Meeting:
NoSPG
Date:
24th September 2014
Item:
44/14
NORTH OF SCOTLAND PLANNING GROUP
th
Minute of virtual meeting held on Wednesday 28 May 2014
at 10.30 am
NORTH OF SCOTLAND
PLANNING GROUP
UNAPPROVED
Present:
Highland:
Ms Elaine Mead, Chief Executive, NHS Highland (Chair)
Mr Jim Cannon, Director of Regional Planning, NoSPG
Ms Deborah Jones, Chief Operating Officer, NHS Highland
Mr Milne Weir, General Manager (North) Scottish Ambulance Service.
In attendance:
Mrs Grace Ball, Programme Manager, Cancer, NoSPG
Mr Keith Farrer, Programme Manager, NoSPG
Ms Lesley Forsyth, Programme Manager, Cancer, NoSPG
Mrs Martha Hay, Executive Assistant, NoSPG
Mrs Anne-Marie Pitt, Child Health Network Manager, NoSPG
Ms Kerry Russell, Programme Manager – Regional Sustainability, NoSPG
Grampian:
Mr Richard Carey, Chief Executive, NHS Grampian
Dr Roelf Dijkhuizen, Medical Director, NHS Grampian
In Attendance:
Mr Mark McEwan, Service Planning Lead, NHS Grampian
Orkney:
Mr Gerry Obrien, Director of Finance, NHS Orkney
Shetland:
Mr Ralph Roberts, Chief Executive, NHS Shetland
Dr Sarah Taylor, Director of Public Health & Planning, NHS Shetland
Tayside:
Ms Lesley McLay, Chief Executive, NHS Tayside
Ms Caroline Selkirk, Deputy Chief Executive, NHS Tayside
In attendance:
Mr James Crichton, Director Mental health Services, General Adult Psychiatry, NHS
Tayside (item 32/14)
NSD:
In attendance:
Mr Christopher Myers, Senior Programme manager, NSD
Videoconference:
Dr Annie Ingram, Director of Workforce, NHS Grampian (Item 28/14)
24/14
Apologies
Actions
Apologies were received from: Mrs Cathie Cowan, Chief Executive, NHS
Orkney/NoSPG Vice Chair; Mrs Deirdre Evans, Director, NSD; Mrs Pip Farman,
Network Co-ordinator, NoSPHN; Mr Gordon Jamieson, Chief Executive, NHS
Western Isles; Prof Gillian Needham, Post Graduate Dean, NHS Education for
Scotland, North Deanery; Mr Graeme Smith, Director of Modernisation, NHS
Grampian; and Mrs Justine Westwood, Head of Planning and Performance, NHS 24.
25/14
Minute of the meeting held on 19th February 2014
The Minute of the meeting held on 19th February 2014 was approved as an
accurate record of the meeting.
North of Scotland Regional Planning Group is a collaboration between NHS Grampian, NHS Highland, NHS Orkney, NHS Shetland,
NHS Tayside and NHS Western Isles
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26/14
Matters Arising / Action Points
The actions listed on the Action sheet were either ongoing, complete or covered
within the Agenda.
i)
Major Trauma Review Implications
Dr Dijkhuizen spoke to the paper submitted and reminded members of the
discussion held at the NoSPG Executive meeting on 19th February 2014. The
National Quality Framework for Major Trauma was agreed by the Board Chief
Executives along with the recommendation to implement a major trauma network
which includes four major trauma centres by 2016. A Major Trauma Oversight
Group had been established to oversee local and regional implementation. NoSPG,
along with the other two regional planning groups are required to develop and
progress clear implementation plans to take forward the national recommendations.
There was also a clear expectation that this work was implemented within existing
financial capacity where possible and that any anticipated financial impact be
clearly identified as part of the development of regional plans.
