Highland NHS Board NORTH OF SCOTLAND PLANNING GROUP Report ...€¦ · PLANNING GROUP Annual Report...

Highland NHS Board1 June 2010

Item 4.8

NORTH OF SCOTLAND PLANNING GROUP

Report by Dr Annie Ingram, Director of Regional Planning and WorkforceDevelopment, NoSPG

The Board is asked to:

Note the Annual Report for 2009/10. Note the Compendium of Events Report for 2009/10. Approve the Workplan for 2010/11.

1 Background and Summary

The Annual Report of the North of Scotland Planning Group, together with the Compendiumof Events Report summarises regional achievements throughout 2009/10 across the clinicaland specialist planning groups and highlights educational initiatives supported in partnershipwith NES. Progress of inter-regional and national initiatives led by NoSPG or by the Directorof Regional Planning are also reported.

Within 2009/10, a new Chair was identified for both the NoS Chairs and Chief ExecutivesGroup and NoSPG Executive. Mr Ian Kinniburgh, Chair, NHS Shetland took over the Chair ofthe NoS Chairs Group from Mr Coutts and Mr Richard Carey, Chief Executive, NHSGrampian replaced Sandra Laurenson as the Chair of the NoSPG Executive.

Improvements achieved through a regional approach include increase in the infrastructure forcardiac services; investment in specialist children’s services; approval of the Initialagreement to establish a regional network for specialist Child and Adolescent Mental HealthServices, including the provision of more inpatient places for adolescents; and theappointment of a preferred bidder to establish the regional secure care facility, supported byan effective regional forensic network.

The Compendium of Events Report for 2009/10 provides an overview of the variety ofregional specialty or project specific events hosted under the NoSPG banner during thisfinancial year. The NoS Chairs and Chief Executives Group1 and the NoSPG Executive2

agreed that in view of the limited changes to the overall workplan, the significant number ofspecialty and project specific events held during the year, and mindful of the financialclimate, that rather than host an annual event for 2009/10, this report be prepared andpresented to the collaborating NHS Boards in addition to the formal Annual Report.

For 2010/11, the Regional workplan has been revised and some workstreams have beendiscontinued. Additions to the workplan include a new workstream to scope the requirementsfor bariatric surgery, in the context of an obesity management pathway for the North and theestablishment of a NoS Workforce Planning and Development Group. Progress against thedetailed objectives and outcomes will be reported throughout the year to both the NoSPGExecutive and the NoS Chairs group.

1 Membership includes the Chairs and Chief Executives of all six NHS Boards, supported by the Regional Director.2 NoSPG Executive membership includes Board Chief Executives and one other nominated representative from Boards, theRegional Director, representation from NES, NoS Medical and Nurse Directors, National Services Division and SGHD.

2

2 Three papers are attached:

i) Annual Report 2009/10ii) Compendium of Events Report 2009/10iii) Workplan 2010/11

3 Contribution to Board Objectives

The Workplan has been developed to enable NHS Boards to achieve the regional objectiveswithin Better Health Better Care.

4 Governance Implications

Patient and Public InvolvementRegional working should only be adopted where there is an added benefit to patientsby adopting such an approach. Whilst the Annual Report describes the many projectsundertaken by NoSPG during 2009/10, there is a section which identifies whatbenefits patients will see as a result of each project. This includes improved patientpathways, modern and fit for purpose facilities, improved access to specialist servicesand sustainable services.

Wide consultation takes place through NHS Board structures in development ofproject objectives. This includes clinical forums and public consultation whereappropriate.

Financial ImpactNo additional resources are requested through these documents.

5 Impact Assessment

An Equality and Diversity Impact Assessment (EQIA) is undertaken within individual projectswhere appropriate.

Dr Annie IngramDirector of Regional Planning & Workforce DevelopmentNorth of Scotland Planning Group

21 May 2010

NORTH OF SCOTLAND PLANNING GROUP

Annual Report

2009-10

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APPENDIX 1

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

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Contents Page Foreword

3

Introduction

4

Benefits to Patients of a Regional Approach

5

Achievements in 2009-10

• NoSPG Clinical Planning Groups • Regional Networks • NoSPG Specialist Planning Groups • Inter-Regional Clinical Planning Groups

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17

26

32

7

Finance

42

Priorities for 20010-11

50

Contacts

54

Appendices: Appendix 1 NoSPG Groups and projects

55


3

Foreword

In October 2009, I took over the mantle of the Chair of the North of Scotland Chairs and Chief

Executives Group, from Garry Coutts, Chair of NHS Highland. Firstly, I want to pay tribute to Garry’s

leadership over the last two years. He has ensured that collaborating NHS Boards have a clear

structure and process for holding NoSPG to account and has helped ensure that our regional team

can deliver.

It took me some time to be convinced of the regional approach. Looking from Shetland, I was

concerned that it would not add value and might even have a negative impact on our services. My

view has changed. The Chair of the NoSPG Executive, until May 2009, was from Shetland and having

seen the work of NoSPG grow and develop, to the benefit of all Boards across the North, and for

those of us in remote and rural areas, the leadership shown by NoSPG around the implementation of

Delivering for Remote and Rural Healthcare, I now believe that regional working is the right approach

for some services. The regional voice is important and can help ensure that services in the North are

sustainable for the future.

I am impressed by the work taken forward under the NoSPG banner and I look forward to working

with Richard and the team over the next two years.

Ian Kinniburgh

Chair NoS Chairs & Chief Executives Group


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Introduction In my first year as the Chair of NoSPG, this report has demonstrated that 2009/10 has continued to

deliver improvements for patients. It is often difficult to quantify what the benefit of regional working

can be, or where it adds value and often, it is not until the end of the year, when the progress of

each of the many workstreams are summarised in one place, can we see the difference that working

regionally can make to the services we deliver across the North to patients.

During 2009/10, the challenges for public finances have been well publicised and the projected

position for years to come will present NHS Boards with greater pressure to deliver effective care that

is efficient not only in the means of delivery but also to the public purse. Working collaboratively will

increasingly offer NHS Boards one way to optimising resources, whether through partnerships with

other Boards, as fostered by NoSPG or through other partnerships with local authorities and the third

sector. Mindful of demonstrating financial prudence, NoSPG agreed not to hold a large Annual

Planning Event but to produce a Compendium of Events, which is published as a companion to this

Annual Report. These specialty specific events are an essential part of the planning that must

underpin the NoSPG workplan and I hope that you will be as impressed as I and my fellow NoSPG

members by the work taken forward on our behalf.

It would be remiss of me in my first introduction not to pay tribute to the work taken forward by my

predecessor, Sandra Laurenson and to thank her on behalf of the NoSPG Executive for the

enthusiasm and drive with which she led NoSPG. I also want to take this opportunity to pay tribute to

David Sullivan, Director of Planning for NHS Grampian who has been an outstanding contributor to

the regional scene over the last seven years. David is retiring from the NHS and will be sorely missed

around the regional table.

As I look forward, I think that some of the challenges that Boards face, we can face together,

working regionally for the benefit of the North. The journey will not be easy, but for some services, it

may be the only way to go.

Mr Richard Carey

Chair North of Scotland Planning Group


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Benefits to Patients of a Regional Approach NoSPG have always been clear that regional working must demonstrate an added benefit to patients.

Whilst our report describes the many projects undertaken by NoSPG during 2009/10, this section

identifies what benefits patients will see as a result of these projects.

These are also reproduced in the relevant section of the Report.

• The recently expanded infrastructure for delivery of cardiac services across the North provides

a regional approach to cardiac services that will ensure consistency of care and enhanced

access to specialist services, closer to patient’s homes.

• Investment in specialist children’s services will sustain services in the North and improve

access, through increased service provision, more staff, better links between services and

education.

• A regional Network for Child and Adolescent Mental Health will provide specialist care as close

to home as possible and provide access to specialist services for those living in the most remote

communities. The regional inpatient unit will be provided within the context of the network and

will ensure that pathways of care are optimised, including transitional support between different

tiers of service.

• The regional element of the Secure Care development will allow patients, defined as requiring

medium secure care, to be cared for within the North, within an appropriate level of security

and ensure that North medium secure and NHS Tayside low secure patients are cared for in

modern, fit for purpose accommodation.

• Obesity is a significant and recognised challenge to good health and obese people are at

greater risk of disease and ill health than those who are not. Access to bariatric surgery, as part

of an overall Weight Management Strategy, is appropriate for some patients. This initiative

would provide access for people of the North, within the North.

• The NoS Eating Disorders Network has already improved pathways of care across the North.

The commissioning of the Eden Unit, the first NHS inpatient facility in Scotland for adults with

an eating disorder will ensure that patients can access care within the North, through improved

pathways of care, with better transition between local services and the regional unit.

• The Oral Health and Dentistry Project aims to improve access to specialist oral and dental care

and to develop a network approach that will provide care locally by suitably trained

practitioners.

• A regional approach to cancer services allows better integration of care, between local areas

and more specialist services, where Boards will work together. A networked approach to care

means that patients across the North have access to the same standard of care no matter

where they live.


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• Safe and sustainable services are available for both emergency and elective care in remote and

rural communities and there are agreed pathways to care in larger centres.

• National planning and regional delivery of the Scottish Neonatal Transport Service ensures that

trained and experienced dedicated teams are available 24/7 to transfer sick babies to the

specialist services that they need, no matter where this is in Scotland.

• The NoS Public Health Network ensures that regional initiatives are informed by the best

available evidence and identified population need, ensuring that decisions made are the best

possible, within the resources available for the people of the North of Scotland.

• The improvement in workload and workforce planning for the nursing and midwifery workforce

will ensure that the workforce capacity and capability is maximised in response to changing

patient need.


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Achievements in 2009-10 Chair of NoS Chairs and Chief Executives Group

Garry Coutts, Chair of NHS Highland has led the NoS Chairs and Chief Executives Group since October

2007. The term of office for the Chair role for both this group and the NoSPG Executive is a minimum

of two years and, in the summer of 2009, Mr Coutts intimated his intention to stand down as Chair.

Mr Ian Kinniburgh, Chair of NHS Shetland was nominated by his peers to assume the role of Chair,

which he did in October 2009.

Chair of NoSPG Executive As noted in the last Annual Report, Mr Richard Carey, Chief Executive, NHS Grampian assumed the

Chair of the NoSPG Executive, in May 2009. Mr Carey is also the current Chair of NOSCAN and has

provided Executive leadership to the NoS Oral Health and Dentistry workstream for the last two

years.

NoSPG Events during 2009

In previous years, NoSPG has reported on the outcome of the annual event, which usually takes place

in the autumn each year. Regional Planning Groups are required to:

‘…to host an annual event to agree the regional agenda for the year ahead and longer term

priorities for action’. 1

Since 2004, NoSPG have hosted a number of successful Annual Events: in March 2004, May 2005,

November 2006, October 2007 and October 20082, which have informed the current workplan. The

workplan, which has 17 high-level objectives and a range of sub-projects and workstreams, has

remained more or less the same, although the initiatives taken forward within each objective have

evolved and changed over time. Latterly, NoSPG events have concentrated on limited aspects of the

regional agenda or cross-cutting issues that impact on all regional projects. All of the sub-projects

have also hosted specialty or project specific events in addition to the planned annual event.

Engagement across the wider stakeholder groups within NHS Boards, particularly non-Executive

engagement is an important aspect of the annual event and this has allowed NoSPG to develop more

robust governance structures, through which the collaborating NHS Boards can be assured that the

work taken forward on a regional basis is appropriate to the agenda of individual Boards and linked to

Boards processes and procedures. The NoSPG Annual Report is presented annually to Boards and

Scottish Government and the workplan is subject to the approval of all Boards each year.

1 HDL (2004) 46 “Regional Planning” 13th December 2004, Annex 1, para 2.2, Scottish Executive, Edinburgh. 2 All event reports can be found on the NoSPG website at www.nospg.nhsscotland.com


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Given the limited changes to the overall workplan, the significant number of specialty and project

specific events held during the year, and mindful of the financial climate, it was proposed to both the

NoSPG Executive3 and the NoS Chairs and Chief Executives Group4 that rather than host an annual

event for 2009/10, that a compendium of these specialty or project specific events be prepared and

presented to the collaborating NHS Boards. This was agreed and a report was produced that

describes the wide range of events that have been hosted under the NoSPG banner during this

financial year. A copy of the report was submitted to Boards with this Annual Report and is also

available on the NoSPG website.

NoSPG Workplan 2009-10 The NoSPG workplan for 2009-10 remained challenging. The workplan still has 17 high-level regional

objectives including: Cardiac Services, Child Health, Child & Adolescent Mental Health, Diagnostics,

Eating Disorders, Neurology, Oral Health and Dentistry, Public Health, Secure Care, eHealth,

Workforce, and links with the North Community Justice Authority (CJA). Some initiatives are better

taken forward in collaboration with either one or both of the other regions. The Inter-regional

objectives, led by NoSPG, included performance management of the Scottish Neonatal Transport

Service (SNNTS), providing Project Director support to the National Remote and Rural workstream

and leading a pan-Scotland initiative to establish a managed service network for cancer services for

children and young people.

Progress for many of the projects has been good and is described in the Clinical and Specialist

Planning Groups section below. Additional workstreams include the regional Nursing and AHP

workload measurement and management projects, identifying the regional response to the challenges

of reshaping the medical workforce, scoping eHealth requirements for the North and the work of the

Integrated Planning Group. Late in the year, the North Boards also agreed to pilot a national video-

conferencing project.

NoSPG Website During 2009/10, NoSPG successfully migrated to a public facing website that can be accessed at

www.nospg.nhsscotland.com. All of the reports produced under the NoSPG banner are available on

the website and the minutes of NoS Chairs and Chief Executive meetings, the NoSPG Executive and

all of the subgroup meetings are published on the website. The website is also used to circulate

papers for meetings through a password controlled area for use by members.

3 NoSPG Executive membership includes Board Chief Executives and one other nominated representative from Boards, the Regional Director, representation from NES, NoS Medical and Nurse Directors, National Services Division and SGHD. 4 Membership includes the Chairs and Chief Executives of all six NHS Boards, supported by the Regional Director.


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NoSPG Clinical Planning Groups

There are 8 Regional Clinical Planning groups which have been established to progress specialty

specific planning. Each group has an agreed workplan and progress against this is summarised below.

NoS Cardiac Services Sub-group

The NoS Cardiac Services Sub-group is one of the longest standing regional collaborations. The group

is led by Dr Malcolm Metcalfe, NoS Clinical Lead for Cardiac Services and supported by Fiona

MacDonald, NoS Cardiac Service Improvement Manager. Five NHS Boards currently collaborate across

the North, including Grampian, Highland, Orkney, Shetland and Tayside.

Benefits to Patients

The recently expanded infrastructure for delivery of cardiac services across the North provides a

regional approach to cardiac services that will ensure consistency of care, and enhanced access to

specialist services, closer to patient’s homes.

The NoS Cardiac Sub-group identified a number of priorities for 2009/10, with particular emphasis

placed on further development of the Regional Delivery Plan through an agreed work programme.

Achievements against this work programme include:

• A Cardiac Services Planning event, in June 2009, which considered proposals for Optimal

Reperfusion Therapy Services for the North of Scotland; Healthcare Practitioner-led service

developments; achieving the 18 week Referral to Treatment Pathway, by 2011; and horizon

scanning for new and emerging technologies.

• A further event was held in February 2010 aimed at reviewing the service and financial plans for

the regional cardiac service delivery across the North for the next 3-5 years.

• Work towards an alignment of NoS patient pathways, including the inter-board pathways by

2010, in order to meet the referral to treatment targets for 2011.

• Development of the business case proposal for an Optimal Reperfusion Therapies (ORT) service,

which will ensure equity across Scotland, is at an advanced stage and will be submitted to NoSPG

for approval early in the New Year. The NoS Plan will be a mixed model, providing Primary

Percutaneous Coronary Intervention (PPCI) and Pre-hospital Thrombolysis (PHT).

• To support the NoS plan, the interventional centres in the North will be required to provide 24/7

access to a Primary PCI service (PPCI) and this is currently not available, although plans are in

development and will be presented to NoSPG in 2010.


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• Engagement with the Scottish Ambulance Service, through a workshop approach, has fostered a

collaborative approach to planning and access to services. This approach provided data analysis

of current patient flows to support the modelling for the ORT plan.

• Improved infrastructure is now in place, providing expanded capacity for North of Scotland

residents who may require Angiography and/or PCI. Two catheterisation laboratories at

Aberdeen Royal Infirmary, the establishment of interventional catheterisation laboratory at

Raigmore Hospital and expansion of capacity at Ninewells Hospitals, has improved local access

and provides a standardised approach to this aspect of cardiac care, across the region.

• A review of the Regional Development Plan for Electrophysiology Services (EP) has highlighted

excellent progress in achieving improvements in delivery of EP services for north residents.

• NHS Grampian continues to be the tertiary Electrophysiology centre for the North, although some

specialist Electrophysiology services are being provided locally, with Raigmore and Ninewells

joining Aberdeen in providing an Implantable Cardioverter Devices (ICD) service across the North.

• The appointment, in July 2009, of an additional consultant to support EP delivery within the north

of Scotland has provided additional capacity.

• eHealth opportunities are progressing, with all hospitals in the North linked into SCI-CHD. All

boards are encouraged to adopt SCI-CHD as the system of choice for patient management and

audit. Continued funding arrangements will be important to ensure sustainability of this as the

designated system in place.

• Video-conferencing potential is being developed as a means of reaching more remote and rural

patients to ensure equity of service provision; for example, to support cardiac rehabilitation.

• Cardiac surgery capacity and demand modelling has been completed with a revised proposal for

service delivery being developed.

• Training and Education remains a priority for the cardiac sub-group. During the year the

Fellowship Training Programme, developed by NHS Grampian has been extended to staff in

Island Boards, with online training opportunities, study days and evening information exchange

sessions aimed at GPs and other healthcare professionals.

Child Health Clinical Planning Group

In March 2009, Dr Michael Bisset, a Consultant Paediatrician within NHS Grampian, was appointed as

the NoS Child Health Clinical Lead, for a period of two years, and has taken over the role of Chair of

the NoS Child Health Clinical Planning Group (CHCP). Mr Ken Mitchell has provided dedicated

Programme Manager support for Child Health since June 2008.


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Investment in specialist services will sustain services in the North and improve access, through

increased service provision, more staff, better links between services and education.

The key objective of the CHCP, during 2009/10, has been the development of a regional plan to

support the implementation of the National Delivery Plan for Specialist Children’s Services, produced

by the Scottish Government. This investment has been phased over three years and this is the third

plan submitted to Government by the North. Once the final investments are in place during 2010, the

North will have invested an additional £4,072,662 in specialist children’s services. This is summarised

in the table below.

Total Investment Year 1 Year 2 Year 3 Total

Regional elements

157,277 738,136 325,978 1,221,391

Pan-Scotland elements

673,622 345,042 607,946 1,626,610

Staffing elements

0 0 1,224,661 1,224,661

Total 830,899 1,083,178 2,158,585 4,072,662

In the first two years, the North Boards targeted the investment to specific specialist services that are

either provided on a regional basis or those services, planned at an all Scotland level but required

regional investment. This included regional investment in a paediatric neurology network, a paediatric

gastroenterology network and the establishment of a general surgery of childhood network. Pan-

Scotland investments included metabolic medicine, complex respiratory medicine and cystic fibrosis,

rheumatology, children’s cancer and regional infrastructure to support implementation. There was

also specific investment identified to support access by remote and rural areas to specialist services,

including locally delivered clinics, video-conferenced support and education packages. The North,

through the North of Scotland Public Health Network (NoSPHN), developed a tool that will be used to

demonstrate the impact of investment, called the ‘Logic Model’. This is vital to ensuring that

investment is recurring.

