National Imaging Programme Board Held on 19 th June 2013 At Programme Management Unit, Churchill House, Churchill Way, Cardiff Present: Paul Roberts (PR) Chief Executive, Abertawe Bro Morgannwg UHB Claire Thomas (CT) Imaging Programme Manager Dr Owen Crawley (OC) Welsh Government Dr Andrew Jones (AJ) Aneurin Bevan HB Dr Sharon Evans (SE) MISC Chair Dr Mike Bourne (MB) Cardiff & Vale UHB Kevin Tucker (KT) Society of Radiographers / Partnership Forum Tony Clarey (TC) Hywel Dda HB Chris Morris (CM) Abertawe Bro Morgannwg UHB Dr Ali Moalla (AM) Hywel Dda HB Keith Francis (KF) Velindre NHST Dr Andrew Wood (AW) Cardiff & Vale UHB Karen Hatch (KH) Aneurin Bevan HB Helen Hughes (HH) Imaging Quality Forum Chair Dr Parvaiz Ali (PA) Medical Physics Representative Dr Sian Phillips (SP) Abertawe Bro Morgannwg UHB Andrew Griffiths (AG) NWIS Pat Youds (PY) Betsi Cadwaladr UHB Alison Kemp (AK) Betsi Cadwaladr UHB Dr David Roberts (DR) Abertawe Bro Morgannwg UHB Chris White (CW) DoTHS Representative Gareth Davies (GD) RCR Representative, Postgraduate Training Advisor for Wales Mark Elias (ME) Consultant Radiologist Betsi Cadwaladr UHB John Rees (JR) Consultant Radiologist Cardiff & Vale UHB Navroz Masani (NM) Consultant Cardiologist Cardiff & Vale UHB Stephen Dorman (SD) Consultant Cardiologist Abertawe Bro Morgannwg UHB Gethin Ellis (GE) Consultant Cardiologist Cwm Taf HB Apologies: Jane Fitzpatrick (JEF) Diagnostic Services Programme Director Tom Henderson (TH) Radis2 Review Board Chair Dr Phillip Wardle (PW) Cwm Taf HB Chris Kalinka (CK) Cwm Taf HB / WRMC Chair Amanda Evans (AE) Powys LHB Liz Hargest (LH) NLIAH Dr Rosemary Fox (RF) Public Health Wales (Screening Services) Steve Buckle (SB) Radis2 Service Management Board Chair Dr Robert Byrne (RAB) Betsi Cadwaladr UHB Secretariat: Stephen Twiddy (SJT) Diagnostic Services Programme Page: 1 of 12
1. Welcome, Introductions and Apologies PR welcomed everyone to the meeting. Apologies were recorded. KH was welcomed to her first Board meeting. 2. Minutes of the Previous Meeting The minutes of the meeting were circulated but not reviewed at the meeting. Matters Arising Matters arising were not reviewed. 3. SBAR Nuclear Medicine and ARSAC Licenses Presentation ME and JR presented to the Board on SBAR Nuclear Medicine and ARSAC licenses. ME highlighted that a large number of ARSAC licence holders across Wales were due to retire in the next 5 years. It was noted that this would have an effect on Nuclear Medicine and PET scanning in future. JR highlighted that there was a successful training programme based in Cardiff but that NHS Organisations were not advertising for posts requiring ARSAC licenses. In the last 10 years only 2 trainees had been appointed following completion of their training in Wales. It was noted that PET would be the next major development for Nuclear Medicine in Wales, and ARSAC licenses were a requirement for it. PR enquired if Nuclear medicine was configured in the most suitable manner. He asked what the strategy for PET in Wales was and where it should be located. He explained that the shape of the service needed to be identified and the workforce plan would follow. No strategic work had been carried out to date regionally on ARSAC licenses although reconfiguration of nuclear medicine was on the agenda of all the regions. PR indicated that service planning work was required to drive the work forward potentially across two regions North and South Wales. PR noted that he had raised Nuclear medicine on the CEO agenda for July. He noted that the CEOs were in the process of setting up a multi HB organisation for further South Wales planning work. At present HDHB were not signed up to this but PR was seeking their engagement in the process. PR suggested that a formal programme with strategic planning, including workforce, needed to be set up for this work with links to this South Wales organisation. PR suggested that a subgroup under NIPB be set up to work on this with support from the South Wales team. PR would seek the agreement of CEOs. Action NIPB/103 PR to raise ARSAC licenses with CEOs and seek their agreement on the planned work across the two regions. MR noted that the process required commissioning input to commission these services. PR agreed but suggested that service planning should take place and then the work could be commissioned. Page: 2 of 12
PA was nominated as the lead for the NIPB, ME would co-chair the work and could be co - opted onto the Board in this role. PR asked ME and PA to agree who would be required on the group. Action NIPB/104 - ME and PA to identify the individuals required on the Nuclear Medicine sub group. PR would clarify with the CEOs if this work fitted into the agenda of the South Wales organisation that was being set up. Feedback from the CEOs would be sent to ME and PA through CT. GD indicated that training requirements needed to be included in the work to ensure that the training needs were met and the funding for places could then be investigated. It was also noted that the involvement of WHSSC would be key and as such there was a need to involve them at the beginning of the process. 