It was noted that Mr Cannon and Mr Smith represented the north at the National
Oversight Group which had made a number of recommendations. It had also been
agreed that when the Clinical Leader for the north was appointed they would also
become part of this Oversight Group. Dates are currently being canvassed for the
first formal meeting of a regional Major Trauma Steering group and the role, remit
and membership will be agreed at the initial meeting. Also, Mr Jan Jansen had
undertaken an initial scoping exercise of requirements against the Quality
Framework which required to be discussed and further developed at the NoS Major
Trauma Steering Group.
Once appointed, it was anticipated the Clinical Leader would co-ordinate the
assessments undertaken in each of the Boards against the Quality Framework. The
three centres across the north will work together as part of a bigger network and
the scoping exercise will assist with identifying the requirements locally to
contribute to a north network.
Ms Selkirk advised that NHS Tayside were aligned with SEAT but would be happy to
share information and keep in touch with what was going on in the north. It was
noted Mr Mike Johnson was the Clinical Lead for NHS Tayside. She added that
“Triage” was the most important issue and at the next meeting of the National
Major Trauma Group the Scottish Ambulance Service will share and present to the
group the expansive work they have undertaken. Each team will also be asked to
feedback and update on the current position, in terms of the two areas: critical
care; and rehabilitation, including repatriation.
Dr Dijkhuizen advised that the Clinical Leader post, was in the process of being
advertised and interview dates being sought. It was noted there had been interest
shown in this role from an Intensive Care and A&E perspective.
Members noted the current position and the next steps. The regional Major
Trauma Steering group will provide NoSPG with regular updates.
Ms Mead requested that any future papers submitted to NoSPG regarding major
trauma should have the Board representatives identified on the cover paper and
advised that Ms Jones would be the NHS Highland contact. Dr Dijkhuizen to
provide the representatives from each Board who will engage with the regional
Trauma Steering group. Mr Weir requested after the meeting that he was included
as being the SAS representative.
RD/MH
North of Scotland Regional Planning Group is a collaboration between NHS Grampian, NHS Highland, NHS Orkney, NHS Shetland,
NHS Tayside and NHS Western Isles
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ii)
North Region Police Custodian and Forensic Services
Mr McEwan referred to the paper submitted and advised that as from the
beginning of April 2014 the NHS had taken on the responsibility of Police Scotland
health. There were nine different models for the provision of a forensic medical
service which had led to a challenge around consistency. The main challenges
were in relation to: funding; workforce availability, particularly in remote and rural
areas; and the introducing of the new IT system (ADASTRA) which had been met
with resistance although it would provide Boards with national data to help with
performance management.
The Forensic Medical Examiners (FME) in the north were working well together.
The Northern Community Justice Authority (NCJA) was seeking representation
from the north, which Mr McEwan would be happy to be that link if members
agreed.
The funding allocation was determined using a formula based on costs incurred by
Police Scotland in 2012-13 and an adjustment to move NHS Boards over a three
year period to an NRAC share of funding. The NHS has taken on a service of sub
NHS standard and a cost was involved in bringing this up to standard. Additional
costs will also be incurred, as there was a requirement for Boards, if they stock
“controlled drugs” on Police Scotland premises, to hold a “controlled drug” licence,
at a cost of £3k for each licence. There was also a requirement to purchase
secure equipment.
Ms Selkirk said that from an NHS Tayside perspective there will be financial
implications and they had a nurse based model which they believe is the correct
model for Tayside, although not the recommended model. Ms McLay had only
signed the Memorandum of Understanding (MOU) for one year in the meantime
until the financial implications were fully understood.
Mr Roberts asked whether it was too optimistic to believe that if the national Board
recognised the issues with NHS Highland that they will recognise the same across
all regions.
Ms Mead explained the NHS Highland issue was that in taking on custodianship of
FME services more than 12 months ago, NHS Highland took on the whole service
and the cost responsibilities, but it cost less when it was under the auspices of the
Northern Constabulary, pre Police Scotland, and when the NRAC share was
applied, the costs increased. NHS Highland operated a consultant and nurse led
model. The Argyll & Bute element had been resolved in the short term, but if
additional resources could not be secured this would affect the level of service
delivered. NHS Highland and Police Scotland were in discussion around: base line
funding; and whether the service could be reconfigured to the needs of Police
Scotland. It was not possible to remain entirely status quo while trying to redesign
a service. In the longer term, NHS Highland has agreed a position and signed the
MOU for the next 12 months, but will during that period, consider what needed to
be done.
