Meeting: NoSPG Date: 25 th February 2015 Item: 22/15 NORTH OF SCOTLAND PLANNING GROUP National Planning Forum 4 th December 2014 NoSPG is asked to: Note the attached Note of meeting from the National Planning Forum meeting held on 4 th December 2014. Synopsis of Paper: The aim of the paper is to update members of the ongoing issues being discussed at the National Planning Forum meetings. The Minute from the meeting held on 4 th February 2015 will be submitted to the NoSPG meeting in on 17 th June 2015.. Board Representation: NHS Board Name Role Mark McEwan NHS Grampian Service Planning Lead NHS Highland Deborah Jones Chief Operating Officer NHS Tayside Brian Kelly Strategy & Regional Planning NoSPG Jim Cannon Kerry Russell Director of Regional Planning Programme Manager Regional Sustainability Page 1 of 9
NATIONAL PLANNING FORUM Date: Thursday, 4 December 2014 Time: 13.30 16:00 (lunch available from 12:45) Venue: Scottish Health Service Centre, Edinburgh Note of Meeting Present Elizabeth Porterfield Lorna Hall James Stevenson Jim Cannon Kerry Russell Allan Gunning Elizabeth Preston Janette Fraser Chris Roberts Catriona Renfrew Elizabeth Sadler Craig Bell Susan Myles Jenny Long Colin Lauder Rachel Green Jacqui Simpson Deirdre Evans Mary Harper Deborah Jones Brian Kelly Irene McGonnigle Martin Bell Mike Higgins Sara Davies Videoconference Mark McEwan In attendance Fatim Lakha Judith Stark Paudric Osborne Paul Currie Iain Robertson Nelson Kennedy (Chair) Head, SG Strategic Planning & Clinical Priorities NHS Health Scotland Executive Support to NHS Board Chief Executives North of Scotland Planning Group North of Scotland Planning Group NHS Ayrshire & Arran NHS Lothian West of Scotland Planning Group Strategic Planning & Clinical Priorities, Scottish Government NHS Greater Glasgow & Clyde Head of Planning & Quality Division, Scottish Government National Planning Manager, Scottish Government Scottish Health Technologies Group Healthcare Improvement Scotland NHS Lanarkshire Scottish Association of Medical Directors SEAT Regional Planning Group National Specialist & Screening Services Directorate (NSD) NHS Dumfries & Galloway NHS Highland NHS Tayside NHS Fife NHS National Services Scotland Golden Jubilee National Hospital Scottish Government Senior Medical Officer NHS Grampian SG Secondee / NHS Lothian Public Health Registrar NHS Public Health & Intelligence (PHI) SG Analytical Services Division SG Strategic Planning & Clinical Priorities Scottish Health Technologies Group NHS PHI Page 2 of 9
1 WELCOME AND APOLOGIES 1. Liz Porterfield welcomed members to the meeting, explaining that Michael Kellet had been called to a meeting with Cabinet Secretary and that she was therefore substituting as chair. 2. Apologies had been received from: Michael Kellet, John Burns (incoming co-chair), Ian Ritchie, Catherine Calderwood, Aileen Keel, Louise Wilson, Jennifer Armstrong (Rachel Green deputising), Justine Westwood, Alex McMahon (Liz Preston deputising), Maggie Waterston (Jenny Long deputising), Cath Denholm (Lorna Hall deputising), Vicky Freeman (Mary Harper deputising), Emelin Collier and Harpreet Kohli. 2 MINUTES OF 25 SEPTEMBER MEETING Paper (14) 28 3. Members were content that paper (14) 28, was an accurate record of the meeting held on 25 September. Action 1: Secretariat to follow up with Frances Elliot on discussion with NSD around possibility of national service development for mesh implants. APPOINTMENT OF NEW FIRST MINISTER, CABINET SECRETARY, MINISTERS 4. Liz Porterfield confirmed the recent Ministerial changes in Scottish Government. The new First Minister had noted her commitment to equality and to the NHS, in particular improving healthcare services. It was confirmed that the new Ministerial team would wish to continue to work together with NHSScotland to deliver safe effective and person centred services. The new Ministers were noted as: Shona Robison Cabinet Secretary for Health Wellbeing & Sport Maureen Watt Minister for Public Health Jamie Hepburn Minister for Sport, Health Improvement & Mental Health 3 PRESENTATIONS 3.1 National Resource Allocation Formula 5. NPF welcomed Paudric Osborne (ASD) and Judith Stark (PHI), who gave a presentation on how the National Resource Allocation Committee (NRAC) formula worked, and the work of the Technical Advisory Group for Resource Allocation (TAGRA) to maintain and develop it. 6. The NRAC formula did not determine the size of the budget, but how to calculate NHS board target shares of the health budget. It was noted that the formula aims to represent equitable access to health care resources given relative morbidity, and the relative costs of delivering services. The fundamental starting point for the formula was (resident) population, and this was weighted to reflect need for, and cost of, services in each area. Populations were weighted using age-sex, additional need and unavoidable excess cost factors, and those weightings were calculated based on predicted need, not how much Boards had spent Page 3 of 9