4. Cardiac Presentation AW, NM, GE and SD presented on Cardiac. NM highlighted in the presentation that the major issue surrounding Cardiac Imaging was currently the need to progress development of collaboration between Radiology and Cardiology at the request of WHSSC. Work had previously been carried out through WHSSC, Cardiologist colleagues had been advised to highlight the matter with NIPB for implementation. Generally it was noted that Cardiac Imaging were the best tests to perform on patients but that the service was not available, due to a lack of access to Cardiac Imaging. It was stated that research showed that each site in Wales was not carrying out enough Cardiac scans to maintain the skill set of professionals and the number of scans was considerably short of what was recommended each year. Waiting times had also been identified as unacceptable with patients waiting 9 months for some scans rather than the recommended 4-6 weeks. The future for these services would benefit from a Radiology/Cardiology partnership. WHSSC had sponsored the work that had been carried out but felt it should be implemented through NIPB. It was noted that the work on how the service can be provided has already been carried out, how this could be implemented remained unanswered. The Board felt that this was not a workstream for NIPB and that WHSSC needed to commission the service. The Cardiac network should be driving this work forward with some input from Radiology. Page: 3 of 12
PR stated that the NHS was shrinking financially and that this type of work would be at the cost of another service. PR suggested that an implementation plan be drawn up over several years rather than a quick implementation. MB agreed with this assessment noting that to invest in the Cardiac work there had to be disinvestment in other services. MB also stated that there was no capital support within HBs for this type of project and Welsh Government would need to be lobbied. PR noted that the Health Technologies fund could be used to support this project. PR also informed the Board that WHSSC were carrying out a review of the prioritisation framework which could see some finances released for other services which Cardiac could benefit from. MB stated that MR scanners across South Wales were Cardiac capable and that there were few good reasons against using the existing provision. It was agreed that commissioning for the service was required, NIPB were not a commissioning body. PR would discuss this with CEO colleagues in WHSSC and the Cardiac Network to ensure that the work was progressed, reports on progress should come to NIPB to keep the Board updated. Action NIPB/105 - PR to raise Cardiac Imaging with CEOs responsible for WHSSC and the Cardiac network A copy of the presentation would be circulated to the Board. Action NIPB/106 - SJT to circulate a copy of the presentation to the Board 5. Neuro Radiology AJ informed the Board that due to many techniques becoming more complex general radiologists were unable to carry out much of the Neuro Radiology work. There was a reduced reporting capacity for Neuro Radiology and ABHB were reliant on an SLA with C&V to provide their service. DR highlighted that in ABMU there was currently a neuro radiology rota for acute Neuro radiology on call. The reporting of many patients was being referred to C&V due to communication and procedural issues this was leading to clinical incidents which were not acceptable. Clarity was required around the communication between ABMU and C&V regarding who could request reports. MB stated that there had been previous reviews which had not been implemented. It was generally agreed that the recommendations of the previous review were still valid. The issues that were delaying changes were contractual issues and personnel issues. It was agreed that any unreasonable constraints should be removed. It was felt that an instruction from CEOs was required to allow the work to be completed. PR agreed that action was required immediately to stop patients being harmed. An agreement would need to be reached, over who could report scans from DGHs. Page: 4 of 12
PR asked colleagues to meet, reach an agreement and implement changes quickly. He would contact Adam Cairns (C&V CEO) and if required CEOs would write to Consultants to facilitate this work. PR informed colleagues that CEOs in ABMU and C&V would expect to see this matter resolved in the next few weeks. PR would ask Adam Cairns to instruct C&V colleagues to complete this work and PR instructed DR to resolve this for ABMU. AW requested that the interim model be time limited so that the longer term issues would be resolved as well. Action NIPB/107 - PR to discuss the Neuro Radiology situation with Adam Cairns and ask him to instruct C&V Radiology colleagues to resolve the matter with ABMU colleagues. Action NIPB/108 - MB, AW and DR to resolve the Neuro Radiology issues urgently. 