In year 3, CHCP members and other stakeholders agreed a different approach, recognising that in the

North, specialist services needs to be built from a secure secondary care base, and have agreed a bid

that invests in the wider workforce, who will support a number of children’s services. The bid

therefore describes investment requirements for nursing, allied health professions, doctors,

pharmacy, psychology, technical and administration staff. In addition, there were agreed investments

in critical care, child protection, children’s cancer, general surgery and continued support for remote

and rural care.

A full copy of the final bid is available on the NoSPG website.


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Child & Adolescent Mental Health ‘Better Health, Better Care’5 affirmed the commitment of Scottish Government to increase the number

of inpatient places for young people with complex and severe mental health problems and in April of

that year, NoSPG agreed to establish a regional Network for Specialist Child and Adolescent Mental

Health Services (CAMHS), which would include commissioning an increased number of inpatient

places for young people6. In January 2009, Neil Strachan was appointed as the Regional Network

Manager, for a period of three years, funded by Scottish Government.

The CAMHS Project Board, established in 2007, was chaired by Danny McLaren, Assistant Chief

Executive, NHS Tayside until his retiral in June 2009, when he was replaced by Caroline Selkirk,

Director of Change and Innovation, NHS Tayside. All six NoS Boards are represented on the Project

Board and where possible by both clinical and managerial representatives. NHS Tayside also provides

capital project management support to the project. A Service Modelling and Workforce Group also

supports the Project Board.


A regional Network for Child and Adolescent Mental Health will provide specialist care as close to

home as possible and provide access to specialist services for those living in the most remote

communities. The regional inpatient unit will be provided within the context of the network and

will ensure that pathways of care are optimised, including transitional support between different

tiers of service.

There has been significant progress during 2009/10, including formal approval by all six Boards and

the Scottish Government of the Initial Agreement for the capital development. This is an important

milestone in the progression of the Project.

During 2009, Scottish Government announced funding of £2m per annum for two years to improve

specialist CAMH services. These funds were disbursed on a matched basis and bids were required to

be submitted regionally. The North Boards submitted a bid for £505,200, including £61,325 to be

allocated to support the regional project. Together with the matched funds from Boards, this provided

funding of £122,650 to support the next stage of the project and develop the Outline Business Case.

The role of the Service Modelling and Workforce Planning Group (SMWPG), chaired by Mr Kevin

Dawson, Service Manager, NHS Grampian, is to develop realistic service models for tier 4 CAMHS

services for North Scotland and has agreed that the specialist network should be established as an

5 (2007) “Better Health, Better Care Action Plan” December 2007, Scottish Government. Edinburgh. RR Donnelley B53881 12/07 6 Inpatient facilities for children, aged 12 and under, are provided on a national basis by the Royal Hospital for Sick Children, Glasgow (Yorkhill)


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Obligate Network7. The challenge to establish a regional approach to these services is compounded

by our geography, and the need for creative solutions that embrace, for example, the potential role

for technology in enabling services, and their accessibility has been recognised by the group.

The SMWPG has an agreed action plan, kept under review by the Project Board and has reported

progress in a number of areas, including:

• Commissioned a needs assessment from the North of Scotland Public Health Network. This was

recognised as a gap to be addressed at the Initial Agreement stage and will inform the

development of service models, and recommendations on the balance of investment between

inpatient beds and local investment to ensure services are as specialist as necessary, as local as

possible.

• Progressed the development of a draft Integrated Care Pathway (ICP) for tier 4 CAMHS across

the North.

• Linked to the ICP development, has been the production of tier 4 service referral and discharge

criteria, to ensure shared clarity in relation to access and appropriate support options.

• A programme of organisational visits to services identified as demonstrating good, and

innovative practice has been undertaken and has included visiting both new and established

adolescent inpatient units in other parts of the UK, along with examples of those where

community based models have been developed to support those in need of intensive support

and treatment.

• A short-life communication and engagement group has been established to bring together PFPI

colleagues from across the North, who have previously collaborated to good effect on regional

projects. This will ensure the development of a comprehensive communication and engagement

plan, to inform and engage stakeholders.

The structure and components of a tier 4 CAMHS Obligate Network are being defined, and with

NoSPG support for a Clinical Lead role, the network will provide a regional governance structure that

will provide a forum ensuring quality, analysing pathway variances and future development. The work

defining the Obligate Network is progressing and will be added to with recommended service models

and workforce plans to fully inform the Outline Business Case (OBC).

North of Scotland Secure Care Clinic

Garry Coutts, Chair, NHS Highland chairs the Executive Project Board for the development of this

important capital and revenue development. Professor Tony Wells, Chief Executive, NHS Tayside is

7 Feeley & Gibbins (2009) “Framework for Obligate Networks” 4th March 2009, Scottish Government, Edinburgh.


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the Lead Executive. This project is a significant capital and revenue development and is supported by

a project team, led by Dave Charles, Project Director. Clinical leadership is provided by Dr Tom White.


The regional element of the Secure Care development will allow patients, defined as requiring

medium secure care, to be cared for within the North, within an appropriate level of security and

ensure that North medium secure and NHS Tayside low secure patients are cared for in modern,

fit for purpose accommodation.

In the first six months of 2009 detailed negotiations continued with the two bidders for the contract

to build the Regional Medium Secure Unit at Murray Royal Hospital (MRH) in Perth, which led to the

appointment at the end of June of the preferred bidder, the consortium known as Taycare, following

approval by all five participating North of Scotland Boards.

Since June, in addition to the very detailed legal, technical and financial negotiations to agree the

contract and the work to obtain Scottish Government approval to these final stages prior to

construction, the Project Team have been looking further ahead to the future staffing needs of the

Unit. At the end of August a one-day Stakeholder Event was held at MRH, attended by 46 staff from

Grampian, Highland and Tayside, representing a wide range of disciplines including Nursing, Social

Work, Administration, Pharmacy, Dietetics, Occupational Therapy, Psychology, Medical and Human

Resources. A summary of the event is provided in the Compendium of Events, which accompanies

this Annual Report and feedback has informed the workforce development action plan. A follow-up

consultation is proposed along with other similar events.

Other work which looks to the future was taken forward by the North of Scotland Forensic Regional

Clinical Governance Group which met on four occasions during 2009. This group has taken over the

role of managing patient flow throughout the spectrum of secure care services and has developed a

database of all North of Scotland patients in secure care out of area placements. A sub-group is

examining the Policies and Procedures infrastructure to promote greater equity of service provision

throughout the North of Scotland. Training events in risk assessment and risk management were

conducted, and with the support of the National Network, training is being organised for Senior

Practitioners in the assessment of drug and alcohol problems and the delivery of psycho-education for

patients. The Regional Network is working together with the West and East of Scotland to examine

the provision of the current low and medium secure services for female patients. Throughout 2009,

there has been great cohesion amongst the current three forensic services in the North of Scotland

and closer working relationships amongst the Regional medium secure care providers. This should

support patient flow and ensure that patients are not placed in an inappropriate level of security.


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News about the new developments in forensic mental health services in the North of Scotland was

presented by Dr Tom White both locally to the Public Protection Forum in Perth and both the

Community Justice Authority (CJA) for Tayside and the CJA covering the North of Scotland8, and more

widely at the International Association of Forensic Mental Health Services Conference. Within the

Secure Care Project itself, the Project Accountant, Lynne Hamilton, has regular contact with her NoS

colleagues through the Finance sub-group, while the Project Director, Dave Charles, attended Board

meetings in Shetland and Grampian in December, and earlier the Chairs and Chief Executives meeting

in Inverness in September in order to keep them updated.

The project now moves forward to conclusion of the contract and the start of construction which will

take two years. Phased opening of the Medium Secure Unit will commence in April 2012 and all three

wards are expected to reach full capacity within two years.

Bariatric Surgery and Obesity Management

In 2007, five of the North Boards agreed a Service Level Agreement (SLA) for the provision of

bariatric surgery services from Aberdeen. NHS Tayside was not party to that agreement. This SLA

was capped at 40 procedures per year for all five Boards. In June 2009, it became apparent that the

agreed level of activity was significantly less than the identified demand and a review was proposed.

Obesity is a significant and recognised challenge to good health and obese people are at greater risk

of developing diabetes, asthma, arthritis, high blood pressure and cancer than those who are not.

Weight Management Strategies exist in all Boards, however, the pathway of care may include some

very specialised services, including bariatric surgery, which are not available in every NHS Board.

Bariatric Surgery is only one aspect of the whole care pathway and NoSPG recognised that any review

of bariatric surgery services needed to be considered within the context of the wider obesity

management pathways. David Sullivan, Director of Planning from NHS Grampian led this work.


Obesity is a significant and recognised challenge to good health and obese people are at greater

risk of disease and ill health than those who are not. Access to bariatric surgery, as part of an

overall Weight Management Strategies is appropriate for some patients. This initiative would

provide access for people of the North, within the North.

8 The North CJA covers Grampian, Highland, Orkney, Shetland and the Western Isles.


16

In June 2009, NoSPG approved the establishment of a short life working group, involving all six

Boards, to:

• Develop and understanding of the demand requirements for Bariatric surgery, within the

context of NoS Boards Obesity Management strategies;

• Develop a NoS patient pathway for the specialist aspects of the service; and

• Ensure that the NoS requirements are reflected in the national plans.

Progress so far

A Workshop was arranged in December 2009, following some scoping work by health intelligence and

individual Boards to discuss bariatric surgery in the context of wider obesity management strategies.

The workshop was attended by 28 representatives from 4 of the 6 NoS Boards (Tayside, Highland,

Grampian and Shetland). At the workshop there was an overwhelming desire from the 4 Boards

represented to work together to provide a bariatric surgery service as part of integrated obesity

management services across the North and discussions focussed on a plan that would ensure that

surgical services could be delivered in two centres, Aberdeen and Dundee, as part of a Regional

Managed Clinical Network.

In February 2010, NoSPG approved a proposal from this workshop to establish a bariatric surgery and

obesity management sub-group of NOSPG to plan and implement the regional network and manage

the interface with any national initiative. It was agreed that Roseanne Urquhart, Head of Healthcare

Strategy, NHS Highland would chair the sub-group, with representatives form each Board area and

that the group would produce a first draft regional delivery plan by July 2010, following the model

developed by the NoS Cardiac Sub-Group/Network, including activity projections and resource

implications. Until this is agreed, the existing SLA should remain in place pending production of the

Regional Delivery Plan, which should include proposals to clear the significant backlog.


17

Regional Networks

In addition to establishing a regional approach to service delivery, NoSPG has also established a

number of regional networks. These networks may be traditional Managed Clinical Networks (MCNs)

in terms of extant national guidance9,10 or, increasingly the networks will also have a role in

supporting service delivery. The following section reports the progress of a number of these

important networks.

Eating Disorders Dr Harry Millar, Clinical Lead for Eating Disorders leads the NoS MCN for Eating Disorders, which was

established to develop a comprehensive structure for the treatment of Eating Disorders across the

North. Mrs Linda Keenan is the Network Manager.


The NoS Eating Disorders Network has already improved pathways of care across the North. The

commissioning of the Eden Unit, the first NHS inpatients facility in Scotland for adults with an

eating disorder will ensure that patients can access care within the North, the pathways of care

will be improved, with better transition between local services and the regional unit.

The NoS MCN for Eating Disorders has, for some years, led the development of a NoS strategy for

eating disorders, which has included planning of services, supporting education for healthcare

professionals and the public and representing the North on national groups. One of the most

significant achievements of the MCN has been the planning and commissioning of the Eden Unit. The

Eden Unit is the North of Scotland Regional Eating Disorders Inpatient Unit for adults and was opened

by the Minister for Public Health and Sport, Shona Robison, in February 2009.

MCN for Eating Disorders

This has been an exciting but challenging year for the Managed Clinical Network and sometimes a

frustrating one, due to staff shortages across Eating Disorder Services in the North. However, a

number of recent appointments should enable more activity and progress in the coming year.

The Eden Unit

The Eden Unit in Royal Cornhill Hospital provides 10 in patient beds and day patient transitional care

for severely ill patients, over the age of 18, from the North of Scotland. A Consultant Psychiatrist, Dr

Jane Morris, formerly a Consultant Psychiatrist in Edinburgh, has been appointed to lead the Unit and

9 HDL (2007) 21 “Strengthening the role of Managed Clinical Networks” 27 March 2007, Scottish Executive 10 HDL(2002)69 “Promoting the Development of Managed Clinical Networks” 12 Sept 2002, Scottish Executive


18

took up post on 1st March 2010. Her appointment will allow the unit to develop and improve on its

success so far.

Admissions to the unit have come from across the MCN including admissions from Orkney and

Shetland. A clinical protocol is in place and work is currently underway to finalise the Operational

Business Policy for the unit.

Aberdeen Eating Disorders Annual Conference

A 4th successful conference was held in Aberdeen in November 2009 and its theme was “Research

into Practice”. There were a number of well renowned keynote speakers and it was extremely well

attended. This conference is hosted by NHS Grampian on an annual basis and both Dr Harry Millar,

Lead Clinician, and Linda Keenan, Network Manager were involved in the planning for the event. A

5th Conference is planned for November 2010 with a theme “Developing New Skills”. This annual

event helps to raise the profile of eating disorders and provides a forum for exchanging both

knowledge and views on eating disorders.

Eating Disorders Education and Training Scotland (EEATS)

This project, which had significant involvement from the MCN, was officially launched at the Aberdeen

Conference in November 2009. A website has been developed (www.eeats.co.uk) where candidates

can register, take the online knowledge test and download materials for undertaking the

accreditation. The scheme provides an across age range and across profession training which can be

undertaken over time (max of 3 years) and if successfully completed will provide the person with a

certificate level equivalent qualification in Eating Disorders. This project’s initial funding from NES

finishes in Feb 2010 but it is hoped that the scheme will become self sufficient. Education and

training in Eating disorders has been highlighted as an area which requires improvement and this

project will help to address this. Raising the profile of eating disorders and providing a method of

increasing the knowledge/skills people can obtain can only improve the service being provided for

people suffering from an eating disorder.

Education

Dr Millar has continued to present workshops for GP’s across the North of Scotland. NHS Tayside

Eating Disorder service have also been running workshops for GP’s in their area to raise the

awareness of Eating Disorders and the service they can provide.

Quality Assurance

The MCN now has a quality assurance sub-group which has met but unfortunately due to the staff

shortages mentioned above has stalled recently. It is hoped that now staffing levels are beginning to


19

stabilise that this can move forward again. This is an area in which the MCN needs to progress over

the forthcoming year.

Electronic Clinical Record

The aim of rolling out the Electronic Clinical Record to NHS Tayside and NHS Highland has suffered

setbacks this year. It has been agreed that it will be up to the IT departments in each area to take

this forward if they wish. In the meantime work is ongoing to provide remote access to the system

for services that have patients in the Regional Inpatient Unit. The system is a vital resource in

providing data on activity within the regional unit and NHS Grampian Eating Disorder Outpatient

Service. The continued appointment of an information officer to extract data from the system has

proved invaluable. The data can be used for audit and research purposes.

Oral Health Network

A Regional Project Board, chaired by Mr Richard Carey, Chief Executive for NHS Grampian, was

established in February 2008. At the time, the project was described as one of the most ambitious to

be agreed by NoSPG, aiming to:

• Establish a Regional Service for the North for Oral and Maxillofacial Specialties in Head and

Neck Cancer and Trauma;

• Establish a Regional Service for Restorative Dentistry;

• Expand the NHS Tayside Managed Clinical Network for Orthodontics to include all North of

Scotland NHS Boards; and

• Develop an intermediate care tier of service provision by supporting the development of a

role for Dentists with Special Interest (DwiSI).


The Oral Health and Dentistry Project aims to improve access to specialist oral and dental care

and to develop a network approach that will provide care locally by suitably trained practitioners.

Progress during 2009/10

This project has always been recognised by NoSPG as a challenging project. The objectives set in

2007 were extremely stretching and the services involved were at different stages of preparedness to

progress the work.

During 2009/10, the main priorities have been to:


20

• Establish the network for Oral and Maxillofacial surgery, ensuring that the additional

consultant posts are agreed by the relevant partners and appointments are made;

• Establish an MCN for orthodontics; and

• Refine the requirements for restorative dentistry on a regional basis.

Progress against the specific objectives within the Project is detailed in the Table below.

1. Oral and Maxillofacial Surgery

1.1 Trauma and Emergency Care

A Regional Service should be established for trauma and emergency care for the North of Scotland. (Priority 1)

• Review of admissions to NoS Accident and Emergency Departments to scope the incidence of Head and Neck and Facial trauma in individual NHS Boards and identify the requirements for a regional network completed.

• Completed an audit and review of emergency care services for facial trauma and emergency admissions out-of-hours for facial trauma to support the redesign of services. The review included emergency care of dental patients as well as the care of facial trauma.

1.2 Dento-Alveolar Care

A “tiered” approach to service delivery should be designed and implemented to ensure that only that activity that is absolutely specialist in nature is referred to specialist services. (Priority 2)

• Following Audit of the proportion of dento-alveolar surgery carried out in secondary care that had the potential to be treated in Primary Care11, work has continued with Boards to develop care pathways for the appropriate referral of dento-alveolar cases from Primary to Secondary Care. The National Dental Task and Finish Group has taken the output from this work and has now commissioned work on a nationally approved pathway for Oral Surgery.

• Work to identify best practice for one-stop services for minor oral surgery has been identified and work is ongoing within NHS Grampian to implement this, including triage arrangements for new referrals, identifying training and education requirements etc.

• Established project with ISD12, the national organisation responsible for data collection and recording to work towards the introduction of the new OMFS specialty code (compared to OS) and to help differentiate between the work of OMF Consultants and other specialists and grades.

1.3 Head and Neck Cancer

A Regional Service should be established for Health and Neck Oncology (Priority 3)

• It was agreed by the NoS OH&D project Board that this work should be commenced as soon as the recruitment of two OMF Surgeons to NHS Highland was completed.

• Meantime, a significant amount of work has been undertaken, in collaboration with representatives of the National Dental Task and Finish Group, the 18 week Improvement Support Team and ISD to improve on data gathering and reporting, thus providing improved data quality to support decision making.

1.4 Complex Care

Consider offering complex OMFS services within only one or two locations within the North of Scotland. (Priority 4)

• It was agreed by the NoS OH&D project Board that this work should be commenced as soon as the recruitment of two OMF Surgeons to NHS Highland was completed.

• Meantime, a significant amount of work has been undertaken, in collaboration with representatives of the National Dental Task and Finish Group, the 18 week Improvement Support Team and ISD to improve on data gathering and reporting, thus providing improved data quality to support decision making.

11 50 – 80% of procedures could be done in Primary Care 12 Information and Statistics Division of NHS Specialist Services Scotland.


