NATIONAL MANAGED DIAGNOSTIC NETWORK

NATIONAL MANAGED DIAGNOSTIC NETWORK NATIONAL SERVICES DIVISION Dr Anne Marie Sinclair Consultant Radiologist MDICN Clinical Lead Alexandra Speirs Network Manager

Contents Contents... ii Executive summary... 1 Introduction... 1 Aim/ Purpose/ Mission Statement of network... 1 Plans for the year ahead...3 Detailed description of progress over the reporting period... 5 Network governance 10 Appendix 1: Network Membership.10 Appendix 2: Finance 12 Appendix3: MDCIN Benchmarking data collection exercise and summary 13

EXECUTIVE SUMMARY The Managed Diagnostic Imaging Clinical Network (MDICN) was in a state of abeyance for the period of this annual report due to key staff vacancies and uncertainty regarding its future funding structure. In view of this situation, it was not able to deliver fully on its stated objectives for this time period. The Lead Clinician for the MDICN resigned in January 2014 and has been replaced by a new lead who took up post in April 2014. In view of this hiatus in the operating of this network, the new clinical lead plans to refresh the Steering group for the network and work with this new group to develop a work plan for 2014-2105 to include the following topics. Revitalising the MDCIN including reinstitution and refresh of the website 7 Day Working in Imaging GP direct access to Imaging PET-CT service assessment Education days Introduction Diagnostic services are an essential part of the patient journey. They assist the clinical team in reaching an accurate diagnosis ensuring patients receive appropriately tailored treatment and avoid unnecessary clinical interventions. 1 It is suggested that around 60-70% of diagnoses are based on imaging and laboratory tests, making them influential in medical decision making. 2 Managed Diagnostic Networks can be defined as co-ordinated, Scotland-wide, groups of health professionals that support diagnostic services to continuously improve service delivery in order to ensure equitable provision of high quality clinically effective services. The Managed Diagnostic Imaging Clinical Network (MDICN) was established in 2009 to tackle the issues raised within the report from Audit Scotland (2008) and the report of the Diagnostic Steering Group (2009). It was initiated to work across board boundaries, acting as a conduit between the service and Scottish Government/central projects. 1. Diagnostic Steering Group Report: Report of the Diagnostic Short life working Group July 201 2. NHS Scotland National Framework Advisory Group Diagnostic Services Report, 2005 1

It is one of four National Managed Diagnostic Networks (NMDNs). These constitute 1. Managed Diagnostic Imaging Clinical Network (MDICN) 2. Scottish Clinical Biochemistry Managed Network (SCBMN) 3. Scottish Pathology Network (SPAN) 4. Scottish Microbiology and Virology Network (SMVN) In its first few years, the core objectives of the MDICN has been to To work closely with services in supporting a broad range of continuous improvement work To challenge boards around best practice and service redesign To develop a collaborative Scotland wide approach to service redesign and improvement To deliver a communication pathway into services to better inform national programmes and objectives It did this by a benchmarking process across Scotland looking at CT, ultrasound and MRI services, feeding back to board s anonymised data on their services to compare with other similar services The MDCIN experienced an interruption in being able to deliver on the objectives for 2013. This was due to the loss of their Network administrator and manager in March 2013 and this coincided with the MDCIN, along with the other diagnostic networks, waiting to hear a decision regarding the review of the networks and information regarding continued funding beyond March 2013. National Review A review of all Diagnostic networks in 2013 identified that whilst the National Managed Diagnostic Networks provided considerable value to NHS Scotland, there was a need to streamline arrangements for commissioning and performance management. There was also a need to provide managerial and administrative support for these networks. Following the NPF Review, Scottish Government Health Services Committee (SGHSC) transferred responsibility for the MDCIN and the other NMDNs to National Services Scotland (NSD) and directed NSS to establish a National Network Management Service (NNMS) to support all noncancer national networks. National meeting Following confirmation of continuing central funding and transfer of commissioning and performance management of the MDCIN and the other National Managed Diagnostic Networks 2

