All Wales Critical Care Implementation Group Agenda Tuesday 6 th September 2016, 2.00-4.00pm Caerdydd 3, Welsh Government, Cathays Park, Cardiff VC dial 521971 from NHS Videoconferencing Network 1. Welcome and introductions Karin Phillips (Chair, Welsh Gov) Caroline Lewis (Welsh Gov) Dave Hope (Wales Critical Care and Trauma Network) Tamas Szakmany (Wales Critical Care and Trauma Network) Hywel Roberts (WICS) Dale-Charlotte Moore (Cardiff & Vale UHB) Sue O Keeffe (Wales Critical Care & Trauma Network) Ed Farley Hills (Wales Critical Care and Trauma Network) Ifor Evans (WCC&TN) Greg Ead (WCC&TN) Richard Self (Abertawe Bro Morgannwg UHB) Gareth Schooley (Cardiff & Vale UHB) Abigail Harris (Cardiff & Vale UHB) Will Marriage (WATCh) for item 5 only. Steve Monaghan Abigail Harris Olivia Shorrocks (Welsh Government) Carly Buckingham (Hywel Dda UHB) Ami Jones (EMRTS) Michelle Sell (NWIS) Matthew Perrott (NWIS) Apologies Zoe Goodacre (WCC&TN) Julia Schooley (WCC&TN) Steve Moore (Hywel Dda UHB) Paul Temblett (Abertawe Bro Morgannwg UHB) Jack Parry- Jones (Aneurin Bevan UHB) Graham Shortland (Cardiff & Vale UHB) Piroska Toth-tarsoly (Cwm Taf UHB) Evan Moore (Betsi Cadwaladr UHB) Stephanie Hire (Hywel Dda UHB) 2. To Approve the Minutes of the last Meeting The minutes of the last meeting were approved subject to correction of Hywel Morgan s name and Sue O Keeffe noted that on page 3 section 5, paragraph 3 the word same was repeated twice. 3. Matters Arising not on the Agenda Item 1 Completed Item 2 on Agenda to be discussed Item 3 on Agenda to be discussed Item 4 representative of NWIS will attend March 2016 meeting Item 5 Completed CCIG(16) Page 1 Draft 2
Item 6 Completed Item 7 Letter drafted and ready to be sent. Item 8 On agenda to be discussed Item 9 OHCA Update: The group steering the development of the OHCA pathway met on the 29 th November to discuss the next steps in agreeing and implementing the pathway. The group has agreed an interim solution in South East Wales to address the concerns raised in the Regulation 28 report from the Coroner about access for OHCA patients to primary PCI when they are not conscious. The group will meet again in January to discuss standard operating procedures for identification of appropriate patients for a centre with a 24/7 cath lab and the agreement of ED consultants to formalise existing arrangements for making a pitstop with a patient in an ambulance to stabilise them for immediate onward transfer. The longer-term solution will require further detailed costing and proper commissioning. There will be a need to increase critical care capacity as well as commissioning sufficient resources to transfer and repatriate patients in a timely manner when appropriate. In an additional item on the agenda, Dr Hywel Roberts updated the group on progress towards an all-wales pathway for devastating brain injury. It is expected that this draft will be circulated to colleagues in related specialities for comment before Christmas. It is hoped that a revised version of the pathway will then be available for full discussion at the first CCIG meeting in 2017 with a view to progressing to implementation after that. Thought needs to be given as to how the implementation of the guidance will be monitored and the effects of the intervention on patient outcomes assessed. Given the limited clinical data in this field an ongoing national audit (or registry) of patients treated through the pathway would be ideal but this will require some careful planning, possibly ethical committee approval and probably some extra resource. 4. Review eicu Tamas Szakmany introduced this item, noting the difference between a Clinical Information System and e-icu (which is a model of telehealth) in critical care. TS explained that before any kind of eicu system can be introduced, a functional electronic clinical information system is required first. Therefore, the CCIG was asked to agree to divide the project into two phases: 1 the procurement and implementation of a CIS into all UHBs and ICUs in Wales, followed by a second phase adoption of e- ICU in UHBs who require it. This was agreed by the group. Clinical Information System for Critical Care It was noted that the project to procure a CIS had been delayed by NWIS but that following a recent high- level meeting of Chief Execs NWIS had now committed to supporting the Procurement of a critical care CIS system for Wales as soon as possible, subject to confirmation by NWIS in writing of a clear timetable of the Procurement Process. CCIG(16) Page 2 Draft 2
