NoS Child Health Clinical Planning Group

Meeting: NoSPG Date: 25 th February 2015 Item: 21/15 NORTH OF SCOTLAND PLANNING GROUP NoS Child Health Clinical Planning Group PG is asked to: Note the attached Minute from the meeting held on 12 th November2014. Synopsis of Paper: The aim of the paper is to update members of the ongoing issues being discussed at the NoS Child Health Clinical Planning Group. 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: Name Role NHS Grampian Dr Christine Bain Ms Lorraine Currie Mr Cameron Matthew Ms Gail Thomson Dr Michael Kathleen Ross Dr Nikolaus Kau Clinical Director for Women & Children s Services Strategic Co-ordinator, Child Health, NHS Grampian Unit Operational Manager - Child Health Unit Operational Manager Neonatal NoSPG Child Health Clinical Lead (Chair) Head of Paediatric Dietetics Clinical lead for Neonatal NHS Highland Mrs Sally Amor Mr Richard Bennie Dr Deborah Shanks Child Health Commissioner Service Manager Child Health Service lead for Children s Services NHS Orkney Mrs Marie O Sullivan Head of Children s Services, Criminal Justice & Primary Care NHS Shetland Dr Sarah Taylor Director of Public Health & Child Health Commissioner NHS Tayside Dr Martin Kirkpatrick Dr Fiona Drimmie Mrs Dawn Sturrock Ms Kay Fowlie Dr Jonathan McCormick Dr Joy Mires Consultant Paediatric Neurologist Clinical Director Paediatrics Service Manager Child Health Commissioner Clinical lead for Respiratory Clinical Lead for Child Protection NHS Western Isles Mrs Emelin Collier Child Health Commissioner 1

NoS Child Health Clinical Planning Group Minute of virtual meeting held on Wednesday 12 th November 2014; 1.30pm to 3.30pm NORTH OF SCOTLAND PLANNING GROUP Present: Approved Dundee: Aberdeen: Inverness: Orkney: NES: SAS: Dr Michael Bisset, NoS Child Health Clinical Lead (Chair) Mr Jim Cannon, Director of Regional Planning, NoSPG Mrs Carolyn Duncan, Child Health Network Manager, NoSPG Dr Fiona Drimmie, Clinical Director for Children s Services, NHS Tayside Mr Keith Farrer, Programme Manager, NoSPG Dr Martin Kirkpatrick, Clinical Lead Paediatric Neurology, NoSPG Mrs Anne-Marie Pitt, Child Health Network Manager, NoSPG Ms Lorraine Currie, Strategic Co-ordinator, Child Health, NHS Grampian Mr Cameron Matthew, Unit Operational Manager - Child Health, NHS Grampian Ms Claire Wood, Principal Officer (AHPs), Highland Council Mrs Marie O Sullivan, Head of Children s Services, Orkney Health & Care Ms Pauline Beirne, Educational Projects Manager (Child Health), NES Ms Carole Morton, Head of Service - ScotSTAR In attendance: Dr Pat Carragher, Medical Director, CHAS Ms Maria McGill, Chief Executive, CHAS Miss Julie Gowans, PA/Administrator, NoSPG (minute) Item Action 40/14 Welcome and apologies Dr Bisset welcomed everyone to the meeting and introductions were made from each location. Apologies were received from: Mrs Sally Amor, Child Health Commissioner, NHS Highland; Mr Richard Bennie, Service Manager Child Health, NHS Highland; Ms Emelin Collier, Child Health Commissioner, NHS Western Isles; Ms Kay Fowlie, Child Health Commissioner, NHS Tayside; Mrs Marie Gardiner, Neonatal Clinical Facilitator; Ms Morag Hogg, Consultant General Surgeon, NHS Highland; Dr Jonathan McCormick, Clinical Lead Paediatric Respiratory, NoSPG; Dr Deborah Shanks, Service Lead for Children s Services, NHS Highland; Mrs Dawn Sturrock, Service Manager, NHS Tayside; Ms Sue Swift, Divisional Head of Nursing, NHS Grampian; Dr Sarah Taylor, Director of Public Health & Child Health Commissioner, NHS Shetland and Ms Gail Thomson, Unit Operational Manager Neonatal, NHS Grampian. 41/14 Minute of meeting held on 27 th August 2014 2

