Highland NHS Board5 April 2011

Item 4.7CHIEF EXECUTIVE’S AND DIRECTORS’ REPORTEMERGING ISSUES AND UPDATES

1 CLINICAL ADVISORY GROUP

The Board is asked to note the progress in setting up the Clinical Advisory Group andestablishing processes by which out of area referrals and new technologies will be considered.

The membership and terms of reference for the Clinical Advisory Group have beenagreed by the Senior Management Team. Recruitment of the members is in progress.The CAG will report its recommendations to the SMT.

The core Clinical Advisory Group has now met twice and is developing processes forconsidering out of area referrals and new non-drug technologies. These draft proposalswill be discussed by the Area Medical Committee, GP Sub-Committee and Area ClinicalForum and comments incorporated into the final versions.

The full CAG will meet in early May to finalise the guidance, which will then be circulatedto all clinicians and managers.

A detailed work programme for the CAG and Core CAG is being developed as theprocesses are being established.

Supplementary Paper 1 includes the recent report to the Senior Management Team and theprocesses for considering out of area referrals and new non-drug technologies.

2 GAELIC LANGUAGE PLAN – UPDATE

We have been in negotiation with Bòrd na Gàidhlig to agree NHS Highland’s final GaelicLanguage Plan following NHS Highland Board approval of the draft plan in December 2009.

Feedback on the draft plan was received from Bòrd na Gàidhlig in October 2010 and a numberof recommendations were made. Some of these were contrary to what had previously beenagreed by the NHS Highland Board and require further negotiation.

The landscape for these negotiations has changed as NHS Scotland has now been servednotice to prepare a draft Gaelic Language Plan. This plan will provide a framework for resolvingseveral of the issues on which NHS Highland had been seeking national guidance, such asbilingual branding.

NHS Scotland had intended to launch a consultation on their draft plan this Spring, but with theElections will be unable to proceed with the timetable as planned. The revised plan is for NHSScotland to hold a truncated consultation and submit a draft plan to Bòrd na Gàidhlig in October2011.

NHS Highland is involved in the development of the NHS Scotland plan and will seek to ensurethat it and the draft NHS Highland plan are complementary. In the meanwhile, where there is aneed for bilingual provision in Highland this work is not being delayed - for example on signagein selected locations where signs are due for renewal.

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3 GIRFEC GETTING IT RIGHT FOR EVERY CHILD

The Scottish Government published CEL 29 (2010) Implementation of the Early YearsFramework through GIRFEC in the health sector, September 2010. The CEL has supported andprompted a range of activity as follows:

Review of Public Health nursing documentation prompted by feedback practitionersacross the NHS Highland system that this would support and improve GIRFEC processand practice.

The development of best practice guidance to support public health nursing practiceacross Hall4, Early Years Framework and GIRFEC with related developments nationallyand in Highland regarding the allocation of health plan indicators and the use of theChild Health Surveillance Programme

A wider review of wider nursing records to ensure they support GIRFEC process andpractice: specialist and community children’s nurses, primary mental health workers,learning disability records are in scope.

In addition, 'Guidelines for maternity services getting it right for every mother and child' wereratified in January 2011. The guidelines were produced to assist midwives in undertakingassessments of health and wellbeing within the context of GIRFEC, Keeping Childbirth Naturaland Dynamic and other recent policy. They pull together the documentation that has beenproduced to support the role of the named midwife working within an integrated approach withpartners in the local authority and third sector. These have been recognised by ScottishGovernment and are informing wider debates over Getting it Right process and practice acrossScotland.

Highland wide guidance for Joint Committee Children and Young People partners on thedelivery of the Getting it Right practice model was reviewed and re-launched in October 2010.

The proposed development of a lead agency model for children’s services will present furtheropportunities to develop this agenda.

4 HEALTH PROTECTION UPDATE

This update provides a short summary of some of the key issues that have arisen in HealthProtection since the last update was provided for the Board.

4.1 Seasonal FluThis winter’s flu produced a typical pattern of illness with a moderate peak of cases of flu likeillness in mid – late January 2011. The main virus responsible was H1N1 Influenza A (i.e. theswine flu strain) but Influenza B took over as the main strain in February/March. More flu casesthan would be expected in a “normal” year became seriously ill and required intensive caresupport but the overall numbers were small compared with the pandemic year.

4.2 Flu VaccineThis year’s seasonal flu vaccine had 3 components one of which was H1N1 and had a goodmatch with the types of virus circulating so was effective at preventing illness. Uptake inHighland was high with 73% (Scotland 75%) of over 65s, and 56% (Scotland 56%) of those inhigh risk groups being vaccinated. This year for the first time pregnant women were one of therisk groups encouraged to take up seasonal flu vaccine and local uptake in this group was over56%. A total of 1377 (16%) NHS Highland staff took up the vaccine, and while still low this wasthe highest ever outside the pandemic year, and compared with 547 staff in 2008 pre pandemic.

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4.3 Mumps OutbreakA mumps outbreak occurred in the Oban area in December - February and affected a total of140 cases. These were mainly young people in their teens and twenties. It is thought to havespread initially through social mixing over the Christmas and New Year period in local youngpeople some of whom were home from studying or working elsewhere. The main findings fromour investigation were that 44% had received 2 doses of MMR, 28% had received one dose andonly 25% were unimmunised with MMR. This suggests some waning mumps immunity fromMMR vaccine. Our work has now been published in Eurosurveillance.

