Mrs Marie O Sullivan, Head of Children s Services, Orkney Health & Care, NHS Orkney

Meeting: NoSPG Date: 16 th March 2016 Item: 19/16 NoS Child Health Clinical Planning Group Minute of virtual meeting held on Wednesday 11 th November 2015, 1.30pm to 3.30pm NORTH OF SCOTLAND PLANNING GROUP Approved Present: Dundee: Aberdeen: Orkney: Inverness: Dr Michael Bisset, NoS Child Health Clinical Lead (Chair) Mr Jim Cannon, Director of Regional Planning, NoSPG Ms Morag Dorward, Child Health AHP Lead, NHS Tayside Mrs Carolyn Duncan, Child Health Network Manager, NoSPG Mrs Anne-Marie Pitt, Child Health Network Manager, NoSPG Dr Jonathan McCormick, Clinical Lead Paediatric Respiratory, NoSPG Mr Craig Millar, Neonatal Network Manager, NoSPG Ms Kerry Russell, Associate Director of Regional Planning, NoSPG Ms Lorraine Currie, Strategic Co-ordinator, Child Health, NHS Grampian Dr Ian Laing, Consultant Neonatologist Reproductive Medicine, NHS Grampian Ms Hazel Whyte, Unit Operational Manager, Children s Services, NHS Grampian Mrs Marie O Sullivan, Head of Children s Services, Orkney Health & Care, NHS Orkney Mrs Sally Amor, Child Health Commissioner, NHS Highland Dr Deborah Shanks, Service Lead for Children s Services, NHS Highland In attendance: Ms Sonja J Goodwin, PA/Administrator, NoSPG (minute) Item Action 31/15 Welcome and apologies Dr Bisset welcomed everyone to the meeting and introductions were made from each location. Apologies were received from: Mrs Emelin Collier, Head of Planning & Development, NHS Western Isles; Ms Maria Dickson, Service Manager - Medical Division, NHS Highland; Dr Fiona Drimmie, Clinical Director for Children s Services, NHS Tayside; Ms Kay Fowlie, Child Health Commissioner, NHS Tayside; Dr Christine Hemming, Divisional Clinical Director, NHS Grampian; Ms Morag Hog, Consultant Surgeon, NHS Highland; Dr Martin Kirkpatrick, Clinical Lead Paediatric Neurology, NoSPG; Ms Caroline Mearns, Educational Projects Manager (Child Health), NES; Dr Joy Mires, Lead Child Protection Specialist, NHS Tayside/NoS MCN Lead; Mr Ken Mitchell, Programme Manager Regional Sustainability, NoSPG; Mrs Dawn Sturrock, Service Manager, NHS Tayside; Ms Maureen Swannie, Children s Services Manager, NHS Orkney; Ms Sue Swift, Divisional Lead, NHS Grampian; Dr Sarah Taylor, Director of Public Health & Child Health Commissioner, NHS Shetland; Mrs Cathy Young, Unit Operational Manager, NHS Grampian and Ms Claire Wood, Principal Officer (AHPs), Highland Council. 32/15 Minute of meeting held on 2 nd September 2015 The minute was agreed to be an accurate record of the meeting. 1

33/15 Matters Arising i) Action sheet Actions as noted some items were to be discussed on the agenda. Mr Cannon commented on the Neuromuscular item and advised that discussions were being held to integrate Neuromuscular into integrated services. Mr Cannon briefed the group on the background around the Neuromuscular Physiotherapist post. There were two elements to consider; a part time Physiotherapist post now vacant following Faye Chappell s departure which was funded by the NDP and was recurrent and, the Neuromuscular Care Advisor post occupied by Emma Condon for two years which had received short term funding from Scottish Government. There would be a final consultation before the options paper was complete. Mr Cannon added that there would be a known point of contact rather than a single point of contact for patients provided by services in individual Health Boards. Mr Mitchell would provide updates to NoSPG and the Child Health Clinical Planning Group (CHCPG) at the next meeting. KM ii) Selective Dorsal Rhizotomy Mr Cannon discussed the concerns around a two centre model for Selective Dorsal Rhizotomy (SDR). Mr Cannon had written to the Chief Executives (CE) advising the concerns of clinicians in the north. Mr Cannon was awaiting feedback from the CE s national meeting where it was being discussed but advised that it was added to the National Risk Share to prioritise. An update would be provided at the next meeting. JC 34/15 Neonatal Update i) Neonatal Network Quality Assurance Framework Mr Millar advised that the Neonatal Network Quality Assurance Framework was divided into two sections; individual responses from individual units, and Discussion, Key Themes & Recommendations. Mr Millar commented on some of the key items identified. 1. Downstream communications Downstream refers to how communication should be directed both from level 3 units, to level 2 units and out into the Community and Midwifery Units as well as reversed from Community to Level 1, 2 and 3 units where there is better communication. It appeared that certain key items did not seem to filter down, for example, there was not an established flow of communication around cot capacity and cot location from the level 3 units and at a national level out into the community. 3. Regional/National Clinical Guidelines The North Network in Scotland seemed to be the only neonatal unit in the UK that did not operate standardised clinical guidelines resulting in a conflict of information for geographically isolated community units. 7. A developed pathway of care between obstetrics and neonatal staff Most of the units within each of the constituent Health Boards were aware of the communication between obstetrics and neonatal staff on a Health Board level but there was a lack of awareness around the regional coordination of the obstetrics and neonatal staff. Mr Millar commented that this item was a priority for the network. Mr Millar invited comments from the group. Dr Laing congratulated Mr Millar on the directness of the document in the absence of a clinical lead and commented that he would like to discuss some of the details further with Mr Millar. Dr Laing considered that 2

