Highland:Ms Elaine Mead, Chief Executive, NHS Highland (Chair)

UNAPPROVED

Present:

Highland:Ms Elaine Mead, Chief Executive, NHS Highland (Chair)

Assynt HouseDr Michael Bisset, Regional Medical Director, NoSPG

Mr Jim Cannon, Director of Regional Planning, NoSPG

Mrs Pip Farman, Network Co-ordinator, NoSPHN

Dr Rod Harvey, Medical Director, NHS Highland

Mr Ronald Macvicar, Post Graduate Dean – North of Scotland region, NES

In attendance:Mrs Martha Hay, Executive Assistant, NoSPG

Raigmore

In attendanceMs Linda Kirkland, Director of Quality Improvement, NHS Highland(Item 55/15 (ii))

Grampian:Dr Nicholas Fluck, Medical Director, NHS Grampian

SummerfieldMr Graeme Smith, Director of Modernisation, NHS Grampian

Mr Malcolm Wright, Chief Executive, NHS Grampian

Neonatal UnitMr Ian Laing, Consultant Neonatologist, NHS Grampian (item 53/15)

Orkney:Mrs Cathie Cowan, Chief Executive, NHS Orkney (Vice-Chair);

Shetland:Mr Ralph Roberts, Chief Executive, NHS Shetland

Dr Sarah Taylor, Director of Public Health, NHS Shetland

Tayside:Dr Alan Cook, Medical Director – Operational Unit, NHS Tayside

NinewellsMs Lesley McLay, Chief Executive, NHS Tayside

Ms Kerry Russell, Associate Director OF Regional Planning, NoSPG

Mr Peter Williamson, Director of Health and Care Strategy

In attendance:Mr Sami Shimi, Consultant Upper GI Surgeon, NHS Tayside / NOSCAN Clinical Lead