21

2. Orthodontics

A Managed Clinical Network should be established in the North of Scotland. Prior learning from the model of Orthodontics in NHS Tayside should be considered as a first step. (Priority 1)

• Proposal to establish a Regional Managed Clinical Network for Orthodontics agreed by stakeholders and endorsed by NoSPG in August 2009, however, funding of trial and ongoing costs have not been identified.

• E-Orthodontics proposal agreed by stakeholders and approved by NoSPG, but the strategy is dependent on trial of proof of concept and there are funding issues as above.

• Established firm links and clear channels of communication with ISD to establish a consistently of approach on SMR returns by NoS Boards. E.g. inclusion of IOTN score on SMR returns.

3. Restorative Dentistry

A Regional Service should be formally established for Restorative Dentistry (Priority 3)

• In collaboration with the 18 week Improvement Support Team facilitated “Visioning Days” in the mainland NoS Boards. Dates for the Island Board to be identified.

• Facilitated Demand, Capacity and Queue work in four out of six NoS Boards. • Established a high level plan for Restorative Dentistry aimed at ensuring a

report and recommendations for future service design and delivery.

4. Workforce (Priority 2/3)

• Through membership of the Network Manager in the National task and Finish group, the North has been able to influence the scope and dimensions of the review to be carried out by the National Dental Workforce Review Group. Promotes the need for Dentists with Special Interest and Consultant Oral Surgeons.

5. Technology

The variety and scope of technologies available should be considered an essential part of the strategic redesign of services. (Priority 1)

• Completed scoping exercise to identify existing video conferencing technologies in NoS NHS Boards and an audit of IT solutions used across NoS Boards (e.g. PAS systems).

• Gained an understanding of the R4 programme used by Dentists in Primary care for comparison of compatibility against other emerging technologies (e.g. Excelicare).

6. Additional Supporting Activities

• Hosted a second successful NoS Oral Health and Dentistry event the outcome from which will inform the project’s workplan for 2010/11.

• Influenced national policy and the approach to be adopted by the 18 week Improvement Support Team in relation to waiting times for dental specialties. A key outcome was the decision not to include dental work undertaken by undergraduate dental students in the 18 week standard.

• Influenced future MMI reporting by all Scottish Boards with regard to dental outpatient procedures carried out in the Acute setting.

• Took the lead role in the design of the “Key Areas to Focus Improvement in Dental Specialties” for the 18 week Improvement Support Team. The document was subsequently distributed Scotland-wide.

The funding for the Network Manager and support comes to an end on 31st March 2010 and whilst

there has been good progress, there remain a number of priorities yet to be progressed by this

project. NoSPG has asked that there needed to be greater clarity over the outstanding work to be

taken forward and have not agreed further resource at this stage.


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NOSCAN

NOSCAN is the Regional Cancer Advisory Group for the North with a role to support the Boards across

the North in their efforts to improve the burden and experience of cancer across the region. NOSCAN

is chaired by Richard Carey, Chief Executive, NHS Grampian, supported by Dr Peter King, Clinical Lead

and Peter Gent, Interim Network Manager.


A regional approach to cancer services allows better integration of care, between local areas and

more specialist services, where Boards will work together. A networked approach to care means

that patients across the North have access to the same standard of care no matter where they

live.

Cancer is responsible for significant mortality and morbidity, not only in the North of Scotland, but

across the country. In 2008, the Scottish Government published ‘Better Cancer Care’13 and ‘Living &

Dying Well’14, that provide direction on how cancer and end of life care should be improved and

NOSCAN, together with the other Regional Cancer Advisory Groups in the west and south east, has

worked with the Boards to implement the recommendations of these.

NOSCAN is a federation of local networks and tumour specific networks that work together to improve

standards of care. Below the overarching regional cancer advisory group, there are local networks in

Highland and Tayside and the Northeast Network involves Grampian, Orkney and Shetland. There are

7 tumour specific networks, including breast, colorectal, lung, urology, gynaecology, haematology and

upper GI that work together to support clinical services on a regional basis. The work of NOSCAN is

overseen regionally by NoSPG and nationally, the Scottish Cancer Taskforce have been established to

oversee the implementation of Better Cancer Care.

The publication of Better Cancer Care and Living and Dying Well has informed the workplan of

NOSCAN over the last year. Following a series of visits to all Board areas last year, a revised workplan

for NOSCAN that was synergistic with the national policy direction, the corporate priorities around

cancer performance and important clinical and organisational developments was approved. Full detail

of the NOSCAN workplan has been published in the NOSCAN Management Report, September 2009,

which is available through the NOSCAN web site at www.noscan.scot.nhs.uk.

Highlights include: North of Scotland Brachytherapy Review; Breast Service Review; supporting

service improvement in cancer services in the North; development of cancer audit capacity;

13 (2008) “Better Cancer Care, an Action Plan”, October 2008, Scottish Government 14 (2008) “Living and Dying Well: a national action plan for palliative and end of life care in Scotland”, October 2008, Scottish Government


23

progressing the eHealth in cancer agenda in the North, including an extensive review of requirements

and barrier to progress; supporting the development of QIS standards for cancer; improving patient

and public involvement across NOSCAN; and review of a number of the Tumour Specific networks to

benchmark progress. Benchmarking reports for Gynaecology, upper GI, colorectal and haematology

are available.

North of Scotland Public Health Network (NoSPHN) Dr Lesley Wilkie, Director of Public Health for NHS Grampian has this year led NoSPHN supported by

the Network Manager, Pip Farman. The Network involves public health staff from across all NoS

Boards except NHS Tayside and is unique at regional level in Scotland. NoSPHN supports NoSPG in

agreed pieces of work and also develops regional approaches to Public Health services, activities and

continuing education. The leadership of NoSPHN is rotated between the NoS Boards every two years

and the Lead role transferred to Dr Sarah Taylor, Director of Public Health for NHS Shetland in

February 2010.


The NoS Public Health Network ensures that regional initiatives are informed by the best available

evidence and identified population need so that we make the best possible decisions within the

resources available for the people of the North of Scotland.

A number of key initiatives have been progressed over 2009/10 and are either complete or rolling

forward across financial years. A small number of initiatives have been delayed as a result of the

priority afforded to local H1N1 responses. Key priorities and outcomes for the year are highlighted

below.

• NoSPHN was asked by NoSPG to show how added benefit to patients could be demonstrated as a

result of new investment over 2008-2011 in Specialist Child Health Services at a regional level.

Following a range of discussions with regional and national groups, NoSPHN developed an

approach using a ‘logic model’ methodology and has worked with the services funded to ensure

both a needs and evaluative based approach to the development of these services. A toolkit to

support work has been developed and is in use and work is continuing into 2010. The NoSPHN

work is also being shared with ISD and the National Development Group to inform a national

evaluation framework. NoSPHN is also working with the Scottish Public Health Network (ScotPHN)

in respect of the implications of the work for other regions and nationally.

• NoSPG asked that NoSPHN review and brief the NoSPG Chief Executives on the potential for

remote and rural bias in use of designated national specialist services and national risk share


24

schemes. NoSPHN worked with staff at NSD on an overview of all services and on two services in

detail and determined that whilst there was no evidence of remote and rural bias there was

evidence of differential use of services. The work also highlighted a number of further queries

which are being addressed by NSD. A further review of more recent service data is planned to

check for any trends in these queries. The work has been shared with the two other regional

planning groups to assess for further impacts.

• NoSPHN has continued to support various workstreams within the National Remote and Rural

Health programme. This has included ongoing work to understand local care pathways to inform

the development pathways of care for common conditions and public health advice or input into

the Evaluation of ERMS and the Emergency Response and Transport programmes.

• NoSPHN routinely advises NoSPG and the NoS Board Chief Executives on bids submitted for

designation as national services. NoSPHN reviewed the 2010 bids using agreed criteria and further

discussed the bids with the NoS Integrated Planning Group and NoSPG before agreeing a NoS

response which was submitted to the National Services Advisory Group (NSAG). NoSPHN has also

worked this year with the Scottish Public Health Network (ScotPHN) to determine how the Public

Health input to the process might be supported across the three regions / nationally.

• NoSPHN commissioned a needs assessment to inform a strategic approach to the development of

Tier 4 CAMHS services across the North of Scotland with particular reference to the development of

the outline business case for in patient provision, investment in community based Tier 4 services

and the development of a regional CAMHS network for the North of Scotland NHS Boards. The

work is due to be finalised by March 2010.

• Support continues to be given to a number of NoSPG programme groups. Public Health staff are

nominated to sit on and advise working groups (e.g. NOSCAN, CAMHS, Cardiac Network) and key

pieces of work have been progressed for example:

- NOSCAN – a presentation was given at the NOSCAN conference with a focus on ‘Risk

Factors in Cancer’, a paper has been developed horizon scanning for new technologies

and a cancer prevention agenda is being scoped for NOSCAN. Links have also been

established with the new Scottish Cancer Prevention Network.

- Bariatric Surgery and Obesity Management Services – health intelligence input has been

given to the initial work of this group.

• NoSPHN successfully secured funding over 2 years (2008-2010) from the Scottish Government for

6 anticipatory care programmes in the North aligned to the national Keep Well programme. The

programmes focus on practices in Dufftown (NHSG), North-West Sutherland (NHSH), NHS Orkney,

NHS Shetland, across NHS Western Isles and further remote and rural practices in each of NHS

Highland and NHS Grampian focussing on Healthy Weight Pathways. The overall aim is to identify

the key issues that are required to make the targeting of anticipatory care working effective in

remote and rural settings. Work during 2009 has aimed to ensure implementation of the

programmes and steady progress has been made and interventions are now being delivered


25

through most of the programmes. Work is also ongoing to both monitor and evaluate the

programmes. The Scottish Government has recently agreed to continue funding to enable the Well

North project to be extended to 31st March 2011.

• NoSPHN has throughout the year worked to review opportunities for collaborative working in the

North on health improvement / health promotion activities. Key areas of focus have been agreeing

areas of shared learning from Well North, workforce development opportunities (e.g. sharing of

training opportunities), contributing to national health improvement developments and reviewing

opportunities for developing social marketing approaches on a NoS basis.

• NoSPHN has also continued to work with other national organisations to maximise engagement

with and links to North of Scotland including NHS Health Scotland, the Scottish Government e.g.

through their Health Improvement Performance Management Group, UKPHRU and the Scottish

Public Health Forum and Scottish Public Health Network. One of the main foci of work is to ensure

that the remote and rural aspects of national developments are recognised and addressed.

• During 2009/10 with the support of NoSPG, NoSPHN has developed a public facing website that

can be accessed at www.nosphn.nhsscotland.com. All NoSPHN papers and reports will now be

available on the website and the site will also be used to signpost to other appropriate Public

Health sites.


26

NoSPG Specialist Planning Groups In addition to the Clinical Planning Groups established by NoSPG, there are also a number of

Specialist Planning Groups that support the process of regional working across disciplines. The work

of these groups is described below.

Integrated Planning Group

Iain Crozier, Chief Executive, NHS Orkney chaired the Integrated Planning Group until his retiral in

2009. NOSPG members would like to extend their thanks to Iain for his commitment to the regional

agenda. Dr Annie Ingram, Director of Regional Planning & Workforce Development has taken over

the chair of this group, which now meets virtually.

The role of the IPG was reviewed this year and the revised remit is to develop a long term strategy to

support the work of NoSPG in three specific ways:

1. Strategic Planning

• To assist NoSPG to develop a long term clinical and workforce strategy to support regional

working;

• To promote and foster a regional approach through the identification of issues, both service

and workforce, which will impact significantly within and across Boards, to determine where

regional working will add value;

• To co-ordinate prioritisation within collaborating NHS Boards and at regional level to ensure

best use of available resources and reflect this in agreements between NoS NHS Boards;

• To plan and monitor patient flows at a strategic level across the North of Scotland to ensure

optimal use of services within the region and to monitor patient flows outwith the region to

ensure appropriate access to services for the population of the North.

• To develop the regional workforce plan;

• To develop a North perspective on national initiatives; and

• To provide support to the Director of Regional Planning & Workforce Development.

2. Projects

• To identify and progress regional projects, where appropriate.

3. Performance Management

• To develop processes, standards and protocols to support effective regional working;

• To scrutinise NoS Service Development proposals and business cases to ensure that these are

robust and meet expected standards;


27

• To performance manage the regional sub-groups, including the agreement of regional

objectives and priorities;

• Ensure that a workforce impact assessment is contained within any emerging NoS plans.

Regional Nursing and Midwifery Workload and Workforce Planning Project

This is a national programme of work, coordinated on a regional basis and taken forward in the North

region by Betty Flynn, Regional Nursing Advisor whose role is to facilitate both the national and

regional aspects of the programme.


The improvement in workload and workforce planning for the nursing and midwifery workforce will

ensure that the workforce capacity and capability is maximised in response to changing patient need.

Nursing & Midwifery Workload & Workforce Planning Project

The Nursing & Midwifery Workload & Workforce Planning Project15, (NMWWPP), was established in

2004, the purpose of which was to develop and implement an objective and systematic approach to

workforce planning and development, for nursing and midwifery. The need for, and importance of, a

consistent workforce planning approach for this large workforce was identified in an audit undertaken

by Audit Scotland16 (2002). Audit Scotland carried out a second audit, and published the findings on

progress against the initial audit in a follow-up report17 in 2007. Since the implementation of the

work programme, most of the 20 recommendations have been achieved and include:

• Systematic processes in place for setting staffing establishments;

• Triangulation process established to support decision-making systems;

• Significant reduction in nurse agency spend across Scotland (reduced from £30 million to £10

million);

• Centralised nurse bank service established in each NHS Board to maximise contribution of NHS

nursing staff on banks (reduced from 96 individual banks to 14 Board banks);

• Balance between substantive, bank and agency use;

• National workload systems, methods and tools developed and implemented, providing improved

workforce intelligence, and to enable national benchmarking;

15 SEHD, 2004, The Nursing & Midwifery Workload & Workforce Planning Programme, Scottish Executive Health Department, Edinburgh 16 Audit Scotland, 2002, Planning ward nursing – legacy or design? Performance Audit, Auditor General, Audit Scotland, 2002 17 Audit Scotland, 2007, Planning ward nursing –legacy or design, A follow-up report, Auditor General, Audit Scotland, 2007


28

• 22.5% Predicted Absence Allowance in all establishments (CEL 618 2007);

• Standardised approach to measuring quality;

• Educational toolkit to support training and education at NHS Board level; and

• Continuing support to clinical leaders.

The programme is currently in a transition phase, which involves completing current work streams

and commitments, establishing the work at NHS Board and national level, and developing the work

programme for the next phase.

The work programme, commencing in April 2010, is in development and will be based on NHS Board

priorities provided by Chief Executives, Nurse Directors, and other stakeholders. The priority areas

requested thus far include;

• Theatres, which will take cognisance of the work of the national Perioperative Group;

• Accident and Emergency, to include ambulatory care;

• Outpatient departments;

• Clinical Nurse Specialists;

• Small wards (remote and rural);

• Bottom-up community tool;

• Refinements and developmental work as identified;

• Development of information systems at local and national level; and

• Integration of work programme with other local and national transformational change

programmes.

The new Chief Nursing Officer for Scotland, Ms. Ros Moore, commenced in post on January 2010.

The post of Programme Manager for the next phase of the programme is currently out to

advertisement. Both of these appointments will influence the development and delivery of the next

phase of the programme.

Regional Allied Health Professions Workload Project

This project was established in 2006 and was formally wound up by NOSPG, as a separate

workstream, in February 2010. The NoS Regional AHP Strategic Alliance was formed in December

2007. The Alliance was an active regional group while the Scottish Government supported the AHP

Workload Measurement and Management Programme, including resources for a Regional AHP Advisor

18 CEL 6, 2007, Implementation of Nursing & Midwifery Workload & Workforce Planning Programme minimum predicated absence allowance, Scottish Executive, 2007


29

post to support this work. This programme has come to an end and the Alliance can no longer be

sustained within existing resources.

The initial focus for the group was implementation of the AHP Workload Measurement and

Management Programme, after the national report was published by the Scottish Government in

2006. The Alliance developed during the period and had a number of primary functions:

• To support the regional development of workload information and methodologies and the

local implementation of the national AHP workload measurement and management

programme.

• To work in partnership across the 6 Boards in the North of Scotland to support AHP service

and role development in priority areas which enhance and support Board and Regional

corporate planning processes and targets.

• To act as a regional network to support the leadership and strategic development of AHP

services across the 6 Boards within the North.

• To support the Regional AHP Advisor in the provision of advice and support to NoSPG and

regional work stream clinical and managerial leaders.

The Regional Advisor post became vacant in March 2009 as the post holder left to take up the post of

Associate Director of AHPs in NHS Highland. As there were only 6 months of national funding

available before the national programme came to an end, it was agreed not to fill the post. The

national AHP workload measurement and management programme came to an end in September

2009.

Progress Report

Progress has been made in a number of areas as summarised in the table below.

National Programme AHP Bank AHP Workload Data Toolkit and Educational Programme for AHPs National Workforce Modelling for AHPs

Regional Programme Improving Workforce Information AHP Grade Mix Review and Workforce Strategy AHP Remote and Rural Fellowships Use of Skills Maximisation Toolkit in 2 AHP groups Child Health AHP Workforce Census CAMHS AHP Workforce Scoping Remote and Rural AHP Workload and Workforce Benchmarking Obligate Network

Boards AHP Workforce data cleansing AHP Workload Data collation PwSI Implementation

RRIG Diagnostic Imaging Workforce Census PwSI Implementation


30

Despite enthusiasm from members, there are insufficient resources to sustain the NoS AHP Strategic

Alliance. Competing priorities and pressures within Boards have made it impossible maintain

momentum within the Alliance membership. A number of Boards in the North do not have an

appointed AHP director or lead and until this is in place in a sustainable format, the Alliance cannot be

sustained in its current form. NoSPG have recognised the positive work of the Alliance but has

agreed the group should be stood down, with arrangements established to manage those work

streams that are continuing.

Medical Workforce Issues

Currently NHS Scotland supports a pattern of service delivery provided by the medical workforce that

includes widespread 24/7 acute care, including receiving, through rotas delivered by doctors in

training, supported by on-call consultant cover available off-site. Sustainability of this pattern of

service delivery is coming under increasing pressure, from changes to medical training and limits to

hours of work, and it is becoming increasingly unsustainable. In June 2009, Scottish Government

issued CEL 28 (2009)19 that required Boards to project future medical workforce requirements for a

number of priority specialties, including Emergency Medicine, Acute Medicine, General Medicine and

Trauma and Orthopaedics, General Surgery and Anaesthesia, by the end of September 2009. The

guidance also recognised that some hospitals would also need to undertake projections for

Obstetrics, Paediatrics and Acute Psychiatry. Projections for all other specialities were requested by

the end of November. Boards were required to report through regional groups and there was an

expectation that Regional Groups would aggregate their returns and assessed against projected

output.

The NoS Medical Directors Group, chaired by Dr Dijkhuizen from NHS Grampian, working through

the NoS MMC Review Group has led the process in the North.

In July 2009, the Medical Directors Group hosted a Medical Workforce Event that aimed to agree a

common approach across the North. The event is summarised in the Events Report, however,

participants concluded that a regional approach should be concentrated in a few specific areas,

including:

• Developing common assumptions, using a scenario planning approach;

• Develop plans for paediatrics and Rural General Hospitals; and

19 (2009) “Reshaping The Medical Workforce: Guidance On Projecting Future Medical Requirements Within Clinical Workforce 2009-2014” 30th June 2009, Scottish Government.


