Diagnostic Services Programme National Pathology Programme Board Held on 12 th October 2012 At Churchill House, Cardiff Present: Jane Fitzpatrick (Chair) (JEF) Programme Management Unit Margie Fielden (MF) Programme Management Unit Stephen Twiddy (ST) Programme Management Unit Christine Morrell (CM) Welsh Government Clive Morgan (CM2) DoTHS Representative, Cardiff & Vale UHB John Tovey (JT) ACB Wales Region Chair Mike Redman (MR) Aneurin Bevan HB Clem Price (CP) Workforce Development, NLIAH David Fletcher (DF) Betsi Cadwaladr UHB Caroline Hill (CH) Cardiff & Vale UHB Owen Crawley (OC) Welsh Government Ian McDowell (IM) Cardiff & Vale UHB Paul Seddon (PS) Obo Glyn Evans, Cwm Taf HB Esther Youd (EY) Cwm Taf HB Mark Hastings (MH) Microbiology Division, Public Health Wales Steve Murphy (SM) Microbiology Division, Public Health Wales Neil Carbarns (NC) Aneurin Bevan HB Jason Shannon (JS) Associate Medical Director, Cwm Taf HB David Cassidy (DC) Royal College of Pathologists Wales Region Chair Bryan Rose (BR) Screening Services, Public Health Wales Andrea Stiens (AS) Hywel Dda HB Chris White (CW) DoTHS Representative, Cwm Taf HB Brent Varley (BV) Obo Andrew Griffiths, NWIS Carol Evans (CE) Obo Mike Bourne, Cardiff & Vale UHB Apologies: Geoff Poole (GP) Welsh Blood Service, Velindre NHS Trust Mark Lord (ML) Betsi Cadwaladr UHB Geraint Williams (GW) Academic Representative, Cardiff University Jan Smith (JMS) Chair of NPPB, DoTHS Aneurin Bevan HB Grant Robinson (GR) Medical Directors Representative, Aneurin Bevan HB Stephen Griffiths (SG) Director of Workforce Development, NLIAH Andrew Griffiths (AG) Programme Implementation Director, NWIS Liam Taylor (LT) DoPC Representative, Aneurin Bevan HB Sally Buckland-Jones (SBJ) Abertawe Bro Morgannwg UHB Glyn Evans (GE) Cwm Taf HB John Murphy (JM) Hywel Dda HB Dave Nuttall (DN) Screening Services, Public Health Wales Paul Labourne (PL) Powys LHB Not Present: Rosemary Fox (RF) Screening Services, Public Health Wales Wynne Williams (WW) Abertawe Bro Morgannwg UHB Steve Sloan (SS) Union Representative, Unite the Union Ian Sharp (IS) DoWF&OD Representative, Velindre NHS Trust 1. Welcome, Introductions and Apologies Page: 1 of 9
JEF welcomed everyone to the meeting and introductions were made. Chris White was attending for the first time as the Directors of Therapies and Health Sciences representative. Apologies were noted as listed. DF informed the Board that ML had temporarily stepped down as Pathology Chief of Staff in BCUHB. 2. Minutes of the meeting of 13 th July 2012 The minutes were accepted as a true and accurate record of the meeting. 3. Matters Arising not covered elsewhere on the Agenda WG Cancer Delivery Plan JEF reported that, at Jane Hanson s invitation, she had attended the first meeting of the Cancer Implementation Group. The Group were working on Lung Cancer Pathways. This first meeting of the Group primarily consisted of Consultants and Primary Care professionals. JEF noted that there had not been any representation from the Pathology community and undertook to follow up with Jane Hanson to ensure future Pathology engagement. Action JEF to follow up with Jane Hanson to ensure Pathology engagement at future meetings of the Cancer Implementation Group. Telepathology Champion for Rural Health JS confirmed that he was keen to be involved as the work linked in well with his current Health Board role as Associate Medical Director. However, he required clarification regarding who the contact in Welsh Government was. It was noted that a Consultant in North Wales who had made himself available as the Imaging Champion had not had any contact from Welsh Government either. JS would liaise with OC to identify the Welsh Government lead and make himself known to them. Action JS to liaise with OC to identify Welsh Government lead for Rural Health. CSW Report BR reported that the CSW report had been circulated but would not be submitted to Welsh Government at this stage. The next steps of the report showed: Workload and workforce were likely to reduce significantly by 2017 Planning for future technological and operational policy changes was required Continuation of a sustainable service was crucial A National Cervical Screening Group including DMs and CDs from Pathology was to be created to manage the changes BR noted that maintaining the current relationship with and support from the HBs was crucial to ensure a sustainable service. 4. Pathology IT Programme Update BV provided an update and reported that the LIMS Project was at red status. BV informed the Board that this related to a combination of LIMS and WCP issues. Some defects in the LIMS were outstanding and the issue of manual configuration was being addressed with Intersystems. Page: 2 of 9
