Aneurysm Screening James Barbour referred to letters pertaining to Abdominal Aortic Aneurysm (AAA) screening circulated prior to the meeting. Clarity had been requested from National Services Division (NSD) on the assumptions around off-setting future costs of implementing the screening programme and associated surgical costs. It was reported that Richard Carey had written to Board Chief Executives in his capacity as Chair of the AAA Screening Implementation Group, advising that although delays were being incurred with the IT infrastructure to support the screening programme, SGHD were still committed to completing the roll out of the programme by 2013. Deirdre Evans informed SEAT that financial modelling work in NHS Lanarkshire suggests that there will be an additional 2m additional cost to implementing the programme. She stated that after the first few years of implementation costs should start to fall. Alison McCallum commented that during screening for AAA, other health risks and conditions such as cardiovascular disease and obesity would be identified, and queried whether account had been taken of the additional costs associated with addressing these issues. She also questioned whether the requirement for additional resources to ensure appropriate participation by ethnic groups had been factored in. Ross Cameron queried whether the modelling assumptions had taken account of the number of men aged over 65 who had not been invited for screening and required emergency surgery for AAA, as this would generate a tail for 10 years or more. Deirdre Evans commented that the experience in England following 3
implementation of a similar programme had shown a reduction in costs after several years. SEAT noted the discussion and comments and agreed that a letter be sent on behalf of SEAT to Richard Carey outlining the issues raised and seeking further discussion at the forthcoming Chief Executives meeting. JSimpson 4 SEAT Initiatives 4.1 SEAT Annual Report 2009/10 Derek Phillips presented a draft of the 2009 Annual Report circulated prior to the meeting. He advised that the report had been edited by the Communications Team at NHS Lothian on behalf of SEAT. A final version will be presented at the next SEAT meeting. James Barbour asked the group to review the contents and provide any comments to the SEAT office by Monday 20 th September. After discussion it was agreed that the SEAT team would consider how the report would be disseminated, acknowledging the costs of publishing and printing. It was agreed that it would be helpful to produce the Annual Report earlier in the year. All JSimpson 4.2 SEAT Learning Disabilities Managed Care Network Tracy Sanderson spoke to the LD MCN Annual Report for 2009 and the MCN Progress Report which had been circulated previously. She thanked the Group for the opportunity to present the reports to SEAT and also thanked Calum Campbell for agreeing to assume the chairmanship of the Steering Group. Tracy highlighted key areas of achievement during the past year, notably the opening of Daleview, the Low Secure Learning Disability Forensic Unit in Fife; the success of rolling out joint education for staff between health and social services; the joint work underway with Local Authorities in looking at packages of care for patients with complex needs; and recent discussions with NHS Tayside on potential opportunities for shared work. In considering future challenges for the MCN, Tracy Sanderson asked SEAT to consider and provide guidance to the MCN on how there might be improved engagement and collaboration with learning disability services for children. She advised that her view was for Learning Disability services to span cradle to grave. She reported that many children with learning disabilities are not diagnosed early enough which creates difficulties for adolescent and adult services. Early intervention can reduce some of the behavioural challenges faced in early adulthood. It was also highlighted that complex and expensive joint care packages for children are removed once the child/adolescent moves on to adult services. Following a wider discussion, James Barbour highlighted that there 4
may be merit in considering the experiences from Total Place, a project in England where public sector agencies work together to maximise use of budgets and ensure optimal service delivery. It was agreed that this item would be taken to the next Directors of Planning and Directors of Finance on Friday 22 nd October for further discussion. Tracy Sanderson was asked to provide a paper proposing what SEAT might wish to do building on the successes already achieved. Within NHS Lothian, Alex McMahon was asked to assist Tracy Sanderson in arranging a meeting with Jim Forrest and Peter Gabbitas. Alison McCallum informed the group that 10-20% of children are born with a learning difficulty. She advised that there was a need to examine how people with a learning disability are able to access services and use them appropriately. Alison McCallum will follow this up with Tracy Sanderson. JSimpson AMcMahon AMcCallum Alex McMahon informed the group that a draft strategy for Autism has recently been produced with the implication that further work will need to be done in this area. SEAT agreed that learning disability services could be considered as a theme at the Away Day. JSimpson Deirdre Evans advised that she was seeking the numbers of learning disabled patients requiring forensic care in Scotland to inform the work of the Inter Regional Forensic Leads Group on medium secure learning disability services. James Barbour suggested that numbers from the SEAT Boards could be sourced from Directors of Planning. George Brechin suggested that the numbers were not immutable and the boundaries between low and medium secure were not fixed. 