NORTH OF SCOTLAND PLANNING GROUP Cardiac Services Sub Group Minute of virtual meeting held on Tuesday 6 th March 2012. NORTH OF SCOTLAND PLANNING GROUP APPROVED Aberdeen: Mr Hussein El Shafei, Consultant Cardiothoracic Surgeon, NHS Grampian (Chair) Ms Claire Nicholl, Unit Operational Manager (Cardiothoracic and Cardiology), NHS Grampian Mr Harry Norton, Finance, NHS Grampian Mr Mark Houliston, GP/Joint Chair MCN, NHS Grampian Mr Deepak Garg, Consultant Cardiologist, NHS Grampian Dr Andrew Hannah, Consultant/Joint Chair MCN, NHS Grampian Ms Sandra Hay, Regional Project Manager, North of Scotland Planning Group In attendance: Mrs Karen Wing, Team Secretary, North of Scotland Planning Group Glasgow: Mr Ken Mitchell, Programme Manager, North of Scotland Planning Group (until item 05/12) Inverness: Orkney: Mr Charles Bloe, Lead Nurse, NHS Highland Mr Peter Clarkson, Consultant Cardiologist, NHS Highland Ms Morag MacLeay, Service Manager, NHS Highland Jill Fletcher, Area Service Manager, Scottish Ambulance Service Mrs Sue Menzies, Long Term Conditions Manager, NHS Highland Ms Amanda Manson, Heart Failure Specialist Nurse, NHS Orkney 01/12 Apologies Apologies were received from Mr Drew Carr, Operations Support Manager, Scottish Ambulance Service; Mr Adam Coldwells, Divisional General Manager, NHS Grampian; Mr Andy Fuller, Divisional Head, Scottish Ambulance Service; Ms Elaine Garman, Public Health Lead, Cardiac Sub Group, NHS Highland; Dr Annie Ingram, Regional Director, North of Scotland Planning Group; Mr Stephen Leslie, Consultant Cardiologist, NHS Grampian; Dr Malcolm Metcalfe, Consultant Cardiologist, NHS Grampian; Mr Clark Paterson, Group Finance Manager, NHS Grampian; Mr Stuart Pringle, Consultant Cardiologist, NHS Tayside; Mr Allan Reid, Head of A&E Services, Scottish Ambulance Service; Mr David Rigby, General Practitioner, NHS Western Isles; Ms Kerry Russell, Assistant Director of Clinical Services, NHS Shetland; Ms Roseanne Urquhart, Head of Healthcare Strategy, NHS Highland; and Ms Jo Veasey, Divisional General Manager, NHS Highland. 02/12 Minute of the meeting held on 7 th December 2011 The minute was accepted as an accurate record of the meeting. 03/12 Matters Arising i) Clinical Lead Mr El Shafei advised that he had been appointed as the new regional clinical lead for a period of two years from 1 st January 2012. He acknowledged the previous achievements of the group, for example, the appointment of a regional EP Consultant, and said that the group would review what had been done and where it could target improvement to best effect.
Mr El Shafei thanked Dr Annie Ingram and Dr Malcolm Metcalfe for their support in the regional agenda over the last few years. ii) Membership, role and remit Miss Hay highlighted that the document had been agreed in principle at the previous meeting. Following a general discussion about individuals who may be nominated by each Board, Mr Mitchell suggested that a revised document be sent to the group, requesting comments by 30 th March 2012. He added that he would then write to Boards for agreement of the nominations. KM iii) Electrophysiology Mr Mitchell said that the planned review of the cost of consumables had not yet been undertaken, although a meeting with Dr Paul Broadhurst had been arranged. It was noted that Dr Jonathan Affolter, Regional EP Consultant was partly funded by Tayside (25%) and Highland (25%). Dr Clarkson commented that NHS Highland had not seen the benefit of the funding and would welcome further discussion and debate on this topic. A short life working group would be established to review service delivery. KM iv) Update on SACCS Mr Mitchell reported that there was an ongoing national debate regarding outreach and level of support. It had however been agreed that the service would provide the level of outreach requested by Boards. Mr Mitchell also said that no consensus had been reached regarding ASD closures and whether they would be included as part of national service. It was noted that Boards were happy with the current service provided in Edinburgh, however, there was an issue of double costs. Dr Clarkson commented that the biggest issue related to re establishing peripheral clinics. He highlighted that a third Cardiologist was to be appointed for the West of Scotland, at the Golden Jubilee National Hospital. Dr Clarkson advised that a three tier structure had been implemented south of the border; however, Dr Hannah suggested that this should be population based, rather than on individual services, for example, ASD. Dr Hannah stated that NHS Grampian would continue the current level of service provided by Mr Walton, although noted that it would be difficult to attract the right skills to replace him.