BV highlighted that there were intermittent performance issues in Microbiology in HDHB. The results validation screen could take 4-5 seconds to refresh. It was noted that this was currently a critical event for Intersystems and all their offices around the world were working to diagnose and resolve the performance issues. No further coding would be uploaded until this was resolved and refresh times were less than 3 seconds, which was within contracted standards. It was noted that there were concerns regarding staff perceptions of the system with such delays compared to the Telepath system. SM highlighted that this was a new system with different functionality and not a like for like Telepath replacement. As such the whole context of the package needed to be considered and changes in working practice would most probably be required to make full use of the system. BV noted that there was a lot of activity due in the next week which included an Intersystems fix that would enable implementation in HDHB to be progressed. BV confirmed testing in HDHB Blood Sciences was due to commence although the 15 th October target date would not be achieved. JEF reported that at the IT Programme Board meeting she had emphasised that the service was concerned about the performance issues and whether Deep See was fit for purpose. JEF confirmed that the absolute priority for NWIS and Intersystems at present was resolving the speed issue. JEF reported that she had informed the IT Programme Board that as the system had been installed in June and that it would have been preferable if resources to fix the performance issues had been allocated when they were first identified. Intersystems had acknowledged this and assured the IT Programme Board that lessons had been learnt. It was noted that Implementation Date Planning had been taking place based on the anticipated resolution of the speed issue in HDHB. JEF had formally recorded that the Pathology community were uneasy and following progress of the implementation in HDHB carefully. If issues were not resolved then further roll out would be unlikely within the current timescales and implementation plans would slip further. BV informed the Board that NWIS had not ruled out hardware, Citrix or network speeds as possible causes of these issues and would work on adjusting the system accordingly to improve performance. AS informed the Board that in the recent CPA inspection of Microbiology laboratories in HDHB, the inspectors had reviewed the LIMS product. They had been impressed with the product and potential of the LIMS. JEF provided an update on Deep See. The Implementation Board were not confident in the product and were concerned that information governance was a major issue. At the present time all users appeared to be able to view all the information that was held on the system for all patients, including those from other HBs. Intersystems were carrying out work to develop specific dashboards and training courses to overcome these issues. It was noted that in a meeting held on Thursday 12 th October, a solution had been identified that would build a suitable security scheme of delegation into the system. A model for this would be taken forward. SM noted that the solution had existed but had not been communicated to the service effectively. It was noted that work would need to be carried out by the service to construct the hierarchy for the scheme of delegation appropriately. Page: 3 of 9
OC noted that the highest risk was a delay beyond the 2012/ 2013 financial year in delivering the product and associated contractual issues. It was noted that NWIS had reported this to the Welsh Government and was working to resolve the issue at the appropriate level. BV highlighted that Withybush was ready to go live and that BCU was expected to follow although they were negotiating this with NWIS at present. BV reported that Blood Transfusion needed a stable system to validate and NWIS were working through the validation process with WBS. BV reported that they were aiming to carry out early testing so that everything would proceed smoothly when validation runs were carried out. BV informed the Board that the LIMS system should be in place by December 2013 with the exception of WTAIL. CW noted that as LIMS is a regular item on the agenda of every Health Board Executive Team, it would be appropriate for NWIS to provide a clear communication to Health Boards regarding the extent and cost of the delays and when benefits would be delivered to HBs. JEF requested a formal communication from NWIS (AG). BV agreed to follow this up with AG and noted that there had been many lessons learnt. Action AG to communicate formally to HBs and the service providing information on the extent of slippage and timescales for when LIMS would be delivered to HBs BV noted that in terms of configuration, the product was basically complete. Some defects remained but modules were available for each HB to test. He stressed that every HB should be preparing to go live. BV noted that additional resources were now being allocated to Genetics. Work was now underway to develop the Genetics module. 