Working with you to make Highland the healthy place to be

HIGHLAND NHS BOARD Assynt House Beechwood Park Inverness IV2 3HG Tel: 01463 717123 Fax: 01463 235189 Textphone users can contact us via Typetalk: Tel 0800 959598 www.nhshighland.scot.nhs.uk Highland NHS Board 6 March 2007 Item 9.1(b) DRAFT MINUTE of MEETING of the CLINICAL PLANNING GROUP (SERVICE REDESIGN COMMITTEE) Board Room, Assynt House Monday 11 December 2006 2.00 pm Present Mr Derek Leslie, in the Chair Ms Margaret Brown Mr Quentin Cox Dr Moray Fraser Dr Alison Graham Dr Roderick Harvey Mr Paddy Hopkins Dr D A Russell Lees Dr Chris Lush Mr Bill McKerrow Ms Heidi May Mrs Margaret Moss Dr Ken Proctor Dr Ian Scott Dr Dennis Tracey (deputising for Dr Eric Baijal) In Attendance Dr Simon Hewick, Consultant Ophthalmologist (for item 7) Miss Irene Robertson, Board Committee Administrator Apologies - Dr Eric Baijal, Mr Stuart Denholm, Dr Erik Jespersen, Mr Paul Leak, Dr Chris MacGregor, Ms Elaine Mead, Mr Ray Stewart, and Dr Angus Venters 1 WELCOME The Chairman was pleased to welcome Margaret Moss, Area Clinical Forum representative, and Dr Moray Fraser, Clinical Director, North Highland CHP to the meeting. With regard to the core business of the Group, the Chairman acknowledged concerns about possible duplication of work with other groups and asked the members to give some thought to the agenda and appropriate issues for inclusion. He flagged up proposals emerging from the Planning Forum around service redesign and the impact on care pathways which the Group would need to discuss in the new year. 2 MINUTES The minute of meeting of 13/11/06 was approved. Working with you to make Highland the healthy place to be

3 MATTERS ARISING 3.1 Argyll and Bute CHP The Chairman updated the Group on progress with regard to the establishment of Service Level Agreements between NHS Highland and NHS Greater Glasgow & Clyde for the services provided to the Argyll and Bute population. With regard to laboratory services, Chris Lush understood that computing equipment was being replaced in Glasgow but not in Oban. He was concerned to ensure that the systems remained compatible. The Group remitted to the Chairman to pursue this issue through the SLA negotiations to ensure compatibility and consistency of service. 3.2 Quality Outcomes Framework (QOF) and Enhanced Services The Chairman advised that Fiona Duff was not available to attend either today s meeting or the next meeting in January. He therefore proposed that she be invited to attend the February meeting. The Group agreed to invite Fiona Duff, Primary Care Adviser to its meeting in February 2007 to give a presentation on the QOF and Enhanced Services. 3.3 Development of Electrophysiology in the North The Chairman reported that there was an ongoing review of this development at the North of Scotland Planning Group, with some clarifications being sought around the specifications for the service. The Group noted the position. 4 STANDING ITEMS 4.1 Local Delivery Plan 2007-2008 As agreed at the last meeting, the Chairman confirmed that he had raised the Group s concerns around the Mental Health and HAI targets with John Connaghan. Mr Connaghan had acknowledged the valid points made by the Group and had given an assurance that these would be the subject of further discussion. The Board would require to submit its Local Delivery Plan to the Scottish Executive Health Department by mid-february 2007 with final sign off in March 2007. Work was currently ongoing to refresh the templates and trajectories to enable these deadlines to be met. The Chairman aimed to bring the draft Plan to the Group early in the new year, although it would not be available in time for the January meeting. The Group noted the arrangements for the review and development of NHS Highland s Local Delivery Plan for 2007-2008. 2

