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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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Version 3

NORTH OF SCOTLAND PLANNING GROUP

Annual Report

2014-15


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NoSPG ANNUAL REPORT 2014-15 CONTENTS

Introduction......................................................................................................... 4

Background ......................................................................................................... 6

Aim ..................................................................................................................... 7

Context ............................................................................................................... 7

Regional Team Update ...................................................................................... 7

Child Health ..................................................................................................... 8

North of Scotland Public Health Network (NoSPHN) ............................................. 8

Regional Workforce Group ................................................................................. 9

Workforce Planning Learning and Development Network ...................................... 9

National Delivery Plan funding for Specialist Children’s Services .......................... 10

Director of Regional Planning - Specific Work .................................................... 10

Regional Networks ............................................................................................. 12

Managed Clinical Network for Specialist Paediatric Child Protection...................... 12

Paediatric High Dependency Care Network ........................................................ 15

General Surgery for Childhood Network ............................................................ 16

Child & Adolescent Mental Health Network ........................................................ 18

North of Scotland Oral and Dental Health .......................................................... 22

North of Scotland Paediatric Gastroenterology, Hepatology and Nutrition Network

(NOSPGHANN) ................................................................................................ 23

North East Scotland Child & Adolescent Neurology Network (NeSCANN) .............. 25

North of Scotland Paediatric Respiratory Network .............................................. 26

Neonatal Network ........................................................................................... 28

North of Scotland Cancer Network (NOSCAN) .................................................... 28

North of Scotland Public Health Network (NoSPHN) ........................................... 33

Regional Services ............................................................................................... 36

Cardiothoracic Regional Service ........................................................................ 36

Regional Mohs micrographic surgery service ..................................................... 37

Managed Clinical Network for Eating Disorders (North Scotland) ......................... 38

Regional Medium Secure Care Services, Rohallion clinic ...................................... 43

Regional Projects ............................................................................................... 48

Single Vascular Service .................................................................................... 48

“A96 Corridor” (Paediatric services) .................................................................. 48

Regional Sustainability Programme ................................................................... 49

Neuromuscular ............................................................................................... 50


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Regional / National Projects ................................................................................ 51

Paediatric Unscheduled Care (PUC) pilot project ................................................ 51

Safe and Sustainable Secondary Transfer and Retrieval in the North of Scotland .. 54

A Geospatial Evaluation of Systems (GEOS) of Trauma Care for Scotland ............. 56

Radiology ....................................................................................................... 57

Priorities for 2015-16 .......................................................................................... 58

Finance ............................................................................................................. 59

Appendices ........................................................................................................ 68

North of Scotland Planning Group Executive ...................................................... 68

Appendix II – New (Substantive) Team Structure .............................................. 69

Appendix III – Workstream Contacts ................................................................ 70


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Introduction

The last year has been a testing one for the NHS in Scotland as we saw increasing levels of

activity and challenges in recruitment, particularly in the north. Against this background the North

of Scotland Regional Planning Group has made significant progress in refreshing the way we plan

collaborative services and also in developing the “Intelligent Region” themes to ensure we reduce

the time spent carrying out that planning where possible. The small regional planning team has

now been restructured to reflect changing needs of the north and in the coming year will regain

the capacity which has been lacking for some time now.

The team have supported a number of work areas over the past year and worked in different

ways with constituent boards to drive forward collaborative working within the north, but also

across regions, and Scotland as a whole, where that makes sense clinically.

During the past year we have seen the departure of several Clinical Leads and core staff and also

the addition of others to fill those vacancies. I would like to thank those who have left, for their

valuable contributions and welcome our new team members whether in temporary rotational roles

or in permanent ones.

This year also saw the recruitment of Dr Michael Bisset as our first Regional Medical Director. Mike

has worked in Regional roles for a number of years and brings a wealth of experience to this new

post. This post will be central to developing a consistent approach to clinical governance across

boundaries as well as providing a structured support framework for the range of clinical leads

across the north. This is a first for Regional Planning in Scotland, and a testament to the

commitment we have in the north, to this way of working.