31

• Scope the potential for a NoS medical bank.

The MMC Review group have continued to meet and submitted both Board specific response and a

regional summary to Government by the due date. In November 2009, following a meeting of the

Scottish Association of Medical Directors (SAMD), further work was requested on the initial priority

specialities and Boards were told not to progress planning into the final group of specialities. This

work has been submitted to Government and a response is awaited.

There are concerns within the North, however, that the planned changes for training grades within

the medical workforce will have a significant impact on service delivery and it is not yet clear how

these will be addressed.


32

Inter-regional Clinical Planning Groups

Whilst the core role of Regional Planning Groups is to take forward projects on behalf of partner

Boards, NoSPG has always had another role, leading nationally driven initiatives, where services

require to be delivered across more than one region or for Scotland as a whole, but do not meet the

criteria for national designation by the National Services Advisory Group (NSAG). NoSPG has a

continuing role in two specific areas: Implementation of Remote and Rural Healthcare, through the

Remote and Rural Steering Group (RRIG); and the Scottish Neonatal Transport Service. The following

section describes progress in both.

Remote and Rural Implementation Group

NoSPG, through the Remote and Rural Implementation Group (RRIG), is responsible to Scottish

Government for the implementation and performance management of Delivering for Remote and

Rural Healthcare’20. This national workstream will continue until June 2010.

RRIG is chaired by Dr Roger Gibbins, Chief Executive, NHS Highland, supported by Mrs Fiona Grant,

National Programme Manager, Dr Ingram, as Project Director and Clinical Leadership is provided by

Mr William McKerrow, an ENT Surgeon from NHS Highland.


Safe and sustainable services are available for both emergency and elective care in remote and

rural communities and there are agreed pathways to care in larger centres.

The role of RRIG is to take forward the recommendations that were identified to be progressed at an

all Scotland level, through specific workstreams and to monitor and report to Government on

progress within both these workstreams and within NHS Boards and their CHPs. Only where a Board

asks for support will the national Project Team work in within an individual Board.

There are five RRIG workstreams:

• Obligate networks;

• Service models and care pathways;

• Workforce and education;

• Emergency response and transport; and

• E-health and infrastructure.

20 (2008) “Delivering for Remote and Rural Healthcare” May 2008, Scottish Government, Edinburgh.


33

A short progress on each of these workstreams is detailed below:

Obligate Networks

The publication of the Framework for Obligate Networks was reported in last year’s annual report.

‘Obligate Networks’ were identified as crucial to the sustaining access for those living in remote and

rural communities, either as a means of sustaining local services or by ensuring access to more

specialist services, not available locally. This concept builds on the well-established MCN approach

that Scotland has pioneered but takes this a bit further and was endorsed by the Cabinet Secretary,

when Delivering for Remote and Rural Healthcare was published.

The Framework reminded Boards that Obligate Networks should be established between NHS Boards

to sustain core services and ensure access to four key specialist services not routinely available in

Rural General Hospitals (RGHs), including Child Health, Mental Health, Radiology and Laboratories. It

was identified that this approach may also be appropriate to secure access to other services not

identified in the list above.

Progress has been variable, with three obligate networks having been confirmed as established.

These are Mental Health and Learning Disability between, NHS Orkney, NHS Shetland and NHS

Grampian; Diabetes between NHS Western Isles and NHS Greater Glasgow and Clyde; and a

radiology network between NHS Western Isles and NHS Borders. A number of other obligate

networks are still in development within and between a number of remote and rural Boards and

larger centres.

Service Models and Care Pathways

Defining the care pathways for the most common clinical conditions and ensuring broad agreement

across the six RGHs was a priority for RRIG and invited Professor Andrew Sim, Consultant Surgeon in

the Western Isles and Professor of Remote and Rural Medicine with the University of the Highlands

and Islands to lead the work to develop an appropriate methodology and work with colleagues to

agree these.

Seventeen Acute Hospital Care pathways, subdivided between three referral pathway groups, have

been designed and agreed by clinical representatives from all 6 RGHS at a meeting in March 2010.

The three referral groups are: Urgent/non-urgent; Emergency; and Malignant; and are further sub-

divided into categories, as follows:


34

Urgent/non-urgent:

Five categories:

• Management within an RGH;

• Management in an RGH with advice from a visiting or another consultant;

• Management in another Hospital after advice from a visiting of another consultant;

• Management in either the RGH or another hospital having been seen by a visiting consultant;

• Management in either the RGH or another hospital having been seen by another consultant.

Emergency

Three categories:


• Management within an RGH with advice from a visiting or another consultant;

• Management in another Hospital.

Malignant

Two categories:


• Management in another Hospital.

These Care pathways will now be printed, in hard copy, for issue to all doctors working within the

RGH and on the web, as a guide for staff.

Emergency Response and Transport

There are two distinct projects within this workstream and have been managed separately.

The role of an Emergency Medical Retrieval Service (EMRS) to support remote and rural areas

was formally established as pilot in June 2008, funded by SGHD. The pilot was commissioned for a

period of 18 months and subject to independent evaluation. The independent review, undertaken by

DTZ, in collaboration with the Centre for Rural Health and the Health Economics Research Unit of

Aberdeen University completed their evaluation in November 2009 and this was subsequently

submitted to Government for consideration. In March 2010, the Cabinet Secretary announced her

intention to establish this as a national service for Scotland.

The service is designed to bring consultant grade doctors, who are either A&E or intensive care

doctors to acutely ill or trauma patients within remote and rural communities. The team are brought

by air ambulance and will treat and stabilise the patient, within the local community, before arranging


35

for and escorting the patient to definitive care. The service also provides a consultant manned

telephone advisory service.

A breakdown of the activity21, since the pilot began, shows that two-thirds of patients are acutely ill

(acute medicine) and one third have suffered serious trauma. There have been 222 retrieval missions,

of which 1022 have taken place at the same time and 187 advice-only calls. Since June 2009, the

activity has continued to increase, with 250 transfers per annum and 220 advice only calls reported at

November 2009.

EMRS missions are defined as secondary retrievals, which mean that the EMRS team is called in by

another health professional after an initial assessment. The EMRS team, when established did not

attend at the roadside in the way that the 999 ambulances will. In December 2008, it was agreed,

however, that in circumstances where the EMRS team would inevitably be called, either by a GP or by

the paramedics in the SAS ambulance, the team could be deployed, as this would reduce the time

delay for the patient to reach definitive care and would potentially improve the overall outcome for

the patient. Since this was agreed, the team have undertaken 19 ‘pre-hospital’ missions.

The pilot has shown that the team are extremely responsive to the needs of remote and rural

communities, with average response times of 25 minutes to team ready, 60 minutes to airborne, 110

minutes to arrival at patient and 240 minutes to delivery of the patient to definitive care. 87% of

patients are admitted to definitive care in less than 6 hours. More conventional transfers in remote

and rural areas tend to take much longer.

The pattern of referral by locality over the first year, by rate of referral per 1000 of population23 in

each area, is demonstrated in chart 1 below, and is as might be expected, for a pilot operating across

the west coast of Scotland, with a number of remote islands and communities without the advantage

of a Rural General Hospital. As the level of local provision reduces, the need for retrieval will increase.

Whilst the service developed from a need to support remote GPs, areas with nurse only provision and

areas with a Community hospital; the service also provides valuable support to the three Rural

General Hospitals in Fort William, Oban and Stornoway, protecting the RGH staff from long transfers

and the consequent impact on local services.

21 Activity June 2008 – June 2009, verified by evaluation team 22 January – June 2009 only 23 Average rate of referral is 1.4 referrals per 1000 of the population within the catchment area. This rate of referral is used to equalise small numbers.


36

The decision by the Cabinet Secretary to establish a two team, one centre service, supporting all of

remote and rural Scotland has been particularly welcomed by RRIG and plans are in hand to

implement this decision.

Strategic Options Framework for Emergency and Urgent Response

The Emergency Response and Transport workstream was tasked with developing a response to the

Delivering for Remote and Rural Healthcare commitment to develop:

“Robust and responsive local community emergency response systems …”24

Remote and Rural Scotland is currently served by a wide range of clinical service configurations,

within a variety of settings that include health care staffed and non-staffed islands, remote mainland

and rural mainland communities and it was recognised at an early stage that a range of options

would be required.

Working in close collaboration with the Scottish Ambulance Service, RRIG tasked the workstream

members to develop a Strategic Options Framework for emergency and urgent response which:

• Clarified the responsibilities and accountabilities for the provision of the appropriate response;

• Set standards for delivery;

24 see 4 above, page 111

Rate of Patient Referral/ 1000/annum by Locality


37

• Identified a range of options that could be considered in different clinical service configurations

and geographical settings;

• Provided supporting evidence to support the proposed models.

In September 2009, RRIG approved a Strategic Options Framework (SOF), based on a Memorandum

of Understanding that clearly identifies the roles and responsibilities for both Scottish Ambulance

Service and territorial NHS Boards in emergency and urgent situations, and includes standards to be

achieved, skills required and the vehicles and equipment that may be deployed.

The Memorandum of Understanding identifies the Scottish Ambulance Service as having the strategic

responsibility for securing a pre-hospital emergency and urgent response services for all the people of

Scotland, including responsibility for the ownership, maintenance and replacement of emergency

response vehicles. Whilst territorial NHS Boards must ensure that appropriate services are available to

receive, admit and treat patients following the pre-hospital phase of care.

The SOF has 3 standards, linked to the NHS QIS standards for Unscheduled Care25, covering

accessibility and availability; safe and effective care; and audit, monitoring and reporting.

In addition, the standards are supported by a description of the skills of those who might respond in

a given situation, from first responders, through ambulance technicians to A&E paramedics and

concluding with specialist retrieval teams, where Medical Consultants are deployed, along with the

emergency response. The types of vehicles and equipment that can be deployed, linked to the skill of

the responder, are also defined. It is envisaged that there may be potential for those working in other

public sector employment within communities to be part of this network of response and this may

include those employed by the public sector or those who currently volunteer in other ways.

These standards are additional26 and may take some time to be achieved. The aim is to provide

standards that would improve patient clinical outcomes and response times would be less critical.

Even so, Standard 1 does require that no patient in a remote and rural community would wait any

longer, than 30 minutes for a local response within the community except in exceptional

circumstances. Where this is a first responder, then a healthcare professional27 will be despatched at

the same time.

25 (2004) “The Provision of Safe and Effective Primary Medical Services Out of Hours: Standards” August 2004, NHS QIS, Edinburgh 26 There are already national emergency and urgent response times set for the Scottish Ambulance Service (SAS) by the Scottish Government. These are: 75% of Category A calls to be responded to within 8 minutes (mainland NHS Boards areas); 95% of Category B calls to be responded to within 14/19/21 minutes (depending on population density); 50% of all emergencies (includes category A and B calls) to be responded to within 8 minutes (ORCON target for Island NHS Board areas). 27 This may be a GP, a nurse, a paramedic or ambulance technician


38

Following approval by RRIG, Scottish Ambulance Service, working with territorial Boards have been

tasked to work together to present implementation plans to NHS Boards and RRIG will monitor

performance. A copy of the SOF was sent to each Board and is available on the remote and rural

pages of the NoSPG website.

Workforce and Education

“Team working, integration and shared competencies are key to the future staffing of

services within remote and rural healthcare.”28

This work has been taken forward by the Workforce and Education workstream, co-chaired by Betty

Flynn, Regional Nursing Advisor and Workforce Programme Manager for the North and Pam Nicoll,

Director of RRHEAL29.

Many of the identified workforce actions were for NHS Boards to progress, although RRHEAL has an

important role to ensure that the educational requirements, identified by Boards and by the other

RRIG workstreams are addressed. Progress against workforce and educational priorities are reported

separately.

Workforce

In the last Annual report, the successful bid to develop Practitioners with a Special Interest (PwSI) in

Child Health, Mental Health and Learning Disability was reported. This has progressed and in March

2010, NHS Shetland advertised the first two PwSI posts in Learning Disability. Other programmes in

Child health are being developed in NHS Western Isles, and NHS Dumfries & Galloway are

investigating the potential of PwSI in Learning Disability/Mental Health within their Board.

A multi-skilled generalist Biomedical Scientist was identified as necessary to sustain laboratory

services in remote and rural areas and over the last twelve months, a short life working group has

been established, linked to work being progressed nationally, to review current and future workforce

needs. It is likely that this group will recommend that an Obligate Network approach is required.

The generic support worker development work is complete and RRHEAL are now seeking to identify

an appropriate educational response.

In 2009, two remote and rural surgical fellows were appointed, with funding for three years and

funding for a remote and rural fellow in Anaesthesia was agreed for a year. In addition, the Specialty

28 (2008) “Delivering for Remote and Rural Healthcare” p39, May 2008, Scottish Government, Edinburgh. 29 Remote and Rural Healthcare Educational Alliance


39

Training Board for Medicine and the Specialty Training Board for General Practice have agreed the

establishment of two programmes, one in the North and one in the west, to offer a general practice

programme with general medicine, referred to in Delivering for Remote and Rural Healthcare as

‘hybrid GPs’. These will be offered in 2010.

Education

RRHEAL is seen as one of the biggest successes of Delivering for remote and Rural Healthcare. The

Alliance exists to:

• Provide a link between NHS services and education;

• Rural proof current NES workstreams;

• Coordinate NES remote and rural activity.

In support of the workforce recommendations RRHEAL has established a number of projects to

ensure that appropriate educational solutions are provided. Successes include establishment of a

Practice Education Network; establishment of systems to identify needs on an ongoing basis;

developing Mental Health Crisis Intervention educational packages; and rural proofing the Child

Health Emergency Care Core Competencies. RRHEAL have also led the R&R radiography working

group to develop appropriate educational packages and are working with Boards to identify the

requirement for Assistant Practitioners in radiography. RRHEAL are also supporting research into the

acceptability and attractiveness of the hybrid GP.

E-health and Infrastructure

This has been one of the most difficult workstream to progress, but there has been progress. Most of

the capital infrastructure recommendations sit within NHS Boards and will be progressed as part of

the Board’s capital planning processes. RRIG has established a small group, chaired by the Clinical

Lead to better describe the clinical solutions that might be delivered by an eHealth platform and it is

planned to work with the Clinical Lead of the Care Pathways workstream and other clinical colleagues

to identify areas for action.

RRIG Sharing and Learning Exchange, September 2009

As many of the recommendations of Delivering for Remote and Rural healthcare are delivered within

NHS Boards, RRIG hosted an event in September 2009, to bring together colleagues from across

remote and rural Scotland, to share progress and identify those areas still to be addressed in the final

year of the project. The event was a real success and a full report is detailed in the Compendium of


40

Events, which accompanies this report and a revised workplan has been agreed by RRIG for the last

few months of the project.

The main priority, identified at the September event was Workforce and the fragility of the current

workforce, particularly but not exclusively the medical workforce. Changes to the way in which

doctors are trained, implemented after Delivering for Remote and Rural Healthcare was published,

are having a significant impact on the medical cover within the RGHs and it has been agreed that the

proposed medical model for these hospitals needs to be revisited. There are also revalidation and

skills maintenance issues for those hospitals where doctors from a primary care background provide

the cover. Two events are planned for March/April 2010, with a wider Workforce Summit to be hosted

in May 2010.

Scottish Neonatal Transport Service

The Scottish Neonatal Transport Service (SNNTS) is a nationally planned but regionally delivered

service, which is performance managed on behalf of all Scotland by NoSPG. Scotland is covered by 3

regional teams: North, East and West, with the North team further divided into two teams one from

Aberdeen and one from Dundee, who share the burden of call between the two sites. The regional

teams will also provide cross cover for each other if one team is out on call and another call is

required. The service prepares an annual report each year, which can be accessed through the

NoSPG web site.


National planning and regional delivery of the Scottish Neonatal Transport Service ensures that

trained and experienced dedicated teams are available 24/7 to transfer sick babies to the specialist

services that they need, no matter where this is in Scotland.

Scottish Neonatal Transport Review

In the 2008/09 Annual Report, it was reported that the Board Chief Executives across NHS Scotland

had asked that the Scottish Neonatal Transport Service be reviewed and a model of service delivery

that did not rely on the payment of allowances to Nurses that requires the continuation of a variation

Order. The Scottish Neonatal Transport Service is recognised throughout the UK and internationally

as an excellent model of service, which provides optimal care to the infants that it cares for. Since its

establishment in 2003, the service has transported over 8000 vulnerable infants. The review

considered a number of options for the future configuration of services, including proposals to


41

integrate this service with other retrieval services. It concluded, however, that the current model of

care was most likely to be sustainable and given the recruitment challenges facing these services,

deliverable. The current configuration also offered the best value for money of the options presented.

This Review was presented to Board Chief Executives in October 2009, who reluctantly accepted the

conclusions, on the understanding that a wider Review of Specialist Transport be undertaken,

involving all specialist Transport Services.

Scottish Neonatal Transport Service 2009/10

The increasing activity trends reported last year have continued throughout 2008/9, with 1525 babies

transferred in the period up to March 2009, however, current projections would suggest that this has

stabilised, with 1353 transfers projected to March 2010. The 2008/9 activity represented a 9%

increase in overall activity when compared to 2007/8. Within that overall increase, the number of

emergency transports increased by 22%, although fewer of these are defined as in the out of hours

period. The period defined as out of hours was changed in year to coincide with the staffed shifts and

is likely to be the main reason that the number of transfers during the out of hours30 period have

reduced. In the same period, the number of transfers by air doubled, particularly in the North. The

increases in activity have had a marked effect on the Scottish Ambulance Service, which is an integral

part of the service.

The Neonatal Transport Service continues to support a comprehensive education programme, with

many courses provided for local teams within their local area. Significant numbers have now

completed the pre transport and stabilisation course, with the Scottish Multiprofessional Maternity

Development Programme (SMMDP) Neonatal Resuscitation Course available for staff from referring

units, usually prior to the transport course. The Stabilisation Handbook has proved to be very

successful and has received plaudits from across the UK. The Advanced Stabilisation Course is a

success and a few modifications have been made following the initial pilot courses. All the courses are

accredited by either NES or Napier University and regularly assessed by external personnel. The

faculty for these courses is drawn entirely from transport personnel.

30 Out of Hours is defined as between 8pm and 8am Monday to Friday and all of Saturday and Sunday


42

Finance This section reports on funding of regional working and includes reports on funding of the NoSPG

Core team, which includes, the Director of Regional Planning & Workforce Development, the

Corporate Services Manager and administrative staff. The Regional Workforce Programme Manager is

also included within the core team, but unlike other staff is seconded to the team. There are also

sections on the Project specific costs.

NoSPG Funding by NoS NHS Boards

The funding of the core NoSPG team has been shared between the six NoS Boards since 2003,

although for a number of years, the full cost of the team has been offset by funding from other

sources, mainly Scottish Government. Through prudent management of these funds it has been

possible to offset the costs to NoS Boards by use of slippage, although it was also highlighted in the

2008/9 Annual Report that from April 2010, the full costs of the core team would be shared between

the Boards.

For 2009/10, the projected costs to be shared between Boards was identified as £147,601, exclusive

of some £156,200 of slippage. Table 2 below summarises the actual costs for 2009/10, which

represents a significant saving against the forecast, achieved through greater use of

videoconferencing to reduce travel costs and the decision not to host an annual event.