4.1.1 Delivering for Mental Health There had been circulated for information a document produced by the Scottish Executive entitled Delivering for Mental Health. This document set out a number of commitments and targets with timescales to take forward the mental health agenda in terms of the delivery and organisation of care, the main focus of the plan being on treating and preventing illness. One of the commitments (Commitment 3) was about responding better to depression, anxiety and stress. To this end the Scottish Executive undertook to work with GPs to ensure that new patients presenting with depression will have a formal assessment using a standardised tool and a matched therapy appropriate to the level of need. It was noted that NHS Highland had a standardised depression rating scale which was unique in Scotland. Ken Proctor commented briefly on the document, noting that a considerable amount of work would require to be done to achieve the aims. There were also funding issues. Implementation of the plan would be taken forward through the Mental Health Network. Heidi May referred to the recently published Review of Mental Health Nursing which had similar themes. She suggested that the opportunity might be taken to join up these two substantial pieces of work. Noted the document, the actions identified and timescales for implementation. Agreed to await reports from the Mental Health Network on progress with implementing the recommendations. 4.2 Balanced Score Card A copy of the balanced score card for NHS Highland and the four CHPs was tabled for information. The score card was being used as a means of identifying performance against a range of key targets and indicators set within the context of the Local Delivery Plan and a number of other supplementary performance measures. Work was ongoing to integrate Argyll and Bute CHP performance with the overall NHS Highland score card. Areas where improvement was indicated included dental registrations and cancer waiting time targets. It was acknowledged that the colour coding system used to indicate levels of performance could be interpreted differently by different people. Providing an accompanying narrative would, it was felt, go some way towards avoiding confusion and ensuring clarity. Fixed tolerances also needed to be developed. The Chairman reported that NHS Highland had been invited to be an early adopter of Citistat, a performance management tool which used operational data as the basis for regular accountability sessions between an organisation s leaders and senior managers with responsibility for service delivery. Noted the performance relating to NHS Highland and the four CHPs. Noted those areas where improvement in performance was indicated. 4.3 Planned Care Margaret Brown reported that formal feedback had been received on NHS Highland s plan from the Scottish Executive who had requested more detail. Accordingly, the plan was being redrafted to meet the Scottish Executive requirements and secure the release of the outstanding funding available for the programme. Meetings were taking place with the CHPs 3

and GP nominations were being invited to participate in the discussions with the specialist services. Quentin Cox reiterated his concerns that the focus appeared to be on achieving the 75% target for elective day cases rather than concentrating on the provision of clinical care and what would most benefit patients. Ms Brown indicated that the proposals were still being firmed up and that there would be an opportunity to respond formally once these were issued. The Group noted the position and would await developments. 4.4 Modernising Medical Careers Alison Graham updated the Group, noting that numbers had now been agreed in Scotland and that agreement across the Deaneries was expected to be reached shortly. Boards had been given an assurance that the new arrangements would not adversely affect rotas; however there was a potential concern around skill mix. There were also several surgical and medical posts in Highland that did not currently have educational approval. Dr Graham confirmed that there would be service gaps but that it was proposed to apply for fixed term specialty posts in the first instance to address the shortfall and thereafter to look at service redesign. There would also be service implications in the current year during interview periods when consultants would not be available to provide clinical care. Consultants involved in interviewing also had to undertake special training necessitating further loss of clinical time. An estimate would need to be made of the costs associated with the interview process in respect of travelling expenses, etc. Consideration would require to be given to the arrangements for future years. There would be implications for Primary Care in terms of GP training which would now take longer than previously, there could also be cost implications as a result of the way in which the training periods were organised. The Group noted progress to date and the actions being taken to address the issues identified. 5 TACKLING INEQUALITIES IN THE NORTH OF SCOTLAND Paddy Hopkins gave a presentation highlighting some of the significant inequalities that exist in the North of Scotland in terms of health and access to health care and how by using clinical data the issues might be teased out and further explored with a view to tackling these inequalities. Thanking Mr Hopkins for his informative presentation, the Chairman suggested that there were clinical issues around anticipatory care as well as the social care element which the Group might reflect on when trying to address inequalities. 6 MRI REFERRALS OUTWITH HIGHLAND There was tabled letter from Mr David Finlayson, Consultant Orthopaedic Surgeon raising a number of issues around MRI referrals outwith Highland. GP Practices had direct access to MRI scans and currently referred patients to NHS Grampian, although it was noted that the number of referrals had reduced considerably since 1 April 2006. In the ensuing discussion the following points were made. The quality of the images, although adequate, was inferior to that of the scans carried out at Raigmore where the latest equipment was available. There could sometimes be difficulties for local clinicians following up scans undertaken out of area, possibly necessitating a second scan and causing further delay in diagnosis and treatment. It was felt that 4

