Item 9.5 Grampian Clinical Ethics Committee 10 02 09

NHS GRAMPIAN

Minutes of Meeting of the Grampian Clinical Ethics Committee held on Tuesday 10 February 2009 at 5.00 pm

in the Committee Room, Foresterhill House

Present

Dr Ruth Stephenson, Clinical Lead/Chair

Mrs Annette Cameron, Speech & Language Therapist

Dr Partha Gangopadhyay, Specialist Registrar in Forensic Psychiatry

Dr Gordon Linklater, Consultant in Palliative Care

Dr Stephen Lynch, General Practitioner

Mr Sam McClinton, Consultant Urologist

Mr Nick Renny, Consultant in Maxillo-Facial Surgery

Mrs Joan Stuart, Lay Member

Dr Willem van Ijiperen, Consultant Paediatrician

Attending

Dr Steve Baguley, Consultant Genitourinary Physician (For Item 2 only)

Item No /

Issue

Action

1 / Apologies
Dr Sarah Christie, Senior Lecturer, Medical Law, RGU
Prof Neva Haites, Vice-Principal and Head of College of Life Sciences and Medicine
Mrs Sue Kinsey, Lay Member
Dr Stephenson welcomed Dr Gaugopadhyay, Dr Linklater and Dr van Ijiperen to their first meeting.
2 / System to Improve Partner Notification for STIs in Grampian (outline proposal)
Dr Steve Baguley, Consultant Genitourinary Physician attended for this item.
The committee was informed that at present there was a 40% identification rate of STI cases by partner. QIS recommended that partner identification should be offered to everyone. The current system was to ask GPs to contact the clinic, and the clinic then contacted the person, but Dr Baguley noted this only happened in 1/3 of cases. It was noted that there were systems already operational in England and Glasgow. Grampian was proposing that at the point of testing there would be an information leaflet and patient information form (not yet available).

Discussion points

The committee was concerned at the lack of mention of consent for partner notification (whilst appreciating that there may be an overriding public health justification for this breech in privacy) as the committee was keen that reassurance was given to individuals that their details would be handled with due care. Dr Baguley reassured the committee that there would be a section for notification so that the person could indicate consent for partner notification and on the forms presented at committee there was now a request for explicit consent. It was noted that in England there was assumed consent and that in Glasgow there had been an increase in identification which was done via GP practices
It was highlighted that there was a high incidence of poor literacy skills, and it was suggested that the information leaflet should be in an accessible format so that people with poor literacy skills would be able to understand it. Mrs Cameron offered to assist with this process.
In addition, the committee was informed that a system has existed for a long time to contact people who had a contagious disease. Usually files were kept only in the GU clinic, but information could also be passed onto the GP if the person requested this. People who attended the clinic were usually happy to be approached for consent and there were very few complaints. The process was different for HIV and Hepatitis B. AIDS and Hep B were the only officially notifiable diseases.
Dr Baguley thanked the Committee members for their questions and comments, and it was agreed that he would proceed with the process. / AC
3 / Note of Meeting held on 11 November 2008
The Note of Meeting was approved as a correct record.
4 / Matters Arising
There were no matters arising.
5 / New Department of Health Guidance on the Range of Services that should be available for Adults with Gender Variance, following Diagnosis: A Review of the Position within NHSG
Issues for the committee to consider
Provision of a facial hair removal service for trans women.
The ethics committee noted that the DOH required provision of a facial hair removal service for trans women as recommended by the DOH guidance and that this service ought to be provided by NHS Grampian. Although costings had been identified in the document it was not clear how the service would be delivered. The committee asked whether this was through the new local dermatology service or through private providers. This was of concern to the committee as the committee noted that the service was currently available in Grampian.
Timing of chest reconstruction and breast augmentation surgery. ‘Currently, this is surgery undertaken after the patient has lived as a member of the gender to which they wish transition for 12 months. (Pages 5 and 6). Members of our local trans gender community have suggested that this service should be available at an earlier stage’.
The committee noted the irreversible nature of this surgery and felt that it was important for a period of time to have elapsed so that the patients could be sure that the transition fully represented their settled wishes. The understanding was that the plastic surgery team currently undertook these operations only on the advice of the psychiatric consultant involved and at the time that he advised. The committee felt that this represented good practice.
Other comments/observations
The committee noted that the specialist services marked as available included scrotoplasty, urethroplasty and phalloplasty which the committee understood were only available in specialist centres in Leeds and London and that this ought to be reflected in the documentation.
It was pointed out that there was an error on page 2 (d) that stated that ‘a Speech Therapist who works closely with trans patients also gives advice on body language and deportment’. This should perhaps be amended to ‘a Speech and Language Therapist who works closely with trans patients gives advice on voice production and communication skills’.
The issue of trans women requesting further services e.g. removal of leg hair, was discussed and it was debated as to whether this should be available on the NHS. At present this was not available to all. It was agreed that this would be the thin edge of the wedge and that the consequences were that there may be more requests for treatment from the general population on the NHS.
6 / Highlighting the Clinical Ethics Committee
It was agreed that the most effective approach would be to try to target clinical specialities. Junior doctors could be taught via NES. It was suggested that there might be a possibility for a formal ethics session within the FY1 and GP programmes. Dr Stephenson had already contacted NES about FY1 and was awaiting a response. The committee also planned to highlight the committee through the GP Newsletter. Nursing and Allied Health Professionals on the committee had also been asked about ways of advertising the committee and its services and responses were awaited. Dr Stephenson and Mrs Cameron agreed to explore the possibility of revisiting the Aberdeen Medical Group. /

RS/AC

7 / Clinical case discussion
Recorded under Confidential Minute.
8 / Core competencies
The UK Clinical Ethics Network had put together a set of core competencies which would hopefully be in press in the near future. It looked at the setup of the committee and the competencies required. The Grampian Clinical Ethics Committee needed to demonstrate that the competencies were met. Dr Stephenson would e-mail the competencies to the committee members, together with her thoughts about how the committee might take this document forward. She emphasised the need for the committee to start taking this forward. / RS
9 / Setting up a Scottish CEC network
There were two other CECs in Scotland, one in Highland, and the other in Glasgow. RS suggested that the Grampian CEC could form closer links with these. The other Chairs of these CECs had expressed an interest in helping to set this up. It was suggested that there could be a web page or in the future perhaps a web forum to support this. A Scottish Network could be more a contact forum and could be very useful for members. If any members of the Grampian CEC wished to assist Dr Stephenson in setting this up, then they were asked to contact her direct. /

RS/All

10 / Training day
The topics suggested had been mass disasters and pandemic flu, and Great Ormond Street Service and how it was run. Once set up, the training day would be advertised to other CECs.
11 / General Medical Council Website
RS recommended this to the Committee as an interesting website. It can be accessed via the website, gmc.org.uk, through the section on Good Medical Practice.
12 / Ethics Briefings
The Chair suggested that the committee might find it useful if up-to-date topical ethics papers from journals were circulated with the agenda, not necessarily for discussion unless otherwise directed, but as a resource for those with limited web access. This met with agreement. /

RS

13 / Other Competent Business
RS asked members to consider the role of Deputy Chair for appointment at the next meeting.
It was requested that a list of the Committee membership be circulated to all members. /

All

RG
14 / Date of next meeting
It was agreed that the date of the next meeting be changed to Tuesday 17 March 2009 5.00 – 6.30 pm in the Committee Room, Foresterhill House