Mr McEwan said the ambition for long term was to make better use of the cross
boundary opportunity of FME capacity, as currently there was no FME on Islands,
so if there was a rape the victim had to travel, instead of the expertise being
deployed to where it was required locally.
Members agreed to Mr McEwan being the north representative on NCJA and Mr
McEwan agreed to raise any issues with this group going forward.
MMc
North of Scotland Regional Planning Group is a collaboration between NHS Grampian, NHS Highland, NHS Orkney, NHS Shetland,
NHS Tayside and NHS Western Isles
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27/14
NOSCAN
i)
Sustaining Oncology Services
Ms Forsyth referred to the Programme Implementation Document submitted and
referred to the workforce challenges with specialist oncology services, which had
impacted on service delivery across each of the three NoS cancer centres. The
NoS Cancer Advisory Forum (RCAF) initiated a strategic review of oncology services
to be led by the NoS Cancer Network (NOSCAN). The review highlighted an urgent
need to map out formal contingency support systems that might mitigate some of
the problems experienced during 2013.
The one year programme aims to facilitate the development of the future service
model which will integrate the three cancer centres into a single NoS Cancer centre
delivered from three sites, with harmonised clinical, operational and governance
structures. The Project plan reflects some of these complexities.
Since their appointment on 28th April 2014 Mrs Ball and Ms Forsyth have met with
managers and clinicians across the north and it was noted a data manager had
been appointed for a fixed term of 18 months, with an estimated commencement
date in August, to support QPI audit and data collection in general.
ALL
After discussion it was agreed that NOSCAN was perceived as being NHS Grampian
centred and that further discussion was required around clinical and management
engagement. It was agreed this would be on the Agenda for the meeting planned
with the Chief Executives on 11th June 2014.
Ms McLay confirmed NHS Tayside’s support around this project and that both she
and Ms Selkirk will look at leadership support around NOSCAN. She was supportive
of enhancing leadership whether this meant augmentation or diversification. Mr
Sami Shimi provided excellent clinical leadership in his speciality in NHS Tayside.
LM/CS
Members noted the progress to date and agreed the programme owner should be
Ms Mead as NOSCAN needed to report as a subset of NoSPG. Mrs Ball and Ms
Forsyth will report on progress to future NoSPG meetings.
ii)
Co-ordinating and contingency planning – Resources
Mrs Ball spoke to the paper submitted and advised that NoSPG and NOSCAN, over
the last 18 months, had co-ordinated patient treatments for neurological cancers
and sarcomas out-with the NoS area. Assessment of the sustainability of these
services indicated a slowly improving picture around workforce availability. In
addition to these areas there was a clear need to put in place escalation and
contingency plans for other cancer groups.
Mrs Ball and Ms Forsyth meet with the three operational managers on a weekly
basis to discuss any pressures which would act as an early sign of any potential
difficulty. They have made themselves available to support immediate contingency
work in the short term. Actions have also been taken to map out all the available
workforce resource in the north to outline workforce availability and gaps, as a
matter of urgency. Mrs Ball and Ms Forsyth are also supporting the generation of a
Scotland wide workforce map and are seeking updates from the Beatson and
Edinburgh cancer centres on a regular basis.
Mr Cannon also advised that a proleptic appointment was being considered as a
regional resource. This additional capacity was a member of staff currently part of
NHS Tayside who was willing to work a proportion of weekends during the
summer. There was a need to minimise risk and Ms Mead said Boards were
North of Scotland Regional Planning Group is a collaboration between NHS Grampian, NHS Highland, NHS Orkney, NHS Shetland,
NHS Tayside and NHS Western Isles
-4-
looking outwith Scotland for some of the solutions, and in particular with the
involvement of Dr Jane Barrett. Mr Farrer said there was also the potential to
explore how to utilise the skill mix. It was also noted that the possibility of an
impending shortfall in capacity was an operational issue and the Mrs Ball and Ms
Forsyth’s roles were to add value and additionality to operational structures.