some of the points could be improved by relatively simple means. In terms of the clinical guidelines Dr Laing understood that they had been good but below par in Aberdeen and advised that Dr Ezzat had permission from Glasgow to begin to use the Glasgow clinical guidelines. There was a national group working to amalgamate and unify clinical guidelines in the next 12 months. Ms Russell explained that the report had been presented to the CHCPG because of the regional action plan that would be provided once the content of the report had been signed off. The first draft of the action plan would be based on feedback received and circulated to the CHCPG. The action plan would then be presented to the NoSPG Executives in December 2015 and then to Scottish Government in January 2016 to review the process. Dr Bisset thanked Mr Millar for his work on the document and encouraged the group to email comments. ALL 35/15 Regional Clinical Strategy Dr Bisset introduced the two Regional Clinical Strategy papers to the group that were presented at the Integrated Planning Group (IPG). Paper 35/15 (i) introduced the background to and the reasons for developing a Regional Clinical Strategy. Dr Bisset advised that it was around issues that had been discussed previously across all specialities about sustainability, specialist services, services with recruitment difficulties, staffing issues and remote and rural healthcare. It was about reviewing areas where there was advantages in working regionally and added value in working collectively. In addition they would look at issues around IT, contracts and collaborative working. Dr Bisset advised that the Regional Stakeholder event held on the 30 th September and the NoSPG Annual Regional event to be held on the 25 th November had informed the followup paper 35/15 (ii) which was the draft Regional Strategy. Further discussion would follow with the CEs, the Public Health Network and other parties to move forward issues regionally. Dr Bisset commented on the National Clinical Strategy being developed by Dr Alex Cameron, Chief Executive, NHS Dumfries and Galloway, that reports on how and which services should be provided nationally, regionally and locally. Ms Dorward advised that for moving forward, the national strategy appeared to be inclusive of all clinical groups, children s services and AHP s and was keen to be further involved. Dr Bisset encouraged a link between the children s services that would feed into the national strategy. Mr Cannon commented on a recent discussion he had with Dr Cameron around timescales and advised that a first draft was being produced that would go to the Cabinet Secretary in December 2015 and be published in 2016. Mrs Amor commented that more discussions were needed around what was commissioned nationally and what could be delivered regionally, and how it would link in with the National Conversation. Dr Bisset advised that there was an extract in the second paper that the CEs had produced, as part of their submission to inform the National Clinical Strategy, that suggests that all specialist paediatric services should be provided nationally and all general paediatric services should be provided regionally. Mr Cannon explained that work produced by Professor Christine Bain, the Medical Director of NSS on World-Class NHS would also inform the clinical strategy. Dr Bisset concluded that the pdf document Mr Cannon referred to would be circulated. WMB 36/15 Paediatric Unscheduled Decision Support (PUDS) Mrs Pitt updated the group on the progress reached following the Paediatric Unscheduled Care (PUC) project. A Paediatric Unscheduled Decision Support Short Life Working Group (PUDS SLWG) had been meeting through 2014 following the PUC pilot to look at lessons learned. A questionnaire had been circulated to all Rural General Hospitals and a number of Community Hospitals to collate feedback on current paediatric unscheduled care 3

