Corporate Programme Office Gyle Square 1 South Gyle Crescent Edinburgh EH12 9EB Telephone [0131 275 6000] Text Relay 18001 [0131 275 6000] Email nss.cpo@nhs.net www.nhs.nss.org Minutes Meeting: Home Oxygen Service Project Steering Board (HOSPSB), Ninth Meeting Date: 28 March 2012, 15:15 to 16:45 Location: Boardroom 1, Ground Floor, Gyle Square, Edinburgh, EH12 9EB Present: (AC) Angus Cameron, NHS Dumfries & Galloway (Chair) (AB) Andrew Buist, British Medical Association (JC) James Cant, British Lung Foundation (CC) Clare Colligan, NHS Forth Valley (NH) Ninian Hewitt, NHS Lothian (PK) Paul Kingsmore, NHS National Services Scotland (GL) George Lindsay, NHS Lanarkshire (JM) John MacEachen, NHS National Services Scotland (WM) Willie McGhee, NHS National Services Scotland (MM) Michael McGovern, British Oxygen Company (CM) Christine McKee, NHS Western Isles via video conference (EM) Evelyn McPhail, NHS Fife (HM) Harry McQuillan, Community Pharmacy Scotland (LMT) Lorna McTernan, Chest, Heart & Stroke Scotland (LME) Lesley Metcalf, Scottish Government Health and Social Care Directorates (PM) Phyllis Murphie, NHS Dumfries & Galloway (DP) Donald Page, NHS National Services Scotland (Deputy for Marion Bennie) (DR) Donald Reece, NHS National Services Scotland (WR) Wendy Robertson, NHS Grampian (MS) Margaret Swankie, NHS Tayside (Deputy for Arlene Wood) via video conference (WT) Wayne Taylor, Dolby Medical (Vivisol) deputy for Alan Speirs Minutes: (ET) Emese Toth, NHS National Services Scotland Apologies: (AA) Alison Anderson, NHS Ayrshire & Arran (MB) Marion Bain, NHS National Services Scotland (SB) Simon Belfer, NHS National Services Scotland (MBE) Marion Bennie, NHS National Services Scotland (MC) Maureen Carroll, NHS Lanarkshire, Representative, NAG for Respiratory MCNs (JF) Jakki Faccenda, NHS Borders (CG) Carol Goodman, NHS Tayside (NH) Nigel Hobson, NHS Western Isles (SL) Stuart Little, NHS Dumfries & Galloway (Deputy for Phyllis Murphie) (MMcL) Morag MacLeay, NHS Highland (Deputy for Lorna Murray) (DM) David Munro, NHS Forth Valley Version: 1.0 (08 June 2012) Page: 1 of 11
(LMU) (CN) (MP) (KR) (AS) (ASP) (PT) (AW) cc only: Lorna Murray, NHS Highland Christopher Nicolson, NHS Shetland and NHS Orkney Michael Pratt, NHS Dumfries & Galloway (Deputy for Phyllis Murphie) Karen Ross, NHS Greater Glasgow & Clyde Andrea Smith, NHS Fife (Deputy for Evelyn McPhail) Alan Speirs, Vivisol (Dolby Medical) Phil Tilley, NHS Western Isles (Deputy for Nigel Hobson) Arlene Wood, NHS Tayside (Deputy for Carol Goodman) Alistair Flowerdew, Golden Jubilee National Hospital 1. Welcome and Apologies AC welcomed all and noted the apologies from the individuals listed above. 2. Minutes and Actions of Last Meeting held on 29 February 2012 DP noted one error on the Minutes of the previous meeting. The following action was agreed: Action 01 (2012/03-28): Per DP s request, ET is to update the Minutes of 29 February 2012 to say that DP is the deputy for Marion Bennie. ET is to version up the Minutes and publish them to the HOSPSB. The meeting Minutes of 29 February were approved, pending the above correction. AC reviewed the status of open actions from the 29 February meeting. These are listed in a log at the end of these Minutes. Older actions were not discussed during the meeting but their statuses are updated in the log at the end of these Minutes. WM advised that he had sent PM a template to be used when she is completing prescriptions for low cylinder usage in order to estimate the usage of the oxygen flow rate. This template will aid in establishing more concrete estimates about cylinder numbers. 3. Community Pharmacies HM spoke to the agenda paper and advised that the paper was the result of a meeting with EM, WM and DR. HM proposed recompense to each pharmacy contractor for the equivalent of 2 years authorised headset rental for each local Board. AC suggested that the numbers authorised could be incorrect and there were two Boards that did not authorise the numbers of contractors. It was agreed that detailed discussions among WM, DR, EM and HM would be required to resolve this issue. DR advised that the small group to negotiate with CPS might recommend a paper to go to NHS Chief Executives and it will be up to Health Boards to determine whether they agree with the nationally proposed figures. LME stated that Scottish Government (SG) would not negotiate recompense between oxygen supplier and NHS Health Boards. AC suggested that there was a need to ensure that any possible recompense for cylinders placed a certain level of responsibility on local suppliers to ensure that cylinders were returned. HM reassured the HOSPSB that contractors would make all attempts to return cylinders. DP mentioned that, when Air Products withdrew from the Scottish market, the reconciliation costs were borne by the exiting company. DR suggested that Directors of Finance (DOFs) would scrutinise the process and would want payments to be reasonable based on what had transpired. MM cited the BOC point of view where a reconciliation process took place in England under different circumstances: Spot checks of inventory were performed and the audit took approximately one year. Version: 1.0 (08 June 2012) Page: 2 of 11