NoSPG noted the potential workforce challenges impacting on breast and lung
cancer and noted the actions currently being undertaken.
iii)
Scottish Government Senior Medical Officer (SMO) Input
Mr Cannon referred to the attached summary paper which detailed how Dr David
Dunlop, who had recently been appointed as part time SMO at the Scottish
Government, could support the NoS regional work in bringing the three cancer
centres together as one more cohesive operational unit for he benefit of patients in
the north.
The paper was noted.
iv)
Cancer Modernisation
Ms Forsyth spoke to the paper submitted. Proposal 1 outlined the shortfall in
therapy radiographers predicted to exceed capacity by 2017. It was noted a two
year fast track post-graduate course was first established in Edinburgh in 2003 to
address a staffing crisis at that time. It was funded for three years from
government cancer monies supporting 15 students in each intake, following which
funding was withdrawn.
GB/LF
NHS Grampian supported the case for funding for post-graduate radiographer
training to be priority top sliced from the cancer modernisation funding of all NoS
Boards based on the NRAC formula. NHS Highland would also be supportive of this
on the basis of the information provided if there was an assurance that every effort
would be made to ensure recruitment of a proportional number of students from
the north, giving NoSPG some reassurance that funding would support students
being committed to the north after training. After discussion it was agreed the
costs needed to be broken down year on year for each Board. In principle,
members supported the case towards funding therapy Radiographer education but
needed to know and understand the costs by board and what reassurance there
was from SGHD that cancer modernisation funding was being continued after this
current year (2014/15). It was agreed that year 1 funding was less problematic
provided more detail and reassurances around recruitment were forthcoming,
however years 2 and 3 funding could not be committed to unless central
modernisation funding was going to be available.
GB/LF
The second proposal was to support the case for funding to underpin the essential
activities of the “Sustaining Oncology Service in the north” programme.
After discussion it was agreed there needed to be an indication of the costing and
that discussion should be held with managers and lead clinicians, to discuss what
the local and regional aims were. It was noted that this issue had been raised by
operational managers. Ms Mead said it was important to ensure the Medical
Directors, Acute Services and Operational Directors were also involved. It was
agreed that this could be taken back through RCAF as the next NoSPG meeting was
not until September 2014. Mr Cannon would organise an urgent meeting to discuss
local aspirations for the modernisation monies and assess the potential for regional
projects to be prioritised. He suggested the meeting was chaired by a senior
executive from one of the boards and would take discussions around this “off line”.
JC / MH
North of Scotland Regional Planning Group is a collaboration between NHS Grampian, NHS Highland, NHS Orkney, NHS Shetland,
NHS Tayside and NHS Western Isles
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28/14
Reshaping Medical Workforce
Following discussion at NoSPG on 18th September 2013 a number of meetings had
been held to discuss this. The Medical workforce Group had existed in its present
form since 2009, although the group which considered medical workforce issues for
the region had existed in some form for longer. The role of the current group was
to work regionally in support of a National initiative to Reshape the Medical
Workforce, which aimed to move away from a service reliant on trainee doctors,
towards a service delivered predominantly by trained doctors, through a reduction
in the number of doctors in training across Scotland, and rebalancing of the training
numbers between the regions. This group reported through the NoS Medical
Directors Group. In 2012 the National Project Board was asked to review what it
was doing and a number of options were taken forward. The review considered
three options and concluded that a speciality by speciality approach was required.
This approach was signed off by the Cabinet Secretary for Health and Wellbeing.
In early 2014, NES working with Scottish Government, identified that there was a
requirement to disestablish some 10 posts across Scotland, but more importantly,
expand training numbers in other specialities by 58 posts (27 Higher Training and
31 in Core). In 2014 NES and SGHD brought a proposal to the NHS Chief
Executives group, not sighted initially by regional groups.