decision support systems and suggestions for improvement. Mrs Pitt reported that the PUDS SLWG had decided that individual Health Boards would look for ways to make improvements rather than take it to a regional level. The one exception would be Grampian who would work with Shetland and Orkney on their pathways of care. Mrs Pitt advised that she would draft a summary report and seek agreement from the PUDS SLWG on the content and recommendations. This would be shared with the CHCPG and then sent onto NoSPG. Mrs Pitt also advised that discussion of the PuC model was ongoing nationally as part of the Clinical Decision Support group and that some of the themes emerging nationally with Paediatrics and other services included a hub that could support differing ways of accessing decision support. Mr Cannon also commented on this work informing the group that the national Programme Directors were looking for clinicians who may be interested in further developing the hub approach. AMP 37/15 Feedback from Children & Young People s Health Support Group (CYPHSG) i) Feedback from workshop held on the 2 nd November 2015 Dr Bisset advised that a CYPHSG workshop was held recently around the National Conversation. The public were expected to respond to the Cabinet Secretary regarding the future of the Health Service. Mr Malcolm Wright, Chief Executive, NHS Grampian and Chair of the CYPHSG advised the Cabinet Secretary that the CYPHSG would collectively identify the top 5 priorities. Consequently the workshop was held and attended by Dr Bisset, Mr Cannon, planners, clinicians and civil servants to discuss recurring themes. Dr Bisset advised that he had facilitated a group at the workshop with Mr Jim Carle, Child Health Commissioner, NHS Ayrshire and Arran, facilitating the other and that they would meet with Mr Wright to produce the document regarding the top 5 priorities. Dr Bisset invited comments from the group. Mrs Amor commented that it would be useful to think about the Public Health input, and to study the epidemiology and evidence. Dr Laing commented that the large number of Health Boards in Scotland (14) could be detrimental to delivering equitable care, a view Dr Laing felt needed to be expressed professionally. Dr Bisset commented that the National Clinical Strategy may address that. Ms Russell clarified with Dr Laing if the fragmentation he referred to was a general risk and Dr Laing confirmed that he found there were differences in funding that resulted in difficulties in delivering plans. Mr Cannon commented that it would be worth seeing how the National Clinical Strategy was going to be implemented before making regional decisions. Dr Bisset would circulate a copy of the final submission from the CYPHSG to the National Conversation, when it is available. WMB 38/15 Child Health Exception Report & Work Plan Dr Bisset invited the group to comment on the Child Health Exception Report or any other item from the Child Health Clinical Planning Group Work Plan that required discussion. Mrs Pitt updated the group on the Child Protection patient participation action which was marked as red. There have been several attempts to put into place methods of engaging with children and families thoughts on child protection medical services in the NoS but progress has not been made. However, Phyllis Smart had recently been in contact with, WithScotland, who they hoped would work with Child Protection services to move this forward. It was also hoped that Barnardos and Police Scotland would be part of the Child Protection MCN Steering Group in the future. The background to the General Surgery of Childhood was that there was funding from the NDP process which went towards staff in Highland and Grampian to build an Educational Support Framework in addition to the Clinical Framework. The question was whether to reform the network to bring together general and rural surgeons and link up with and support the tertiary consultants to sustain the service in the North. Mrs Pitt added that there was interest in completing work across the North of Scotland and that time was needed if the network was set up again. Dr Shanks commented that from a governance 4

point of view that a network was needed to look at national standards. In terms of pathways around Paediatric Surgery, Dr Shanks suggested that Mrs Pitt could contact Dr Jonathan Whiteside, Consultant, NHS Highland. AMP 29/15 AOCB Ms Russell commented on the Neonatal items on the exception report and advised that the Neonatal section had been updated and reflected the current agenda. i) Dr Bisset advised that he had stepped down as the Paediatric Gastroenterology Network lead in April 2015 and that Kathleen Ross, Lead Dietician. NHS Grampian would be covering the interim post for 6 months, when the post would be advertised again. ii) Mr Cannon advised that he had met with Mrs Fowlie who had identified an issue with the provision of CAMHS Intensive Psychiatric Care (IPC), for children and adolescents within Tayside Board. The patients in the group would be placed at the Regional Young People s Unit (YPU) or in adult in-patient units. This was a group of patients that fell between the two and the question was whether provision should be delivered on a regional or national basis. There would be a paper presented to the CHCPG requesting a mandate to scope that work. Dr Bisset commented that CAMHS was between children s services and the wider mental health agenda and currently, from a Scottish Government perspective, it was in the mental health arena. This was not the case in all Health Boards in the NoS as CAMHS services were part of the children s services in Highland and Tayside but not in Grampian. There was not an equivalent mental health group to the CHCPG in the NoS. Ms Dorward commented that there was a regional planning group called the Service Modelling Planning Group formed to set up the YPU. The group still met but was now called the Service Modelling and Workforce Planning group (SMWPG) and worked around the functioning of the service. Mrs Amor commented that the Programme Board, the SMPG and CAMHS SMWPG were concerned with the delivery of Tier 4 services and that clarity was needed around their role in regard to IPC. Mr Cannon summarised a number of issues; governance of the Tier 4 network, the inpatient unit and the SMWPG. The question was how to deal with IPC. In-patient care provided by the YPU was less complex because it was hosted in Tayside but the wider governance aspects of the network element was more complex. Funding had just been agreed across the boards for the clinical lead for the network. Dr Anne Gilchrist, Consultant Psychiatrist CAMHS, NHS Grampian, has been supporting the lead role but was not the lead in post. Mrs Fowlie had approached Mr Cannon to advise that she would be writing a paper which she planned to present to the CAMHS SMWPG. The item therefore was at present to give notice to the CHCPG of the issues and the next steps. 30/15 Date of Next Meeting / 2016 meeting dates FINAL 2016 meeting dates confirmed since the meeting as follows: Wednesday 10 th February 2016, 13.30 15.30, OPD meeting room, RACH Wednesday 4 th May 2016, 13.30 15.30, OPD meeting room, RACH Wednesday 24 th August 2016, 13.30 15.30, OPD meeting room, RACH Wednesday 9 th November 2016, 13.30 15.30, Sidlaw room, Kings Cross, Dundee Video conference facilities will be available. 5