5. Follow-up from Workshop The Future Delivery of Pathology Service in Wales JEF reported to the Board on the paper drafted following the workshop. MF had collated the comments from the workshop and they were attached in Annex 3. JEF highlighted the recommendation to CEOs asking for a mandate to develop a blueprint for a National Pathology Service and steps to move from the current to the future picture. CE noted that in the SWOT analysis, clinical interface appeared at the bottom of the list. She felt this needed to be reviewed as Clinical interaction was currently excellent and any new plan should account for this and not damage it. It was suggested that the report should expand on some of the points listed to clarify reasoning. It was also suggested that the clinical interaction point links in well with the local ownership point. It was noted that this document needed to be worded to convey a clear message for an audience not in Pathology. DF voiced concerns that the paper appeared to jump to the conclusion that a National Pathology Service was the answer without sufficient evidence to reach this conclusion. He pointed out that the Future Service Delivery document published in 2008 made recommendations about regional services and asked what had changed from the time of the FSD document in 2008 to this paper. Page: 4 of 9
OC pointed out that the suggestion to hold the workshop and develop the report came from NPPB members, post-fsd. At the time of publication of the FSD it was considered appropriate, however the workshop showed potential for exploring a National Service. It was suggested by JEF that some of the wording in the document might be adjusted, including altering National Pathology Service to Nationally Managed Pathology Service. There was a general consensus that for a Nationally Managed Pathology Service, form should follow function and there would be regional or local delivery as appropriate. It was clarified that developing a blueprint for a Nationally Managed Pathology Service meant to scope out such a service and establish if a Nationally Managed Service would provide benefits over the current situation, what was the best option and possible models. JEF informed the Board that OC would present the paper to CEOs and Welsh Government. OC suggested that the paper should be presented to the CEO forum by Jan Smith, as Chair of the NPPB and then the CEOs could present it to the CEO and EDT meeting. It was agreed that comments on the paper should be sent to MF by 19 th October. The document would then be re-drafted by JEF and circulated out of committee. The paper would then go to the CEO forum. Actions Comments on the draft document to MF by 19 th October JEF to re-draft document and circulate out of committee 6. Strategic Programmes South Wales Programme MF reported that the engagement document on the South Wales Programme had been published and was available on the websites of each organisation involved, namely ABHB, C&VUHB, CTHB, ABMUHB and Powys LHB. JS reported that it was a challenging agenda which had been downsized from the original plans. HDHB had not been included due to a consultation on local plans. Powys had been included due to the impact on their patients. The drivers for the work included medical recruitment and sustainability issues. The Programme would consider how to have fewer sites for the services which were included as part of the work, for example Consultant-led A&E services. These services would have to be organised on the basis of how the population accessed unscheduled care. These services were currently provided across 9 hospital sites in the HBs which would, under current reconfiguration plans become 6. The Programme had suggested that most of the services should be delivered from 4 or 5 sites, 3 of which are given, namely UHW, Morriston and SCCC (in future). The remaining 1 or 2 sites were being engaged on. It was noted that Pathology could not make any firm decisions until the outcome of the Programme was known. It was noted that Pathology was flexible in its approach and would be able to adapt to the changing requirements of the Service. It was also noted that this was likely to be the first step towards more wide-ranging service reconfiguration. Genetic and Genomic Medicine Development CM reported that C&V UHB were producing a paper on a Human Genetic Strategy. The group had reconvened and were holding workshops which would include a focus on bioinformatics. A workforce & education meeting on the UK level was due to be Page: 5 of 9
held next week. As the framework was developed Wales would review it. The paper from C&V UHB and Cardiff University was due to go to CEOs in the Autumn. Modernising Scientific Careers CP reported to the Board that meeting structures were being reviewed and that the MSC Implementation Management group had been established. It was Chaired by Kath Davies, DOTHS at HDHB, and included Profession Specific Group (PSG) leads. The PSG lead for Life Sciences is Clive Morgan. The Vice Chairs for this Group are Clive Morgan and Adrian Thomas (Assistant DoTHS, C&VUHB and BCUHB respectively) The Career framework for bands 2-4 was developing. An apprenticeship approach and clear pathway for development was being mapped out and competencies defined which would drive workforce Modernisation. The competencies would define roles and would help address governance issues regarding role specifications. There would be a formal mechanism to record achievement of competences. It was noted that Wales work was not directly linked to the work underway in England but there was a need to develop in parallel to fit in with this system and to explore