The Gyle:Mrs Deirdre Evans, Director, NSS

49/15 / Apologies
Apologies were received from: Mrs Kathleen Carolan, Director of Nursing NHS Shetland; Ms Sharon Duncan, Employee Director Rep, NHS Highland;Ms Anne Gent, HR Director, NHS Highland; Ms Judith Golden, Employee Director, NHS Tayside;Mr Gordon Jamieson, Chief Executive, NHS Western Isles; Mrs Deborah Jones, Chief Operating Officer, NHS Highland; Mr Milne Weir, General Manager (North) Scottish Ambulance Service; MrsJustine Westwood, Head of Planning and Performance, NHS 24; and Ms Lorna Wiggin, Director of Acute Services, NHS Tayside. / Actions
50/15 / Minute of the meeting held on 17th June 2015
The Minute from the meeting held on17th June 2015 was approved as an accurate record of the meeting.
51/15 / Matters Arising / Action Points
The action plan was noted; all items were either complete or on the Agenda for discussion.
52/15 / NoSPG Constitution – Sign off
Mr Cannon explained that the NoSPG Constitution, which should be signed off on an annual basis, had not been updated since 2014 and was last signed off by all north Chief Executives in 2011. The Constitution was a reflection of the role and vision of the North of Scotland Planning Group and the recent amendments were noted on Appendix III.
There was a suggestion that sign off should be delayed until the regional clinical strategy had been developed,which would identify a clearer strategic plan. The terminology could be clearer around the role, responsibilities and membership of the various groups.
Members agreed that subject to the above amendments the Constitution will be submitted to the NoSPG meeting on 16th March 2016 as a final document for sign off. This will be a live document which can be amended in future as appropriate changes are agreed. / KR
53/15 / Neonatal Quality Framework – Sign off
Mr Lang informed the group that Mr Craig Millar, Neonatal Project Manager, NoSPG had prepared this framework prior to leaving NoSPG and he had visited eight centres to obtain information in preparation of this document. Mr Lang informed that there were a lot of things which could be improved, with some quick wins, particularly in terms of communication and benchmarking. Ms Russell had been chairing the Neonatal Steering Group which had good engagement. A few barriers had been overcome in moving this forward and measures are in place to work through solutions. This Framework would be submitted to SGHD in January 2016 after NoSPG sign off, and it had already been signed off at the Neonatal Steering Group, NoSChild Health Clinical Planning Group. The neonatal units in the north were now operating more “regionally” with positive impact on neonatal cot capacity, which was being managed throughout Scotland.
Mr Cook had observed that NHS Tayside only had one representative on the Neonatal Steering Group, however Ms Russell explained that NHS Tayside collaborated with SEAT for neonatal services, but a representation on the Steering Group from NHS Tayside was appreciated. Mr Smith advised that it was good to see progress being made but he would have a discussion with Ms Russell following the meeting on the detail of the wording relating to Dr Grays, before the paper was submitted.
Members agreed this was an excellent piece of work, there was still of lot of work to be done, but there was a clear plan going forward. The paper was endorsed. / GS/KR
54/15l / Regional Finances Quarterly Submission
i) Quarterly Reporting
Mr Cannon spoke to the paper submitted. He advised that the quarterly report was still a work in progress as the NoSPG Management Accountant was currently absent. He advised that the in-yearunderspend on the project summary was noted ascirca £500k, which was more than had been expected, but this was a reflection of the lack of capacity within the team over the past 2 years and was a one off non recurring under spend. Ms Mead explained that the NDP under spend monies discussed at previous meetings had now been agreed as being repatriatedand Boards were now alerted to thisadditional under spend of £500k.Confirmation of this figure would be sought from theManagement Accountant when she returned from leave.
ii)Delegated Authority
Members were asked if Mr Cannon could have delegated authority over the £500k in-year under spend,aligning it to support agreed regional pieces of work going forward. This delegated authority would speed up delivery on regional work, allowing Mr Cannon to manage resources to best effect and reducing the need for lengthy individual negotiations for small amounts of money, when a piece of work had been agreed. Mr Cannon re-iterated the fact that the NoSPG executive would ultimately remain accountable for this money and he would manage it on behalf of the group.
Mr Smith said he would be happy with this, but there needed to be agreement on the prioritisation process for where this would be spent. Ms Mead would also want to see the priority process but was comfortable if this came from IPG. Ms McLay said if this was under different circumstances she would have no difficulty endorsing this, but her recommendation would be for the money to be returned to Boards, because of the financial difficulties and given the efficiency measures in place over the last six months every penny was accounted for.
Mr Roberts said the issue was around timing, and asked if this would be done over an 18 month period or before the end of March? There was also the question on how high level priorities were set for NoSPG and the resource behind it. The money should be spent on things which would make an impact.
Ms Mead requested that a decision on this was deferred until the rest of the agenda was complete,to allow for a discussion around anything which was pressing and relatingto this. / JC
55/15 / Planning Surgical Services at Regional Level
Mr Cannon spoke to the paper submitted, which was seeking agreement on the principle to look at surgical services as a whole rather than individual sub specialties. He opened this up for discussion, but asked members to hold their thoughts until the more specific pieces, such as Upper GI had been discussed. Members were asked to consider whether a process could be agreed which would later be dealt with at IPG. Ms Mead said this was a discussion around the approach rather than the detail and to take these principles forward when discussing the next two papers.
Mr Smith said it was necessary to look at this seriously as the north had a different pattern of services compared to the rest of the country. A broader view should be taken in relation to surgery, but was unsure about necessarily looking at all surgery at the same time as there weregroupings which would be sensible to look at in the first instance i.e. some of the cancer surgeries are linked. The balance between the micro and doing everything would need to be planned as doing everything would not be doable. Mr Cannon, had a previous conversation with Mr Smith and Mr Williamson when they had thought that prioritisation could happen within a whole system approach, and that when operational delivery of services was compromised this would raise these services to the top of the priority list, for example Upper GI, where some mitigation could be put in place and be a top priority, but the operational delivery was the key focus.
Ms McLay said there was sense around what was suggested and this would be a proactive approach instead of reactive, but the only caveat would be that the Upper GI was already about clinical risk and accountability of clinical risk and therefore, a separate discussion may be necessary for this. Ms Mead agreed and said that some of the piece of work around Upper GI had already been done andwe were now trying to retrofit a process around that, it did not invalidate it but it means that things were in different places on that timeline.