The minute was agreed to be an accurate record of the meeting. 42/14 Matters Arising i) Action sheet Most of the actions from the previous meeting had been completed. The others would be covered under separate agenda items. ii) Neurophysiology At the last meeting Dr Kirkpatrick raised the issue of the sustainability of the paediatric neurophysiology service in Tayside due to the retiral of the single handed neurophysiologist in Tayside. This was likely to also be an issue in Grampian in the near future. Since then Dr Kirkpatrick had met with Samantha Batty, who has been commissioned to start discussions around neurophysiology requirements in both adult and paediatric services. He suggested that it would be helpful for Ms Batty to meet with Mr Cannon and Mr Farrer to allow her to fully understand the NoSPG infrastructure. Audrey Warden had also contacted Mr Cannon around the adult service and he and Mr Farrer would progress this. Dr Kirkpatrick would pass on Mr Farrer s contact details to Ms Batty to allow her to make contact. MK 43/14 Neonatal Update Mr Farrer advised that Marie Gardiner has returned from her secondment to the role of Neonatal Clinical Facilitator. One of her main pieces of work would be on developing national patient information and guidance documents. She would also be in touch with Boards regarding an update against the implementation plan. Dr Petr Kalous, Neonatal Consultant in NHS Grampian, has been appointed to the Clinical Lead post. This post will be for 2 sessions and work was ongoing around the third funded session which may be used to provide an educational role. 44/14 CHAS Update Dr Pat Carragher and Ms Maria McGill gave a presentation to the group providing an update on the work being carried out. The current workplan has been based on feedback from families which has shown that they would like to see CHAS continue to provide the same service to reach a wider group. The CHAS vision is that children and young people in Scotland have access to palliative care when and where they need it and CHAS collaborates with NHS Boards, local authorities and other charities to provide this. A piece of work is currently underway to identify numbers of children using the service. Dr Carragher reported on clinical activity data which showed an increase in the numbers of patients accessing the service, as well as an increase in the complexity of care required. Ms McGill outlined some of the impacts of the implementation of the plan, with regard to care, support and connections. Dr Kirkpatrick asked if there was a difference between families of babies and older children in terms of where they wished to be treated. Dr Carragher advised that every family was different and that CHAS has been small enough to manage cases on an individual basis. Dr Bisset advised that the regional team had been looking at the issues around honorary contracts for clinical staff working across Boards. Ms McGill confirmed that this was also an issue in CHAS for staff and they were yet to identify a simple solution. 3