the apprenticeship route. An Oversight Board was being set up and a date had been set for the first meeting. Cardiff Metropolitan University (CMU) was due for an accreditation visit for their PTP Life Sciences course on the 18 th October. Work had been progressed to enable the Genetics service to support the requirements of the PTP course, and it was hoped that this would contribute to the ability of CMU to achieve accreditation. Bangor University were finalising their course and would apply for an accreditation visit soon, with the aim of having a course in time for 2013 intake. Progress with HSST would be reported at a future meeting. On 8 th October the Academy for Healthcare Science was launched. The Minister for Health and OC had spoken at the launch. It was noted that there had been a good attendance and it was appreciated that Board Members were present. The Academy for Healthcare Science had been recognised by the HPC as an education provider and would be the route to statutory regulation of Clinical Scientists who had completed STP courses. They would also be providing an equivalence route. 7. Updates from Regional Pathology Groups South East Wales JEF updated the Board on progress in South East Wales. A paper had been prepared for CEOs in April on work in Histopathology and Microbiology. Discussions with CEOs had taken place, and after some delay, the CEOs nominated Paul Hollard as the lead to support Pathology to take the work forward in the region. JEF had met with Sian Harrop-Griffiths, on behalf of Paul Hollard, to investigate methods of progressing the work. It was noted that the South East Wales CEO forum no longer meet which had caused significant delay to the work. Sian Harrop-Griffiths and JEF had been working to develop structures to progress the work. The outcome of this was that a group would be established which would contain the Regional Collaborative membership from South East and South West Wales and additional people from outside the Pathology community including Finance and Planning. Paul Hollard had agreed to Chair the group as a planner and the CEO s representative. JEF had requested a CEO as Senior Responsible Owner and Paul Page: 6 of 9
Roberts (ABMU) had been approached. JEF would provide a briefing to PR next week. JEF was working with planners to identify someone from the service to Programme Manage this work so that the work was service led. It was noted that the PMU would still support the ongoing work. JEF would send a briefing to the service and the first meeting would be called shortly. Action JEF to send a briefing to the service explaining arrangements being developed to take forward Pathology reconfiguration work across South Wales JS requested that the Board should be clear what was being requested from Planning colleagues in terms of outputs from the new group. It was suggested that as part of the work across South Wales there would need to be an information gathering exercise and that Planning input would be essential to progress the work, which Paul Hollard as Chair would be able to facilitate. There was a query as to whether the two South Wales regional groups would still exist or whether they were being merged into a single group. SM also raised concerns regarding the clarity of decisions in disciplines when crossing regional boundaries. JEF assured SM that PHW Microbiology would be involved in the new group to ensure that they were fully engaged during discussions and decisions. JEF indicated that at present the Regional Pathology collaboratives were lacking a strategic vehicle to progress work that had been carried out. The new group is what had been proposed and would provide the appropriate strategic links to continue this work. It was noted that currently strategic issues frequently do not align with local and regional plans. It was suggested that a Nationally Managed Service would have the appropriate strategic overview to resolve these issues. It was agreed that this work could be scoped in future but projects that were underway should not be stopped or slowed down. This also applied to any reconfiguration within HBs. It was noted that drivers for all change in Pathology were operational need and immediate pressures. Changes had to be made to ensure a continued sustainable service in the context of the bigger strategic picture. South West Wales AS reported on progress in South West Wales. The region had concentrated on Cellular Pathology. Having carried out initial work to identify and score options, they had reached a point where they felt unable to progress the work further without additional support from Finance and Planning colleagues. The group had carried out workforce modelling based on the highest scoring hub and spoke options. At present all regional meetings had been suspended due to the consultation processes underway in HBs. It was anticipated that the new group would provide the vehicle to progress this work. It was noted that medical workforce pressures persist in the region and that a regional solution was still required although this would need to take account of local plans. CW emphasised that even if organisations were in an engagement or consultation process, it did not need to stop groups like Pathology from considering other options so long as they remained mindful of how the options balance against national strategies. Page: 7 of 9