In the interim there had also been a UK Training review, by the GMC, of the
approach to training of post graduate doctors across the whole of the UK. The
Review reported in late 2013 and the recommendations have been broadly
accepted by both professions and the four UK Health Departments. The outcome
of that was to revert back to a generic model of training, requiring doctors to have
more generic competencies.
When the NoSPG Director of Regional Planning, Mr Cannon, came into post it was
agreed that Dr Ingram would continue as Chair of the regional Medical Workforce
Group but in light of the evolution in medical workforce planning, was this the right
group for what was now needed?
Separately, NHS Grampian and NHS Orkney have been looking at medical
workforce issues and sustainability around some of the services which grew out of
work from SGHD involvement to support NHS Orkney. Creating obligate networks
was a real challenge to NHS Orkney and NHS Grampian in relation to surgery, O&G.
At NoSPG on 18th September 2013, there was a discussion about a continued need
to work across Boards. Reference was made to ongoing discussions between NHS
Grampian and NHS Orkney, which NHS Shetland had participated in. There was
also discussion regarding the recruitment challenges facing all NoS Boards. A
meeting was organised by Mr Cannon in March 2014 between the Chief Executives
of NHS Orkney, NHS Shetland and Dr Ingram, as chair of the NoS Medical
Workforce Group. At that meeting the role of the current group and the continued
need for a regional group was discussed and it was agreed that there may be a
continued requirement for a group, albeit with a different much wider purpose.
There were also wider issues, which were raised in real time within oncology, in
terms of having insufficient specialist resource and that there must be a way
Boards could work collaboratively instead of replicating service areas.
In refreshing the group there would need to be service developers involved and it
would also be important, for consistency to retain the knowledge of those who
have previously been involved. Dr Ingram would intend to step back as Chair of
the group and suggested there was the potential for involvement at Chief Executive
level which would highlight the importance of this group.
Ms Mead took the opportunity to thank Dr Ingram for the excellent work she had
North of Scotland Regional Planning Group is a collaboration between NHS Grampian, NHS Highland, NHS Orkney, NHS Shetland,
NHS Tayside and NHS Western Isles
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done over the years.
Mr Carey agreed with the idea and recommendation that it needed to be
reconstituted but planned correctly. The group needed to be reconfigured with
operational management but also needed medical input, even if it was only for
specific issues. Dr Ingram said it was important to have the right people for the
right discussion and had to be topic specific.
There was one final meeting of the National Project Board and Dr Ingram would
report following that meeting.
After discussion it was agreed the group should: be looking for regional solutions;
needed to be topic specific; consider remote and rural areas; and should include
Service Managers and Medical Directors. Ms Mead said she would like to take Dr
Ingram up on her offer of assistance and Mr Roberts was approached to be the
Chair of the Group. It was agreed membership of this group would be further
discussed with the Chief Executives at their meeting on 11th June 2014.
29/14
AKI
EM/ JC
Programme Manager Regional Sustainability
i)
Project Objectives
Ms Russell, spoke to the paper which detailed the planned objectives of the
Regional Sustainability work stream. There had been progress to date in that the
regional e-health leads group was now re-convened and engaged. In the near
future there will be some additional regional programme management resource
(post in each region funded centrally) and Ms Russell will link closely with them.
Ms Russell also advised she had commenced a data needs assessment framework
to which Ms Mead requested there was a link with the Scottish Ambulance Service
as it had undertaken a similar exercise. Ms Russell will submit an Action Plan to
NoSPG on 24th September 2014.
KR
Members noted the paper submitted.
ii)
NoSPG Annual Event
Ms Russell spoke to the paper which shared the thinking around the planning for
the NoSPG Annual event scheduled for 20th November 2014 at the Aberdeen
Exhibition & Conference Centre. It was agreed the Programme would need to be
varied to attract attendance. Ms Russell was planning to finalise the Programme
within the next 2-3 weeks and members were asked to submit any suggestions to
Ms Russell by Wednesday 11th June 2014. Members were also asked for their
commitment to support attendance.