4.4 Health Protection StocktakeNationally a review of health protection arrangements in Scotland is ongoing. I am on theworking group and we are due to report by November. This will shape HP services for the yearsahead but will undoubtedly be influenced by other boundary/structural changes within NHSScotland which may emerge after the Election.

4.5 Blood Borne Viruses/ Sexual Health FrameworkA new Scottish framework for sexual health plus Hep C, Hep B and HIV is out for consultation.This seeks to merge these work programmes and funding streams, adding value and reducingoverlap/duplication. Funding allocations for 2011/12 are still awaited.

4.6 Private Water SuppliesPrivate Water Supplies are numerous in the Highlands and both Councils and ourselves havereviewed our policy and procedures for handling microbiological or chemical failures in PrivateWater Supplies. New agreed protocols are now in place.

4.7 Western IslesThe Health Protection team continue to provide health protection advice and supervision to NHSWestern Isles during working hours on a daily basis. In addition the Public Health team provideon call out of hours cover 365 days a year. What started as an interim arrangement to coversick leave in the autumn of 2008 has now lasted for 2.5 years.

5 HIGHLAND BREAST FEEDING STRATEGY / INFANT FEEDING ADVISORS

NHS Highland Breastfeeding Strategic Framework was launched in 2010 throughout NHSHighland and both Argyll and Bute and Highland Councils. A Breastfeeding strategic committeehas been successfully set- up chaired by Dr Margaret Somerville, which overseesimplementation of the Framework.

5.1 Breastfeeding rates at 6 – 8 weeks – HEAT 7 targetNHS Highland’s breastfeeding data for 6 – 8 weeks is reported from ISD using the CHSP-PS.The data is always reported in arrears of about 6 months and last data for NHS Highland is30.7% for June 2010. CHP’s vary considerably with Mid CHP showing high rates of 36.2%compared with rates of 24.7% for both North and A and B CHP’s. Data recording and reportingthroughout NHS Highland is being improved through a CHSP-PS Implementation Group, whichshould enable more accurate statistics of 6 – 8 week breastfeeding data.

5.2 UNICEF Baby FriendlyBoth Raigmore and Caithness General Hospital have full baby friendly accreditation. North, Midand SE CHP’s have achieved stage 2, so have the Broadford and Belford Maternity Units. Aand B CHP have stage 2 assessment booked for April 2011. This has been a fantasticachievement for NHS Highland and demonstrates the hard work and commitment of all staffinvolved with supporting pregnant and breastfeeding women.

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5.3 Volunteer Breastfeeding Peer SupportersThrough CEL 36 and NICE 11 guidance, externally accredited peer support training was boughtin from both the National Childbirth Trust and the Breastfeeding Network. This training has beengiven to 87 volunteers within the NHS Highland area. The volunteers have followed the NHSHighland Volunteer Policy and are supported by the Infant Feeding Advisors who have providednumerous pathways to ensure the Breastfeeding Peer Supporters are integrated and involvedwithin the organisation. All women who deliver now within North, Mid and SE CHP’s will beoffered telephone contact with a peer within 48 hours of hospital discharge and systems are inplace to guarantee the same for A and B CHP. Peers also run post-natal support groups andattend parentcraft classes. The success of the Ross-Shire Peers was highlighted when theywon a NHS Highland Staff Award this year.

5.4 Curriculum for Excellence and School Breastfeeding Awareness SessionsDuring breastfeeding awareness week in June, the infant feeding advisors offered breastfeedingawareness sessions to primary 5 and 6 pupils throughout the Highland Council area. Thesessions were based on “mammals” and linked to the Health and Wellbeing outcomes for theCurriculum for Excellence. A design a poster competition was run in conjunction with this andthe winning poster is now NHS Highlands Breastfeeding Poster.

5.5 NHS Highland Breastfeeding Welcome StickerWe have offered all community pharmacists within NHS Highland the opportunity to partake inthe scheme and we have had a great response from them. Work is on-going with both Highlandand Argyll and Bute Councils to improve the up-take within their public places.

5.6 Problem Breastfeeding and Frenulectomy ServiceWeekly a clinic is run for acute breastfeeding problems including a unique frenulectomy service.The clinic is full most weeks and is fully audited with the service proving in-valuable in supportingwomen to breastfeed for as long as they choose.

6 IMPLEMENTING THE EQUALITY ACT 2010 – BRIEF OVERVIEW

The Equality Act 2010 extends, harmonises and replaces the separate pieces of equalitieslegislation currently in force. The Act introduces the concept of ‘protected characteristics’, whichdefines those offered protection against less favourable treatment, harassment or discriminationin service delivery and employment (certain exceptions apply). These characteristics are: Age,Disability, Gender re-assignment, Marriage & Civil Partnership, Pregnancy & Maternity, Race,Religion or Belief, Sex and Sexual Orientation.

A full briefing on the implications of the Act and proposals for an NHS Highland responseto its requirements will be made to the Board in due course. A few key points arehighlighted below:

Public Sector organisations are subject to a ‘General Duty’ to advance equality, toeliminate discrimination, harassment and victimisation and to foster good relationsbetween persons who share a relevant protected characteristic and persons who do notshare it.