CW also challenged the Board that as the NPPB they should be considering how to keep services running, for example Cellular Pathology in SWW and ensuring that services do not collapse. CW also pointed out that Pathology does not require public engagement so changes could be progressed fairly quickly. CW questioned if plans should stop at the regional boundaries, both across South Wales and further afield across the whole of Wales. North Wales DF reported that positive progress was being made in North Wales with reconfiguration proceeding at pace. The final part of YGC refurbishment was expected to go live in September 2013. A proposal had been put to the BCU Board for Microbiology in Wrexham to transfer to the control of Public Health Wales. Workforce Tier 4 appointments had been made and Tier 5 and beyond were expected by mid 2013. DF reported that service users were increasingly recognising the benefits of the reconfiguration being carried out. He acknowledged that clinical engagement was hard work but encouraged colleagues to push through to the benefits. DF noted that integrated IT was needed to complete implementation of the North Wales plans as soon as possible. 8. National Pathology Operational Managers Group DF presented the ToR which had been refined since the previous NPPB meeting. The title had been changed from Management Group to Mangers Group. The Board endorsed the ToR for the National Pathology Operational Managers Group. DF reported that part 1 of an All Wales audit of POCT against CPA requirements had been reported to the group and had shown clearly how the new structure could work effectively with Quality Managers and POCT Co-ordinators groups represented on the NPOMG. Action DF to report on the findings of Part 1 of the All Wales audit of POCT to the January NPPB. The ESR codes were re-submitted with narrative added to assist with use of the codes. DF stressed that these were not intended to undermine national work underway, and were a methodology to allow 80-90% of staff to be consistently coded. 9. Any Other Business OC reported to the Board on the issue at Kingsmill Hospital regarding false positive Oestrogen Receptor Tests for Breast Cancer which had emerged following an audit. OC noted that it was not currently clear what had happened and that details were still to emerge on the technical reasons. A letter from Dr Bruce Keogh, Medical Director at the Department of Health, had been circulated amongst Histopathology colleagues. OC requested that the letter be brought to the attention of Pathology departments so that they could check the recommendations. Page: 8 of 9
OC asked that this be an incentive to review Quality Control procedures and aggregate results. OC acknowledged that a letter could be issued by the Welsh Government on this matter but requested that the DoH letter be circulated to the Board for information. He requested that in the covering note it should state that the letter from Dr Bruce Keogh had been circulated in Professional groups in Wales. It was suggested that the Histopathology SSAG and the Quality Managers Forum follow up and progress the review. Action MF and SJT to circulate letter from Dr Bruce Keogh to NPPB and NPOMG DC reported that he had been appointed Treasurer for RC Path and as such a new Chair of the Welsh Regional Council would be appointed. This would be DC s last meeting of the NPPB as the RC Path representative. JS thanked DC for arranging the successful visit of the RC Path President in May 2012 which enabled the profile of Pathology in Wales to be raised. AS reported the clinical element of Microbiology services in Withybush were being transferred to Public Health Wales in time for the CPA accreditation visit It was noted that the April and October dates for NPPB conflicted with DoTHS dates and would need to be amended. Action SJT to amend dates for NPPB in April and October 10. Date and Time of Next Meeting The next meeting is scheduled to be held on Friday 11 th January 2013 from 11:00 13:00pm at Programme Management Unit Offices, 4 th Floor, Churchill House, Cardiff. Item Action Individual 3 JEF to follow up with Jane Hanson to ensure Pathology engagement at JEF future meetings of the Cancer Implementation Group 3 JS to liaise with OC to identify Welsh Government lead for Rural Health. JS 4 AG to communicate formally to HBs and the service providing information AG on the extent of slippage and timescales for when LIMS would be delivered to HBs 5 Comments on the draft document to MF by 19 th October Board 5 JEF to re-draft document and circulate out of committee JEF 7 JEF to send a briefing to the service explaining arrangements being JEF developed to take forward Pathology reconfiguration work across South Wales 8 DF to report on the findings of Part 1 of the All Wales audit of POCT to the DF January NPPB 9 MF and SJT to circulate letter from Dr Bruce Keogh to NPPB and NPOMG MF/SJT 9 SJT to amend dates for NPPB in April and October SJT Page: 9 of 9