6. Radiology Workforce SP and GD presented on progress within the Radiology workforce workstream. There were concerns that all of the NIPB workstreams were affected by workforce issues and training requirements. GD highlighted that the training scheme in North Wales was fit for purpose but that the scheme in South Wales was not. SP and GD had produced a paper which had already been presented to the CEOs. Consultant expansion in Wales was the lowest in the UK and that whilst training numbers in England were increasing Wales had fewer trainees today than in 1997. It was also noted that many trainees moved abroad rather than staying in Wales once they qualified. Due to the age of the Consultant workforce it was estimated that 41 Consultant Radiologists would retire by 2018. The current number of trainees would not be able to replace all of those posts and the figures did not include the current vacant posts that have not been advertised. GD and SP presented three recommendations: More training places were required in Wales Ability to fluidly configure the placements of trainees to the most appropriate location. This should be the hospital that could provide the best training. A different form of training should be provided. An academy approach was suggested. This would still provide trainees to departments and would also be able to act as a reporting hub for insourcing. The Academy would also be able to provide training for radiographers and other health professionals and would have a role in quality assurance of diagnostic tests being undertaken. GD noted that the report and its recommendations had been accepted in principle by the CEOs including extra national training numbers. Four extra training places had been funded by the Deputy CMO. These had been agreed late in recruitment process and it was felt that there was little chance of finding suitable candidates to fill the places, therefore no recruitment had been undertaken. Page: 5 of 12
The central funding model would allow for the trainees to be placed in the best place for their training needs; this was still being discussed with the Deanery AK asked for confirmation that North Wales would not be disadvantaged by work being undertaken. GD indicated that the concern for North Wales was that the training arrangement with Mersey was a gentlemen s agreement. GD and SP were working with the Deanery to formalise this arrangement. The paper and recommendations were specifically targeted to the issues in South Wales. The Board agreed that the three recommendations should be taken forward and noted that the CEOs had already agreed this proposal. DR noted the Board s thanks to SP and GD for progressing this work and also highlighted that the Academy was a good proposal that has shown results in England. PR asked what the NIPB needed to do to continue the work. 1. More Training Places - Discussions were underway, this would be funded centrally by the Deanery. GD considers this process complete from NIPB perspective. 2. Fluid placement of Trainees - Discussions were underway with the Deanery. SP reported that papers needed re-evaluating. PR indicated that if she required any support to contact him. It had been suggested that SP and GD present to Finance directors to raise awareness. 3. Academy A formal project would need to be set up. PR suggested a sub group of NIPB. There would be some capital requirements to make this happen and discussions about location and which NHS body would host it would need to be held. GD highlighted that partnership was key, there were facilities already under consideration that were ready to use but currently out of service. It was also noted that Radiographic numbers needed to be increased in workforce planning to allow for the trainees to take posts in Wales. It was noted that Wales needed to workforce plan, it was felt that the placement of trainees would aid in this. PR stated that a formal project team would be required and that SP and GD might be able to seek support through the South Wales team. PR would highlight this work with the South Wales team. A Project chair would need to be agreed, presently SP and GD were jointly leading, they would discuss the future leadership of the project and feedback to NIPB. Action NIPB/109 PR to highlight the Academy work with the South Wales team. Action NIPB/110 - GD and SP to decide on project leadership arrangements Page: 6 of 12
7. Workstream Leadership MDT KF was seeking a Clinical lead to support the work as SP had withdrawn from MDT due to her work on Radiologist Workforce. It was suggested that a lead radiologist could be an individual that did not sit on NIPB. Mark Robinson and Rhian Rhys were suggested and would be approached for the role. KF would continue to be the NIPB lead on the workstream. Rural Wales There was no-one present to discuss progress. CT was able to confirm that the workstream had now found a way forward and would have something more substantial to report at the next NIPB meeting. Performance Management MB had submitted a paper, he felt that this work should be presented to CEOs to receive a mandate due to the large amount of work that was required and to ensure that the work would be completed. He proposed starting the work following the CEO mandate in September/October. MB indicated that the first stage would be for colleagues to meet and determine what