The Equal Opportunities Committee considered the proposed public sector specificduties in early March and decided to recommend postponement of their enactmentpending further consideration of responses received during the consultation period. Thisfollows communication from interested parties that reflected a view that the proposedduties did not extend far enough.

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Employers and individual employees will be liable for discrimination, harassment orvictimisation carried out by their employees or against their employees by third parties,unless all reasonable steps to prevent this have been taken. A case can be pursued bya 3rd party who need not have been the subject of the discrimination, harassment orvictimisation.

New provisions of protection for ‘Discrimination by association’ and ‘Discrimination byperception’ come into force. This means if an individual is mistaken for someone whohas a protected characteristic or associates with someone who has a protectedcharacteristic, they are protected from discrimination.

The new positive action provisions can be applied in recruitment scenarios whencandidates are otherwise equally well matched for a post.

Except in certain circumstances, an employer can no longer ask about an applicant’shealth before they have been offered a job.

7 NHS HIGHLAND eHEALTH STRATEGY REFRESH

The current NHS Highland eHealth Strategy was finalised in July 2009 and formally adopted atthe August 2009 meeting of the Highland NHS Board. The Strategy was brought up to date or“refreshed” and presented to the December 2010 meeting of the Highland NHS Board afterbeing considered by the NHS Highland eHealth Strategy Group and subsequently the CorporateTeam.

Detailed discussions took place at the December Board meeting. Various comments were madeon the Strategy document including the requirement to establish explicit links with the StrategicFramework seven characteristics and further consideration of the forward capital fundingenvironment. It was agreed that further discussion would take place at the February BoardMeeting; unfortunately it was not possible to submit a revised document.

In the interim period the Scottish Government have written to and consulted with Scottish NHSBoard eHealth Leads over the development of a National NHS Scotland eHealth Strategy for theperiod 2011–14. The intention is to develop a new Finance Strategy that can support aneHealth Strategy 2011–14 and in line with current financial reality. This process is at present atan early stage but it is already clear that the allocation of National eHealth Strategy funding willbe based on yet to be fully defined outputs rather than the present formula basis which utilisesNRAC. The focus will be on outcomes rather than on the underlying enabling technology.

The central strategic work confirms a clear intention to ensure stability in budgets in the 2011-12transitionary year. The fundamental change in terms of funding is a movement from eHealth asa capital investment programme towards a revenue based improvement programme of the typeaddressed by LDP and HEAT trajectories with inclusion in NHS Boards LDPs commencing in2012-13.

The national Strategic re-direction described above has resulted in eHealth Leads being askedto consider five eHealth Strategic aims which are congruent with the already stated localstrategic direction.

1 To exploit IT to help bring about savings, reductions in wasteful variation and efficientworking practices;

2 to enable patients to react electronically with the NHSS;

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3 to shift the balance of care to improved community and social care support for patientswith long term conditions and mental health problems;

4 to improve clinician availability of patient information, tools to work with that informationand communicate it with other contributors to care; and

5 to improve medication management as an essential part of patient care.

In strategic terms eHealth Leads of NHSS Boards have been requested to think around andpropose the outcomes seen as priorities and meaningful under the headings.

The current refresh of the NHS Highland eHealth Strategy was arguably slightly ahead of its timegiven the revised strategic direction and funding arrangements which are as yet to fully emergefrom the consultative National Strategy work taking place.

It is also important to specifically note that the Initial Agreement (IA) in respect of PatientManagement System (PMS) implementation was agreed at the recent meeting of the NHSHighland eHealth Strategy Group and that preparation of a Full Business Case (FBC) iscommencing.

It is suggested appropriate that the NHS Highland eHealth Strategy be further amended andrefreshed, in effect a “refresh of a refresh” in the context of comments made at the DecemberBoard meeting and when the full detail of the revised National Strategy is known. It is suggestedthat this further refresh be finalised by the end of September 2010 when the full Nationalstrategic direction change will be known and communicated.

In the interim period progress against the specific agreed actions from the refreshed Strategycontinue to be reported and discussed with some rigour at each meeting of the NHS HighlandeHealth Strategy Group.

8 NHS REGIONAL PLANNING – NORTH OF SCOTLAND PLANNING GROUP ANDWEST OF SCOTLAND PLANNING GROUP

A copy of the Briefing from the North of Scotland Planning Group for February 2011 is circulatedas Supplementary Paper 2 to this update. A copy of the Briefing from the West of ScotlandPlanning Group for February 2011 is circulated as Supplementary Paper 3 to this update.

9 PHARMACY PRACTICES COMMITTEE

Application by Community Pharmacies (UK) Limited to provide pharmaceutical servicesat Nairn Town & County Hospital and Primary Care Centre, Cawdor Road, NAIRN, IV125EE

The appeal against the decision of NHS Highland Pharmacy Practice Committee in relation tothe Nairn application was heard on 2 March 2011 by the National Appeal Panel. The NAPupheld the decision of the PPC that the application was not necessary or desirable to secure theadequate provision of Pharmaceutical Services in the neighbourhood. A copy of the full decisionis available from the National Appeal Panel website athttp://www.shsc.scot.nhs.uk/shsc/default.asp?p=131

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10 UPDATE ON VOLUNTARY ORGANISATION MANAGEMENT

10.1 Devolution of Budget ResponsibilityThroughout 2010 further work has been undertaken to complete the devolution of both thebudget and SLA management of previously centrally held voluntary organisation budgets to theCommunity Health Partnerships. As of 1st April 2011, all budgets which are appropriate to bedevolved will be the responsibility of the Community Health Partnership’s and these amount to34 services with annual funding of £472k.