(NMDN s), a national one day meeting on the 24 th January 2014 was organised for the NMDNs and their stakeholders. The purpose of the event was to enable and provide the SCBMN and the other NMDN s with the opportunity to engage with their stakeholders in: exploring the implications of these changes identifying stakeholder expectations assessing future needs in terms of workforce resource and organisational structure developing strategic plans that will enable NMDN s to deliver their objectives over the next three years Agreeing quality/performance measures. During the event it was outlined that all nationally commissioned networks are to be subject to robust performance management arrangements to include o A formal service agreement o Biannual written reports o Regular meetings and communication with NSD to set objectives o Monitoring of progress against work plans. o Monitoring against a set of core principles set out in SGHSC guidance. o Provision of reports to NSSC through NSD o Formal review every 3-5 years to inform a decision on continuing central funding. Accountability Structure It was agreed that although NMDNs would be accountable to SGHSC through the National Specialist Services Committee (NSSC), the Diagnostic Steering Group (DSG) would continue to have an ongoing advisory role. Since 1 st April 2014 the MDCIN along with the other Diagnostic and Clinical Networks are hosted under one single National Network Management Service (NNMS) through National Services Scotland. MDICN OBJECTIVES Revitalising the MDCIN 3

Due to the hiatus in the funding and staffing of the MDICN and the new structure under which it now operates, the first objective of will be to re-establish a network and develop a work plan in collaboration with a new steering group Benchmarking Decide the best way to progress benchmarking activity following the recent discussions at a network event. 7 Day Working in Imaging Inequity of access to imaging on a seven day basis is thought to be a key element in different patient outcomes at weekends. The network aims to work with the National 7 Day Taskforce to ensure that plans for instituting 7 day working within Imaging is developed in an equitable and sustainable way across Scotland. GP direct access to Imaging There is inequity of access for GPs across Scotland to imaging services. The network aims to look at this issue with our network members, in particular, looking for consensus on best practice and implementation Education Days Support at least two of these per annum to communicate the work of the members and to provide a forum for sharing of best practice. network to PET-CT Service assessment The MDICN will be responsible for collating and analysing PET-CT data Scotland and making recommendations for the service. from across the. 4

Detailed description of progress over the reporting period Please develop and update the table below to include the network s designation objectives and related agreed annual objectives. When planning for the year ahead, please consider the standard statements in the guidance section to inform the development of annual network objectives. RAG status key RAG status RED (R) AMBER (A) GREEN (G) Description Little/no progress been made to date to achieving network objective/standard Significant progress been made to date to achieving network objective/standard, however further work is required to fully achieve the network objective The network has been successful in achieving the network objective/standard Objective Planned start/ end dates Description of progress towards meeting objective Outcome / evidence RAG status PATIENT CENTRED: Providing care that is responsive to individual personal preferences, needs and values and assuring that patient values guide all clinical decisions Insert network designation objectives in relevant sections 1.SEVEN DAY WORKING To contribute to the Scottish Governments proposal to Seven Day Working and Diagnostics. Ongoing Lead Clinician is reviewing the work of the SCBMN to ascertain what is happening in this diagnostic area, in addition This work is just beginning, as the Task force on Seven Day A 5

Objective Planned start/ end dates Description of progress towards meeting objective to preventing any duplication of un-necessary work. The Lead Clinician along with the clinical leads of the 3 other Diagnostic Networks to meet and discuss the Seven Day Working Outcome / evidence Services, was established in April 2014. Appendix 3 RAG status 2.POSITRON EMISSION TOMOGRAPHY (PET) SCANNERS The Scottish Government has requested National Services Scotland collect and collates all the Scottish PET data activity. March 2014- Ongoing The Scottish Government has started to supply NSS with quarterly PET activity data. NSS has begun to collate the quarterly PET returns. The information that is collated will be analysed by the MDCIN and form a report which will show the number of PET scans used in that year, along with a projection of the future year s use CONTINOUS QUALITY IMPROVEMENT 6