Action 2: Secretariat to circulate summary paper for information [issued with these minutes] 3.2 NSS Discovery Benchmarking Tool 7. Kennedy Nelson from PHI provided NPF with a demonstration of the Discovery benchmarking tool, currently in development. Discovery will see the consolidation of a number of existing tools, with a focus on informing quality improvement, patient safety, and performance and planning. Once live, PHI intends to provide an information reporting and benchmarking service, incorporating the electronic Discovery system as well as information consultancy. It was expected that the benchmarking will incorporate six key improvement areas from the 2020 vision, and allow benchmarking at Board and hospital service level. 8. Members thanked Nelson for the informative presentation. On the possibility of incorporating further information, on health & social care integration, workforce, and operational information, it was noted PHI would be happy to work with national groups to decide in cooperation with Boards what further information might be included in the tool. Nelson also confirmed work was ongoing to scope what was possible in terms of linking Discovery with existing datasets, with the aim of establishing a wraparound service. 9. The current plan was for the NHS version of Discovery to be delivered in April 2015, and consideration could then be given to building in additional information requests. However it was acknowledged that further conversations would be needed in terms of developing additional functionality. Action 3: Deirdre Evans to discuss with Nelson Kennedy the potential crossover between existing NSS systems and Discovery. 3.3 SHTG strategy & development 10. Iain Robertson set out SHTG s strategy on non-medicine technologies and provided an overview of new SHTG products. 11. It was recognised that processes around the approval of new medicines was wellestablished. However on new Non-Medicine Technologies (NMTs) the process was not yet as streamlined. Roughly speaking there may be around 1000 new NMTs per year, with levels of available clinical and cost effectiveness evidence varying. At CE mark stage, only a modest evidence base was needed, and therefore SHTG had been considering ways to make better use of the evidence and information available for NMTs to help support NHS Boards decision making. As such, a new SHTG product, the Innovation Medical Technology Overview (IMTO) had been launched recently, which provides a summary of the available evidence and information around the efficacy and cost of NMTs that have been through the IMTO process. 12. SHTG were also considering moving to a model of inviting themed calls for reviews, and suggested that NPF s input would be welcomed in suggesting possible topics for evidence reviews. The excellent working relationship between NPF and SHTG was emphasised, and it was agreed that NPF would continue to work closely with SHTG to contribute to the development of the NMT strategy. Page 4 of 9
13. It was noted that consideration was being given to NMTs in areas such as molecular pathology, and other areas within the diagnostics sphere. It was confirmed that close linkage between SHTG, SG, NHS Planning and the Diagnostic Steering Group would ensure these areas of potential overlap were considered going forward. SHTG also confirmed that its work on NMTs maintained close links with SG s ongoing Innovation work. 14. There was some discussion of cost-effectiveness evidence for NMTs. Susan Myles noted that this might take the form of primary economic analysis or more straightforward simple mathematical analysis, depending on the technology in question. However, the mechanism for collecting primary cost effectiveness data, which was time and resource intensive, and the short life of patents for NMTs, meant that primary economic analysis of NMTs could be challenging. It was confirmed however, that SHTG were working with Small and Medium-sized Enterprises (SMEs) on gathering cost effectiveness data where possible, and the NMT process incorporated a feedback loop to ensure such issues were taken into account. 4 DISCUSSION ITEMS 4.1 Minimally-Invasive Radical Prostatectomy (MIRP) Paper (14) 30 15. The West and North Regional Planning Directors provided updates on their plans to move to minimally-invasive radical prostatectomy (MIRP), as set out in paper (14) 30. 