Mr Cannon asked where CHAS would take referrals from and Ms McGill confirmed that they would take patients from all types of referrals including family referrals with agreement from a GP or consultant. Ms McGill confirmed that around 10% of CHAS s budget of around 12.5m for this year was statutory funding with the remainder being voluntary contributions. It was suggested that as CHAS is beginning to provide more services which would traditionally be provided by NHS Boards then there should be an increase in statutory funding. Ms McGill advised that discussions were currently underway with NHS Tayside and Child Health Commissioners around this. Dr Bisset confirmed that the group would be happy to be contacted by the research team to provide information where required. 45/14 Transitions Mrs Duncan spoke to the paper which had been circulated to the group. She had collated this information following liaison with specialist nurses to identify what teenage and transition clinics are in place across the North. Dr Bisset added that in future it was likely that the age range could increase, from the current upper limit of 16, although there was already some flexibility around this depending on the individual. The group also agreed that it was important that adult services better understand the needs of young adults. 46/14 ScotSTAR Update Ms Morton provided a verbal update to the group. ScotSTAR had moved over to the Scottish Ambulance Service as of 1 st April. Ms Morton had been working with Andrew McIntyre, Associate Medical Director, and Sandra Stark, Paediatric Nurse Consultant and suggested that moving forward one of the two should attend this group. Ms Morton advised that there had previously been an issue with populating the neonatal and paediatric rotas in Aberdeen but that this had improved following collaboration with Fiona Francey and Gail Thomson. Ms Morton had also been involved in discussions with Mrs Pitt and Mr Cannon on risks to inter-hospital transfers in the north and a risk assessment was being developed for submitting to the NoSPG Executive Group in December. The group agreed that one of the main issues was around the transfer of the child requiring high dependency care and Dr Kirkpatrick suggested that the repatriation of children from PICU in Glasgow or Edinburgh to their local HDU should also be highlighted. Ms Morton agreed to include this in the report. It was hoped that a stakeholder event would be organised to look at all issues in NoS. 47/14 Paediatric Unscheduled Care The group had been circulated the evaluations of the project, including the Executive Summary, the external evaluation and the Clinical Lead report. A PUC workshop had been organised in parallel with the SCTT event on 6 th November, which a number of stakeholders had been invited to attend. Mrs Pitt advised that there had been some enthusiastic discussion around taking forward the principles in a different model, potentially involving Highland providing support for Western Isles and Grampian providing the support that they already provide to Orkney and Shetland but on a more formal basis. Mrs Pitt would circulate a AMP summary of the discussions to the group once available. Mr Cameron confirmed 4

that there was more enthusiasm in Grampian around adopting some form of similar model, with the support being provided by the existing consultant cohort. The group were asked to feed back to local specialist consultants and doctors in remote areas. ALL Mr Cannon had also met with Michael Kellet, Chair of the National Planning Forum and it had been agreed that it would be appropriate to take remote decision support to the NPF. 48/14 Paediatric Critical Care Mrs Pitt had circulated a paper providing an update on discussions which have been taking place both regionally and nationally. Previously there had been a National Critical Care Steering Group, however this had not met for some time and it had been proposed that this was replaced with an inter-regional group, driven by clinicians. The aims of the group would include agreeing definitions, developing shared standards and data collection and audits and the group would report to regional Child Health Clinical Planning Groups. The next meeting was being arranged for January 2015 and this would be used to agree a terms of reference, workplan and membership for the group. There was some national NDP funding available which had originally been used to fund a national coordinator post, however it has since been agreed with NSD that this would be split between the three regions to be used to maintain the national and regional work. The NoS regional network had agreed to use this to support a regional clinical lead. A bid had also been submitted for some NDP slippage money to supplement this and the bid scoring panel had proposed that this could be looked at alongside similar bids for clinical lead funding for general surgery for childhood, and this would be explored. Mrs Pitt advised that the West and South East regional high dependency networks already have identified clinical leads, however they are not funded for additional sessions to carry out the role. Mr Cannon suggested that the support from other regions should be highlighted in the bid for NDP funding. It was felt that it was important that the inter-regional group had somewhere national to escalate any issues to in order to ensure that the national focus was not lost and that there was input from PICUs. It was suggested that the group could potentially escalate issues to the Children and Young People s Health Support Group. It was acknowledged that high dependency or critical care was too large a service area to be a national designated service therefore NSD had agreed for the regions to take this forward nationally, although this model could be reviewed in a year s time. It was agreed that it was important not to define transfers too narrowly and it was agreed that transfers would cover all critically ill children without defining high dependency. The group agreed in principle with moving forward with the inter-regional group and to the funding being used to support a clinical lead role for a year in the first instance before being reviewed. 49/14 Bidding for NDP underspend Mr Cannon advised that an internal panel had met in July with a view to reviewing the initial bids received, however there had been some discomfort around this being done internally and it had been felt it would be helpful to seek external advice. On doing this it had been agreed that an external panel would be formed and asked to score the bids against the agreed criteria. Following this the external panel met virtually to discuss the bids received and a summary of the feedback 5