Objective Planned start/ end dates Description of progress towards meeting objective Outcome / evidence RAG status 1.BENCHMARKING The MDICN will start to collecting data with which they can use to benchmark their services. Ongoing A benchmarking model exercise was circulated to the MDICN Steering Group (December 2014). Appendix 3 A The MDCIN steering group agreed that they wanted to continue with in-house data collection. The network has to decide what data they want to collect and what system they want to use to collect the data. EFFECTIVE SYSTEMS AND PROCESSES 1. Revitalising and updating the MDCIN website. It needs updating and transferred to the National Network Management Service. To be started NSD is gathering information from MDCIN to ascertain when the current web hosting domain name and who hosted NSD will provide the MDCIN with a universal template and R 7

Objective Planned start/ end dates Description of progress towards meeting objective the MDCIN website Outcome / evidence work collaboratively with the MDCIN to revitalise and renew the current website to enable the MDCIN to effectively communicate and share ideas amongst one another. RAG status 2. To work collaboratively with the three Managed Diagnostic Networks and NSD to enhance diagnostic delivery. Ongoing A meeting is being organised that will give the Lead Clinicians the opportunity to discuss issues that affect/impact diagnostic service delivery. A meeting is being planned for June 2014 R 8

Objective Planned start/ end dates Description of progress towards meeting objective Outcome / evidence RAG status TIMELY: Reducing waits and sometimes harmful delays for both those who receive care and those who give care 1.GP direct access to Imaging To look at the issue of GP access to diagnostic imaging for patients, with high suspicion of cancer, to ensure equity of access for patients across Scotland 2014 For discussion with the steering group as to best practice across Scotland and barriers to full adoption Not yet commenced A 9

NETWORK GOVERNANCE Network Lead Clinician Dr Anne Marie Sinclair is the Clinical Director of Imaging (NHS Greater Glasgow and Clyde). Dr Sinclair was appointed Lead Clinician of the MDCIN on 1 st April 2014... Alexandra Speirs is the MDCIN Programme Manager (.3 Sessions) who is currently employed on a fixed term contract until June 2015. The Network is supported by Sherral Newsham who is on a permanent contract. The SCBMN Program Manager is line managed by Catriona Johnson, Program Associate Director National Network Management Service. The MDICN has a Clinical Steering group which consists of Clinical Directors and Managers from across Scotland (15 members). The MDICN is accountable to Scottish Government through National Services Division. The Diagnostic Steering Group provides influence and are key stakeholders for the MDCIN. Appendix 1: NETWORK MEMBERSHIP Lead Clinician: Dr Anne Marie Sinclair Network Scientific Manager: Vacant Programme Manager: Alexandra Speirs Programme Support Officer: Sherral Newsham 10

STEERING GROUP REPRESENTATION Current membership is: Clinical Lead Programme Manager Dr Anne Marie Sinclair Alexandra Speirs NHS Ayrshire & Arran John Parker NHS Borders NHS Dumfries & Galloway NHS Fife NHS Forth Valley NHS Grampian NHS Greater Glasgow & Clyde NHS Highland Richard Cannon Janette Burdock Paul Kelly Judy Stein Sandra Robertson Angus Thompson Iain Robertson Jason Walker NHS Lanarkshire NHS Lothian Clinton Heseltine NHS Orkney NHS Shetland NHS Tayside Kenneth Fowler NHS Western Isles 11

APPENDIX 2: FIANANCE For the reporting period 2013-2014, all of the 4 NMDN s costs have been combined. The cost for all of the NMDN s is 179,757; included in these costs are the Lead Clinician, Program Manager, Program Support Officer, meetings, travel and IT/consumables. 12

APPENDIX 3: MDCIN BENCHMARKING SUMMARY. Benchmarking options review summary. Three benchmarking options were put forward to all 26 of NMDCIN steering group members, in advance of the National Managed Diagnostic Stakeholder Event. Nine responses were received NHS BOARD OPTION 1 NHS Ayrshire and Arran Continue with the status quo OPTION 2 Tag on to the English System OPTION 3 Third party benchmarking NHS Dumfries and Galloway NHS Dumfries and Galloway NHS Fife NHS Fife NHS Forth Valley NHS Lothian NHS Tayside NHS Tayside Qualitative summary of the responses Option1: Since, we are all comfortable with the system. There would need to be some investment in streamlining date collection and process to improve the time lag to enable a more online using a data warehouse approach. In summary, Option 1 preferred option but we do need to look in greater detail at the other two options to see how they be used to supplement the current system and to provide the desired outcomes Option 1 the Lothian preference This has been set up in a form that is useful to the Radiology Depts across Scotland. It is acknowledged that we need to promote effective use of the data to improve service efficiency. After discussion with clinical colleagues it appears that Option 1 is preferable but it is recognised that this is resource intensive and if support was available for this function then it is clearly has significant work undertaken to refine data sets etc. 13