Work continues apace on existing networks and agreed projects, however significant progress has

been made in some key areas across the region:

• Development of the Regional Oncology Clinical Board

• Agreement to establish a networked Vascular Surgery service across NHS Grampian and

NHS Highland, supporting NHS Orkney and NHS Shetland with links to NHS Western Isles

• Completion of the CAMHS in patient unit and establishment of the CAMHS network to

support patient pathways “upstream” and “downstream” from the unit.

The Sustainability programme has delivered on infrastructure work streams, as part of

implementing the “Intelligent Region”, working closely with colleagues in the North of Scotland

Public Health Network. This programme is central to the renewed focus and move towards the

team becoming more involved with longer term planning.


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Latterly NoSPG has endorsed the development of a Regional Clinical Strategy to augment national

work, which will see a higher level national strategy emerging during 2015 / 2016. This will

reaffirm regional planning firmly within relevant high priority areas and focussed on work which

will help sustain high quality services delivered as close to home as possible. The Regional Medical

Director will support this work directly, helping to identify clinical priorities and critical co-

dependencies as we move towards an increasing number of shared and networked services to

ensure sustainability.

I commend this report to you as a testament to the hard work, and record of the outputs from,

the regional team, as they support us in initiatives across the North Boards. I am pleased to

continue chairing NoSPG for a further year and look forward to reporting further progress during

2015 / 2016.

Elaine Mead

CEO NHS Highland

Chair

North of Scotland Planning Group


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Background

Regional work in the North covers a number of service and “infrastructure” areas and different

types of activity, which can broadly be categorised into Networks, Services and Projects. These

categories are simply a means to make sense of the broad agenda for the reader and are listed in

Appendix III.

In some cases activity bridges two or more categories; for example some of the NoS Paediatric

and Dental Health Networks deliver service across Health Board boundaries and have funded

Clinical Lead and Managerial support, and although defined here as “Managed Clinical Networks”

were set up to deliver service more akin to “Service Networks”. This does not remove traditional

MCN responsibilities such as facilitation of education, and continuous improvement work, which

they also fulfil.

There are other regional network arrangements which are “light touch”, carrying only minimal

resource implications from the NoSPG team (admin support), however deliver an important

function in terms of improvement and redesign support for the boards within the region.

Regional services have in some instances been agreed and hosted directly within a board and

don’t necessarily form part of the regional planning teams’ work plan. This report serves as a

means of reporting, to regional partners, for these services.

Regional Projects are generally time limited pieces of work with specific objectives. They are

sometimes funded separately and in other cases under the umbrella of the work plan for the

Regional Planning team, executed within existing resources.

The Regional Planning team remains a small and nimble function, in relative terms, which acts as

an agent of the NoS Boards collectively, able to respond to the needs of the service by supporting

cross boundary collaborations in a variety of ways.

Over the past 18 months the team has undergone significant changes as it was formally

restructured to include the North of Scotland Cancer Network (NOSCAN) staff and to better reflect

the needs of the north boards. Appendix II shows the new team structure and lists new,

substantive team members.


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Aim

This report aims to provide a vehicle to report on all regional work, in recognition of the breadth

and depth of cross boundary collaboration, for the benefit of patients in the north.

Regional collaborations are necessarily varied, with different levels of input from the regional

team. This report aims to describe progress in each area, as well as briefly describe the input from

the regional team, as an indicator of added value to the NoS Boards.

Context

Regional Team Update

The core regional team saw a sustained reduction in capacity during 2014, as a result of staff

leaving for promoted posts and secondments. Vacancies were unable to be filled because of the

ongoing organisational change process which was facilitating the team restructure. This limited

the progress of some regional projects and reduced the amount of new work possible.

During 2014 / 2015 NOSCAN staff was incorporated into the single regional team and office

functions were brought closer together, allowing skills to be shared, maximising capacity and

increasing sustainability of regional functions.

The newly restructured team will see more emphasis on planning functions, with slightly less input

to secondary care and operational work, where more reliance will be placed on operational and

other colleagues within Boards, to progress projects. Although this creates some tension to

release capacity within boards the regional team will continue to be flexible and act in different

capacities, depending on the piece of work, recognising the need for board ownership of projects.