Action: SM to draft a letter on behalf of Steve Moore to Andrew Griffiths, NWIS, asking for a clear commitment, along with detail of resources and timetable for the Procurement process. TS noted that a detailed and comprehensive specification for a Critical Care Information System had been developed by himself and the project manager. He requested that all group members read through the specification and forward any comments to himself. He also requested that the specification was shared with relevant clinicians and IT departments within the HBs It was noted that the specification would need to be reviewed and signed off by the lead IT Directors of each UHB. Also while the majority of funding for the CIS implementation would be provided by the 1 million WCC&TN fund, there would be cost implications for UHBs in terms of new critical care equipment purchases, software licences and staff training. Action: SM to draft another letter to UHB Chief Executives and Chief IT Directors, requiring sign-off of the technical specification and the requirement of investment of capital finances. Abi Harris noted that Chief Executives had signed up to the general concept of the clinical information system but that IM&T Directors had not been informed. She suggested a proforma could developed allowing Chief Executives to confirm IM&T sign-up to this project. Michelle Sell (NWIS Procurement) confirmed that they had reviewed the specification and had a number of issues and amendments that they wished to raise. Because of the detailed nature of these it was requested that these be raised in a separate meeting of NWIS staff and GE TS to discuss and resolve these issues so that the project is not delayed (Action). 5. Urgent: Paediatric Intensive Care Capacity Will Marriage of Wales and West Acute Transport for Children (WATCh) presented a paper summarising the issues of Paediatric ICU bed availability, noting that the system is totally overloaded with Bristol and Cardiff Paediatric ICUs often over- capacity and children being cared for in operating theatres. WM suggested that Wales Adult ICUs could potentially receive paediatric patients as it is a better environment than in a local operating theatre. WM asked the Group if ITU clinicians would be prepared to care for children in adult critical care units as the transport system was struggling to cope with the lack of available paediatric critical care capacity. The general consensus among the Intensivists and Anaesthetists in the group was that adult critical care units are already at full capacity and Intensivists and nursing staff do not have the skills, knowledge or equipment to care for critically ill paediatric patients safely. CCIG(16) Page 3 Draft 2
CL: To ensure that all UHBs Delivery Plans had a clear policy and process for caring for critically- ill children. 6. Review of Ministerial Fund GE presented a paper summarising progress on the three main projects progressed by the Critical Care and Trauma Network: Clinical Information System, Peer Review and Follow- Up Clinics pilot study. The CCIG was asked to note progress on these three projects. The paper also presented a spreadsheet which summarised all the applications for funding for the approx. 935k of slippage of the Ministerial Fund that had been received. 32 applications in total had been received totalling 1,138k, and the breakdown by Health-board was as follows:- It was noted that 3 Health Boards had submitted total applications under their proportion of the core allocation, whereas 3 UHBs total exceeded their percentage allocation of the total funds available. SOK noted that one of the proposals was a joint BCUHB/ABM/WAST bid but that all of the costs had been allocated to BCUHB. It was noted that this fund is a revenue fund only and that four Health- Boards had also submitted various bids for capital equipment funding. Noted that for those ten applications over the 5000 capital limit, Welsh Government are seeking clarification on the ability to fund these projects from capital funding with sacrifice made from the CCIG revenue funding allocation. Action: Caroline Lewis to clarify this with WG Finance colleagues ASAP and provide clarification on which projects can be funded to WCC&TN colleagues. The group noted that there were ten applications which were very detailed and clear in terms of their minor funding requirements, and in description of the project, how the project will be evaluated and met at least three of the CCIG delivery themes. These were given status of green on spreadsheet. The CCIG agreed, that these projects would be assigned requested funding to go ahead. Finally, it was noted that 12 applications were incomplete (Amber on spreadsheet) in that these applications did not provide sufficient information and/or financial detail to enable the group to make a decision on these applications. The CCIG agreed to refer these applications back to Wales Critical Care & Trauma Network staff to identify the requested information so that a Chair s decision on behalf of CCIG can be made to provide funding to those projects that qualify ASAP. CCIG(16) Page 4 Draft 2