AC added that his intention is to have a paper submitted to the NHS Chief Executives. The paper would have to be drafted by 25 April 2012 ahead of the Chief Executives 9 May meeting and would need to contain firm numbers. MM said that BOC wants to start the process of stock checking with pharmacy contractors as soon as possible. There was further discussion around CPS reconciling cylinders with BOC prior to negotiations. HM pointed out that this reconciliation process would be easier to execute after negotiations had taken place. EM suggested that there is a risk to Health Boards if they do not allocate sufficient money for cylinder and headset reconciliation. The following action was agreed: Action 02 (2012/03-28): By 25 April 2012, WM is to draft a paper detailing a proposal for change in oxygen service provision throughout Scotland for presentation at the 9 May NHS Chief Executives meeting. The paper is to include: concrete numbers for inventory estimates of headsets and oxygen cylinders in community pharmacies recompense proposals for unused or lost inventory proposals for logistical arrangements for Dolby Medical to pick up unused inventory and how this will be monitored proposals for auditing the process of determining the inventory numbers at community pharmacies 4. Chest, Heart & Stroke Scotland (CHSS) Support for Project LMT discussed papers she had written to support the project. LMT asked for feedback on the papers from the HOSPSB. 1) Coping with breathlessness draft master.doc LMT explained this is a draft factsheet that summarises how patients can cope with breathlessness. The last page is meant to be a wallet card for patients who are having trouble breathing. DP commented on the last page of the document and suggested adding wording similar to the following: Your community pharmacist will talk through the inhaler technique with you". 2) Oxygen Assessment Information draft master.doc LMT raised the following points about this document: The language on the document is not yet patient friendly. It is difficult to explain hypoxemia to patients. The goal of the document is to explain that the need for oxygen can be a long term issue. Patient assessment to determine whether someone needs oxygen is required. Oxygen will not benefit everyone. DR suggested a small Short Life Working Group (SLWG) to assist LMT with finalising the above mentioned documents and looked for volunteers. PM suggested that LMT make use of the existing sub group from the NAG. It was agreed that pharmacy input would be important and CC also agreed to participate. Action 03 (2012/03-28): LMT is to finalise the Oxygen Assessment Information draft master.doc and Coping with breathlessness draft master.doc documents for review at the 23 May 2012 meeting of the HOSPSB. AC summarised that the strength of these documents is that they are owned by CHSS so that the advice and guidance contained in them comes from a neutral charity third party. Version: 1.0 (08 June 2012) Page: 3 of 11
5. British Lung Foundation (BLF) Support for Project JC said that BLF would use consistent and up-to-date messages about the project with NSS through its various media and patient outreach channels as summarised here: BLF Helpline BLF Newsletters and quarterly publication BLF Team to transmit key messages and advice to Breathe Easy Groups when responding to calls Use Patient Representatives across Scotland to provide service-user views for NSS and for Health Boards Where appropriate, supporting Health Boards at a local level and sharing best practices/challenges with Health Boards, key stakeholders (NSS, Dolby) Linking to project documentation via the BLF website to go live in June 2012 DR asked whether BLF can support NHS Dumfries & Galloway in their pilot. JC advised that BLF would be happy to support this Health Board as they already have a good relationship with them via their Breathe Easy Group. The following action was agreed: Action 04 (2012/03-28): PM of NHS Dumfries & Galloway and JC of BLF to work together in the pilot phase of the transfer of home oxygen service during May 2012 by harmonising communications messages and reaching out to patients and the public via multiple media and patient outreach channels. JM suggested that it would be difficult to identify one patient group as a source of good news stories. JM proposed that Health Boards gather positive news stories at a local level