During Q4 2014 / 2015 the two programme managers supporting the SOSNOS programme

(Sustaining Oncology Services in the North of Scotland; Ms Lesley Forsyth and Mrs Grace Ball) had

their 1 year secondments extended for a further year; one from regional “under spend” and the

other with match funding from the Scottish Government. Also in Q4 Ms Kerry Russell (temporary

Programme Manager on the “Sustainability” programme) was successful in her application to the

post of Associate Director of Regional Planning.

During 2013 a temporary Clinical leadership post was agreed (2 years part time) in recognition of

the importance of clinical input to strategic planning and redesign across boundaries. This post will

specifically support the clinical aspects of current and emerging regional work and play an

important and central role in the regional sustainability work. This post was recruited to during

2014 with Dr Michael Bisset taking up post in April 2015.


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The new team structure was delivered at no additional cost to the NoS Boards and is detailed in

Appendix II.

Child Health

A significant amount of regional work has been generated by central funding, as part of the

National Delivery Plan (NDP) for children’s services. As a result we have an overall Child Health

Clinical Lead (Dr Mike Bisset, Consultant Paediatrician, and NHS Grampian) who chairs the

regional Child Health Clinical Planning Group (CHCPG) and oversees a number of work areas,

providing strategic guidance and support to Network Managers and Lead Clinicians across the

whole Child Health agenda.

The Child Health programme of work has continued to focus on supporting and developing

regional networks where required, and projects that have developed from the recommendations in

the North of Scotland Paediatric Sustainability Review. These projects are:

• Continued exploration and description of an obligate network for Child Health in NoS.

Following a workshop held by the CHCPG in May 2014 which focused on the concept of

the obligate network. An Obligate Framework for Child Health in the North of Scotland

was agreed at the CHCPG meeting in February 2015.

• Delivery, evaluation and implementation of learning from the pilot Paediatric

Unscheduled Care Project offering a single point of contact to rural practitioners

(described later in the report).

• Establishing transport requirements for children requiring high dependency care or

specialist clinical escort, where care needs do not require transfer to Paediatric Intensive

Care units (described later in the report).

North of Scotland Public Health Network (NoSPHN)

The core NoSPG team continues to work in close collaboration with NoSPHN across a number of

areas of work. NoSPHN provides ongoing advice and support to NoSPG work programmes through

Public Health colleagues who sit on the regional networks (for example: NOSCAN; the Cardiac

Network and the Dental Health Network) and through direct engagement with NoSPG work.

Public Health colleagues have been engaged in supporting NoSPG in relation to review activities

e.g. the NoS Integrated Planning Group and the NoSPG annual event.

In addition NoSPHN has provided support to work programmes through for example use of Public

Health related tools developed from the NoSPG horizon scanning work, the intelligent region, and

evaluation tools for example logic modelling.


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NoSPHN collaborations have been particularly valuable during 2014/15 as we work towards a

redefined focus, building on previous work (“Intelligent Region”) to deliver on a wider and more

holistic planning function, which focuses more on strategic planning for sustainable services in the

north.

Pip Farman (NoSPHN Network Coordinator) continues to provide direct support alongside public

health colleagues from across the region. This support is at times advisory and at others as a core

part of the project team. A separate summary of work is provided later in this report under

“Regional Networks”.

Regional Workforce Group

Chair: Ralph Roberts (CEO, NHS Shetland)

NoSPG support: Kerry Russell (Associate Director, NoSPG)

This new group was convened early in 2015, in response to a variety of workforce issues. It has

close links to the medical workforce agenda, currently being led By Dr Annie Ingram on behalf of

the NoS boards, and also the Workforce Planning Learning and Development Network.

Proposed work streams include collaborative work on:

• Workforce intelligence

• Recruitment / retention

• Regional Clinical Strategy – workforce implications

• Remote and Rural workforce models

Workforce Planning Learning and Development Network

The Workforce Planning Learning Network continues to meet bi-monthly to enable sharing of

knowledge and ideas across the region. Specific sharing has included the development of the

Physician Associate role including placements as part of their course, providing data and

information in relation to specific parts of the workforce and the work RRHEAL has supported

around the development of competencies for a generic Health and Care Support Worker role.