16. A paper was due to be considered by West of Scotland Planning Group on 5 December around MIRP, which included reference to capacity planning, patient pathways, co-dependencies and preferred site for the service. In the North, plans to offer MIRP to all patients from January 2015 were now in place. However, it was noted that there may be issues around sustaining MIRP services and consequences for wider urology services in Highland/Western Isles. Action 4: The North and West of Scotland Planning Directors agreed to provide further updates on the moves to Minimally Invasive Radical Prostatectomy which set out timescales and volumes at the next NPF meeting on 4 February. 17. There was some discussion of the impact that changes in the radical prostatectomy pathway might have on wider urology services, particularly on some Boards ability to meet cancer waiting times targets. It was agreed that discussion was required to further define requirements and responsibility for taking forward work to address this. Action 5: Liz Porterfield and Catriona Renfrew to follow up on potential need for and scope of a potential wider review of urology services. 18. It was confirmed that arrangements for clinicians to discuss prostatectomy were in hand. A meeting to be hosted by the Royal College of Surgeons Edinburgh, was being planned for early in the New Year. 4.2 Adult Critical Care Stocktake Paper (14) 33 19. In December 2013, the NPF considered a paper (NPF 13-31), from the Scottish Critical Care Delivery Group which asked for a review of adult critical care services across Page 5 of 9
Scotland. An outline plan for a review was presented to the NHS Board Chief Executives meeting in January 2014. 20. Board Chief Executives asked NPF to carry out an initial stocktake of adult critical care resources across Scotland, before any consideration of a full review. In April 2014, the scope of the stocktake was agreed by NPF and the Chief Executives group. The information sought (as agreed by NPF) covered beds, staffing, patient sources and flows, issues and pressures, and future plans. 21. The chair welcomed Fatim Lakha to present her report to NPF. The report set out the findings of the stocktake of critical care in Scotland, based on data gathered from Boards in July and August 2014. Key findings included: All hospitals have a standardised approach to identifying and responding to the clinically deteriorating patient; Staffing pressures at consultant, nurse and junior doctor level; 8% of consultant workforce eligible to retire in next 3 years, with difficulties in recruiting to junior posts this raises concerns about sustainability of the clinical workforce; Admissions largely stable for 2007-2013; and, Occupancy levels and throughput of patients in some units is negatively affected by delayed discharges and other problems with patient flows, including problems further downstream; 22. NPF thanked Fatim for a comprehensive and detailed piece of work. 23. Liz Porterfield reaffirmed the earlier commitment to share the stocktake findings with the 7-day Sustainable Services Taskforce. It was proposed that as a next step, in the normal way, the findings are presented to Board Chief Executives (BCEs) at their meeting in January, along with any recommendations from NPF. It was agreed that BCEs should be invited to advise if they wished NPF to take forward any work relating to the stocktake findings at a national level, and if so how and who should take this work forward. BCE s advice will be considered at the next NPF meeting on 4 February. Action 6: Fatim Lakha and Liz Porterfield to take critical care stocktake findings and report NPF s recommendations to the BCE meeting in January. Action 7: Secretariat to share stocktake presentation and data (as noted in the report appendices) with NPF [issued with these minutes]. 4.3 TAVI Report from TAVI Review Group Paper (14) 34 24. Chris Roberts gave an update on the outcomes from the TAVI Review Group (TRG) meeting on 5 November. TRG met to consider the first two years of operation of the national TAVI service, based at Royal Infirmary Edinburgh. TRG found that: the TAVI service at Royal Infirmary Edinburgh continued to deliver a high-quality service with excellent outcomes. In light of this, TRG recommended the TAVI Clinical Oversight Group (TCOG) should stand down, but may be recalled at discretion of TAVI Review Group. Page 6 of 9