Table 2: North of Scotland Planning Group Regional Planning forecast expenditure

2009/10

£

Staff Costs 97,700

Non-pay costs 22,300

Total 120,000

The expenditure by NHS Board is summarised in table 3 below and includes Board contributions to

the core NoSPG team but not to project specific costs. These are reported separately below. In

2008/9 Board shares were reported by Arbuthnot share, for 2009/10, this has been updated to reflect

the move towards NRAC.


43

Table 3: Regional Planning Forecast Expenditure 2009/10

Arbuthnott Proposed Actual Forecast

by NHS Board % £ £

Grampian 35.8 52,841 42,960

Highland 25.8 38,081 30,960

Orkney 1.6 2,362 1,920

Shetland 2.0 2,952 2,400

Tayside 31.7 46,788 38,040

Western Isles 3.1 4,576 3,720

100 147,600 120,000

Workforce Development Funding

Allocations from Scottish Government ceased in 2007/8, however, in June 2008 NoSPG members

agreed that the remaining slippage should be used to offset the full costs of the NoSPG team and the

cost of the Regional Workforce Programme, to implement the Workforce Review. The costs of this

post were further offset through agreement with Scottish Government to combine this post with the

Regional Nursing Advisor post, with Scottish Government funding the post for 2008/9 and NoSPG

funding the post fully in 2009/10.

Table 4 summarises the available funding, committed expenditure and projected slippage.

Table 4:

Workforce 2009/10 £ £

Available funding

NES Allocation - Developing Workforce Capability 6,000

Funding b/f from 2008/09 216,232

222,232

Estimated Expenditure

Developing Workforce Capability 1,000

Regional Management & Admin 156,600

157,600

Slippage available in 2010/11 64,632

It should be noted that the workforce capability funding is ring-fenced and is not available for wider

use in NoSPG. The slippage will be used in 2010/11 to fund the salary of the Workforce programme

Manager, as per the current agreement until March 2011.

Regional Nursing Workload Advisor

This post has been funded since 2006 through monies allocated by SGHD, whilst funding for travel

and associated expenses has been funded by NoSPG since April 2007. During 2008/9, SGHD

proposed that these posts should be extended for a further year until 31st March 2010, but asked


44

Regional groups to fund all costs. The source of regional funding is primarily from NHS Boards and

whilst the posts were seen as valuable, Boards in the North could not identify the additional resources

required. Following discussion with the National Programme Manager and representatives of the

Nursing & AHP Directorate of SGHD, and following successful recruitment of the current Nursing

Advisor to the Regional Programme Manager post (see above), it was agreed to combine these posts

from October 2008, with the postholder undertaking both roles on a half time basis. It was further

agreed that SGHD would wholly fund the salary costs for this arrangement until 31st March 2009,

following which all costs would be borne by NoSPG. Expenses remain the responsibility of NoSPG.

In December 2009, however, Scottish Government agreed to extend the project for a further two

years and proposed to reinstate the half time funding for this post from April 2010 and there will also

be an allocation towards the cost of administrative support, not previously provided. Travel costs will

remain the responsibility of NoSPG. Table 5 provides a break down of the income and expenditure

over the last three years.

Table 5: 2009/10 2010/11 2011/12

NMWWP Programme £ £ £

Funding available 50,000 300,000

Slippage from previous year 150,500

50,000 300,000 150,500

Observation Studies 50,000 117,000 117,000

Project Manager (0.5wte) 32,500 33,500

50,000 149,500 150,500

Slippage carried forward to following year 0 150,500 0

The £50,000 for 2009/10 is ring-fenced funding to support the costs of workload tool development as

part of the national project.

Regional AHP Adviser

The Regional AHP Adviser left the regional post at the end of February 2009, to take up a promoted

post in one of the NoS Boards and was not replaced. In 2009, Scottish Government also announced

further funding for the AHP role, however, these funds were not transferred into the regional

allocation.

Regional CHD Service Improvement

The Regional Clinical Leader for Cardiac Services is funded by the Boards from recurring Waiting

Times funding. This was agreed in 2006, and in 2008, the current post holder was funded for a

further 2 years until September 2010.


45

The Cardiac Service Improvement Manager post was funded through allocation from the national

Waiting Times Unit, initially for a period of 2 years until September 2008. In June 2008, the Access

Support Team confirmed further funding for a period of three years until June 2011. The funding

allocation and utilisation is described in Table 6 below.

Table 6: REGIONAL CHD SERVICE IMPROVEMENT

2009/10 £

2010/11 £

2011/12 £

Funding available

SEHD Allocation 50,000 50,000

Slippage from previous year 59,580 42,723 24,323

109,580 92,723 24,323


Co-ordinator 58,000 62,000 31,600

Travel/Accommodation 6,000 6,000 3,000

Event 2457

Training 200 200

Misc 200 200

66,857 68,400 34,600

Slippage carried forward to following year 42,723 24,323 -10,277

It should be noted that the post was banded at Agenda for Change Band 8b, but funding was limited

to £50,000, unless otherwise agreed. Scottish Government have been asked to fully fund this post.

Child Health and Neonatal Transport Review Funding

Funding for the Child Health Programme Manager and the NoS Clinical Leader have been secured

through the National Delivery Plan for Specialist Children’s Services funds available over the last two

years and continuing in 2010/11. The North bid for these resources on a recurring basis and to date,

this has been agreed and is summarised in Table 7 below.


46

2009/10 2010/11 Table 7: Neonatal Transport/Child Health £ £

Funding available Contribution from Specialist Children's Services 110,980 113,180

110,980 113,180


Manager 62,700 61,000

Clinical Leader 28,480 28,480

Admin Support 5,900 12,000

Travel 6,700 6,700

Supplies 7,200 5,000

110,980 113,180

It should be noted that the Manager post is banded at Agenda for Change band 8b but the

postholder’s substantive grade is different. The Programme Manager also supports the Scottish

Neonatal Transport Service.

Child & Adolescent Mental Health Services (CAMHS) Funding

In March 2008, NoSPG sought funding from Scottish Government to scope a regional network for

Specialist CAMH services. In June 2008, SGHD confirmed £70,000 for three years from 2008 until

2011. The postholder took up post in January 2009 and will continue until December 2011.

2009/10 2010/11 2011/12

Table 8: Regional CAMHS Network £ £ £

Funding available

SEHD Allocation 70,000 70,000

Slippage from previous year 56,100 68,100 78,100

126,100 138,100 78,100


Manager 47,000 49,000 42,500

Travel 10,000 10,000 8,400

Supplies 1,000 1,000 700

58,000 60,000 51,600

Slippage available 68,100 78,100 26,500

In January 2008, further funding was identified for investment in specialist CAMHS services and

NoSPG secured £122,650 recurring funding from 2009/10, with £61,325 from SGHD funds, matched

by £61,325 shared between the NoS Boards. Table 9 summarises the position for 2009/10.


47

2009/10 2010/11 2011/12

Table 9: CAMHS Specialist Funding £ £ £

Funding Available

SGHD funding 61,326 61,326

Grampian 22,117 22,117

Highland 15,732 15,732

Orkney 1,020 1,020

Shetland 1,190 1,190

Tayside 19,373 19,373

Western Isles 1,894 1,894

Slippage from previous years 85,842 31,544

122,652 208,494 31,544


Project Team 31,000 61,200

Clinical Leader 28,750

Admin (band 4 0.5 wte) 5,810 12,000 6,100

Professional fees 75,000 25,000

36,810 176,950 31,100

85,842 31,544 444

It should be noted that the Clinical leader post has been funded for one year from slippage within the

project team. The Project team resource will be required in 2010/11.

Regional Oral Health and Dentistry Network

In 2007/8 arrangements were made to share the costs of the Oral Health and Dentistry project across

the North Boards. NHS Grampian had already funded 13 months of a secretary and it was agreed that

the other North Boards would share the balance with effect from 1st April 2008 until March 2010.

In addition, it was agreed that when the current funding for the Network Manager post ceased that

the Boards would share these costs until March 2010. This was effective from 1st January 2009,

although the travel and other expenses were shared from 1st April 2008. Table 10 summarises the

position.


48

2009/10 2010/11 Table 10: Oral Health & Dentistry Project £ £

Funding available

Regional income - Network Manager 74,800

Regional income - Secretarial Support 21,900

Slippage from previous year 12,246 8,221

108,946 8,221


Regional Manager 67,500

Support 21,900

Travel 6,800

Misc 500

Analysts Fees 4,025

100,725 0

Slippage carried forward to following year 8,221 8,221

This project has not been funded beyond this financial year.

Remote and Rural Funding

This is a national workstream led by NoSPG. In 2008/9, Scottish Government funded the programme

Manager and Support for two years until July 2010. Table 11 below summarises expenditure.

Table 11: Remote & Rural 2009/10 2010/11

£ £

Funding available

SGHD Allocation -Programme Management 110,000

SGHD Allocation - SAS Island Service 60,000

PWSI bid 4,500

Slippage from previous year 130,300 146,600

304,800 146,600


Co-ordinator 88,000 22,500

Admin Support 12,500 3,100

Travel/Accommodation 11,900 3,000

Training 2,300

Lead Clinician

Events & other expenditure 13,500 3,000

PWSI bid 30,000

SAS Island Service Consultation 115,000

158,200 146,600

Slippage carried forward to following year 146,600 0


49

Managed Service Network for Cancer Services for Children and Young People

In 2009, the Director of Regional Planning was asked to lead a process to establish a National

Managed Service Network for Cancer Services for Children and Young People. This is a pan-Scotland

initiative. Funding was provided through the National Delivery Plan for Specialist Services for Children

and Young People to appoint a Programme Manager for two years to support this development. In

addition, the Director has agreed with NSD to oversee the pan-Scotland funding allocations. This was

agreed as an SLA with NHS Tayside.

Table 12 below summarises the income and expenditure to date.

2009/10 2010/11 Table 12: MSN Children & Young People with Cancer £ £

Funding available

NSD Funding 45,900 698,144

45,900 698,144


MDT Co-ordinator 27,400 60,416

Support 4,900 11,450

Travel 2,500 10,000

Palliative Care - Paediatric Consultant 9,600 33,344

Misc (Equipment etc) 1,500

MSN Facilitation 9,000

Late Effects 120,112

Late Effects IT System 418,150

Teenagers & Transition 15,672

Audit & Trials 20,000

45,900 698,144

Slippage carried forward to following year 0 0

During 2010/11, it is planned that the MSN will be established and the governance arrangements,

including financial reporting may change.


50

Priorities for 2010-11

Cardiac Services

The Integrated Planning Group hosted an event, jointly with the NoS Cardiac Sub group in February

2010 to review the Regional Delivery Plan and identify priorities for the next five years. The priorities

include:

• Agree refreshed Regional CHD Plan with partner boards to reflect service developments and

future aspirations.

• Ensure service developments reflect national strategies31 and standards32 and are benchmarked

to ensure optimal and efficient service models.

• Engage with Primary care through local MCN networks and the Cardiac Sub group to promote

improved access and better outcomes for patients locally.

• Ongoing demand and capacity planning for cardiac services, Electrophysiology, Cardiothoracic

surgery, Optimal Reperfusion and Interventional cardiology to support continued sustainable

service delivery.

• Encourage robust referral pathways which utilise cardiology expertise across the NoS using

electronic support systems and telemetry, where possible.

• Ensure alignment of NoS patient pathways in order to meet the referral to treatment targets for

2011.

• Complete the business case proposal for Optimal Reperfusion Therapies for submission to

NoSPG and Scottish Government.

• Review cardiac catheterisation laboratory capacity across the North.

• Monitor and review the implementation of the Electrophysiology Plan.

• Progress a North of Scotland perspective on workforce planning to ensure cardiology expertise

is utilised across the NoS.

• Continue to review inter hospital transfer arrangements to propose solutions which are

acceptable to patients and service requirements.

• Identify and progress eHealth opportunities for improved referral and patient management.

• Consider new sustainable service developments and treatments that align with national

strategy, clinical standards and add value for patients.

31 (2009) “Better Heart Disease and Stroke Care: Action Plan” June 2009, Scottish Government, Edinburgh. ISBN 978-0-7559-8067-3 32

(2009) “Draft Clinical Standards for Prevention and Treatment of Coronary Heart Disease”, NHS Quality Improvement

Scotland, February 2009 (www.nhshealthquality.org)


51


Completion of the NDP bidding process has been all consuming for the NoS CHCP group over the last

three years. In 2010/11 there will be an ongoing requirement to monitor investment and

demonstrate the additionality achieved by this targeted investment. The CHCP have however had the

opportunity to stand back and have identified a number of other priorities for the coming year. These

are summarised in the table below.


Objectives for 2010/11 • Define a Children’s Service for the North of Scotland, which is not constrained by the Health Board Boundaries and

includes specialist services, secondary care and primary care.

• Ensure that the NoS NDP plan is fully implemented ensuring the evaluation process is supported appropriately.

Develop a model which ensures sustainability of paediatric Critical Care within the NoS, which links to NHS Board ECF

Groups.

• Develop an implementation plan for the establishment of obligate networks for child health.

• Develop a Regional approach to workforce planning at all levels, including regional appointments, where appropriate.

• Lead the development of models to support the provision of remote and rural paediatric care.

• Develop a network for the provision of paediatric Surgical Services in the North, including the implementation of the

nationally developed care pathways.

Regional Approach to Child & Adolescent Mental Health The Project Board has plans in place to restructure Project management arrangements to support the

development of the Outline Business Case. It is expected that during 2010 the OBC plans will be

refined and presented to NHS Boards for consideration in early 2011. Through the Service Modelling

and Workforce Development Group plans for integrated care pathways, the establishment of an

Obligate Network and the supporting planning required for the OBC will be progressed.

Regional Secure Care project

The top priority for the Regional Secure Care project is to achieve Financial Close before 31 March

2010. Thereafter, we look forward to the first sod being cut and to building work getting underway

at last. The contractor, Taycare, will start on site about 4 weeks after Financial Close and we will all

make the transition from discussing the detail on the drawing board to monitoring the construction,

which is expected to take two years. The Addendum to the FBC will be presented to the NoSPG

Boards once it is complete and we will continue to ensure that the Boards are provided with regular

updates on progress.


52

North of Scotland Public Health Network

NoSPHN will continue to progress ongoing developments from the 2009/10 workplan and develop

new requests for work as appropriate including:

• Ongoing support to the evaluation of the Specialist Child Health Service programme.

• Reviewing and advising on bids submitted for designation as national services for 2012.

• Advising and supporting NOSCAN in the development and implementation of agreed objectives,

scoping the support needs for the Breast Cancer Service review, further horizon scanning for new

technologies and assessing health improvement opportunities.

• Further supporting collaborative approaches to Drug and Therapeutics across the NoS.

• Supporting NoSPG / NHS Boards in response to the national Remote and Rural Implementation

plan

• Public Health support to the Bariatric Surgery and Obesity Management Services review.

• To support the Cardiac Services Network and scope the health information support needs for the

regional delivery plan.

• To organise professional development opportunities including an event focussed on Public Health

and Planning (May 2010).

• Implementing and evaluating the Well North anticipatory care programmes.

• To deliver an agreed programme of regional and national public health activities.


Following the RRIG Sharing and learning Event in September 2009 a new workplan for the final six

months of the project has been developed by RRIG and approved by both NoSPG and Scottish

Government.

The priorities for the final stages of the project include:

• Reviewing the R&R workforce model, particularly the medical workforce, to develop a

sustainable model for the future and hosting a Workforce summit in May 2010;

• Refine guidance on the role and function of the Extended Community Care Teams;

• Publish Acute Hospital Care pathways for common conditions;

• Refine IT functionality requirements to support Care pathways;

• Implement Scottish Government decision for the Emergency Medical Retrieval Service;

• Ensure launch of Strategic Options Framework; and

• Agree and progress an appropriate exit strategy for RRIG.


53

Financial Commitments Each year an estimate of the projected costs to be shared between NHS Boards are provided at the

end of the Annual report. Table 13 describes the projected expenditure for 2010/11. This continues to

include a small amount of off-set for the Workforce Programme Manager post, which will reduce costs

overall. Given the decision by SGHD to offer half time funding for the Nursing Advisor aspect of this

post, it will allow the Workforce Programme to continue for a further year until March 2012.

Table 13: 2010/11 Regional & Workforce Proposed Structure

Workforce £

Regional £

Director 98,900

Corporate Services Mgr 47,100

Programme Director 66,600

Admin support 22,800

PA Support 22,300

Office support 9,000

Travel 15,000

Event 15,000

Misc 10,000

66,600 240,100

In June 2008, NoSPG agreed that the full costs of the NoSPG team would be met wholly from Boards

from April 2010. The following table (14) summarises the commitments for NoS Boards for 2010.

Table 14: NoSPG Costs by Board Shares NRAC

Grampian £89,917 37.45%

Highland £59,977 24.98%

Orkney £4,058 1.69%

Shetland £4,346 1.81%

Tayside £75,632 31.50%

Western Isles £6,171 2.57%

£240,101 100.00%


54

North of Scotland Planning Group Contacts

Mr Richard Carey (Chair) Chief Executive

NHS Grampian Summerfield House

2 Eday Road

Aberdeen AB15 6RE

Tel: 01224-558508

[email protected]

Miss Sandra Laurenson Chief Executive

NHS Shetland Brevick House

South Road

Lerwick Shetland ZE1 0TG

Tel: 01595-743063

[email protected]

Mrs Cathie Cowan Chief Executive

NHS Orkney Garden House

New Scapa Road Kirkwall

Orkney KW15 1BQ

Tel: 01856 888223

[email protected]

Dr Roger Gibbins Chief Executive

NHS Highland Assynt House

Beechwood Park Inverness

IV2 3HG

Tel: 01463-704838

[email protected]

Mr Gordon Jamieson

Chief Executive NHS Western Isles

37 South Beach Road Stornoway

Isle of Lewis

Tel: 01851-708005

[email protected]

Prof. Tony Wells

Chief Executive NHS Tayside

King’s Cross Clepington Road

Dundee DD3 8EA

Tel: 01382-424049

[email protected]

Dr Annie Ingram

Director of Regional Planning & Workforce Development

NoSPG Office

King’s Cross Clepington Road

Dundee DD3 8EA

Tel: 01382-527977

[email protected]

www.nospg.nhsscotland.com


55

North of Scotland Planning Group Structure

North of Scotland

Chairs and Chief Executives Group

North of Scotland

Planning Group – Executive Group

(NoSPG)

Medium Secure Care Clinic Project

Eating Disorders Network

NOSCAN

Public Health Network (NoSPHN)

Cardiac Services Network


Scottish Neonatal Transport Service

CAMHS Project Board

NoS Oral Health and Dentistry Project

Bariatric & Obesity Management


North of Scotland

Medical Directors Group

North of Scotland

Integrated Planning Group

North of Scotland

Nurse Directors Group

North of Scotland

Workforce Planning & Development Group

APPENDIX 2NORTH OF SCOTLAND

PLANNING GROUP

COMPENDIUM of NoS EVENTS2009/10

March 2010

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

2

Introduction

This Compendium of NoS Events is a report which summarises the range of events that have taken

place, under the auspices of the North of Scotland Planning Group (NoSPG), over the last financial

year (2009/10). The Framework for Regional Planning1 requires regional planning groups:

‘…to host an annual event to agree the regional agenda for the year ahead and longer term

priorities for action’. 2

Since 2004, NoSPG have hosted a number of successful Annual Events: in March 2004, May 2005,

November 2006, October 2007 and October 20083, which have informed the current workplan. The

workplan, which has 17 high-level objectives and a range of sub-projects and workstreams, has

remained more or less the same, although the initiatives taken forward within each objective have

evolved and changed over time. Latterly, NoSPG events have concentrated on limited aspects of the

regional agenda or cross-cutting issues that impact on all regional projects. All of the sub-projects

have also hosted specialty or project specific events in addition to the planned annual event.