success looked like in their organisations and across Wales. This would be lined up with what Welsh Government and NHS Wales organisations required. This would provide KPIs that would line Imaging services up with patients, major stakeholders and NHS Wales organisations. MB indicated that this was a team development of what success looks like. It would enable colleagues to enable reporting in a timely fashion to ensure that actions can be taken before KPIs are failed. AK noted that the work was started on the basis of how Welsh Government viewed Imaging services. At present they only measured waiting times and NIPB wanted to demonstrate the breath services that were carried out. MB noted that this would provide comparable information between departments. PR noted that the paper appeared to be conceptual and enquired how the work could be progressed to reality. MB informed the Board that he had a 6 week or 24 week plan to implement the work but it would take colleagues out of their normal roles to carry it out. There was a feeling from the Board that they were being asked to commit to something they did not fully understand. Page: 7 of 12
AK indicated that she would like to push this work forward and was happy to meet with colleagues who were interested to put more meat on the bones so that the NIPB had more information to use to approve the remaining work. PR agreed that a first meeting should take place and then report to NIPB for further agreement. MB indicated that all organisations would need to be involved in the meeting. PR agreed and informed MB he had the Board s commitment to that point. He also highlighted that HH should be involved in the work. Action NNIPB/111 - MB to arrange the first meeting and report back to the Board after the meeting. Paediatrics SE had been leading on the work but felt it would be more suitable if AW took the lead as the hub was located in C&V. SE indicated that the work had been carried out and was to be taken forward by Planning colleagues. SE felt that the South Wales Programme would not have much impact on what had already been decided. The two models under consideration were a Hub and spoke model in South Wales or a Cardiff and Bristol model for the out of hours rota. AW felt that the Problems were not in Cardiff but in the spokes. AW was happy to lead but felt that someone from the spokes should assist in the workstream. There was some confusion over the engagement of Paediatric Radiologists with the work currently underway. It was noted that the models that Paediatric Radiologists had rejected were not under consideration by the workstream. The primary issue was around On call and it was noted that the secondary issues would not cause a major problem once On call has been dealt with. PR noted that Paediatric Inpatient would be reduced to four/five sites in light of the South Wales programme. The model had support to proceed; the rota would mainly be provided by paediatric radiologists in Cardiff, any DGH radiologists practicing paediatric radiology could support the rota. DGH colleagues could be involved in the hub and spoke approach but their HB would have to decide the level of involvement. It was agreed that the first step would be the on call rota. AW would lead the work and would discuss a possible stakeholder in the spokes with SE. Action NIPB/112 - AW to investigate a stakeholder to work on the workstream Page: 8 of 12
8. Updates on Progress Radiologist Workforce The item was covered under item 6. MDT The item was covered under item 7 Paediatric Radiology The item was covered under item 7 Rural Wales The item was covered under item 7 Performance Management of Radiology Services Covered under item 7 Reporting/Outsourcing Advanced Practice SB presented on behalf of LH. Work had been undertaken to provide a baseline measurement of advanced practice in HBs and to identify if they mapped to the Welsh Government framework for advanced practice. The next phase of work would be further analysis of questionnaires, to investigate any issues identified and engage with national work and the post registration career framework for AHPs and education. It was noted that the work should link in with the Academy work already being carried out by the radiologist workforce workstream. 7 Day Working DR reported that a workshop had been held on 7 th June and all HBs had been represented. A BMA representative provided information on the Welsh contract and informed the group that it provided no barriers to 7 day working. KT had discussed the SoR approach to 7 day working and CM had provided the range of options for 7 day working to the group. DR informed the Board that they had received positive responses locally to their proposals. CM indicated that a matrix had been prepared to demonstrate the spectrum of 7 day working options which colleagues could use to help implement a 7 day working service. It was noted that consultant colleagues would need to be negotiated with regarding changes to work plans but if they refuse reasonable changes it could be forced through. Page: 9 of 12
