NHS GRAMPIAN
Minute of Meeting of the Grampian Clinical Ethics Committee
held on Tuesday 1 September 2009 in the
Committee Room, Foresterhill House at 5.00pm
AGENDA
PRESENT:
Dr Ruth Stephenson, Clinical Lead/Chair
Rev Fred Coutts, Hospital Chaplain
Mr Francis Edwards, Consultant Nurse in Children & Young People’s Palliative Care
Dr Partha Gangopadhyay, Forensic Psychiatrist
Dr Stuart Hannabuss, Lay Member
Ms Fenella Lewthwaite, Senior Physiotherapist
Dr Gordon Linklater, Consultant in Palliative Care
Mrs Elizabeth McDade, Non-Executive Board Member
Mr Nick Renny, Consultant in Maxillo-Facial Surgery
Mrs Joan Stuart, Lay Member
ATTENDING
Mrs Rosie Gauld, Administrator to the Committee
No / Item / Action1 / Apologies and Welcome
Apologies for absence were noted from Dr Sarah Christie, Prof Neva Haites, Dr Stephen Lynch, Dr Ed Paterson and Mr Scott Styles.
The Chair welcomed Fenella Lewthwaite and Mr Francis Edwards to their first meeting and introductions were made round the table.
2 / Minute of Meeting held on 26 May 2009
Copies of the Minute had been previously circulated with the agenda. The Minute was approved as a correct record.
3 / Matters Arising
3.1Constitution
Copies of the revised Constitution had been circulated with the agenda. Two main changes were noted:-
(i)There is no maximum number for membership (currently standing at 18)
(ii)A quorum would be six members including the Chair or Deputy Chair
The amendments were approved by those present and the Constitution would now be submitted to Grampian NHS Board for ratification. / RS
3.2Clinical Ethics Teaching Day
A programme and papers had been distributed for the Teaching Day on Friday 4 September 2009. It was noted that the item on the report on embryo selection had been replaced with a session on pandemic flu.
The Chair and Deputy Chair of the Inverness committee and Deputy Chair from Glasgow would be attending.
3.3Core Competencies
A copy of the UK Clinical Ethics Network document on Core Competencies would be sent to the two new members of the Committee. This would enable members’ core competencies to be considered in any forthcoming teaching events. / RG
3.4Highlighting the CEC
The Chair explained that although many Committees undertook analysis in relation to policy, very few clinical cases were submitted for discussion.
The Chair asked for members’ thoughts around highlighting the Committee in order that clinical cases could be brought to the CEC for ethical views. Members were also asked to consider bringing along any anonymised clinical cases they had dealt with. Of particular interest would be mental health issues.
3.5Scottish Ethics Network
The first meeting would be held on Friday 1 September 2009 when it was planned to have discussion around Scottish clinical ethics; good practice; how other CECs deal with looking at policy and how they integrate with their own Health Board. The aim would be to set up a Scottish Ethics website.
3.6Ethics Teaching
The Chair and Gordon Linklater had met with staff from the Professional Development Department to discuss whether ethics teaching could be contained within some of the existing education structures. From the discussion it had been agreed that an initial session would be given to the Charge Nurse level. The Chair would be happy to discuss further with any member who wished to be involved.
The Chair was meeting Mr Roos, Medical Director for Orkney later in September. / RS
4 / Cancer and Surgical Waiting Times
The Chair had written to the Medical Director following the last meeting. A response had been received from the Service Improvement Manager – Acute Services to the effect that issues were being dealt with.
Mr Renny advised that funds were being allocated to deal with the waiting list problems for patients requiring a local anaesthetic. However, the concerns of the Radiologists about prioritising of patients for cancer treatment remained.
The Chair advised that it would be useful if the Radiologists took forward the radiology issues as a group
5 / Health Tourism
Mr Renny explained that he was raising this subject as it was becoming increasingly apparent that more cases who have ben treated abroad were presenting to the NHS for further treatment usually of complications. Health tourism was where individuals from other countries visited the UK to obtain tratment on the NHS, and also when patients from this country go abroad and pay for treatment elsewhere which cannot be obtained in the UK, often cosmetic procedures. The main concern is that some of these patients who have had treatment abroad develop complications and then expect the Health Service to treat them.
Discussion took place on the ethics around whether patients who would not be eligible for treatment under NHS rules in the UK, but who have gone abroad for this treatment and had complications, whether they should be treated by the NHS; how far should NHS treatment proceed – life-saving/emergency only/resolving all or some functional symptoms/resolving cosmetic symptoms; and if treated in the NHS, should the patient pay for treatment.
It was felt that it could be argued that the contract was between the patient and the provider abroad and that the NHS was not directly involved in the causation and could, therefore, argue non-involvement. It was noted that the EU patient would be treated on the NHS with no problem, but complications arose when treatment was given outwith the EU. For treatment which the NHS would normally provide, the NHS would cover these patients privately.
It was also felt that the ethos of the NHS was to perceive and treat the needs of the population, and this did not depend on merit. The whole ethos of the NHS was to address the level of safety and elimination of pain.
Mr Renny was aware of cases already within NHS Grampian and felt that the numbers would definitely increase.
The committee noted that although it would be helpful to have some sort of policy document or guidance on these issues in relation to health tourism, it would be very difficult to write because each case would be distinct and the needs of the patient different.
The committee was unaware of any local guidance, Dr Stephenson intimated that the Scottish government had issued guidance which specifically related to co-treatment. She also concluded by stating that it would be useful to look at this guidance in relation to the issues at hand. / Rolling item
6 / Exceptional Treatment Panels
Dr Stephenson advised that the CEC had a seat on the Panel which looked at requests submitted to the Health Board for exceptional treatment which was not available in Grampian because the NICE guidance did not allow it.
It was noted that meetings are usually arranged at short notice, ie within two weeks. At the moment Dr Stephenson sat on the Panel but requested members of the Committee to consider acting as her deputy. Francis Edwards agreed to deputise on any Paediatric Panels which may be arranged. Other members would give it consideration and contact Dr Stephenson direct. / All
Dr Stephenson intimated that the CEC would be asked for a clinical ethics input to the NHSG Transplantation Committee.
7 / Item for Information
7.1Ethics Briefings
Two papers were noted:-
(i)By E Chrispin, V English, J Sheather and A Sommerville – J. Med. Ethics 2009; 35; 459 – 460
(ii)By V English, R Mussell, J Sheather and A Smmerville – J. Med. Ethics 2006; 32; 247 – 248
7.2Priority Setting in Healthcare
Copies of a paper entitled ‘Priority-setting in healthcare: a framework for reasonable clinical judgements’ had been circulated previously with the agenda. Noted.
8 / Other Competent Business
Nil.
9 / Date of Next Meeting
It was agreed that the next meeting scheduled for 13 October 2009 be cancelled as it fell within the school holidays. The next meeting would take place on Tuesday 10 November 2009 at 5.00 pm in the Committee Room, Foresterhill House.
The Chair asked for the members’ thoughts on having meetings every two months as opposed to monthly. After discussion it was agreed that it was easier to have dates in the diary and cancel any meeting if necessary. There was also provision for holding an extraordinary meeting and also for a small group of members to meet to discuss any issue that may arise. Dr Stephenson was also happy to receive e-mails, although nothing of a clinical nature would be put in an e-mail.
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