and disseminate as appropriate. WM suggested that publishing good news stories about the project might be more useful after benefits have been documented following the NHS Dumfries & Galloway pilot. AC agreed with JM s advice. There was discussion about contact with NHS24. DR advised that he had been in contact with NHS24 in the past to discuss the change in oxygen service and intends to have further discussions going forward. DR mentioned that both the Dolby Plan and the Project Brief had been shared with NHS24. LME asked DR about project links to other stakeholders. LME stressed the importance of engaging actively with all project stakeholders and recording correspondence with them on a regular basis. DR reminded the Board that at the last meeting, a discussion about stakeholder communications was held to ensure that no stakeholders were missed out from the identified scoped list. DR advised that he had also spoken with relevant individuals at the State Hospital (part of NHS Lanarkshire Health Board). LME made the strong point that it is the responsibility of the project to be explicit with stakeholder contacts. CC asked about the last communication to Medical Directors and wanted to ensure she would be copied into any future correspondence. CC asked DR to take the following action: Action 05 (2012/03-28): DR is to confirm back to CC whether the email sent to NHS Forth Valley s Medical Director on 24 February 2012 included her. 6. Risk DR referred to the RID Log, version 0.29. He addressed some of the risks specifically: NSS-R25: DR said the likelihood on this risk has been increased from a 3 to a 4 because the project was nearing the date of service transfer. AC added that he did not get a sense from GPs in his Health Board that the change in GP prescribing practices would be considered unreasonable. Version: 1.0 (08 June 2012) Page: 4 of 11
Action 06 (2012/03-28): LME asked DR to leave risk NSS-R25 on the RID Log red until NHS Dumfries & Galloway have gone through their transfer in oxygen service. AB noted that there is a need for some short educational materials to be published for GPs, namely in palliative care, as the message about change in GP prescribing has not gotten through. AB suggested that the documentation include what to do in various scenarios. This change was agreed. AC stated that it is crucial to communicate properly with GPs. PM mentioned that she is working on the training package as part of the preparation for the NHS Dumfries & Galloway pilot. SGPC help was requested for the facilitation of the GP training package and with general information about the project. The following action was agreed: Action 07 (2012/03-28): AC asked AB to send a message regarding the change in oxygen prescribing to GPs via local medical committees and the SGPC. DR asked whether risks NSS-R04 and NSS-R28 should be closed. LME replied that Government do not anticipate a change in policy. AC said these risks could be closed. If necessary, they can be reopened in the future. Action 08 (2012/03-28): DR is to close risks NSS-R04 and NSS-R28 on the RID Log. 7. Project Initiation Document (PID, version 0.5) DR advised that the PID document was based on the Project Brief. Other project documentation is linked into it. DR asked for approval on the PID. It was agreed that the document would be marked as approved unless alterations were suggested to DR by 5 April 2012. Action 09 (2012/03-28): All members of the HOSPSB are to suggest changes to the PID version 0.5 by COP Thursday, 5 April. 8. Communications Update 1) JM advised he has placed generic articles about the project in the GP Pharmacy Newsletter and onto the HFS website. 2) JM said he will be placing an order for printed leaflets and posters. Most people had responded with requests for specific numbers of printouts; for those who have not, JM will make estimates and order accordingly. Other Stakeholders: DR reported that he had made contact with MoD Homes and discussions were ongoing about the relevance of the project for MoD Homes. DR reported he had also spoken with and emailed Alison Smith, Chair of the association of private hospitals. 9. Project Plan and Update AC tabled the Dolby Plan and asked whether anyone wanted to report changes in their local plans. All those present affirmed that the current timelines were acceptable. 10. Any Other Business The HOSPSB decided that the meeting scheduled for 18 April would be cancelled. The next meeting would take place on 23 May as scheduled. Action 10 (2012/03-28): ET is to send a cancellation for the 18 April meeting to the HOSPSB. Dates of Upcoming Meetings: Version: 1.0 (08 June 2012) Page: 5 of 11
Wednesday, 23 May 2012, 15:00 16:00, Conference Rooms 4 and 5, Victoria Quay, Edinburgh, EH6 6QQ Monday, 25 June 2012, 15:00 16:00, Boardroom 2, Ground Floor, Gyle Square, 1 South Gyle Crescent, Edinburgh EH12 9EB Version: 1.0 (08 June 2012) Page: 6 of 11