ALL
Ms Mead said the programme had to be something that was real and worthwhile
for people to attend.
After discussion with regard to the costs to support attendance, it was agreed that
delegates would submit expenses claims via their own Boards but support could be
given to promote attendance from Island Boards as long as the Event costs
remained within budget. It was also agreed that in order to promote good
attendance from Island Boards it was important to ensure the videoconference
aspect of the Event was well planned and appealing. Attendance in person not only
had a cost implication, but the practicality of attendance also had an impact on
sustainability of services. Ms Russell would investigate the use of connectivity, pod
casts etc.
30/14
KR
Review of Paediatric Intensive Care
North of Scotland Regional Planning Group is a collaboration between NHS Grampian, NHS Highland, NHS Orkney, NHS Shetland,
NHS Tayside and NHS Western Isles
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Mrs Pitt spoke to the paper submitted and advised that the National Specialist
Services Committee (NSSC) will consider a review of Paediatric Intensive Care
(PICU) in Scotland at its next meeting on 20th August 2014. Mrs Deirdre Evans,
National Services Division was therefore seeking views from Regional Planning
Groups to be taken into account at that discussion. In the first instance Mrs Evans
presented the paper at the NoS Child Health Clinical Planning Group (CHCPG) on
14th May 2014. The paper outlined that there were potential implications for both
paediatric high dependency care and paediatric intensive care, depending on the
outcome of a UK consultation on a new definition of paediatric critical care.
The feedback from the CHCPG was intended to inform discussions at the National
Patient, Public and Professional Reference Group (NPPPRG) and the NSSC.
Discussion at the CHCPG showed that whilst clinicians expressed support in
principle for the definition outlining a spectrum of critical care, concern was
expressed that the PICU Review suggested a need for growth of services centrally
when care more locally had increased and was preferred. Investment throughout
the NDP had increased the high dependency care capacity in the north which the
data in the PICU review did not reflect as it only went up to 2011. Members were
asked to note the discussion and feedback from the NoS CHCPG members about
the PICU Review and encourage feedback from their individual Boards to the
NoSPG team.
ALL
It was noted the north had a different view to the other regional planning groups,
therefore it needed to be clear that the information submitted would be from a
north position. Mr Carey agreed that this was key and as Chair of NSSC said it
would be good if he was made aware of the north view in advance of the next
meeting and agreed that it did not make sense to spend additional money and he
would be happy to make that point at the meeting. Ms McLay endorsed this view.
Mr Myers said NSD would very much welcome a north view at the NPPPRG and
advised that the proposed definition of critical care is narrow in only including the
national level 3 practice, and excludes the local and regional practice undertaken in
level 1 and 2 critical care. He added that equity of access data as presented in the
report was based on population rather than NRAC.
AMP
Mrs Pitt would prepare a draft paper for Mr Carey as he would represent the north
view at the NSSC meeting.
31/14
NoSPG Draft Annual Report
The draft Annual Report was noted and members were requested to submit their
comments and amendments to Martha Hay by Wednesday 11th June 2014.
32/14
ALL
Adult Male Medium Secure Care (Rohallion)
i)
Risk Assessments
Members were reminded that this item was on the Agenda as a result of the recent
patient escape from Rohallion, and raised an issue of principle around regional
services. The Rohallion issue was being used as an example to start a discussion
around whether there was a mechanism or a need to advise NoSPG members of
these incidents at an early stage. It may be that partner boards would like to be
involved in a governance role for regional services, by having the opportunity to
comment on risk assessments or mitigation plans if they go beyond normal day to
day management or governance. Ms McLay suggested NHS Tayside works with Mr
Cannon to agree a process which could potentially then be used across regional
service areas. Mr Cannon will contact Mr Crichton to discuss.