4.3 MCN for Child Sexual Abuse Annual Report and Workplan Ross Cameron referred to the previously circulated Annual Report and Workplan from the regional MCN. He advised that the MCN had been established for a fixed period of 2 years with a key objective of developing a sustainable regional model for service delivery in SEAT. Ross Cameron reported that significant progress had been made during the last year, with details of progress highlighted in the Workplan. Slippage monies accrued from the National Delivery Plan for Specialist Children s Services are being used to upgrade equipment across the region to ensure compliance with forensic and Crown Office standards. Alison McCallum commented that this was an example of where there was a clear advantage for a small specialist service to be planned and delivered regionally and suggested there could be one designated clinical specialist for the region. Ross Cameron advised that the MCN is developing an exit strategy 5
to ensure a robust network continues following cessation of funding. It was agreed that Ross Cameron would take this suggestion to the MCN Steering Group. He noted that if there were any ongoing revenue costs, these would be kept to a minimum. RCameron 4.4 National Delivery Plan for Specialist Children s Services 4.4.1 National Delivery Plan (NDP) for Specialist Children s Services Update Jan McClean referred to a previously circulated update paper. She confirmed that Year 3 allocations had been made to SEAT accommodating a 5% reduction in funding imposed by Scottish Government. A reduction of 5% had also been applied to Children s Cancer funding but has not affected the top-sliced funding for Royal Hospital for Sick Children, Edinburgh. Jan McClean reported that there is likely to be additional slippage accrued during this financial year which the Scottish Government have indicated may be used by Boards in support of NDP objectives. All slippage monies are required to be identified by Boards through a quarterly finance report submitted by SEAT. On behalf of NHS Borders, Calum Campbell gave thanks for all the work undertaken on this project. 4.4.2 DGH Competencies Jan McClean advised that this item related to a consultation document circulated in July 2010 by the Royal College of Paediatrics and Child Health. The report was commissioned by the National Delivery Plan for Specialist Children s Services Implementation Group, but had been circulated prior to discussion at that group. Scottish Government colleagues have advised that the draft report is not currently endorsed or sponsored by them, but will be discussed at the next National Delivery Plan for Specialist Children s Services Implementation Group in October. Jan McClean advised that the draft report had been discussed at the SEAT Children and Young People s Health Services Planning Group and comments had been collated and drafted into the attached letter. SEAT endorsed the comments in the letter and agreed that the letter should be sent on behalf of the Regional Planning Group. JMcClean 4.5 Workforce Planning 4.5.1 Update Derek Phillips referred to the paper circulated prior to the meeting which offered an update on the workforce issues. He highlighted that the Scottish Government has issued a consultation document on Higher Specialty Training Numbers for 2011 2015. The methodology adopted would result in a decrease of higher trainees across NHSS of between 473 and 848 trainees over the five year period. Derek Phillips stressed that the number varies significantly due to uncertainty over CCT dates. The document also indicates a provisional reduction of around 111 trainees in 2010 2011 6
although there is no detailed information on the speciality or region that will see reductions. He confirmed that more detailed discussions are ongoing to clarify the detail behind these projected numbers. Derek Phillips estimated that these proposed NHSS reductions would result in a worst case scenario of a reduction of c200 higher trainee posts in the SE Deanery over the same period. 4.5.2 Projected Higher Specialty Training Numbers - Consultation The consultation raises a number of key issues. It states that core training numbers can be determined regionally subject to meeting training requirements. Also that it proposes a move away from using National Training Numbers to determine training numbers and adopting WTE this would compensate for the increasing amounts of maternity/paternity leave, out of programme experience and vacancies which all reduce the numbers of trainees to support service delivery. Derek Phillips was asked to comment on the proposed deanery split identified in the consultation. He confirmed this had been discussed in detail at a meeting chaired by Alan Boyter in August 2009. The view of the group was that this reflected a fair distribution for the SE but that there had to be careful monitoring of the distribution as further reductions were made in trainee numbers. He was also asked to comment on the impact of the oversupply of CCT holders may have on service productivity. He identified that the oversupply will provide a good supply of CCT holders and it should enable boards to fill vacancies, reduce agency locum costs, redesign the workforce, etc. However there remain issues around how they might be employed, existing T&Cs and costs associated with using trained doctors Out of Hours. The overall impact will be determined by the success of workforce and service redesign. The group were asked to consider the draft response to the consultation pulled together by Professor Paul Padfield as chair of the RMWG. After detailed discussion a number of minor amendments to the draft letter were suggested and Derek Phillips was asked to link with Professor Paul Padfield, Dr Ross Cameron and George Brechin to finalise the response and to ensure the final version was sent to the SGHD in line with the timescales agreed. DPhillips 4.6 Regional Cancer Advisory Group James Barbour provided an update for SEAT from the immediately preceding meeting. Areas for discussion had included the Non- Surgical Oncology Review which had highlighted possible nonrecurring resources; the Scottish Medicines Committee process for agreeing new medicines; and the implementation of the electronic chemotherapy prescribing system (CEPAS) in SEAT. 7