ACTION No. Action Responsible Party Status Action 01 (2012/02-29): AC will write to Medical Directors encouraging them to make contingency plans for prescribing oxygen in emergency situations, with reference made to the RMCN NAG guidance. AC Action 02 (2012/02-29): DR is to re-word and rescore some of the risks n the RID Log, and send out a new version to the HOSPSB. DR AC raised this topic at the Association of Medical Directors. Completed. This was discussed under agenda item 6. Completed. Action 03 (2012/02-29): All Health Board Leads are to send feedback to JM on the communications from 24 February to Medical Directors. All Health Board Leads JM asked HOSPSB Health Board Leads whether anyone has sent the letter out to others within their Health Board as suggested in the communications. Open. Action 04 (2012/02-29): Action 05 (2012/02-29): JF agreed to check the status of the RMCN NAG Guidance document as to whether it is fit to be published more widely and advise the HOSPSB. JM is to post a link to the RMCN NAG Guidance document on the HFS website. JF JM The Guidance document is now on the HFS website and the Knowledge Network. Completed. The Guidance document is now on the HFS website and the Knowledge Network. Completed. Version: 1.0 (08 June 2012) Page: 7 of 11
Action 06 (2012/02-29): ALL Steering Board members are to get back to JM regarding any change of wording to the FAQ s by COP Wednesday, 7 March. ALL Steering Board members JM received no changes. The FAQ s document is now on the HFS website. Completed. Action 07 (2012/02-29): Action 08 (2012/02-29): JM is to update the leaflet on the inside left panel by deleting the last sentence For other patients and replacing with new wording. JM is to update the wording on the bottom inside right panel under the What if I run out unexpectedly section. JM is to update the poster with some new wording as per discussion during the Steering Board. JM JM JM has made these changes and the leaflet is now on the HFS website. Completed. JM has made these changes and the poster is now on the HFS website. Completed. Action 09 (2012/02-29): When all Project documentation has been posted to the HFS website, JM is to send all Steering Board members a direct link to the individual documents. JM All relevant project documentation is on the HFS website. ET has sent the relevant links on JM s behalf. Completed. Version: 1.0 (08 June 2012) Page: 8 of 11
Action 10 (2012/02-29): Action 11 (2012/02-29): DR/WM are to update the HIA with the wording in parentheses (under the Dependencies column in the More equitable section): If not, there would be a need to understand the increase in demand. ALL are to request specific changes to the PIA document by 7 March to DR. DR/WM ALL The HIA has been versioned up to version 1.0 and is now on the HFS website. Completed. No changes were requested. The PIA is now on the HFS website. Completed. Action 12 (2012/02-29): Action 13 (2012/02-29): ALL Health Board Leads are to get back to WM by COP Friday, 9 March if they would like their move date to the new oxygen service to be adjusted. DR advised that he would send out the finalised Dolby Plan on Monday, 12 March to ALL on the HOSPSB to confirm in writing that the Plan has been agreed. ALL Health Board Leads DR All Health Boards stated they were happy with the proposed plan. AC said that if anyone has issues they should contact DR. Completed. ET has sent out the Plan on DR s behalf. Completed. Version: 1.0 (08 June 2012) Page: 9 of 11
Action 01 (2012/01/27): DR asked that HM and AS provide any additions to the Patient Scenarios document. HM, AS This item can now be closed since the scenarios have been published with the MCN NAG Guidance and the responsibility for updating will remain with the MCN NAG. Closed. Action 03 (2012/01/27): JM asked ALL to provide him with feedback on their uses of/target audiences for the Home Oxygen Service poster. ALL Closed. Action 04 (2012/01/27): Action 07 (2012/01/27): Once BOC discussions are successfully concluded, JC and LMT will post the Home Oxygen Service poster and the FAQ s document onto their respective charity websites. The content of the FAQ s will be used as scripts for their respective Helpdesks. ALL are to indicate to JM how many hard copies of the Home Oxygen Service Poster and Leaflet they will require. JC, LMT ALL JM will liaise with JC of BLF and LMT of CHSS regarding this and report back. Ongoing. This was covered under agenda item 8. Closed. Version: 1.0 (08 June 2012) Page: 10 of 11
Action 09 (2012/01/27): ALL Health Board Leads are to share local communications with the HOSPSB for consistency in Project communication. ALL Health Board Leads Ongoing. Version: 1.0 (08 June 2012) Page: 11 of 11