10.2 SLA MonitoringAll voluntary organisations’ activities, funding utilisation and outcomes were monitored againstthose expected in March 2010 and this process will be repeated in the first quarter of 2011-12.To aid this process, an updated and comprehensive monitoring pack is near completion and willbe distributed to all managers responsible for voluntary organisation budgets in early April.

10.3 SLA Funding PoliciesWork has begun to categorise NHS Highland’s 47 core SLA’s into those which can be regardedas grant aided or commissioned. This will allow us to develop appropriate funding andmanagement policies for each sector.

10.4 Joint SLA CompletionThe vast majority of SLA’s are jointly funded with the Highland Council (currently 76% of totalcore funding) and good progress has been made in 2010-11 with the sign off of comprehensiveSLA’s now being 50% complete This has involved considerable joint working with both theHighland Council and the Community Health Partnerships.

10.5 Funding Policies NHS Highland & The Highland CouncilNHS Highland has agreed that all voluntary organisation budgets will be frozen at 2010-11levels in 2011-12 and a full review will determine whether the services currently funded are inline with local needs. The Highland Council’s policy is variable and applies as follows:

Grant funded organisations will receive a minimum 5% reduction in funding for 2011-12following a decision whether or not to provide ongoing support

Commissioned services with voluntary organisations will receive a 5% reduction infunding effective for the 2 year period to March 2013 with some exceptions

10.6 Planning For IntegrationWork is underway with the Highland Council contracts dept., to complete a joint database ofvoluntary organisation funding, and excluding children’s services, the 2010-11 funding identifiedto date across both organisations is just short of £8m. A joint meeting is being planned in Aprilto start discussions about aligning our working processes and exploring how we might reducethe burden on voluntary organisations by having a single process for monitoring performance.This work is independent of Planning for Integration but would be complimentary to it, should itbe decided to proceed in May 2011.

Chief Executive’s OfficeAssynt House

25 March 2011

SUPPLEMENTARY PAPER 1

PAPER FOR SENIOR MANAGEMENT TEAM – 24 FEBRUARY 2011ESTABLISHMENT OF THE CLINICAL ADVISORY GROUP

The Senior Management Team is asked to:

Approve the membership, proposed recruitment methods, remit and reporting structure forthe Clinical Advisory Group and its core group

Approve the proposed principles for managing tertiary referrals that lie outwith existingService Level Agreements

Approve the proposed principles for managing the introduction of new health technologies Discuss the process by which patient pathways are developed and approved for

implementation Approve the proposal for developing an integrated care pathway for respiratory disease Note progress with development and implementation of the integrated care pathway for

dementia (Appendix 4)

1. The Board has approved in principle that a Clinical Advisory Group be set up reporting to theSenior Management Group. This paper sets out progress to date with agreeing the role,remit and membership of the group and the processes by which it will conduct its work.Appendix 1 sets out proposals for membership, relationships and role for the CAG and thefollowing paragraphs set out current thinking on how the CAG and its core group will managetertiary referrals and new non-drug health technologies. Relationships with groupsdeveloping clinical pathways are then considered.

2. Tertiary referrals for treatment or management not available either within Highland healthservices or from existing contracts with external providers

Such referrals should be Made by a consultant, with the agreement of the GP Made only after appropriate investigation and treatment within Highland and agreement

that the proposed treatment is the appropriate course to take for the patient, havingconsidered alternatives

Made to reputable external providers who can demonstrate adherence to nationalguidance and standards

Made for a specified evidence-based reason

Decisions on whether or not to approve requests for such referrals will be made by the coregroup of the Clinical Advisory Group and ratified by the CAG. A process for receiving andconsidering requests is being developed, including an appeals process.

No referrals to external providers should be made without following this process onceapproved and in place.

3. The introduction of newly licensed drugs is managed through the ADTC, but new non-drug health technologies (such as new diagnostic tests or operative procedures) are notcurrently managed in this way. Proposals for introducing such new technologies shouldbe submitted to the CAG for approval via its core group. This group will specify theinformation required from the proposer, in terms of the evidence base, serviceimplications, costs, alternative strategies and health gain before the proposal can beconsidered in detail.

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A process and template is in development for managing the introduction of newtechnologies in this way. New technologies introduced without approval from the CAGand the Senior Management Group will not be supported.

4. A number of clinical pathways have been developed by clinical networks, collaboratives andother groups. They are at various stages of development and implementation acrossHighland. While it is not anticipated that the CAG will take ownership of pathways, thegroup’s expertise may well be needed to explore the evidence base around a particularaspect of a pathway and provide advice to the group developing it or advise SeniorManagement Group on appropriate referral or intervention criteria.