5 Regional Liaison Initiatives 5.1 Update on Reprovision of RHSC Edinburgh Alex McMahon updated SEAT on the Reprovision Project, advising that due to issues with building on a PFI site, the programme had slipped 9 weeks. He confirmed that the commencement of building works was still scheduled for March 2011 with the new hospital expected to open in November 2013. It is anticipated that the Full Business Case will come to SEAT in January 2011. Gavin Brown requested that a revised schedule for the Full Business Case, and in particular the finance information, be circulated to Directors of Planning and Finance, to allow Boards to schedule the Full Business Case into their local governance arrangements. AMcMahon James Barbour reported that a recent report into the fundraising activities of the Friends of Sick Kids had found no evidence of any wrongdoing but had raised issues in respect of governance. James Barbour confirmed that a new partnership arrangement with a significant fundraising organisation was close to being announced, with confidence that the required sum could be raised within the designated timescale. 6. National Initiatives 6.1 National Initiatives Update Report Deirdre Evans spoke to a previously circulated update paper. James Barbour commented that the Paediatric Epilepsy Surgery proposal for national service designation was not submitted by NHS Lothian as stated in the paper, but by the Scottish Paediatric Epilepsy Network, although the site for service delivery was proposed as Royal Hospital for Sick Children, Edinburgh. Deirdre Evans agreed to make the appropriate changes. DEvans A discussion followed on the methodology of costing proposals with the Group agreeing that proposals should be clear in identifying costs borne by the NHS to ensure a fair comparison. In particular, clarity was required regarding the Great Ormond Street costs and also on any associated costs being Borne by Boards as a result of families from Scotland having to travel to London. 7 Regional Minutes The following minutes were circulated prior to the meeting for information and were noted. 7.1 Minutes of the SEAT Directors of Planning and Finance Meeting on 7 th May and 2 nd July 2010 7.2 Minutes of the SEAT Children & Young People s Health Services Planning Group on 14 th April, 26 th May, 6 th July 2010 8
7.3 Minutes of the Regional Cardiac Planning Group on 30th April, 4th June and 6th August 2010 7.4 Minutes of the Medical Directors, Directors of Public Health, Directors of Nursing on 21st January 2010 7.5 Minutes of the MCN CSA Steering Group on 2 nd March 2010 8 Communications 8.1 NHS Fife Gavin Brown advised that the newly formed Board had met on three occasions and reported that it had been a positive experience for NHS Fife. A second HAI inspection has been carried out. 8.2 NHS Tayside Peter Williamson advised that Tony Wells, Chief Executive, is retiring at the end of January and that Elizabeth Wilson, Nurse Director retires at the end of September. 8.3 NHS Borders Calum Campbell stated that there was nothing to report. 8.4 NHS Education for Scotland Bill Reid stated that there was nothing to report. 8.5 Scottish Government Health Department Robbie Pearson referred to the work of the National Planning Forum and in particular the work on horizon scanning. He emphasised the importance of avoiding 'surprises' and that the horizon scanning process was intended to act a mechanism for ensuring the service and Scottish Government were aware, at an early point, of reviews underway and their potential consequences. Robbie also referred to the recent Audit Scotland report on Emergency Departments and the work that was underway to respond to the recommendations. 8.6 NHS Forth Valley Janette Fraser informed the group the new Forth Valley Royal Hospital had now opened to patients. Positive feedback had been received from patients and staff. An open invitation was extended to SEAT members to visit the hospital. 8.7 NHS 24 Justine Westwood stated that the Business Case for Stroke Thrombolysis was progressing and they are about to recruit technical support for the project. 9
8.8 NHS Dumfries and Galloway Mary Harper stated that there was nothing to report. 8.9 Scottish Ambulance Service Heather Kenney informed SEAT that there had been good attendance at the Scheduled Care Event in July. The SAS are currently undertaking a 12 week intensive improvement programme. It was proposed that following this exercise, SAS may wish to engage with SEAT on regional opportunities for efficiencies. SEAT Chief Executives are to be invited to the Remote and Rural Strategic Option for Emergency Care Event on the 12 th November in Pitlochry. 8.10 NHS Lothian James Barbour confirmed that the new Lothian Community Hospital would soon open. Lynne Khindria advised that NHS Lothian have made significant progress with planned reductions to the workforce, with over half of the reduction already achieved. Alex McMahon informed the group that Susan Goldsmith is working with other SEAT Directors of Planning and Directors of Finance on the East Coast Costing Model. The intention is to bring an update to the next SEAT on 5 th November 2010. SGoldsmith 9 Any Other Business None raised. 10 Date and Time of Next Meeting Friday 5 th November 2010, 10.00am. NHS Fife, Conference Room 4, Lynebank Hospital, Dunfermline, KY12 0SW 10