Dr Bissetreferred to an outline paper which had been discussed at the NationalSustainability & 7 Day Services Taskforce Group, and asked how we ensure this was synergistic with that work, as something similar was already being planned. Mr Cannon, who is a member of the Taskforce had raised at the last meeting that the north were looking at surgical services and had forwarded this paper to Mr Ian Findlay who Chaired the national work, therefore it was a case of ensuring links were there.There was a danger that a review was undertaken which made recommendations which would compromise the work being done in the north if they were not closely aligned.
After discussion it was agreed this was a good start to a set of principles which broadly members were signed up to, but the difficulty would be in the detail of specific areas. Therefore in general, members were content to mandate IPG to look at whether this could be broadened out and build on principles in the paper and re-submit as a working document to NoSPG in March 2016. Taking individual services in isolation and not thinking through consequences and co-dependencies across the health system could be profound and could have a suite of negative consequences.
i)Urological Surgery Review
Mr Cannon informed members that the implications of robotic surgery for prostate surgery has had a knock on effect across the country which was reflected within the paper and this was where the suggestion of a review of urological surgery had emerged from. The evidence that was collected as part of the National Robotic Implementation Group which had been submitted to the National Planning Forum (NPF). The NPF, based on the evidence collected, said that there was a significant risk in a number of boards that uorological surgery would be unsustainable during the next 2-5 years, therefore a wider urological surgery review was recommended. After discussion at the NPF there was a suggestion that this would be done through a regional approach so it would be done with the same set of principles and standards through the three regions. This paper was submitted to ask members, given the previous paper just presented and discussed, whether this was something Boardswanted to explore as a separate issue or as part of a wider surgical review over a slightly longer period, given that it had acute implications, especially for NHS Highland.SEAT and WoSregional planning groups had accepted there was a need for a review but wanted to see it matched against wider surgical discussions as well, therefore they accepted in principle but wanted to see how it fitted into regional work before going ahead, which will be reported back to the NPF.
Mr Cook advised that NHS Tayside hadexperienced acute problems in urology, in terms of meeting cancer waiting times as it was reliant on one surgeon.These were extended lists and did not have a sustainable capacity to deliver in terms of urology, therefore need to look at a wider regional approach. NHS Tayside were looking to the north in terms of support for urology. Mr Harvey also confirmed NHS Highland had a major sustainability issue in relation to urology and current capacity but also recruitment and retention,also suffing from singlehanded practitioners in sub specialties of urology, particularly in terms of cancer.
It was asked, in terms of priority was this a secondary priority in terms of Upper GI but still near the top, or could it be looked at in 6 months to a year? After discussion it was agreed the key thing which trying to avoid was the knock on consequences to interdependent services.
It was agreed this discussion would be taken off line with the three mainland medical directors. It was agreed this was a high level priority and the future model should be explored.
ii)OMFS update
Ms Kirkland spoke to the paper submitted on behalf of Ms Deb Jones. The paper set out the situation in terms of NHS Highland patients. Some areas of the service worked reasonably well but there wascurrently no OMFS surgeon present on site therefore NHS Highland had to look at a different way of working. The challenges have been around oncology patients with assistance being sought from other Boards, NHS Tayside in particular. A paper was presented to the NoS Oral and MaxillofacialProject Board on 7th December 2015 and after discussion it was agreed to carry out a systematic review of NHS Highland’s service in order to make it more sustainable. One way forward was for a service specification for NHS Highland patients to be drafted and to open discussions with colleagues in NHS Grampian and NHS Tayside in terms of how to take forward that model with colleagues.
It was noted Ms Jones was keen that this had an operational imperative and needed to be dealt with now and also that it was a Board responsibility to deliver these services. The paper was therefore alerting NoSBoards to a requirement for a longer term plan. The next steps would be to draft a service specification and have discussions with other Boards on how to take this forward to make the NHS Highland service sustainable.
Mr Smith was aware of the issues and confirmed his participation in relation to specifications. Mr Cook advised that NHS Tayside have had constructive discussions with NHS Highland and have been able to assist in the short term. NHS Tayside was in discussion with NHS Fife and was looking at collaborative approach with them also, but NHS Fife had an SLA for a head and neck cancer part of the service.
It was agreed Ms Kirkland would have wider discussions prior to preparing a specification to ascertain whether this should be in the context of a north model. / JC
JC
LK
56/15 / Cancer Services in the NoS
i)Upper GI SLWG Final Report
Ms McLay spoke to the paper submitted and advised that there had been dialogue around Upper GI for a number of years. Mr Shimi led a SLWG based on clinical opinion that had been formed over a period of time and met with clinicians during 2014 who indicated a single centre was the way forward for the north. Mr Shimi led a process from April – October 2015 which resulted in a paper being submitted to RCAF in November 2015 with a series of recommendations, two of which were relevant: implementation of an MDT; and move to a single centre for this very small volume number of patients. There had been national views articulated around this, but it was important Boards came to a recommendation through the region, and as Chair of RCAF Ms McLay had been informed that people were happy to have arrived at this stage, but in terms of managing risk, the risk remainedwith individual Boards until it became a regional service.
Mr Shimicontinued and took the opportunity to thank all members of the SLWG for their input. The paper was endorsed at RCAF and members were asked to accept the recommendations contained therein. He explained that the reason for urgency around this was that thiswas the second SLWG which had been formed over the past five years. The clinicians had all agreed that a single centre was the way forward and all clinicians have expressed concern around carrying out surgery in the same way as in 2013. Mr David Dunlop, (SGHD Senior Medical Advisor) was seeking an urgent resolution as there were clinical risks to patients and clinicians.
There was a discussion around the options of a single centre, and MsMclaythen referred to the recommendations within the paper and requested that each one was gone through separately to obtain feedback and actions going forward. However, it was agreed that the crux around all of this were the financial issues and an underpinning part was that if the recommendations were accepted it could result in increased spending. To avoid being caught up in the nuances of different recommendations, members were asked if there was agreement across the north and fundamentally acceptance that the work which had been done showed there was a need to take three centres into one centre,which would allow one centre to be appropriately resourced.