In order to ensure equitable and efficient care across the Highland population, SeniorManagement Group may wish to specify that particular pathways are developed. It is likelythat such pathways would have the following characteristics:a. Cover a major health problem for Highland in terms of burden of illness and cost to

health servicesb. Be framed in terms of a clinical presentation (e.g. breathlessness) rather than a clinical

diagnosis (e.g. heart disease)c. Be integrated across primary, community, secondary and social care, with reference to

tertiary services where appropriated. Give clear indications for referral onto next stage of pathway and criteria for specific

interventions

After development, pathways should then be considered at SMG. It is likely that differentservice configurations will be required in different locations to deliver the specifiedinterventions, so a clear implementation plan will need to be produced alongside thepathway and approved by SMG unless it is thought that implementation only requires localconsideration and action.

If no existing group is developing pathways the SMG wishes to see in place, then SMG willtask a lead clinician and manager to undertake the work, linking to CAG, ADTC, professionaladvisory committees and clinical governance as required.

It is likely that SMG will only want to commission one or two pathways a year in this way. Asuggestion for the first pathway is to take breathlessness and respiratory disease. Appendix2 provides an update on progress with the dementia pathway.

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Appendix 1

CLINICAL ADVISORY GROUP(previously Clinical Board)

Membership

DPHMedical DirectorNursing DirectorAssociate Medical DirectorR&D DirectorChair of Ethics CommitteeDirector of PharmacyCPHM (leads support team)1 GP (nominated by AMD and GP sub-committee)1 Nurse (nominated by ND and NMAHPAC)1 AHP (nominated by associate Director and NMAHPAC)1 consultant (nominated by MD and AMC)Lay representation (could be done with 2 members, recruited via PPF, or via input throughindividual topics - expert patients, etc – or both)

In attendance: relevant support team members, any expert clinicians co-opted for specific topics,patient group reps if requested

Terms of Reference

Meets quarterly Quorum – 2 Board directors, 3 clinical representatives, 3 health professions represented Remit

o To provide expert clinical advice on health technologies, based on evidence ofeffectiveness and cost-effectiveness (where possible) with local service interpretationand resource impact, to the Board’s senior Management Team

o To advise on/ratify decisions of core support team on tertiary referrals outwith currentSLAs

Recommendations on individual topics will be scoped during meetings and approved aftercirculation of final wording

Approved recommendations will be sent to the original requesting group for action andcopied for information to the management group, relevant operational units/servicedepartments, clinical governance and clinicians

A summary report detailing topics referred, topics/questions prioritised for detailed work,resulting recommendations and action by group will be submitted to the SMT on an annualbasis

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MEMBER OF CLINICAL ADVISORY GROUP

JOB DESCRIPTION

To attend a 3 hour meeting quarterly, either in person or by videoconference, and prioritiseattendance, ensuring that a majority of meetings are attended each year (i.e. a minimum of 4/6annually): meeting dates will be set on an annual cycle to enable clinicians to free up their timeTo send an agreed deputy if cannot attendTo read the papers in advance and come prepared for discussion (papers will be circulated atleast a week in advance)To contribute to the discussion by critically appraising the evidence presented and helping todraft recommendations based on the results of the discussionTo be prepared to provide/respond to requests for additional comments/approval of draftrecommendations outwith the meetings by emailTo be aware that this contribution is not reliant on specialist knowledge of one specific clinicalarea – if a question and topic is discussed by the CAG that falls within the area of specialistknowledge of one of the members, then that member may be asked to withdraw from thediscussions or undertake the co-opted (non-voting) role of expert adviser – decision at thediscretion of the CAG chairTo be aware that this role is undertaken on behalf of the Health Board and thatrecommendations, while evidence-based in terms of patient/population focus, must take Boardresource, financial and strategic circumstances into account

Person Specification

Clinical background (medical, nursing, AHP)Length of experience (at least 3 years in career grade post)Demonstrable interest in evidence-based practiceResearch and audit experience (desirable)

Reflective practitionerClear thinker, able to apply evidence to clinical policy decisions and synthesise evidence ofdifferent types from disparate sources to reach workable and affordable solutions

For lay members:As above, but with demonstrable experience of this type of discussion rather than clinicalbackground

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CORE GROUP

Membership: CPHM, admin, PH scientist, (PH trainees), service planning, finance/IRFDPH, MD, ND for tertiary referral decisions required outside main meetings and toapprove triage decisions

Terms of Reference

Meets ?fortnightly or possibly virtually Reviews tertiary referral requests and issues form for completion by referring clinician if not

already available Reviews other requests from “management group” and others to review topics for inclusion

in pathways, guidance, etc and prioritises topics for work on the following criteria:o Topic in line with Board strategic frameworko Major PH problem/likely major health gaino Potential for disinvestment or other resource re-allocation/service redesign

Reviews in conjunction with research governance current research trials and provides anassessment of implications for CAG

Reviews topics for disinvestment

For work agreed for detailed consideration: Identifies relevant expert to advise and help with work on prioritised topics (maybe uses

SpRs from relevant specialty) Clarifies question to be addressed with requester Conducts literature review and identifies relevant papers to support expert, includes cost-

effectiveness evidence where possible Assembles relevant service activity and costs, producing budget and service impact

information Requests lay/patient views from relevant group if appropriate Produces report for main CAG at least 2 weeks prior to meeting date