preliminary discussion between the patient s GP and local specialist would be helpful in determining whether a scan was in fact required. It was recommended that direct access should apply for specific conditions as part of an integrated care pathway. To this end it was proposed that a stocktake of existing protocols be undertaken and that NHS Grampian be invited to share their protocols with a view to developing condition specific protocols for direct access. There was also a need to do some modelling in terms of capacity. With regard to SLAs, the Chairman indicated that NHS Highland would continue to fund any out of area referrals until the situation was clarified and resolved. On the separate issue of direct access to CT scans, some concerns were expressed around radiation implications. Margaret Brown agreed to ascertain the position. Agreed that a stocktake of protocols for direct access be carried out, to include those developed by NHS Grampian. Remitted to the Chairman to write to Mr Finlayson and the referring practices to inform them of the views expressed during discussion and the proposed actions. Noted that Margaret Brown would clarify the position with regard to direct access to CT scans. Dr Simon Hewick joined the meeting 7 DEVELOPMENTS ASSOCIATED WITH AGE RELATED MACULAR DEGENERATION The Chairman welcomed Dr Simon Hewick, Consultant Ophthalmologist to the meeting. Alison Graham summarised the position, noting current treatment for Age Related Macular Degeneration (ARMD) and the development of new drugs. One of these drugs, which was more effective than the existing treatment, would be coming on the market next year. Dr Hewick gave details of the numbers of potential new patients who might benefit from the new drug and the estimated cost of the product. There would also be cost implications in terms of staffing and clinical accommodation required to provide the service which had not yet been identified. Limited savings might be achieved on the social care side, as patients began to benefit from the treatment and required less support. The Group noted that there was also another, equally effective but cheaper, drug available which was not licensed for ARMD use. Given the anticipated benefits to patients, the Group supported the new drug on clinical grounds. This was just one of several new drugs which had been approved by the SMC which carried a cost impact but for which no new funding was available. In this connection, the Group emphasised the importance of horizon scanning, planning and prioritisation, while taking due account of ethical considerations and benefit to patients. The Group also recommended that the unlicensed product should be further explored and Dr Graham suggested that this should be taken up with the SHTB. Agreed to recommend that the new drug should go forward into the prioritisation process. Remitted to Dr Graham to pursue the issues around the unlicensed product with the SHTB. Remitted to Dr Graham to prepare a paper providing full costings of the proposed development for consideration at the next meeting. 5

Dr Hewick left the meeting 8 REVIEW OF NURSING IN THE COMMUNITY Heidi May outlined the background to the Review of Nursing in the Community in Scotland explaining that it had been undertaken as part of Delivering for Health. The Review report proposed a new service model for nursing in the community which would entail merging the roles of the District Nurse, Health Visitor, School Nurse and Family Health Nurse into a new, single Community Health Nursing discipline sitting within and supporting a wider multidisciplinary, multi-agency context. The role of the Practice Nurse could not be addressed because of different employment regulations; however collaborative working between general practice and community nursing would be central to providing seamless patient care. The new model would be tested in Scotland over the next two years and Highland had been confirmed as one of four development sites. Ms May informed the Group that concerns had been expressed by the Health Visitors Union about the impact of the proposed model on patient care. Margaret Moss indicated that the Allied Health Professions took a positive view of the proposed new role, as they felt it would facilitate joint working, training and education. The Group noted the proposals for the new community nursing model and the next steps in its development. 9 FUTURE AGENDA ITEMS The following items were proposed:- Savings Plan (meeting on 8 January 2007) Multiple Sclerosis services across NHS Highland Epilepsy services Physiotherapy waiting times The Chairman also proposed to bring North of Scotland issues to the February 2007 meeting. A list of North of Scotland Planning Group projects would be circulated to the members in advance of the meeting. 10 DATE OF NEXT MEETING The next meeting would be held on Monday 8 January 2007 at 2.00pm in the Board Room, Assynt House. The meeting closed at 5.00pm 6