Engagement across the wider stakeholder groups within NHS Boards, particularly non-Executive

engagement is an important aspect of the annual event and this has allowed NoSPG to develop more

robust governance structures through which the collaborating NHS Boards can be assured that the

work taken forward on a regional basis is appropriate to the agenda of individual Boards and linked to

Boards processes and procedures. An Annual Report is presented annually to Boards and Scottish

Government and the workplan is subject to the approval of all Boards each year.

Given the limited changes to the overall workplan, the significant number of specialty and project

specific events held during the year, and mindful of the financial climate, it was proposed to both the

NoSPG Executive4 and the NoS Chairs and Chief Executives Group5 that rather than host an annual

event for 2009/10, that a compendium of these specialty or project specific events be prepared and

presented to the collaborating NHS Boards. This was agreed and the following sections describe the

wide range of events that have been hosted under the NoSPG banner during this financial year. Full

progress against all workplan objectives will be reported in the Annual Report.

Dr. Annie K IngramDirector of Regional Planning & Workforce DevelopmentNorth of Scotland Planning Group

March 2010

1 HDL (2004) 46 “Regional Planning” 13th December 2004, Scottish Executive, Edinburgh2 Ibid, Annex 1, para 2.23 All event reports can be found on the NoSPG website at www.nospg.nhsscotland.com4 NoSPG Executive membership includes Board Chief Executives and one other nominated representative from Boards, theRegional Director, representation from NES, NoS Medical and Nurse Directors, National Services Division and SGHD.5 Membership includes the Chairs and Chief Executives of all six NHS Boards, supported by the Regional Director.


3

Index Page

NoS Clinical Planning Groups

NoS Cardiac Services Sub-group18th June 2009

4

Child Health Clinical Planning Group27th October 2009

5

North of Scotland Secure Care Clinic – Stakeholder Day28th August 2009

8

Obesity Management including Bariatric Surgery15th December 2009

9

Regional Networks

Oral Health Network24th November 2009

11

NOSCAN5th March 2009

13

NoSPG Specialist Planning Groups

Regional Workforce Event15th June 2009

15

Medical Workforce Event3rd July 2009

17

National Initiatives led by NoSPG

Remote and Rural Event1/2 September 2009

19

Conclusions 22


4

NoS Clinical Planning Groups

NoS Cardiac Services Sub-group18th June 2009

The Regional Delivery Plan for Coronary Heart Disease 2006-10 describes how, working regionally,

five of the Boards across the North6 aimed to plan and deliver services in a way that will seek to

reduce the burden of coronary heart disease (CHD) to the benefit of patients in the North. The

current plan aims to strengthen the care provided within communities, working through the local

MCNs but recognised that where intervention is required, these should be planned and some

delivered on a regional basis for the benefit of the people living in the North.

Specific plans included improving access to services, investment in a regional infrastructure and

support for local and regional investments. The plan sought to increase the number of interventional

cardiac catheter laboratories across the North and this has largely been achieved, with increased

capacity in Aberdeen, Dundee and from 2010, in Inverness. Plans to improve access to specialist

services, through a regional approach, such as electrophysiology have been progressed, including the

appointment of a regional EP consultant to take forward planned development and improve capacity

for enhanced regional and local service delivery have also bee progressed.

In 2009, Scottish Government published a new strategy for CHD7, which continues to see the regional

approach as an important aspect in the delivery of CHD care. Included in the priorities identified for

regional overview is consistency in the approach to Optimal Reperfusion Therapies; the importance of

investing in cardiac rehabilitation and heart failure services within NHS Boards, linked across regions;

continuation the regional approach to interventional cardiology; and the potential to develop

Percutaneous Aortic Valve Replacement/Transcatheter Aortic Valve Implantation (TAVI) services,

initially on a national basis, with the potential to develop regional models in the future, whilst

recognising that there is benefit in developing national and regional methodologies to manage the

implementation of new and emerging technologies. Other recommendations include a common

approach to audit and patient management through SCI-CHD Acute Coronary System with regions

encouraged to implement and use this systems across board areas.

A one day planning event for heart services health professionals across the North of Scotland, held in

June 2009, aimed to identify current and future service requirements, over the next 3-5 years,

concentrating on Optimal Reperfusion Therapies (ORT); Nurse and AHP led services, particularly

6 NHS Western Isles link with the west region for cardiac services, however there is some evidence of western isles patientsbeing referred to Raigmore for outpatients and angiograms, suggesting the potential that patient flows may change followingthe establishment of interventional capability in Inverness.7

(2009) “Better Heart Disease and Stroke Care Action Plan” June 2009, Scottish Government. Edinburgh. RR Donnelley B60795

06/09 ISBN 978-0-7559-8067-3


5

cardiac rehabilitation and heart failure services; and vital links including transport. Participants also

considered new and emerging technologies, including device closures and TAVI to determine what

best might be provided on a regional basis or within Boards but as part of a wider regional or national

network. A key requirement for all services is achievement of the Government guarantee to patients

of a whole journey pathway of 18 weeks from GP referral to treatment for all by December 2011 and

the implications that this would have for plans for CHD services.

The day was well attended with 48 colleagues from across the North and from Scottish Ambulance

Service participating in the event. It was clear that a revised Cardiac Delivery Plan is required that

updates the existing plan and identifies the agreed priorities between 2010 and 2015. The output

from the day identified a number of the key service requirements, including the need for a clear ORT

plan for the North, which would, given our geography, be a mixed model that includes primary

Percutaneous Catheter Intervention (PCI) and pre-hospital thrombolysis (PHT); the need for a

transformational approach to redesign that will optimise the use of all of the available capacity in the

North; a clear process for horizon scanning of emerging technologies, although there was general

agreement that where there are small numbers of potential cases, such as for TAVI, the approach

needed to be progressed at an all-Scotland level.

The regional approach to planning and delivery of cardiac services has been recognised as one of the

real successes for regional working in the North and this was attributed to the strong collaborative

working between partner Boards. It was recognised that the output from the day would require

refinement and to be included within the wider strategic direction of cardiac services across the North

and a further day is planned for February 2010.

Child Health Clinical Planning Group27th October 2009

In 2008, Scottish Government announced significant funding to be allocated over three years, on a

regional basis, to improve specialist services for children. In 2008/9 and 2009/10, the North, in

common with the other regions and a number of Special NHS Boards submitted bids for investment.

The event hosted by the Child Health Clinical Planning Group, in October 2009, aimed to develop the

North of Scotland bid for 2010/11, which is the final year of funding. In addition, the event

considered what the future workplan of the CHCP should be and how the group might approach the

workforce challenges currently being experienced by paediatric services across the North.

National Delivery Plan

The National Delivery Plan (NDP):

“… Establishes a national infrastructure for the sustainability of specialist children’s services inScotland, not just in the specialist hospitals but also in District General Hospitals and in the


6

community. It identifies work that needs to take place at a national and regional level tosustain and develop services, drawing down the additional £32M committed over the 3financial years.”8

The NDP has identified a number of areas for investment at both a pan-Scotland and regional level,

including:

Oncology Services; Cystic Fibrosis; Rheumatology; General Surgery of Childhood; Inherited Metabolic Disease; Gastroenterology; and Child and Adolescent Mental Health.

This final priority received investment through top-slice funding and is managed separately from

these other services. A number of other services have also been identified for investment in 2010/11,

at either a pan-Scotland or regional level, and regional groups were asked to consider these.

North Scotland - Year 1 and Year 2 investment

The following table summarises the areas of investment by the North Boards in 2008/9 and 2009/10.

In addition, the North bid included specific investment to support access to services within remote

and rural areas and non-pay costs.

NoS Regional Investment NoS Investment in Services Planned on a Pan-Scotland Basis

Regional Infrastructure Neurology network General Surgery network Gastroenterology network

Metabolic Complex respiratory/Cystic Fibrosis Oncology Rheumatology

When combined year 1 and year 2 recurring investment is £1,871,957. The recurring investment is

dependent on the regions being able to demonstrate added benefit to patients and the CHCP has

worked with the NoS Public Health Network (NoSPHN) over the last two years to develop ‘The Logic

Model’, which will demonstrate the impact and added value to North patients of the investment.

2010/11 Priorities for the NoS NHS Boards

Investment over the last two years has aimed to target investment to sustain or improve particular

specialist services. This has often meant, however, that the proposed investment is a very limited part

time post, for example, 0.2wte of an AHP to support Cystic Fibrosis (CF) services in Aberdeen. Such

posts have proven very difficult to appoint to and the intended benefit has been difficult to realise.

8 Better Health, Better Care – National Delivery Plan for Children and Young People Specialist Services in Scotland – January2009 – ISBN- 978-0-07559-5879-


7

16 proposals had been prepared in advance of the October event, many aimed as before at small

levels of investment in specific services, however, there were also some proposals that aimed to

invest across professional disciplines to the benefit of a range of specialist services. In the North, the

core paediatric service is built from a strong general paediatrics base, with some staff having special

interest in a number of related sub-speciality areas. Following discussion on criteria for prioritisation,

it was concluded that whilst investment should continue to support the specialist services, this would

best be done through more general investment in each of the mainland Boards in Allied Health

Professionals, Nursing, Psychology, Pharmacy, Technical staff and Medical sessions. Such an

approach would allow Boards to recruit to whole posts, enable improved training opportunities and

allow succession planning to be taken into account. It was agreed that within the general approach

those specialist services that would take priority would be nephrology, respiratory medicine and CF,

rheumatology, allergy, gastroenterology and neurology.

The group did agree that there was also a need for specific investment in Critical Care, General

Surgery of Childhood and Child Protection. Investment to allow access to services in remote and rural

areas was again identified as an important element of the bid.

Future Workplan for North of Scotland Child Health Clinical Planning Group

The current role and remit of this group is to:

Lead work in relation to the National Review of Child Health Services; Develop a strategy for children’s services in the North of Scotland; Implement the regional aspects of the Emergency Care Report; Take a lead on the implementation of rural paediatric issues; Undertake workforce planning on behalf of Child Health Services; and Develop and performance manage regional managed clinical networks and child health; Develop a Child Protection Network, which supports local clinicians.

Participants took the opportunity to review the challenges facing the region and to consider what

should be included within the future workplan and it was proposed it should include:

Cross-boundary working, particularly in relation to ensuring a sustainable model forsecondary and tertiary care.

Standards: Development of clinical standards to ensure consistent approach across theregion or development of a regional approach to the use of national standards Trainingacross a range of areas, both informal and formal training.

Remote and rural (mainland health boards supporting island boards). There is a need toexplore the development of obligate networks for child health.

Workforce issues, including employment issues across boards. Audit: Establishment of mechanism to under take regional audits. Electronic access across boards to medical records, labs; etc. Need national IT strategy- same equipment, system and data.

A revised workplan is in preparation.


8

North of Scotland Secure Care Clinic – Stakeholder Day“From here to Rohallion”28th August 2009

National guidance and legislation have been key drivers behind the plans for re-provision and

expansion of existing NHS Tayside low secure services and the establishment of a regional medium

secure care service, providing for the populations of Tayside, Grampian, Highland, Orkney and

Shetland NHS Boards.

The implications of the planned developments for staff are likely to be wide ranging with managing

the transition, from where we are now, to where we will be in a very few years time, a major task. As

well as changes in the physical accommodation at Murray Royal Hospital, there will be changes for

people, in terms of new, additional staff, new team configurations and relationships expanding

beyond the NHS Tayside boundaries. There will be associated changes in the way the service will

operate including new processes in the way staff work, new standards and new leadership and

management structures.

As part of managing such a transition it was agreed to hold an initial, one day Staff Stakeholder

Event, with objectives for the day being to:

present the design plans for the SCC buildings; understand the context of the developments and why change is needed; improve our understanding of what will change; and help identify what must be preserved.

The event was open to all members of forensic multi-disciplinary teams and all grades of frontline

staff, working in the low secure forensic services and IPCUs in the North of Scotland. The event was

seen as the first stage in an ongoing process to keep staff informed and involved in the journey

“From Here to Rohallion”.

The Event

Invitations went out to service managers and clinical leads involved with in-patient forensic services

within Highland, Grampian and Tayside. A total of 46 staff attended the day. Understandably, the

majority of clinical staff (30) were from Murray Royal Hospital, with 6 from Grampian, 4 from

Highland. The range of staff attending included; Nursing Medical, Occupational Therapy, Psychology,

Social Work, Pharmacy, Dietetics, Podiatry, HR, Administration, Secretarial and Management.


9

The Programme

The day included presentations on the policy context; how regional working would impact on delivery

of care in the clinic; the role of the regional Forensic Network and the design of Rohallion, followed by

group discussions that concentrated on:

What is the service likely to look like in the future? What opportunities & challenges lie ahead for staff? Given what we know now, are new skills required? What hopes & aspirations do you have for role development? How do we maintain & look after the current staff? What ideas do you have about recruiting new staff?

Outcome

General feedback on the Stakeholder Event was positive. The feedback from the group discussions

demonstrated clear consistency between the groups, with comments overwhelmingly positive, but

also realistic.

A workforce development action plan is being developed, which will identify specific tasks and lead

responsibilities. In taking forward these tasks, many of the staff who attended the Stakeholder Event

will be asked to contribute further.

Obesity Management including Bariatric Surgery15th December 2009

In 2007, five of the NoS Boards: Grampian, Highland, Shetland, Orkney and Western Isles, agreed a

Service Level Agreement (SLA) for the provision of Bariatric surgery service, based on the surgical

service provided in NHS Grampian. NHS Tayside re-established a surgical service in Dundee for

Tayside patients and did not participate in the agreement.

The planned activity was for 40 procedures per year and the fixed and variable costs were shared by

the five participating Boards.

It was acknowledged early in 2009 that the capacity within the service is insufficient to cope with

demand both in the North and across Scotland as a whole. Indeed the recently established National

Planning Forum discussed Bariatric surgery on the 22 July 2009 emphasising that any national work

should be underpinned by regional experience, views and input.


10

NoSPG had already agreed at the meeting of 10 June 2009 to establish a short-life working group to

review the position across all six NHS Boards in the North, develop proposals for the future and

influence the national discussion.

A NoS workshop to discuss bariatric surgery in the context of wider obesity management strategies

was held on 15 December 2009, attended by 28 representatives from 4 of the 6 NoS Boards9, the

outcome of which was:

An overwhelming desire from the 4 Boards represented to work together to provide a bariatricsurgery service as part of integrated obesity management services across the North.

Discussion focused on surgical services delivered in two centres, Aberdeen and Dundee as partof a Regional Managed Clinical Network.

The establishment of a formal bariatric surgery/obesity management sub-group of NOSPG wasproposed in order to plan and implement the regional network and manage the interface withany national initiative.

The need for a structure and processes for regional delivery of these services irrespective ofany national initiatives or network was stressed.

The sub group would establish the scope and terms of reference for the regional network,particularly the extent to which the network would focus on surgical interventions and widerobesity management pathways and strategy.

The sub group would commission a more robust and detailed analysis of demand and capacity. The sub group would develop a single, surgical pathway and ensure that this is fully integrated

with wider obesity management pathways. The sub group would agree the criteria for access to surgical interventions in the NOS. The sub group would develop a workplan for the network. The sub group would lead the NOS input to any national discussions. The sub group should be chaired by a member of the NOSPG pending development of a

network and establishment of the usual leadership arrangements. The sub group would produce a first draft regional delivery plan by July 2010 following the

model developed by NOS Cardiac Sub Group/Network, including activity projections andresource implications.

The existing SLA should remain in place pending production of the Regional Delivery Plan whichshould include proposals to clear the significant backlog.

Lead managers from each Board have been asked to nominate representatives for the subgroup,

Proposals were submitted to NoSPG in February 2010 and approved.

9 Tayside, Highland, Grampian and Shetland


11

Regional Networks

Oral Health Network24th November 2009

In November 2007, NoSPG approved a proposal to adopt a regional approach to service delivery of

oral health and dentistry services and identify opportunities where regional working would improve

the patient experience and contribute to workforce solutions. The aim was to develop a sustainable

model of dental care that addresses the needs of North patients. Following a detailed needs

assessment, a number of stretching objectives for the project were established, broadly related to the

main secondary care sub-specialty services within Oral Health and Dentistry, including Oral and

Maxillo-Facial Surgery; Orthodontics and Restorative Dentistry. There were also a number of cross-

cutting objectives identified including workforce and the use of technology.

The event in November 2009 was the second event hosted by the project and aimed to:

explore opportunities for collaborative working across the North of Scotland;

showcase models of good practice and innovation of collaborative working; and

raise awareness of national initiatives with regard to the 18 week standard for dental

specialties.

The event was attended by 52 colleagues from across all of the North, other regions, NHS Education

for Scotland, the Universities of Aberdeen and Dundee and Scottish Government and was hosted in

the new Aberdeen Dental School. Progress across all areas of the project was noted, with particular

emphasis on the potential for integration between primary and secondary care, the emerging

potential of eHealth to support orthodontic care, and how to better plan for workforce challenges.

Participants also considered in detail how the care pathways for each sub-speciality area might be

improved.

It was concluded that for the future:

Building networks and working together is key to the ongoing success of the project.

Use of the capacity and demand modelling as a lever for change.

Further work around demand and capacity across the pathway as a whole was required and

that this would require board ownership, built from the bottom up.

Workforce is a major issue and needs to be fed into the demand and capacity work.

Data and functionality of systems needs to support achievement and monitoring of the

pathway, but needs national solutions.

There remain a number of challenges still to be addressed. These are summarised in the table below:


12

Oral and Maxillofacial Surgery

Establish a regional service for oral and maxillofacialspecialties in head and neck cancer and trauma

Achieve the level of agreed establishment for OMFS surgeonsagreed across the NoS and progress plans to establish theNetwork.Identify agreed clinical pathways, including identification ofcentres of excellence to improve outcomes in sub-specialtyareas, particularly cancer.Develop education packages to support earlier detection oforal cancer within primary care.Achieve SIGN guidelines.Improve health promotion.

A Regional Service should be established for trauma andemergency care for the North of Scotland. This should besupported by a Regional on-call rota.

Establish how this would work, in collaboration with widerstakeholder and develop plans to implement.Implement process of audit and review to improve outcomes.

Orthodontics

Implement a regional MCN for orthodontics, to include tele-orthodontics, to support the needs of the North and thedelivery of service locally.

Establish regional MCN for Orthodontics to review referralprotocols and care pathways, including identification of areasfor standardisation to improve equity.Work with primary care to review referral pathways, usingspecialist orthodontic practitioners, where appropriate andavailable.

Implement a trial of Phase I and Phase II of the e-Orthodontic Strategy – proof of concept.

Identify funding to support trial and complete functionalspecification. And progress using agreed project managementmethodologies.