ii)
JC
National Adult Male Learning Disabilities (NAMLD)
North of Scotland Regional Planning Group is a collaboration between NHS Grampian, NHS Highland, NHS Orkney, NHS Shetland,
NHS Tayside and NHS Western Isles
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Mr Crichton advised that there had been discussions over the last 12 months
around bed capacity in the medium secure estate (nationally) and more recently at
a meeting on 22nd April 2014 at which Mr Geoff Huggins had requested a feasibility
report around the relocation of the NAMLD service into Rohallion, with a view to
relieving particular capacity pressures in the west of Scotland. Mr Crichton advised
that there were two parts to the meeting: SGHD believed it was not an issue; and
NHS Tayside believed there were not enough beds to service the needs of the
north, although SGHD said there were enough beds but they were currently not
being utilised. Waiting Times were also looked at and currently Rohallion had only
one patient on the waiting list. The preferred option from an SGHD perspective
was to support the transfer of the NAMLD to Rohallion, but that would encounter
operational and logistics issues as staff had already been recruited who may not
have the appropriate skills, and staff with the appropriate skills may be difficult to
recruit to, posing a risk to patients.
Ms McLay had established a Steering Group to discuss these issues in more detail
and Ms Wilson was in the process of preparing a paper for submission, which will
be circulated within the next week or so.
LMc/BW
Ms McLay said it was clear there was enough capacity in the system (nationally)
and that we would have demand to fill this capacity, it would not be practical to
move the NAMLD service to the unit, where consultants had already been recruited
without the relevant expertise.
It was agreed further discussion on this matter would take place at the Chief
Executives meeting on 11th June 2014. Ms McLay confirmed that NHS Tayside have
not replied to SGHD advising the north was uncomfortable with the decisions and
would await the discussions on 11th June to prepare a response from all the north
Boards.
LMc
Mr Farrer said that this was likely to be raised at the next National Planning Forum
meeting and it was agreed the stance at that meeting would be that the Chief
Executives were considering the impact in the reduction in capacity of medium
secure beds, and were preparing a response. Ms McLay confirmed there would be
a paper outlining how the Feasibility study would be approached, would be
available for the discussion on 11th June.
33/14
Paediatrics
i)
Paediatric Unscheduled Care
Mrs Pitt spoke to the paper which provided members with a statement of progress
since the meeting held on 19th February 2014 and updated members on the
evaluation and next steps. The paper highlighted the risks associated with a
potential gap between the current pilot project ending on 31st July 2014, and a
decision on the next phase not being taken finally until the next NoSPG meeting on
24th September 2014. The pilot draft evaluation was received in February 2014 and
the final version on 14th April 2014. After discussion of the evaluation at the PUC
Project Board, an agreement was reached that an interim model for a regional PUC
service should be further developed and tested over a period of 24 months and
would have the following core elements: single point of contact for telephony;
access to a consultant with an agreed timeframe; use of video conference to
enhance triage and decision making; overall management of the trialled model to
gather data, to ensure co-ordination and reduce variability; and wider referral base
within the north with potential for a pan Scotland model.
Members were asked to note the project update; agree the principle of a two year
interim model; support the ongoing development and refinement of an interim
North of Scotland Regional Planning Group is a collaboration between NHS Grampian, NHS Highland, NHS Orkney, NHS Shetland,
NHS Tayside and NHS Western Isles
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delivery model by the Project Board to bring back to NoSPG for agreement in
September 2014; discuss the risks described; and agree the proposed process of
risk assessment.
Ms Mead said she was disappointed that there would be a gap in service as it
undermined what Boards were trying to achieve across the north, and that for
future work there needed to be more robust planning to ensure there was a robust
exit strategy.
Dr Dijkhuizen said there were a number of issues for Island Boards as NHS Orkney
and NHS Shetland had not taken part in the pilot, and there had been tension
between a centralised decision support service and local networks that were
already existent in the north. The feedback from local clinicians was that there
were issues with the pilot, and the way in which it was being piloted could
undermine local relationships. NHS24 believed it could deliver decision support
from anywhere, but this was a sterile view and undermined the relationships
clinicians have with each other. There were lessons to be learned from this pilot, in
particular those clinicians and service user’s views should be taken into account.