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Core CB

Clinical governance:QIS, Guidelines

Significant events, SPSPQuality strategy

NHS Highlandmanagement group

ACF and PACsAdvice and scrutiny ofpathways and guidance

BOARD

Informatics groupAudit, monitoring

Implementation of decisionsthrough locality managementstructures

Quality Hub

ADTC

Clinical networks,Collaboratives,

SLWGs, etc

Public and patient participation

Clinical Advisory Group

New technologiesTertiary referrals

ResearchDisinvestment

CoreCAG

Clinical Ethics Committee

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Appendix 2

NHS Highland is required to produce a series of mental health Integrated Care Pathways.Standards to be met have been set nationally, and monitoring agreements are expected to benotified to us. One of the condition-specific pathways is on dementia. The recent NationalDementia Strategy emphasised Government expectations that a dementia pathway will beintroduced in every area of Scotland.

In Highland, a cross-CHP group met for some months, and produced a draft ICP. The CHPGeneral Managers have included completion of the dementia ICP in a draft work Mental HealthWork Plan and, subject to final agreement; the original group can be reconstituted to completethe process.

Once the ICP is complete, each area will need to consider how to meet the required nationalstandards. Further work will also be required on the arrangements to monitor the pathway. Asthere is no community mental health information system in most of Highland, a local monitoringsystem is likely to be required.

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Process for considering Out-of-Area (OOA) referral requests

This process should be followed by clinicians who wish to refer an NHS Highland patient to ahealth care provider out-with NHS Highland for a service (diagnostic or treatment) that is notprovided within NHS Highland.

There may be instances where a clinician wishes to refer a patient out-with NHS Highland for asecond opinion – i.e. the patient has been assessed by an appropriate NHS Highland clinician,but review by another clinician is sought. In this situation, the referring clinician should arrangefor the patient to be reviewed by a second appropriate NHS Highland clinician, rather than makean out-of-area referral.

Clinicians wishing to refer a patient out-with NHS Highland should consult the list ofnon NHS Highland services that are covered by Service Level Agreements whichNHS Highland has entered into, and nationally funded services. (See Note 1)

If the proposed OOA referral is covered by the services included onthis list, the referring clinician can make the referral in the normal way.

If the proposed OOA referral is not covered by the services includedon this list, the referring clinician should contact NHS Highland’s ServicePlanning Team for advice. (See Note 2)

If clinicians are uncertain if the proposed OOA referral is covered bythe services included on this list, they should contact NHS Highland’sService Planning Team for advice. (See Note 2)

Following discussion, Service Planning colleagues may advise that an OOA referralrequest form should be completed and submitted. (See Notes 3 - 5)

Fully completed out-of-area referral request forms should be sent to the ServicePlanning Team. (See Note 6)

Fully completed out-of-area referral request forms will be discussed at ClinicalAdvisory Group (Core Group) meetings and decisions taken.

A letter informing clinicians of the outcome of their request will be sent from theExecutive Director chairing the Core Group meeting at which the decision wastaken. (See Note 7)

This letter will be copied to the Service Planning Team in order that the necessarycontractual arrangements can be made if the referral request is approved.

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Note 1: A list of non NHS Highland services covered by Service Level Agreements andnationally funded services is available on the NHS Highland intranet. (The list isbeing developed, and the URL will be confirmed)

Note 2: Advice on OOA referral requests can be obtained from the following colleagueswithin the NHS Highland Service Planning Team.

Paul Nairn, Service Planning Managero Tel: 01463 706768o e-mail: paul.nairn@nhs.net

Lynne Roe, Service Agreement Managero Tel: 01463 706770o e-mail: lynne.roe@nhs.net

Note 3: OOA referral request forms should be completed collaboratively by colleagues inprimary and secondary care.

For example:

A GP may submit a request on behalf of one of their patients, followingdiscussion with an appropriate NHS Highland secondary care consultant.

An NHS Highland consultant may submit a request on behalf of a patient,following discussion with the patient’s GP.

Note 4: Clinicians advised by the Service Planning Team to complete and submit an OOAreferral request form should not make the OOA referral unless they have beeninformed by the NHS Highland Clinical Advisory Group that the referral requesthas been approved.

Note 5: It is anticipated that clinicians will be informed of the outcome of their OOAreferral request within two months of fully completed OOA referral request formsbeing submitted. It is recognised, however, that a minority of OOA referralrequests will need to be dealt with more urgently.

In such circumstances, requesting clinicians should contact the Service PlanningTeam, using the contact details above, to discuss the referral and the timeframewithin which a decision is required. If appropriate, consideration of some referralrequests will be fast-tracked.

In such circumstances, the Service Planning Team will discuss with therequesting clinician the action that the clinician should take.

Note 6: Only fully completed OOA referral request forms will be accepted. Followingsubmission, forms will be returned to the submitting clinician if they are not fullycompleted.

Note 7: Fully completed OOA referral request forms will be considered at ClinicalAdvisory Group (Core Group) meetings.

The requesting clinician will be informed of the outcome of their request withintwo months of a fully completed OOA referral request form being submitted.