Restorative Dentistry

Establish a regional service for restorative dentistry on thebasis of the assessment of need.

Scope regional requirement, including capacity and demandand develop proposals to achieve 18 weeks RTT.Agree and implement unified care pathways that will improveoutcomes and equity.

All Specialties

A “tiered” approach to service delivery should be designedand implemented to ensure that only that activity that isabsolutely specialist in nature is referred to specialistservices.

Establish project to develop and implement an intermediatetier of service provision by supporting the role of dentists witha special interest.

Agree and establish core data sets for all dental specialtiesacross the NoS

Encourage consistent use of specialty codes within secondarycare and record and monitor care in other sectors.

Aberdeen Dental School

Work across the region with NHS Grampian on establishingthe dental school for the North of Scotland.

Ensure Outreach Teaching and Future Centres for trainingtake account of the needs of all NoS Boards.

National Initiatives

Ensure that the recommendations of the National Task andFinish Group for Dentistry are communicated to NoS Boardsand implemented.

Ensure understanding and appropriate use of clock stop/startprinciples for dentistry in all NoS Boards.Ensure that clinical outcome coding for dentistry isestablished in all NoS Boards.Continue to work with ISD and the 18 week Improvementand Support Team to identify, agreeCore data sets for dental procedures carried out in secondarycare. Implement same in NoSBoards.

These challenges will form the foundations of a workplan for Oral Health and Dentistry for the year

ahead, 2010/11.


13

NOSCAN

5th March 2009

Better Cancer Care – a northern approach

The launch of Better Cancer Care, in 2008, and the establishment of the Scottish Cancer Taskforce

Group, in 2009, is a measure of the government’s ambition to improve the experience of cancer

throughout Scotland. NOSCAN exists as a regional configuration, not a department, to work together

to support and embrace such policy.

NOSCAN held its 5th Conference in March 2009, bringing together around 130 healthcare

professionals, management colleagues, representatives from charitable organisations, government

colleagues, representatives from the medical supplies industry and members of the public. The event

was jointly Chaired by Dr Chris Goodman, Consultant Urologist, Ninewells Hospital, Dundee and Mr

Peter King, NOSCAN Lead Clinician and General Surgeon, Aberdeen Royal Infirmary. The event was

opened by the NOSCAN Chair, Mr Richard Carey, who is also Chief Executive for NHS Grampian.

Aim of the event

The aim of the conference was to bring together the partner Boards that make up the North of

Scotland Cancer Network to reflect upon cancer care across the north and options for future direction

for improving cancer prevention, care and end of end of life management on a regional basis.

The programme covered some of the broad challenges facing the NHS, and therefore cancer,

including: emerging public health challenges, such as obesity and the associated rise in cancer

incidence; developments in palliative care in Highland; supporting remote and rural hospital working

and the need to have a deliverable regional plan to support such developments. There was also

opportunity to reflect upon progress around some of the nationally coordinated cancer network

services; progress around eHealth to support delivery of care and changes to existing waiting times

performance measures set for the NHS Boards through Better Cancer Care. The programme also

included horizon scanning of emerging drug treatments and finally the importance of having strong

and clear clinical leadership to help guide the delivery of cancer services in the future. Break out

sessions allowed for focus on how to improve engagement with the public in service planning,

improving the effectiveness of the tumour specific MCNs, identification of the educational priorities to

enable improved care delivery and finally, how to achieve more effective engagement with clinical

staff and their teams to improve regional delivery.

Outcome


14

The cancer network team will be firming up its efforts to support the delivery of regional wide

working through improved linkage of operational services, clearer understanding of the regional wide

priorities and ensuring the availability of information that enables planning and delivery of services.

A workplan for 2010/11 is in draft form and will be agreed by NoSPG at its April meeting.


15

NoSPG Specialist Planning Groups

In addition to the Clinical Planning Groups established by NoSPG, there are also a number of

Specialist Planning Groups that support the process of regional working across disciplines. The events

hosted by some of these groups during 2009/10 are described below.

Workforce

A Workforce for the Future - Regional Workforce Planning and Development in the Northof Scotland15th June 2009

The North of Scotland Workforce Planning and Development Event held on 15th June 2009, aimed to

reinvigorate the regional approach to workforce between the six Boards. This event brought together

a specific group of individuals, including Directors of Human Resources, Workforce Planners, Regional

Project Managers and representatives from Nursing, Medical, Allied Health Professions, Partnership,

Strategic Planning and Education. The event was held in the Centre for Health Science, Inverness and

participants were invited on an individual basis. In total, 35 attended from across all NoS Boards.

The need for the Event arose from a desire by the Boards to better understand the links between

national, regional and local workforce planning and development in order to improve engagement and

to develop more effective ways of working as a region. There was also a wish to develop a shared

understanding of the wider NoSPG Workplan, the challenges of working regionally and consider the

opportunities that a cohesive north region approach would bring.

The event aimed to develop a consensus about how to move the regional agenda forward, in a way

that fosters agreement and understanding, reduces duplication, identifies how and where there would

be added value in working collaboratively and how this would benefit regional projects and

collaborating NHS Boards. An agreed remit for regional working, supported by agreed systems of

communication, to underpin a co-ordinated approach across the north region that builds intelligence

in workforce issues across the north to the benefit of Board and regional initiatives was sought; along

with agreement on the necessary structures and processes required to make this happen.

A Workforce for the Future

Following presentations that considered the regional approach, the Workforce Review undertaken in

2007 and a perspective from NES, there were workshop sessions that focused on what helps and

hinders regional working; what success might look like and how that might be measured; and finally

what structure was required to take regional working forward. The focus for the discussion included,


16

ways of working, communication processes, structures that would need to be in place to support

regional working, to consider what is the added value, and how to move forward.

Workshop One identified the key challenges for regional working as communication, capacity and

responsibility and accountability. Communication was identified as the greatest challenge. There was

a need to know what was happening across the north, in order to develop a wider understanding of

the issues, workplans and projects, and the priorities and the sense of direction at Board, regional

and national level. Capacity was a concern, both at operational and strategic level, particularly on the

impact regional working may have on the individual within Boards. There were positive views about

having a regional resource in place, which was recognised as the route through which there would be

more involvement and engagement in regional working. A need for a workforce group in the north

was identified as workforce issues were acknowledged as the key challenge for sustainability of

services in the north region.

Workshop Two produced a consensus that success would be recognised by an appropriate structure,

with defined ways of working and clear lines of authority, responsibility and accountability in place;

improved communications that identify how and where, each Board fits within the regional picture

and the specific regional projects. A mixture of solutions were generated with both bottom-up and

top-down approaches, which would encourage sharing, learning and development of regional

solutions; and improved collaboration with education to support the sustainability and delivery of

services across the north region.

Workshop Three reached agreement on a collective accountability to find ways to work together to

support regional working. The need for a multi-professional regional workforce group, to support the

work of the North of Scotland Integrated Planning Group (IPG), was agreed.

The added value in working regionally, where appropriate, was the driver for redesign of services and

workforce and promoting culture change in order to sustain services.

Outcome

Six key priorities were identified. They were:

1. A Regional Workforce Group should be established.

2. A Regional Workforce Plan will be produced that defines the unique differences between

Board and Regional workforce planning, and clearly identifies the added value of taking

this approach.


17

3. Key workforce priorities identified within the 17 high level objectives in the regional work

plan, taking cognisance of how to better integrate regional and Board workforce

priorities, to allow the individual Boards to focus on what are the key priorities for them.

4. Key workforce priorities identified within the Remote and Rural Programme.

5. Ensure high level workforce structural sustainability.

6. Future training needs to be developed on a shared training and best value model

approach.

Medical Workforce Event

3rd July 2009

Since November 2008, NoSPG have debated the emerging challenges facing the medical workforce

across Scotland in general, and facing the North of Scotland Boards, in particular. Following a

detailed discussion in February 2009, members agreed that the NoS Medical Directors Group should:

1. Develop a set of proposals, in collaboration with the North and East deaneries that considers the

interfaces between NoS Boards and the potential to change service design to sustain services

through a different approach e.g. Elgin and Raigmore. This should include a review of rotas

with vacancies to consider how this might be addressed through changes to training

programmes, workforce design and Working Time compliance.

2. Bring recommendations to NoSPG that considers the necessity of 24/7 services, role of

telemedicine and how these might be sustained through a different approach.

In June 2009, the Scottish Government published guidance10 that required Boards to complete an

assessment of the projected medical workforce within a number of priority specialties of Emergency

Medicine, Acute Medicine, General Surgery, Trauma & Orthopaedics and Anaesthesia by the end of

September 2009. This assessment was required to take account of projected reductions11 in the

number of doctors in training. Obstetrics, Paediatrics and Acute Psychiatry were also identified as

priorities for some hospitals. All other specialties were to be reviewed by the end of November 2009.

A one day event was therefore held on 3rd July 2009 to help participants work through the guidance

and to develop an initial understanding of where a regional approach would add value. Around 30

colleagues from across the region attended the event.

Aim of the event

10 CEL 28 (2009) ‘Reshaping the Medical Workforce: Guidance on projecting future medical requirements within the clinicalworkforce’11 Projected reductions were of 25% in ST 1 and 2 doctors and 40% for doctors at ST 3 and above.


18

The aim of the event was to:

1. Develop a plan that will support the government policy requirement to reshape the medical

workforce.

2. Identify opportunities and/or requirements to redesign, particularly but not exclusive, where

these have interface issues between Boards or need a solution that goes beyond a Board;

3. Identify the necessary 24/7 services and develop a range of scenarios to sustain these for the

future;

4. Define what trained doctor requirements there are in the North and develop plans to assure

that that this can be met, including how the other professional groups might help;

5. Develop next steps and agree actions to be taken forward.

Participants debated the national context in which the exercise was taking place, considered how the

guidance would be implemented and debated in groups the immediate pressures facing all Boards,

the implications for services of an ageing population and an ageing workforce.

Outcome

There was an agreement to work collaboratively across the North, with the work hosted through the

MMC Review Group. It was agreed to concentrate the regional approach in a few specific areas:

Develop common planning assumptions, using a scenario planning approach;

Develop plans for paediatrics, including a specific paediatrics event. This was discussed at the

later Child Health event discussed above and is being progressed by the CHCP within the

workplan for 2010/11.

Scope the potential for the establishment of a regional medical bank to reduce reliance on

locums and reduce costs to Boards.

Develop medical workforce plans for the Rural General Hospitals that are extremely

vulnerable to small changes in workforce. This is being taken forward under the auspices of

the Remote and Rural Implementation Group (RRIG).


19

Inter-regional Clinical Planning Groups

Whilst the core role of Regional Planning Groups is to take forward projects on behalf of partner

Boards, NoSPG has always had another role, leading nationally driven initiatives, where services

require to be delivered across more than one region or for Scotland as a whole, but do not meet the

criteria for national designation by the National Services Advisory Group (NSAG). NoSPG has a

continuing role in two specific areas: Implementation of Remote and Rural Healthcare, through the

Remote and Rural Steering Group (RRIG); and the Scottish Neonatal Transport Service.


1st and 2nd September 2009

Delivering for Remote and Rural Healthcare (DFRRHC)12 was launched by the Cabinet Secretary for

Health and Well Being, in May of 2008, as Scottish Government’s approach to achieve sustainable

healthcare for remote and rural communities. A Chief Executive’s Letter (CEL)13 identified a lead

from the Health Directorate of Scottish Government and an NHS Board Chief Executive for the

workstream and instructed the North of Scotland Planning Group (NoSPG) to lead this national

programme over a two year period. The Remote and Rural Implementation Group (RRIG) was

therefore established as a sub-group of NoSPG to bring together the representatives of remote and

rural Boards from all three regions and key stakeholders to provide leadership and direction to

implement those recommendations that need to be taken forward in a co-ordinated way. RRIG was

also tasked with providing regular performance management reports to the Scottish Government

Health Department (SGHD) on progress against implementation.

In September 2009, RRIG hosted ‘Delivering for Remote and Rural Healthcare – One Year On,

Sharing and Learning Event’. 120 people from across Scotland attended the event, including

colleagues from NHS Shetland, linking via video-conference, for all or at least part of the day and the

keynote speaker presented via video link from British Columbia, Canada.

Following a reminder of the policy context, Professor Dave Snadden, Vice Provost of the Medical

School of the University of British Columbia (UBC), joined the event, as keynote speaker, by videolink

to provide a perspective from rural Canada, concentrating on his experience of training

undergraduate doctors, embedded within remote campuses.

12 (2007) Delivering for Remote and Rural Healthcare, The Final Report of the Remote and Rural Steering Group Nov 2007SGHD ISBN B56045 05/013 (2008) CEL 23 (2008) “ Implementation of Delivering for Remote and Rural Healthcare Care” Scottish Government,Edinburgh


20

Workshops concentrated on the main RRIG workstreams of Obligate Networks, Emergency Response

and Transport, Emergency Medical Retrieval, Service Models and Care Pathways, Workforce and

Education and emerging areas, including the potential to develop a remote and rural network and the

potential to improve services through integration of health and social care.

In addition to the presentations and workshops sessions all Boards had been asked to prepare story

boards to share good practice through the ‘Market Place’. A number of territorial Boards, the Scottish

Ambulance Service, the Scottish Centre for Telehealth, the Joint Improvement Team and the RRIG

workstreams all submitted displays. 20 Storyboards were displayed and electronic versions of these

can be accessed via www.nospg.nhsscotland.com.

Boards were then given time for discussion to agree their priorities in the form of an Action Plan, and

to identify priorities for RRIG for the remaining year of the Implementation programme.

Outcome

The outcome of the event was agreed as follows:

Policy Influence:

promote remote and rural issues at policy level;

influence the centre to support broader remote and rural sustainability by encouraging a

joined up public sector approach to creating community resilience; and

influence workforce policies.

Obligate Networks:

ensure that the importance of the Obligate Network approach is reinforced to all Boards;

support the notion that the Obligate Network approach is the way to do business in the

future;

remind Boards of the Obligate Networks required as necessary by Delivering for Remote and

Rural Healthcare. These are defined as required to support the core services of surgery,

medicine and anaesthesia within the RGHS; and to support radiology, laboratory services,

Child Health and Mental Health services in remote and rural areas;

build a database of Obligate Networks; and

stimulate a CEL.

Service Models and Care Pathways:

work more closely with JIT to integrate teams and services to sustain local care;


21

encourage integration with Local Authorities, particularly in the area of out of hours health

and social care service;

ensure that models of care are integrated across traditional primary and secondary care

boundaries and across community care;

finalise High Level Care Pathways;

encourage the development of local protocols, and

co-ordinate the development of protocols through the creation of an electronic Directory of

the Pathways and protocols which is accessible by all.

Emergency Response and Transport:

support the implementation of the outcomes from the Evaluation of EMRS;

encourage the building of community resilience;

ensure the SOF is signed off;

influence the formalisation of the SOF; and

clarify the performance management arrangements for the implementation of SOF.

Workforce and Education:

Encourage robust workforce planning based on competences not posts;

host a Workforce Summit to establish core models;

use outcomes of Summit to influence national policy

ensure sustainable remote and rural medical training programmes are in place which reflect

the needs of service;

ensure educational solutions are developed to support the outcomes of the workforce

summit;

ensure that proleptic funding continues to be available to ensure sustainability of services in

remote and rural areas;

address the revalidation issue for GPs who are working over and above their GMS contracts;

NES/RRHEAL to continue to pursue the accreditation of Level 2 in Acute Medicine and GP

Intermediate Care competencies;

creation of a single NES ‘Distributed learning Platform’; and

RRHEAL to work more closely with Higher Education Providers to ensure connect with

National Health Service policy.

e-Health and Infrastructure:

evidence the issue in relation to the IT infrastructure and it’s limitations on practice;

lobby the case for enhancing the IT infrastructure;

influence the centre to support joint working with other aspects of the public sector and

others to explore possible funding solutions for enhancing the IT infrastructure; and


22

ensure that Scottish Government develop an integrated transport strategy.

Remote and Rural Network:

A ‘virtual’ remote and rural network should be created which is accessible by all involved

across the continuum of care. Existing resources such as the Association of Community

Hospitals should be pulled on and a single electronic point of access developed to a

Directory/information portal. This could be achieved using the methodology approach to the

Patient Safety Programme Model.

Exit Strategy

develop and exit strategy from RRIG which is not unnecessarily bureaucratic; and

Repeat this Event near the end of Implementation Programme.

Conclusions

Regional working continue to thrive across the North of Scotland, despite the difficulties that the

collaboarting NHS Boards face, in terms of geogrpahy. In the areas where it has been recognised that

a regional approach can add value to the services available to patients and the ability of a Board to

provide those services, the workplan continues apace. The regional agenda is of such diversity that

only through topic specific events can the priorities for services and the future plans be properly

identified and agreed. Increasingly, the financial challenges faced by Boards will lead to a review of

the regional approach in some areas, bjut it will also provide opportunities for collaborating NHS

Boards to consider a different approach to delivery of other services.

This report has been prepared for the Board members of the NHS Boards that collaborate across the

North to report on progress, in the absence of the NoS Annual event and the report is commended to

Boards for aproval.

20 January 2010


23

Appendix 1

North of Scotland PlanningGroup Structure

North of ScotlandChairs & Chief

Executives Group

North of ScotlandPlanning Group –Executive Group

(NoSPG)

E-Health Group

NoS Oral Health &Dentistry Project

Eating DisordersNetwork

Medium Secure CareClinic Project

Diagnostics Sub Group

NOSCAN

Public Health Network

CAMHS Project Board

Cardiac ServicesNetwork

Child Health ClinicalPlanning Group

Scottish NeonatalTransport Service

Remote and RuralImplementation Group

North of ScotlandIntegrated Planning

Group

NoS AHP StrategicAlliance

North of ScotlandMedical Directors

Group

North of ScotlandNurse Directors

Group

1

APPROVED

Objectives Goal/Outcome Lead Board/Officer Tasks Progress Report

Development of modern integrated approach for the care of forensic patients, including the

development of secure

accommodation for the North of

Scotland.

NoS patients are cared for in an appropriate environment and level of security.

Prof T Wells, Chief Executive, NHS

Tayside

Mr Dave Charles,

Project Director

1. Deliver project as per project programme (early 2012).

2. Ensure that the project is supported by an

appropriate workforce plan.

3. Ensure that project is developed with full

engagement of all stakeholders including interest groups, carers and the community.

4. Ensure that the requirements of the HDL

(2006) 48: Forensic Services are addressed within the planning of the new facility and onward management, including the establishment of a regional forensic services network.

5. Ensure that participating Boards are kept updated regarding affordability and value

for money.

1.

Work Plan 2010/11 NORTH OF SCOTLAND PLANNING GROUP

lpowe01

TextBox

APPENDIX 3

2


Establish a regional

service for Oral Health and

Dentistry across the NoS

A sustainable model

of dental care, which addresses the needs

of NOS patients.

Mrs H Strachan,

Oral Health Manager

Mr R Carey, Chief Executive,

NHS Grampian

Dr Ian Bashford, Medical Director, NHS

Highland

1. Establish a regional service for oral and

Maxillofacial specialities in head & neck cancer and trauma.

2. Establish a regional service for restorative dentistry on the basis of the assessment of

need. 3. Implement a regional MCN for orthodontics,

to include tele-orthodontics, to support the needs of the North and the delivery of service locally.