PR asked for the final matrix to be presented to the NIPB for endorsement prior to it being circulated to colleagues. Action NIPB/113 - CM to present matrix to NIPB for endorsement It was noted that ABMU were implementing step 1 on the matrix initially, this could include outpatients as an option. Breast Radiology CT highlighted that a second workshop had been undertaken. The model had been scoped and the group were now looking to engage with breast surgeons. PW and RF had wanted to clarify that the model being proposed was suitable with NIPB and with CEOs. It was noted that the proposed model was not included in the papers submitted to NIPB, this would be required to ensure collective support prior to CEOs. CT would circulate a report and seek support out of committee via email. Action NIPB/114 - CT to circulate a report on the Breast Radiology model and seek support for the next stage of the work out of committee Radiology in relation Major Trauma & Emergency Medicine was deferred until the completion of the South Wales Programme. 9. Procurement through Shared Services MB briefly highlighted that a Cardiology and Interventional radiology multi-provider framework was going out to tender through Shared Services. He would request colleagues be put forward for the reviewing group. There would still be local accountability on what was actually purchased from the framework. PR requested that MB write a brief on the matter to be circulated out of committee. Action NIPB/115 - MB to circulate a briefing on the Procurement work 10. Imaging IM&T Update 11. AOB OC noted the IM&T paper. He highlighted that HIW had flagged the need for RADIS to record patient doses. A paper on this would be circulated to colleagues through CT. Action NIPB/116 - OC to circulate paper from HIW to the Board through CT Post Registration Career Framework for AHPs SB would be submitted to fill nomination and would be co-opted to the Board in that capacity. Page: 10 of 12
Workshop with Royal College of Radiologists OC noted that an issue had been raised with CMO by RCR. RCR were seeking a workshop with NIPB regarding ISAS. It was noted that currently only five organisations in England had completed the process and that it was a large amount of work and expense. It was agreed that NIPB had a professional responsibility to receive the presentation from RCR to provide feedback. HH noted that BCU were in contact with other sites involved in the ISAS process and would provide feedback. CT would to liaise with HH on the structure of the day. David Parker from BCU was an assessor for ISAS and should be involved in the day. Action NIPB/117 - HH and CT to liaise on arrangements for the RCR Presentation Waiting Times OC highlighted that Statistics on Diagnostics and Therapy waiting times were produced by Stats Wales. These showed that Radiology waiting times were increasing. The trend for patients waiting over 8 weeks was going up, which could suggests something was out of balance. The graph showed an increase since May 2012. The Welsh Government approach was to raise it as an issue which needed consideration with organisations. OC indicated that PR wanted to highlight this with CEO colleagues. OC would be investigating further with more detail about which HBs are affected and which modalities. CT would be in contact with colleagues regarding the data. Action NIPB/118 CT to contact colleagues regarding the waiting times data. Actions SE noted that she would like to see actions acted on and requested an action log for each meeting including a section on why actions had not been completed. This was agreed by the Board 12. Date and Time of the Next Meeting Wednesday 25 th September 2013, Programme Management Unit Officer, 10:00am - 1:00pm Page: 11 of 12
Action Log Action Number Action Lead NIPB/103 PR to raise ARSAC licenses with CEOs and seek their PR agreement on the planned work across the two regions. NIPB/104 ME and PA to identify the individuals required on the Nuclear Medicine sub group. ME & PA NIPB/105 PR to raise Cardiac Imaging with CEOs responsible for PR WHSSC and the Cardiac network NIPB/106 SJT to circulate a copy of the presentation to the Board SJT NIPB/107 PR to discuss the Neuro Radiology situation with Adam Cairns PR and ask him to instruct C&V Radiology colleagues to resolve the matter with ABMU colleagues. NIPB/108 MB, AW and DR to resolve the Neuro Radiology issues urgently MB, AW & DR NIPB/109 PR to highlight the Academy work with the South Wales team PR NIPB/110 GD and SP to decide on project leadership arrangements GD & SP NIPB/111 MB to arrange the first meeting and report back to the Board MB after the meeting. NIPB/112 AW to investigate a stakeholder to work on the workstream AW NIPB/113 CM to present matrix to NIPB for endorsement CM NIPB/114 CT to circulate a report on the Breast Radiology model and CT seek support for the next stage of the work out of committee NIPB/115 MB to circulate a briefing on the Procurement work MB NIPB/116 OC to circulate paper from HIW to the Board through CT OC & CT NIPB/117 HH and CT to liaise on arrangements for the RCR Presentation CT & HH NIPB/118 CT to contact colleagues regarding the waiting times data. CT Page: 12 of 12