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Process for introducing New Health Technologies within NHS Highland

Note 1: For the purposes of this document, ‘health technology’ encompasses diagnosticand treatment modalities.

Note 2: For the purposes of this document, ‘new health technology’ covers:

The proposed introduction of modalities not currently provided by NHSHighland, and

Modalities currently provided by NHS Highland which clinicians wish to usefor a new indication.

Note 3: It is anticipated that outline service redesign proposals will be developed byappropriate clinical, managerial, planning & finance colleagues within NHSHighland’s operational units.

Note 4: Prior to submission to the NHS Highland SMT, outline service redesign proposalsshould be discussed by the senior management team of the operational unit fromwhich the request originates.

Only those service redesign proposals supported by the unit’s seniormanagement team should be submitted to the NHS Highland SMT forconsideration.

Note 5: Fully developed versions of outline service redesign proposals supported shouldbe submitted to the NHS Highland SMT for consideration.

Only fully developed service redesign proposals supported by the seniormanagement team of the sector from which the request originates should besubmitted to the NHS Highland SMT for consideration.

Colleagues wishing to introduce a new non-pharmacological health technologywithin NHS Highland should submit an outline service redesign proposal to theNHS Highland Senior Management Team (SMT). (See Notes 1 - 4)

The NHS Highland SMT will consider outline service redesign proposals and reacha decision on whether the proposal should be further developed at the current time.

Service redesign proposals which are supported by the NHS Highland SMT shouldbe further developed.

Fully developed service redesign proposals should be submitted to the NHSHighland SMT for consideration (See Note 5)

North of Scotland Planning Group is a collaboration between NHS Grampian, NHS Highland, NHS Orkney, NHS Shetland, NHS Tayside and NHS Western Isles

NHS Board Briefing February 2011

A meeting of the NoSPG Executive was held on 23rd February 2011. The following briefing has been prepared to update the North NHS Boards on the outcome of the meeting.

NoSPG Projects

CAMHS

It was reported given the revised capital situation in Boards, funding for the new unit has been discussed with Scottish Government Health Directorate colleagues, who have advised that funding

had been set aside for revenue to capital transfer by Government, to ensure continued progression of

a number of significant capital developments across Scotland. It was proposed that the NoS CAMHS development should be included within these arrangements, which will be allocated through the

recently advertised East Central hub.

At the request of NHS Highland, it was agreed that the Argyll & Bute CHP would not be part of the

project.

Cardiac Services

A paper outlining the priorities to 2015 was submitted and eight priorities approved for action.

Eating Disorders

A risk share proposal was agreed in principle by partners that will allow Boards to share the costs of a

private sector admission, when no place was available at the Eden Unit.

Emergency Care Network

NHS Grampian and NHS Orkney have initiated discussions regarding the establishment of an

emergency care network, as recommended by the final report of the Remote and Rural Implementation Group. Other partners have been encouraged to become involved.

eHealth Shared Services

A group has been established to consider shared services across the North of Scotland. Priorities identified include service desk, out of hours support and development of a system for use when the

NHS takes over responsibility for healthcare within prisons. The group will also act as the advisory group for eHealth issues that arise from the regional workplan.

Oral Health & Dentistry

Members agreed that dedicated clinical leadership was required in this project and it was agreed that Dr Ray Watkins, Consultant in Dental Public Health, NHS Grampian should be invited to provide

regional leadership on behalf of all NoS partners.

NORTH OF SCOTLAND PLANNING GROUP

North of Scotland Planning Group is a collaboration between NHS Grampian, NHS Highland, NHS Orkney, NHS Shetland, NHS Tayside and NHS Western Isles

Weight Management

A review of weight management services across the North of Scotland has been undertaken. It was

agreed that Boards required appropriate and sustainable weight management services in place at local level and that specific criteria to be met before referral for surgery should be confirmed. An

Implementation Group is to be established to manage the timescales and mechanism for introducing

the new criteria and take forward the recommendations of the report.

hub initiative

The relevant contracts have now been signed and hub North Scotland Ltd has been formed, with Mr Gerry Donald, NHS Grampian as Participant Shareholder Director. The three frontrunner projects

being progressed are: Aberdeen Community Healthcare Village; Tain Health Centre; and Woodside

Medical Practice. A number of other projects are emerging.

National Work Streams

TAGRA

A small group is to be established by Scottish Government Health Directorate to resolve outstanding

issues from the TAGRA Report which considered the impact of NRAC on remote and rural Boards. NoS Boards will be represented on this group.

NoSPG Business Management

NoSPG Reorganisation

Mr Neil Strachan had been appointed to the substantive Regional Programme Manager for Child

Health and CAMHS post, with Mr Ken Mitchell appointed to the Regional Programme Manager for Acute Services and Workforce. This post is fixed term for two years.

The group expressed thanks to those colleagues who would be leaving the team for their hard work

over the years, noting that the regional work would not be as far forward without them. Thanks go

to Mrs Helen Strachan, Mrs Betty Flynn and Ms Fiona MacDonald.

NoSPG/NoSPHN Planning Event

A planning event will be held on the 21st September 2011, to consider the future workplan, including

the horizon scanning work being undertaken by NoSPHN.