Finally, the group noted that Betsi Cadwaladr s total funding request of 501,886 was distorted by a single application for capital funding of 296,326. This application was received from a joint consortium of WAST/ BCUHB/ABM and was therefore questioned if this could even apply for funding from the CCIG. In a similar vein The SAIL database, was not part of Aneurin Bevan s bid but rather a WCC&TN bid for funds. It was also noted that if this application was rejected it would bring Betsi Cadwaladr s total funding to under their proportional limit and also the total of all applications would be 841,786 under the total funds available of 935k. Following the CCIG meeting, WG Finance have confirmed that they will fund all the capital projects subject to Cabinet Secretary approval but not including the WAST/ EMRTS bid which would be funded outside of the CCIG process. 7. Peer Review Visits Ifor Evans reported that a pilot Peer Review in Hywel Dda Health-board took place on 19 th /20 th October and reviewers drawn from across NHS Wales visited all the sites in the Health Board with critical care units Early feedback from both the Health Board and visiting reviewers has been extremely positive. The report from the visit is being prepared in collaboration with the reviewers and the Health Board and will be circulated in due course. Action: Ifor Evans to gain clarification on how to proceed in terms of the Governance of the Peer Reviews now that the WCC&TN is hosted by the NHS Collaborative. 8. Refreshed Delivery Plan Reporting Framework Olivia Shorrocks went through the latest planning guidance and the requirement to include delivery plans in future versions of Health Boards IMTP. The group will have a role in reporting performance to WG. The new responsibilities for the Implementation Group are:- Refresh national priorities and send updated planning guidance to health boards every September to support them in their IMTPs Implementation Group to escalate any areas of concern to Welsh Government. Design peer review process Produce an annual statement of progress to Welsh Government Co-ordinate Peer review on Health Board annual progress reports Terms of Reference Caroline Lewis presented the Terms of Reference for the CCIG which have been amended to reflect the changing role of the group following the planning guidance referred to above. Membership of the group needed to reflect the role of members CCIG(16) Page 5 Draft 2
of the group. Noted that the Group name in the Terms of Reference needs to be amended to the Critically Ill Implementation Group. It was also noted that membership of the group should be updated to reflect the change of the Networks to form the Wales Critical Care and Trauma Network. Agreed that Abi Harris would be Vice Chair for Group. CL and ZG to make amendments to the Terms of Reference. Delivery Plan CL noted that SOK had pulled together the refreshed Delivery plan for the Critically Ill and that this needs to go to the Cabinet Secretary before Christmas. ACTION: Group members agreed to forward comments to SOK by Friday 9 th December. SOK will revise and return to CL. Agree the delivery priorities for 2017/18 - Agreed that DTOC should remain as a priority. Agreed to include capacity planning in the priorities for 2017/18. 9. Capacity Plan Capacity plan CL introduced this paper. The group members noted that this was a crucial paper and concern was expressed that greater consideration and preparation needs to be given before this can be agreed. Specifically in relation to possible restructuring of other services and the impact that will have on critical care service delivery plans. Some concerns were raised that some organisations (Health Boards) were already doing this process and it was important not to reinvent the wheel or add to the burden so we should find out what they are doing first. Action: ZG to contact UHB Reps to understand current Health Board-level capacity planning and feed this intelligence into this report. 10. Date and time of next meeting 22 nd March 2017 at 14:00 CCIG(16) Page 6 Draft 2