from this had been shared with this group. The panel had felt that all of the bids required more information and this had been fed back to bidders. It was agreed that a number of bids could go forward to the next stage, which would involve a Project Initiation Document being developed and taken to the NoSPG Executive Group in December for agreement. It was felt that other bids were not ready to progress to this stage and bidders had been asked to resubmit their bids, taking into account the feedback from the panel, to be reconsidered before potentially moving to the PID process. They would then be considered at the following NoSPG Executive Group meeting in February 2015. Mr Cannon agreed to answer any queries regarding specific bids outwith the meeting. A number of bids had been asked to provide an exit strategy before resubmitting and there was a query around why this was necessary in the case of a pilot project. Mr Cannon explained that with pilot services there was also a danger of raising expectations and leaving a gap in service at the end of the pilot period and there would need to be explicit sign up from Boards that they were prepared to risk this. He added that it had been felt there was a need to be clearer whether projects were truly pilots or a test of change, where the service had already been piloted in other areas. There had been a number of bids received from AHP colleagues and it had been suggested by the panel that these were looked at together and prioritised by AHP leads. Ms Woods confirmed that she had organised a teleconference with colleagues to discuss this further. As mentioned under item 48/14 there had also been some similar bids submitted around funding for regional clinical lead roles and it had been agreed that it may also be helpful to look at these together. There had also been some discussion around the variance between bids for certain costs, such as consultant sessions and travel/it costs and Mr Cannon was carrying out a piece of work with Diane Kidd, NHS Tayside Management Accountant, to standardise these costs. 50/14 NES Update Ms Beirne spoke to the update report which had been circulated to the group, outlining the key pieces of work currently being undertaken by NES. The main drive was supporting the response to the aspirations of the Children & Young Person s Act which will be implemented in 2016. Also, in support of the paediatric advanced practice agenda, with four education posts recruited to in April and related work around this. Another major workstream would be the refocused health visitor education programme and the revised role of the school nurse. NES would also be undertaking a governance role in supporting higher education institutions with the establishment of an educational governance steering group to monitor progress against the recommendations agreed by the Scottish Executive Nurse Directors. A national plan for CPD to support existing practitioners is also being developed. Work also continues around maternity services. Ms Beirne confirmed that there would be a number of requirements for paediatric consultants and trainees and that consultation was planned with medical and dental colleagues. It was also recognised that the key recommendations go beyond wider than children s services. 51/14 Feedback from Children & Young People s Health Support Group 52/14 AOCB There was no update as there had been no meetings of the CYPHSG since this group last met. Their next meeting would be held on Monday 15 th December. North of Scotland Child Health Workplan 6

Mrs Pitt advised that she had been involved in some discussion with Ms Swift around the desired outcomes of this group and suggested working up a workplan to be brought back to this group which would feed into the sustainability review and obligate network discussions. This would also allow the group to look regionally at services and identify vulnerable services in a structured way. Paediatric Neuromuscular Care Advisor The fixed term funding for the regional neuromuscular care advisor post was due to end in December and Boards had not agreed to fund the continuation of the post. Following discussion at the NoSPG Executive Group it had been agreed that a piece of work will be carried out with key clinicians to identify areas where work on pathways would be required and drive an improvement plan regionally. It had been felt that the areas which required most work were around diagnosis, disease escalation and transitional care. Mr Farrer would bring a paper on this to the next meeting of this group. KF Regional Database Access Dr Drimmie advised that she had been copied in to correspondence from the national renal network (SPRUN) requesting funding to access the West of Scotland database and asked if this was something which should be funded by Health Boards or from NDP funding. Mr Cannon advised that there had been ongoing discussions for some time around IT requirements to support cross-boundary working and that work was being carried out to reinstate a functional regional ehealth group led by Alison Hawkins. Dr Drimmie agreed to forward the communication on to Dr Bisset and Mr Cannon and if it is considered to be a regional issue this would be taken to the regional ehealth group. 53/14 Date of Next Meeting Wednesday 4 th February 2015 at 1.30pm. Further 2015 meeting dates are as follows: Wednesday 13 th May Wednesday 2nd September (please note change of date from 26 th August) Wednesday 11 th November Close. 7