4. Establish a project to develop an intermediate care tier of service provision by

supporting the role of Dentists with SI. 5. NHS Boards ensure that local discussions to

support implementation are concluded. 6. Work across the region with NHS Grampian

on establishing the dental school for the North of Scotland.

7. Ensure that the recommendations of the National Task and Finish Group for Dentistry

are communicated to NoS Boards and implemented.

8. Ensure that Corporate and Clinical Governance requirements are addressed

throughout each of the project areas.

1.

3


The NoS MCN for

eating disorders will improve patient

care in terms of quality, access and

appropriateness.

NoS patients have

access to appropriate services for the

management of eating disorders.

Dr Harry Millar, Lead

Clinician, NoS Eating Disorders Network

Mrs Linda Keenan,

Network Manager

Dr A Ingram, Director of RP&WD

1. To continue to provide direction, assist in

decision-making and contribute to any service redesign.

2. To continue to involve users in developments of the MCN.

3. Care pathways are currently in place but will be kept under review in the light of

experience of the new regional inpatient unit.

4. To develop a quality assurance framework

and submit to NoSPG, then QIS for accreditation.

5. To develop website further to include information on Eden Unit.

6. To help promote the EEATS accreditation scheme in its inaugural year.

7. Continue to raise awareness with GPs/Counselling services across the region.

8. Review Eden Unit’s first operational year and ensure monitoring systems are in place

and being adhered to. 9. Development of Electronic Patient Record

reports. 10. See to give NHS Tayside / NHS Highland

“read only” access to the EPR. 11. Improve quality of data input.

1.

4


To progress the work

of the Cardiac Service Network for the NoS and to ensure that regional plans are in place to deliver quality, evidence based services, which meet

national waiting time targets.

To deliver NoS

cardio-thoracic surgery and interventional cardiology services, which meet national standards and waiting time’s targets.

Dr M Metcalfe, NoS

Cardiac Clinical Lead for Cardiac Services

Ms Fiona MacDonald, Service Improvement

Manager

Dr A Ingram

Director of RP&WD

1. Refresh Regional CHD Plan with partner

boards to reflect Board plans for future delivery of specialist services, ensuring appropriate governance arrangements in place.

2. Ensure service plans reflect the NoS Board responses to national strategy documents.

3. Demand and capacity planning for cardiac services, EP, Cardiothoracic surgery,

ORT/PCI to support sustainable service delivery and achieve RTT Targets.

4. Engage with Primary care through local MCN networks and the Cardiac Sub group to promote improved access and better

outcomes for patients locally. 5. Encourage robust referral pathways that

utilise cardiology expertise across the NoS using electronic support systems and

telemetry, where possible. 6. Develop robust workforce plans to support

service plans. 7. Agreed plans in place between NoS Boards

and SAS for cardiac patients who require transfer between service are required.

8. Support and benchmark service developments once approved.

9. Provide capacity to undertake agreed Board specific projects.

1.

5

Objectives Goal/Outcome Lead Board/Officer Tasks

Progress Report

Set strategic direction

for cancer services for the North, support

service Improvement and Commission

regional and national infrastructure

improvements

Ensure equity of

outcome for cancer patients across the

North.

Mr Richard Carey

Chair, NOSCAN

Mr P Gent Network Manager,

NOSCAN

Mr P King, Clinical Lead

1. Develop detailed workplan for the north

based upon individual Board’s cancer action plans against ‘Better Cancer Care’. This will

include site visits and direct links into the local Board cancer strategy/steering groups

(by May 2010). 2. Undertake a regional audit of chemotherapy

services in line with standards set out in CEL (2009) and NCEPOD (2009).

3. Support NHS Boards to develop action plans

against Better Cancer Care and develop a process for agreeing the regional aspects of

work. 4. Continue to undertake tumour specific

service reviews, with timetabling and reporting processes agreed through NoSPG.

5. Represent and report national committee work in relation of the National Cancer

Taskforce and the key sub-groups (Scottish Radiotherapy Advisory Group,

Chemotherapy Advisory Group and Cancer Quality Steering Group).

6


Develop a sustainable model of care for

children’s services across the North that

implements national and regional strategy.

A regional approach to neonatal services is

defined and implemented.

Services for children are planned, where

appropriate, on a regional basis and

where necessary delivered using a

regional model, specifically in relation to the implementation

of the regional aspects of the

Delivery Plan, Child Protection and support the work of the CAMHS group.

Dr M Bisset Clinical Lead, Child

Health

Dr A Ingram Director of RP&WD

Mr K Mitchell,

NoS Programme

Manager

1. Define a virtual Children’s Service for the North of Scotland, which is not constrained by the Health

Board Boundaries, including specialist, secondary and primary care.

2. Ensure that the NoS NDP plan is fully implemented ensuring the evaluation process is supported

appropriately. 3. Develop a model which ensures sustainability of

paediatric Critical Care within the NoS, which links

to NHS Board ECF Groups. 4. Develop an implementation plan for the

establishment obligate networks for child health. 5. Lead the development of models to support the

provision of remote and rural paediatric care. 6. Develop a network for the provision of paediatric

Surgical Services in the North, including the implementation of the nationally developed care

pathways. 7. Develop a Regional Child Protection network to

support local delivery. 8. Develop a NoS Neonatal Implementation in

response to the National Neonatal Services Review. 9. Develop a Regional approach to workforce

planning at all levels, including regional appointments, where appropriate.

10. Develop a regional training and education plan linked to the implementation of the NDP, which ensures that medical, nursing and AHP can assess

relevant training and education programmes. 11. Establish mechanisms which allow for PFPI to be

effectively developed within the Regional Child Health arena.

12. Develop a communication plan which ensures AHP, medical and nursing staff are aware of and engaged in the work of the CHCPG.

1.

7


Establish a regional

specialist network for CAMHS, providing

specialist CAMHS expertise across the

region, including access to an

increased number of inpatient places, with the context of that

Network.

A tier 4 regional

inpatient service for young people with

complex and enduring illness, networked

with local Board services, is accessible

within the North.

Dr A Ingram

Director of RP&WD

Mr N Strachan Regional CAMHS

Network Manager

TBC Clinical Lead

Mr A Tippet Project Manager

(Capital Project requirements)

1. A Regional Adolescent Mental Health

Obligate Network should be defined and established, linking local services and the

regional inpatient facility, providing support, expert advice and ensuring that appropriate

protocols and systems of care are developed.

2. A purpose built inpatient unit, initially planned on 12 places but of a design that could be expanded, will be established.

3. The Project Board will review the project structure having successfully progressed the

Initial Agreement. This will involve an amended role, membership and function of the Project Board and Service Modelling and Workforce Planning Group.

4. Clinical Lead will be appointed for 1 year, with appropriate objectives to support

planning and delivery of network. 5. Arrangements will be developed to involve

and engage with young people and their families in the development of the unit and

regional network. 6. Link into relevant national workstreams e.g.

national initiatives linked to CAMHS Integrated Care Pathway development and workforce related developments.

7. An outline business case will be prepared, and presented to NoS Boards, for

submission to Capital Investment Group subject to approval of all six NoS Boards.

1.

8


1. To understand the demand requirements for

Bariatric surgery, within

the context of NoS Boards Obesity

Management strategies.

2. To develop a NoS patient pathway for the specialist

aspects of the service.

3. To ensure that the NoS requirements are reflected in the national plans.

There is an agreed

care pathway for Obesity Management

within the North of Scotland, including

access to specialist Bariatric and plastic

surgery

Ms R Urquhart,

Head of Healthcare Strategy, NHS H

1. Establish a NoS SLWG for Obesity

Management to consider the North requirements, particularly in relation to

Bariatric Surgery. 2. The existing NoS SLA for Bariatric surgery

is reviewed. 3. Demand and capacity requirements for

Bariatric surgery for the NoS are established. This may include a review of the potential to utilise capacity in

Grampian and Tayside. 4. Appropriate patient pathways for Bariatric

Surgery are established within the context of the wider obesity management arrangements and, where necessary, are amended to ensure a sustainable service for the NoS.

5. Clear guidelines for access to specialist

services are developed and agreed by all NoS Boards.

6. The NoS has appropriate input to the wider national debate, led by the NPF.

1.

9

National Workstreams


Conclude the work of

the national Remote and Rural Implementation Group Report.

A framework to

sustain a safe range of healthcare provision within remote and rural areas for Scotland is

implemented.

Dr R Gibbins

Chair, RRIG

Dr A Ingram, Project Director

Mrs Fiona Grant, Programme Manager

1. Review the R&R workforce model,

particularly the medical workforce, to develop a sustainable model for the future and hosting a Workforce summit in May 2010.

2. Refine guidance on the role and function of

the Extended Community Care Teams. 3. Publish Acute Hospital Care pathways for

common conditions. 4. Refine IT functionality requirements to

support Care pathways. 5. Implement Scottish Government decision for

the Emergency Medical Retrieval Service. 6. Ensure launch of Strategic Options

Framework. 7. Agree and progress an appropriate exit

strategy for RRIG. 8. Identify role of NoSPG going forward to

support R&R agenda.

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A Managed Service

Network for children and young people

with cancer should be developed, by

building on the recently established

National Managed Clinical network (NMCN) (CATSCAN),

and supported by additional investment

from Scottish Government through the National Delivery Plan for Children and Young People’s Specialist Services.

Establish a

sustainable model of service within the

context of the new Managed

Service Network for Scotland.

Dr A Ingram,

Director of RP&WD

Mrs W Croll, National MDT

Programme Manager – Children’s Cancer

1. Develop plans to establish a Managed Service

Network (MSN) for Children and Young People with Cancer and drive implementation.

2. Redesign existing children’s cancer services to achieve MDT working across many sites, while

improving cross-site working between the main cancer centres and shared care centres.

3. Review scope and role of the Managed Clinical Network for Children and Young people’s cancer services (CATSCAN), supporting evolution towards

quality and governance arm of MSN. 4. Provide ongoing support to CATSCAN throughout this

review and transition. 5. Facilitate and support pan-Scotland investment plans

for palliative care, late effects and teenagers with cancer, ensuring that proposed business cases/plans are submitted to MSN for approval.

6. Develop plans to ensure that audit and trials

administration is properly resourced going forward and that opportunities to link with established

mechanisms for support are identified and pursued. 7. Establish plans to support networking of services

across Scotland including establishing requirement to link electronic prescribing systems.

8. Develop NDP plan for 2010/11 that provide appropriate investment in each centre, including specific investment to allow Edinburgh to achieve the required status.

9. Ensure that there is adequate investment in shared

care centres and provide support o Aberdeen to ensure that the role and investment in that centre is appropriate for future service delivery but within context of national MSN approach.

1.

11

Objectives

Goal/Outcome Lead Board/Officer Tasks Progress Report

Performance

management of Scottish Neonatal

Transport Service (SNNTS) on behalf of

NHS Scotland Board Chief Executives.

Sustainable transport

service, covering all Scotland, through a

regional model with cross cover able to

act timeously as required.

Dr Phil Booth,

National Director, SNNTS

Mr K Mitchell,

NoS Programme Manager

Dr A Ingram Director

of RP&WD

Mr D Carson,

Financial Controller, NHST

1. By April 2010 – develop proposals for a

revised management structure for the service.

2. Review existing working practices to ensure that the service is functioning efficiently.

3. Produce a combined annual report for the period 2008/09 and 2009/10.

4. Participate in the national review of Specialist Transport Services.

1.

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Specialised Planning Groups


Progress Report

An Integrated

Planning Group will promote and foster a regional approach through the identification of

service, workforce and financial planning

issues which will impact significantly

within and across Boards to determine

areas where regional working will add value.

NoSPG business is

well managed and the collaborating NHS Boards are sighted on regional initiatives

Dr A Ingram,

Director of RP&WD

An integrated planning group will support the development of a

long-term strategy to support NoSPG, including: 1. Strategic Planning

• To assist NoSPG to develop a long term clinical and workforce strategy to support regional working;

• To promote and foster a regional approach through the

identification of issues, both service and workforce, which will impact significantly within and across Boards, to determine where regional working will add value;

• To co-ordinate prioritisation within collaborating NHS

Boards and at regional level to ensure best use of available resources and reflect this in agreements

between NoS NHS Boards; • To plan and monitor patient flows at a strategic level

across the North of Scotland to ensure optimal use of

services within the region and to monitor patient flows outwith the region to ensure appropriate access to

services for the population of the North. • To develop the regional workforce plan; • To develop a North perspective on national initiatives;

and • To provide support to the Director of Regional Planning

& Workforce Development. 2. Projects

• To identify and progress regional projects, where

appropriate. 3. Performance Management

• To develop processes, standards and protocols to support effective regional working;

• To scrutinise NoS Service Development proposals and

business cases to ensure that these are robust and meet expected standards;

• To performance manage the regional sub-groups, including the agreement of regional objectives and priorities;

• Ensure that a workforce impact assessment is

contained within any emerging NoS plans.

1.

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The NoS Public Health Network

(NoSPHN) will support the NoSPG

agenda, the delivery of agreed objectives

and those of the NoSPG workstreams –

and identify these within the NoSPHN workplan and develop

regional approaches to public health

services and activities where there is an agreed added value to doing so and monitor and report.

The work of NoSPG is evidence based and

based on the health needs of the

population.

Dr Sarah Taylor Clinical Lead, NoSPHN

Mrs Pip Farman,

Network Manager

1. Advise the NoS BCEs, NoSPG and NoS IPG on regional and national papers and

processes. 2. Review and advise on bids submitted for

designation as national services (by June 2010).

3. Advise and support NOSCAN in the development and implementation of agreed

objectives and scope the following: • The requirements to support the Breast

Cancer Service review.

• A Cancer technologies impact assessment.

4. To support a collaborative approach to Drug

and Therapeutics across the NoS. 5. To continue to support the Child Health

programme including: • A needs and evaluative approach to the

development of the national Specialist Children’s Services bids (March 2011).

• Assess child health activity flow data

across Scotland to inform service planning priorities and developments.

6. Review the support needs of the CAMHS programme.

7. To review and support NoSPG / NHS Boards

in response to the national R&R Implementation plan including:

• Review of RRIG further health information needs

• Supporting an audit of the Orkney workforce model

• Support the development of pathways

of care for common conditions. 8. Contribute Public Health support to the

Bariatric Surgery and Obesity Management Services review.

9. To support the Cardiac Services Network and scope the health information support needs for the regional delivery plan.

10. To organise professional development opportunities including an event focussed on Public Health and Planning (May 2010).

1.

14

11. Implement and evaluate the Well North

anticipatory care programme (to 2010). 12. To deliver an agreed programme of regional

public health activities.

Objectives Goal/Outcome Lead Board/Officer

Tasks Progress Report

Professional support

and guidance to

support the regional agenda.

Sustainable Medical

Workforce

Sustainable model of

Out of hours care

Dr Roelf Dijkhuizen

Chair, NoS Medical

Directors

Dr A Ingram DRP&WFD

1. Review the out of hours requirements of

small DGHs across the region to identify a

sustainable model of care, delivered on a regional basis.

2. To provide continued support through the MMC Review group to Boards in the

development of plans to support the reduction in the number of doctors in training.

3. Working with other NoS groups, including the NoS Workforce Planning & Development Group, identify opportunities to redesign services on a regional basis that supports service sustainability.

4. Provide peer support for medical directors across the region.

1.

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To support and

progress the work of the Integrated

Planning Group and the North of Scotland

Planning Group by identifying

workforce planning and development issues that will have

significant implications within

and across Boards and recognise where regional working is appropriate and will add value.

An affordable and

sustainable multidisciplinary

workforce model(s) that addresses

service needs and ensures the delivery

of sustainable services and safe quality patient care.

Provide an integrated planning function for service, finance, education and workforce.

Collaborating NHS Boards are informed

and sighted on regional initiatives

and ensure they are integral to Board

workforce planning systems.

Mr M Sinclair, HRD,

NHS G & Mrs A Gent, HRD, NHS H -

co-Chairs NoS Workforce Planning &

Development Group

Mrs B Flynn Workforce

Programme Manager

1. Advise IPG and NoSPG on regional and

national workforce planning and development issues.

2. Review and advise on national workforce policy.

3. Support the development of north region perspective on national workforce initiatives.

4. Assist IPG and NoSPG to develop a workforce strategy to address regional workforce issues and support regional

workforce planning and development. 5. Develop integrated planning function for

service, finance, education and workforce. 6. Develop regional workforce work plan. 7. Action and progress key workforce priorities

(as agreed by NoSPG). • Reshaping Medical Careers

• RRIG • Child Health and CAMHS • Integrated Secure Care with focus

on Medium Secure Care • Oral Health and Dentistry

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Progress Report

Implement,

coordinate and facilitate the final

Phase of the Nursing & Midwifery

Workload & Workforce

Planning Programme

A sustainable and

trained workforce in place across the

region, capable of delivering nursing &

midwifery services to meet the needs of

patients. Strategic approach to

support NHS Boards embed and sustain

the national nursing and midwifery workforce planning tools, methods and systems, including educational tools and

monitoring and information systems

for supplementary staffing within NHS

Boards to influence and underpin local,

regional and national workforce planning.

Mrs B Flynn,

Regional Nursing Workload Advisor

Dr A Ingram Director

of RP&WD

The NMWWPP team will facilitate and coordinate

the final phase of the national Programme. In the North regions the emphasis is on providing

facilitation, encouragement and expertise in the development of a long-term strategy to embed

the work of the Programme within NHS Boards and will include:

National • Establishment of specific national projects to

include workforce information, staff bank, community benchmarking profile, for ongoing

monitoring, updates and development.

• Coordinate and facilitate:

o The completion of current work streams and developments

o The implementation of agreed work streams

o The ongoing development of workload

tools and methods. o Further development of educational

toolkit to support the wider workforce. Regional

• To facilitate and co-ordinate work streams in

NHS Boards in the north region to ensure systems and processes in place to make best

use of available resources to delver safe and effective patient care.

• To ensure a north perspective that informs and influences national initiatives relating to the nursing and midwifery workforce.

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Direct regional

collaboration on all relevant eHealth

projects.

The benefits of

eHealth are exploited to support joined up

care in all settings across the North with

minimised effort to the benefit of patients and clinicians.

There will be no

formal eHealth group and work will be

taken forward through other

workstreams.

1. Lead the National VC Pilot Project in the

NoS. Project Board chaired by Dr Ingram. 2. Prepare an eHealth/IT definitions document

for use by non-eHealth professionals and assist communication and understanding.

3. Map all current VC facilities within Scotland. This is being progressed by the National VC pilot Project Board.

4. Map the eHealth clinical requirements of the Remote and Rural acute care pathways,

including identification of those pathways, currently identified for transfer, where through eHealth investment, patients could be retained in their local areas. This will be taken forward at the Acute care pathways meeting in March 2010.

2.


Progress Report

To establish links between the North Boards, excluding NHS Tayside and the North of Scotland

CJA.

Health priorities are adequately reflected in the North CJA plans.

Dr A Ingram Director of RP&WD

1. Establish Health Sub Group to more appropriately support direct communications between CJA and NHS Boards.

2. Sub Group to review CJA documents to ensure that the NoS health priorities are

adequately reflected.

1.

Dr. Annie K Ingram Director of Regional Planning & Workforce Development North of Scotland Planning Group 19 March 2010 P:\NoSPG\work plans\2010-11\2010-11_work plan_Final_190310.doc

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