04/12 Optimal Reperfusion Therapy (ORT)/ Percutaneous Coronary Intervention (PCI) Mr Mitchell gave a brief summary of the workshop held on 27 th January 2012 to discuss the ORT model for the North of Scotland. He noted that although useful, further work was required but that a paper would be submitted to the Integrated Planning Group (IPG) on 16 th May 2012 for discussion. There was a discussion regarding the 120 minute time from diagnostic ECG to balloon and local interpretation of what this meant in terms of drive time. It was noted however that there was no national guidance on the use of 120 minutes. It was noted that the areas of concern within the North were west Moray and Fort William. The group agreed that discussion was required between NHS Highland and NHS Grampian as to whether the policy should be to take west Moray patients to Inverness rather than Aberdeen, and not to double door by taking to Dr Gray s in Elgin first. The NHS Highland flowchart had been agreed with the Scottish Ambulance Service and it was suggested that the same be mapped out for NHS Grampian. Dr Hannah, Dr Garg and Ms Fletcher agreed to meet to discuss. AH/DG/JF Ms Manson expressed concern that the island Boards were not included in such planning. 5/12 Cardiac Surgery Review of SLA It was noted that a review of the current SLA, developed in 2004, was ongoing. Mr Norton highlighted that as activity had dropped over the last three years, NHS Grampian were exposed by 700k. A data collection exercise recently undertaken had shown a significant drop in activity for both NHS Tayside and NHS Highland and further work would be undertaken to understand the reasons for this. Dr Clarkson said that referrals should now begin to increase from NHS Highland as links were now stronger with Aberdeen, following the establishment of weekly MDT meetings. Work on revising the SLA would be concluded by the next meeting of the group. SH 06/12 Local MCN Updates Dr Houliston said that the NHS Grampian agenda had been guided by the QIS report, the CHD Action Plan and the recent Audit Scotland report. He added that the integration of Primary care and Secondary care was also important. It was noted that NHS Tayside did not currently have an MCN. Mr Bloe commented that the NHS Highland MCN had concentrated the development of pathways. 07/12 Workplan A draft workplan for 2012/13 had been developed and comments should be submitted to Miss Hay. Mr El Shafei said that the workplan should be realistic and reflect what the group has agreed to do, and the outcomes should be capable of being monitored. ALL
08/12 National Advisory Committee for Heart Disease 09/12 AOCB Mr El Shafei advised the he and Miss Hay had attended the meeting held on 21 st February 2012. Miss Hay, referring to the briefing circulated, highlighted that the 200k funding previously discussed, and not supported by this group, had now been allocated. She advised that Chest Heart and Stroke Scotland (CHSS) had been asked to submit a proposal for a web based training resource, similar to the of Stroke Services (STARS) and that this had now been agreed, although it had been made clear that the North of Scotland did not support the bid. It was noted that 500 600k would be available in the next financial year and that a process, including clear criteria, would be developed for assessment and prioritisation of the bids. Mr El Shafei also highlighted that no decision had yet been reached regarding ORT. i) Audit Scotland Report Mr El Shafei said that the report covered areas such as audit, outcomes, savings and avoidance of waste, all of which should be considered in the regional plan. There was a discussion regarding shared procurement and it was suggested that pacemakers may be an area for the group to consider. Dr Hannah highlighted that there was a gap in relation to CT coronary angiography. He went on to say that previously, NHS Grampian had been able to access the service at Raigmore, however, patients were currently being referred to the Golden Jubilee National Hospital. It was noted that it would be preferable to keep patients within the region where possible. In response to a question from Mr El Shafei, Dr Clarkson confirmed that the procedure was being used more and more and although tends to be overread, is an excellent negative rule out test. Dr Clarkson said that 12 per week were carried out at Raigmore. It was agreed that this should be discussed at the next meeting. All ii) Future meetings There was a discussion on whether video conferencing facilities was suitable or whether face to face meetings would be more beneficial for this group. It was suggested that given geography, travel time and the current financial climate, VC was a decent compromise and that most meetings should use this medium. It was agreed that an annual event would be beneficial. The group agreed to look at moving the next meeting to an Inverness venue. iii) Cardiac Services Website Mr El Shafei said that the group may wish to look at the development of a North of Scotland Cardiac Services information resource for patients.
10/12 Date and time of next meeting Tuesday 12 th June Committee Room, Foresterhill House 10.30 A schedule of dates for 2012 will be as follows Subsequent meetings have been scheduled for: Tuesday 11th September Committee Room, Foresterhill House 10.30 Tuesday 4th December Committee Room, Foresterhill House 10.30