Option 2: Established process, Clinical practice isn t different in England so valid re comparisons. Ability to compare to more Trusts/ Boards would mor4 truly reflect relative performance Option 3: Less labour intensive and less risk of report taking so long that the data is out of date. Forth Valley has worked with Civil eyes previously and found data collection would be of value, however unfortunately did not proceed further with any further work. Data collected would be standardised and comparable across NSH Scotland. Good practice/outcomes could be shared. Felt previous data was not comparable across boards as data collected was slightly different in most cases. The use of Civil Eyes would remove these discrepancies and data would be more useful. Though detailed discussion may be required, I would prefer OPTION 3, Combined Responses One and two- both have useful historical data to see trends. Option 3 Looks more useful than option 2; in addition 2 of the largest Boards are already using this data so it would make sense to widen this to all of Scotland. Option one worked well but was incredibly labour intensive, which I think precludes it as a viable long term option Additional Responses There is also the need to focus on National service delivery and how the data is used to inform decision making. I would suggest we look more closely at the third party option to see if they could help with this aspect. I regard s to option 2; the two health systems are now significantly different in delivery and ethos. This would make it difficult to get any meaningful data. However, we do need to look carefully at this option as we may learn something that proves useful. Option 2, not much in common with English model and with current changes will be moving farther apart. Option 3 Costly and slow progress from my experience. If option 1 is not possible then Option 3 is second choice. Would rather stay with option 1 if not everyone signed up to option 3 14

BENCHMARKING OPTIONS FOR THE NATIONAL MANAGED DIAGNOSTIC CLINICAL IMAGING NETWORK (NMDCIN) FOR CONSIDERATION: OPTION 1: CONTINUE WITH THE STATUS QUO In-house benchmarking In-house benchmarking by MDICN which includes two separate collections both administered by the network. Description of the option: Scottish Minimum Imaging Dataset, this involves recording high level modality/ referrer data. Benchmarking data, which is modality based :CT, MRI scanning etc Advantages A large amount of data has already been collected in this way We have a validation system for the data which permits the contributors to retain ownership of their data Previous workgroup structures allowed development and determination of data points by members of the MDICN Disadvantages It has been found to be a laborious and resource intensive procedure. Reports have been delayed due to resource issues We have not managed to convert benchmarking variation to improvement in productivity or outcome. OPTION 2: Tag on to the English System The second option is to tag on to the English method of data collection Diagnostic Imaging Dataset (DID). Description of the option They DID captures information about referral source and patient type, details of the test (type of test and body site), demographic information such as GP registered practice, patient postcode, ethnicity, gender and date of birth, plus items about waiting times for each diagnostic imaging event, from time of test request through to time of reporting. Advantages Disadvantages An established IT system of data collection and analysis. It would allow the network to benchmark against the National English system We would need to determine whether it is feasible to tag on to the English Benchmarking System Probably less control over data parameters that are collected In addition, due to scope and 15

Option3- Third party benchmarking definitional requirements the data is not directly comparable with Diagnostic Test Waiting Time Statistics FOR EXAMPLE: Civil Eyes Research Currently used by NHS Lothian and Greater Glasgow and Clyde health boards Description of option Civil Eyes Research believes that benchmarking can be best conducted with participation so that managers and clinicians can establish why practice is different by understanding the context of peer hospitals and populations. Advantages An organisation that collates data analyses and prepares the data on behalf of the MDICN network. 3 rd party benchmarking model lifts collates, presents and packages data, no-one else is responsible for this CER works within geographical areas where services can be viewed across a patch. Disadvantages Need to be commitment from everyone to sign up to the identified 3 rd party benchmarking option Less control over the way that the data is presented or the data points that are analysed 16