Mrs Pitt would co-ordinate a risk assessment on the impact on service on the
withdrawal of this service with a clear timeframe of when the service would be
wound down. Dr Dijkhuizen said there was a lot of commitment to evaluate this
properly, and he would be able to provide names of clinicians to help in agreeing
the model before bringing it back.
AMP
Mr Carey said that a lot of the options were predicated by additional capacity and
there was no way we would get additional capacity between now and August.
Ms Mead requested the risk assessment be done quickly and circulated around this
group with suggestions on whether there was anything could be done to sustain
the service until a new model was in place. Mr Cannon confirmed this would be
carried out and advised that Mr Froggatt (SG) was keen to support the model as it
was in line with the direction of travel and a new programme of work around
community health services for children, but for SGHD to match fund he was keen
that it was rolled out to RGH’s and GPs.
The PUC Project Board were undertaking the options appraisal on Monday 2nd June
2014 and in the interim a risk assessment with Medical Directors would be
undertaken to ascertain if Boards were prepared to carry the – potential -clinical
risk of a gap, or not.
ii)
AMP
AMP
A96 Corridor
Mrs Pitt gave an update on the current position. It was noted this work was still in
a development phase and the bulk of the work would not take place till later in the
year, given the lack of definition around scope and agreed methodology to
progress. Mr Carey advised that this project was being taken forward as part of
the NHSG child health strategy. The model which may emerge would not
necessarily need to have 24/7 consultant paediatric cover in Dr Gray’s as there
could be an alternative model during the day, but it needed to be sustainable. Mr
Weir requested that the SAS be involved in these discussions as any impact on
pathways will impact on ambulance cover in the local communities.
AMP
Ms Jones informed that the public would want a more holistic service rather than
an acute model. Mr Carey said that the model needed to be owned and developed
by the GP community in Moray and that it was indeed a broader more holistic
exercise than just about acute care facilities as other parts of pathways in primary
care would potentially hold some of the solutions to sustainability.
North of Scotland Regional Planning Group is a collaboration between NHS Grampian, NHS Highland, NHS Orkney, NHS Shetland,
NHS Tayside and NHS Western Isles
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Meetings to be arranged to discuss how to support this work going forward so that
it was in place immediately after the referendum has taken place.
34/14
AMP
Single Vascular Service
Members noted the paper which outlined the proposed network approach to deliver
the single vascular surgical service across NHS Highland and NHS Grampian. Mr
Farrer requested members to note the impact of the new vascular surgical service
on the other referring Boards in the north, namely Island Boards and he proposed a
series of discussions with NHS Shetland, NHS Western Isles and NHS Orkney to
discuss this further.
35/14
Regional Imaging Proposal
There was nothing else to report on the regional Imaging proposal at the present
time, due to lack of capacity to progress.
36/14
Sustaining Regional Cardiothoracic Surgical Services in the North of
Scotland
The paper submitted was noted.
37/14
NoSPG Workplan – Exception Report
The NoSPG Workplan and Exception report was noted.
38/14
NoSPG Sub Groups
The papers submitted providing an update on the following NoSPG sub groups
were noted.
i)
ii)
iii)
39/14
NoS Public Health Network
NOSCAN
NoS Child Health Clinical Planning Group –12th February 2014
National Update
The National update paper submitted was noted.
40/14
National Planning Forum
v)
Update on 16th April 2014
The draft Minute from the National Planning Forum meeting held on 16th April 2014
was noted.
41/14
Any Other Competent Business
There was no other competent business discussed.
42/14
Date of Next Meeting
The next meeting will be a virtual meeting held on 24th September 2014 at
10.30 am.
Proposed 2014 NoSPG meeting dates
17th December 2014
North of Scotland Regional Planning Group is a collaboration between NHS Grampian, NHS Highland, NHS Orkney, NHS Shetland,
NHS Tayside and NHS Western Isles
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Freedom of information notice: Board members should note that their names will be listed in the
Minute which will be published on the public website.
North of Scotland Regional Planning Group is a collaboration between NHS Grampian, NHS Highland, NHS Orkney, NHS Shetland,
NHS Tayside and NHS Western Isles
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