NoSPG Membership

Three new Chief Executives have taken up post since the last meeting: Ms Elaine Mead, NHS Highland; Mr Ralph Roberts, NHS Shetland; and Mr Gerry Marr, NHS Tayside. Formal thanks to the

retiring Chief Executives were noted.

Date and time of next meeting

The next meeting will be held on 27th April 2011 in Inverness.

Dr Annie Ingram

Director of Regional Planning & Workforce Development North of Scotland Planning Group

8 March 2011

WEST OF SCOTLANDREGIONAL PLANNING GROUP

Briefing Paper

The following in a resume of the outcomes of the West of Scotland Regional Planning Group Meetingheld on the 11th February 2011

1 Integrated Regional Services- Workshop Session

Updates on the 6 key priority areas were received:

Recruitment: Chair Patricia Leiser

The Recruitment SLWG. had identified initial conclusions was that it would be possible to introduce changesin how Boards operate recruitment in the West to achieve efficiencies in the recruitment process andreduction in duplicated effort which would deliver cost savings in:

Recruitment Services within the WoS Identify common service provision of routine recruitment administration transactions Align opportunities for redesign with implementation of eESS as technical solution to drive efficiencies,

significantly reduce paperwork and repeat data input – one record per candidate

Advertising Further reducing immediate advertising costs and having a long term solution based on

technology

Regional Recruitment Campaigns Using the framework of SMT recruitment process to assess if the concept of regional recruitment

campaigns could be rolled out across other high volume recruitment activity Creation of WoS job portal to market regional WoS recruitment campaign activity

Regional Recruitment Processing Hub

Establish hybrid model of WoS Recruitment Processing Hub where majority of transactional /routinerecruitment processing activities would support recruitment and selection decisions managed locally-this would be critical success factor in managing single recruitment system across WoS.

Audit (internal): Chair Jeff Ace

The RPG noted the option appraisal work of the Audit SLWG and asked them to pursue option iv, i.e.‘Create a single WoS Internal Audit function through either a single external supplier or an enlargedNHS function’ – noting current contract restrictions would see this in place post 2013.

Public Health: Chair Fiona Mackenzie

After reviewing the update report, the RPG agreed that it would be necessary to reframe the remit ofthis review group to ask them to consider what a regionally shared public health service would looklike with a single integrated public health function.

SUPPLEMENTARY PAPER 3

2

Procurement: Chair Allan Gunning

The procurement group had explored four options and recommended a Project Management ApproachBased on SFS Consortium Groups: As option ‘c’ with activity being allocated across Consortium memberBoards rather than full WoS area. The RPG endorsed the report and the proposed way forward.

Payroll – e-Payroll rollout working: Chair Ian Reid

The Payroll SLWG concluded that it would be possible to achieve savings if a regional approach wastaken to the management of payroll. This could involve creating a virtual regional payroll service, inwhich all staff across the region provided a payroll service to all Boards. The RPG endorsed thereport and the proposed way forward.

Remote Working –telehealth links, to support radiology reporting and /or relieve pressured medicalstaffing rotas: Chair Heather Knox

Agreement had been reached by the SLWG to prioritise laboratory and ultrasound for early work but to alsoconsider West of Scotland provision of routine radiology reporting. A specific area identified for early workwithin laboratory services was regional provision of mortuary services. The RPG endorsed the report. It washowever agreed that the group should pause in taking the laboratory medicine work forward until there wasclarity around strategic direction.

2 National Risk Share Schemes

The WoS RPG agreed the collective position of the WoS RPG with respect to three national risk sharearrangements within NHS Scotland and indicating that WoS Boards wish to move to an arrangement basedon 3 year rolling averages and propose to base Board shares on 50% 3 year rolling average and 50% NRACshares during 2011/12 and 100% 3 year rolling averages for 2012/13 onwards.

3 Radiotherapy services NHS Scotland

A paper from Regional Cancer Advisory Group (RCAG) outlined a number of recommendations for thefuture provision of radiotherapy across NHS Scotland and in the West of Scotland in particular. Thepaper also set out a range of actions being pursued to maximise capacity and manage demand whileretaining the quality of care that is provided.

There was discussion around waiting times for radiotherapy and it was noted that there was capacitywithin Tayside but patients from the WoS were not willing to travel

If an extra machine was commissioned in the WoS this would be sited within the regional oncologycentre, utilising Bunker 12

Clarity was sought around funding. It was thought that movement and re-designation of a machineshould not result in the loss of funding. If an extra machine were to be commissioned the capital costswould be provided centrally but the impact on revenue would need to be carefully assessed.

The RPG concluded that there was broad agreement to support the recommendations as outlined in thepaper to improve capacity within the West of Scotland; more clarity would however be required around thefinancial arrangements. This would now go back to RCAG for further work.

4 National Service Division Update

National Spinal Deformity Surgical Service (Scoliosis)• It had been agreed to restrict the admission criteria to this service

3

• A letter to be sent to the SGHD to agree waiting times

Review of the National Musculoskeletal Surgical Sarcoma Service• De-designation of the service had been approved• MDT Coordinator to be funded nationally• Mrs Evans agreed to provide written confirmation of this and to provide clarity around thefinancial arrangements.

Stephen WhistonHead of Planning, Contracting and PerformanceArgyll & Bute CHP7th March 2011