Current patient volume was around 60 TAVI cases per year, with no evidence of any unmet demand across Scotland; letters from TCOG chair and CMO to Boards in 2014 had not identified any unmet demand. Based on patient volumes, there was currently no case to expand to more than one TAVI centre for Scotland. TRG recommended that the situation should continue to be kept under review, and the TAVI Review Group should meet 6-monthly, with a view to updating NPF in December 2015. 25. NPF agreed that: the TAVI service at Royal Infirmary Edinburgh should be commended for continuing to deliver a high-quality service with excellent outcomes. There is currently no clear evidence of unmet demand for TAVI and therefore no strong grounds for expansion of the service. Expansion should not be ruled out in future, should unmet demand be identified, and a safe and sustainable route to expansion can be found. the TAVI Review Group should continue to meet every 6 months, with a view to updating NPF in December 2015. 4.4 Remote Decision Support Paper (14) 35 26. Jim Cannon introduced paper NPF (14) 35, on remote decision support - the provision of appropriate (clinical) advice swiftly at an appropriate level - to clinicians located remotely. The paper set out some of the key challenges including provision of appropriate support to help reduce professional isolation. 27. Jim noted that discussions had been ongoing with a range of parties with an interest in this issue. Directors of Planning had discussed and were supportive of a coordinated approach to looking at this issue, in terms of a strategic and joined up approach across a range of groups/interests. It was agreed that Jim Cannon should take forward the recommendations in the paper, along with DoP colleagues, and suggest a workable model for remote decision support. It was also agreed that progress would be reported to NPF in June 2015. Action 8: Jim Cannon to take forward the recommendations in the paper, and suggest a workable model for remote decision support. A progress report would go to NPF in June 2015 5. WRITTEN UPDATES Paper (14) 36 28. NPF noted written updates on the Major Trauma Oversight Group, Trans-Vaginal Mesh Working Group, Robot-Assisted Surgery for Prostate Cancer, and the Endometriosis subgroup. Action 9: Secretariat to follow up the action from the previous meeting with Frances Elliot and Jacqui Simpson, to agree planning representation/involvement in the Mesh Working Group. Action 10: Secretariat and Catriona Renfrew to follow up and agree Planning representation for the endometriosis working group. Page 7 of 9
Radiotherapy (RT) 29. A late update paper on radiotherapy was tabled at the meeting, from David Dunlop, recently appointed chair of the Radiotherapy Working Group. The paper set out a request that NPF agree changes to the scope of the group, to widen its remit to develop a national plan to include chemotherapy and surgery as well as RT. 30. Jim Cannon noted that he disagreed with the phrasing of the update in relation to work in the North of Scotland - the paper failed to reflect the very positive work being carried out in the North. There was some concern, that the issues in the North of Scotland were being used as a platform for change for national work. Liz Porterfield advised that the paper s intention was not to criticise the North, in fact it was explicit that what was required was a change in the approach of the NPF working group so as to achieve the outcomes needed. If as seemed clear there was a perception that the excellent work in the North was not recognised, it was explained in the strongest terms this was not the case, quite the opposite. Concerns about the point regarding the number of cancer centres nationally were raised. It was confirmed that a reduction was not planned which was already clear given the additional (6 th ) RT treatment centre being built in Lanarkshire as a satellite of the Beatson WoS cancer centre. 31. These comments notwithstanding, NPF agreed the change in the remit of the Radiotherapy working group. 6. HORIZON SCANNING Interventional Radiology/TIPSS 32. NPF would be asked to consider a review of interventional radiology service provision for TIPSS (Transjugular Intrahepatic PortoSystemic Shunts) across Scotland. There had been some delays in bringing this forward but initial work to scope the problem would now take place over the next couple of months, with a detailed paper expected to be ready for consideration by NPF in April. 7. ANY OTHER BUSINESS 33. NPF recorded thanks to Caroline Selkirk, who was taking up a new role with the British Association of Adoption and Fostering in London, for her contribution during her tenure on NPF as Deputy Chief Executive of NHS Tayside. 34. NPF had published weight loss surgery guidance in 2012 and had committed to reviewing its implementation. A questionnaire on access to weight loss management programmes and bariatric surgery would be circulated to NHS Boards, to collect information on provision across Scotland. It was hoped that the findings from the survey would be ready to discuss at the NPF meeting in February. Action 11: Regional Planning Directors to provide Secretariat with updates on implementation of the vascular services quality framework, for the agenda in February. Page 8 of 9
8. DATES OF NEXT MEETINGS 35. NPF 2015 meeting dates: All Wednesdays 4 Feb 22 Apr 24 Jun 23 Sep 2 Dec. All meetings start at 13:30, at Scottish Health Service Centre, Edinburgh. The Quality Unit December 2014 Page 9 of 9