The network has provided a consistent, collective approach to workforce planning using the 6

Steps methodology across the North of Scotland, has supported workforce sustainability, ensuring

the provision of a safe and affordable workforce and consistent delivery of safe standards of

patient care.

The network has also initiated the development of an agreed data set based on “Big Questions”

such as “is recruitment truly more challenging in the North of Scotland compared to other


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regions?” Further work this year has been in reviewing and updating the Network’s Terms of

Reference.

National Delivery Plan funding for Specialist Children’s Services

National Delivery Plan (NDP) funding for Specialist Children’s Services was introduced in 2008 for

3 years. NDP funding provided significant investment to develop and sustain tertiary and

secondary paediatric services. The funding was confirmed as permanent and recurring by the

Scottish Government in the summer of 2011. Over the course of the past 4 years, there has been

a modest build-up of NDP funds which were allocated to the North (due to delays in recruiting to

posts or services that were agreed). During early 2014 NoSPG agreed that this non-recurring

money should be available to allow for one-off applications for funding.

The North of Scotland Child Health Clinical Planning Group (CHCPG) developed and agreed a

process whereby staff from the NoS Health Boards were invited to submit bids for projects or

temporary posts that reflected the principles of the NDP and showed collaboration amongst Health

Boards. Seventeen bids were developed by staff, with support from the NoSPG team, and then

considered by an independent panel based on the criteria agreed by NoSPG. The panel made

recommendations to the CHCPG as to which bids should be funded and were presented to NoSPG

in December 2014.

However, due to financial constraints experienced by Health Boards a number of questions were

raised relating to how these bids compared to Health Board priorities and whether there were

more pressing causes. The outcome of further discussion with the NoSPG Executive resulted in the

NDP under spend being distributed back to Health Boards rather than funding the bids submitted.

Director of Regional Planning - Specific Work

During 2014/15 the Director of Regional Planning (DRP) undertook specific national work as part

of his remit. This included representing the north, and the Directors of Planning on a number of

groups, in particular where there is an imperative for the north:

• 2020 Vision Capital and Facilities Change Management Plan Programme Board

• National Patient, Public & Professional Reference Group

• National Planning Forum

• Scottish Health Technologies Group

• National Managed Network Service Project Board

• National Clinical Decision Support Steering Group

• Sustainability and 7 Day Services Taskforce

• Radiotherapy working Group

• Major Trauma Oversight Group


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• Children and Young People’s Health Support Group

The North DRP continues to work closely with his counterparts from the other 2 regions, meeting

on a monthly basis to explore common areas of work and areas where inter regional collaboration

might add value. This informal networking reduces duplication and maximises effort for the

benefit of all boards in Scotland.


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Regional Networks

Managed Clinical Network for Specialist Paediatric Child Protection

Clinical Lead: Dr Joy Mires (Designated Doctor, NHS Tayside)

NoSPG support: Mrs Anne-Marie Pitt (Child Health Network Manager)

Introduction

Dr Joy Mires has continued to provide clinical leadership to the network on secondment for 2 PAs

per week but reduced to 1 PA for a further two years from December 2014. The network has

involved all the North of Scotland Health Boards except for NHS Western Isles, who link in with

the West of Scotland Child Protection MCN. The availability of clinical leadership has allowed the

network to develop into a fully functioning MCN which is multi-disciplinary and includes partner

organisations.

The first formal MCN Steering Group was held in February 2015, chaired by Dr Mike Bisset, which

in the future will include NHS Western Isles in further collaboration as part of the network.

Activity

Activity on child protection cases and medical examinations has historically been collected

differently throughout the region. However the network has agreed a minimum data set for

medical examination activity, which has been collected manually by all Health Boards from July

2014 and the following results indicate activity and outcomes of child protection medical

examinations within each Health Board. The data (figure 1) shows examination activity for a six

month period; data from the last quarter is still being verified.

It should be noted that all of NHS Orkney child protection medical examinations are currently

carried out by the specialist service within NHS Grampian. Similarly child sexual abuse forensic

examinations for NHS Shetland are carried out in NHS Grampian. The two other regional MCNs are

awaiting the results of this data collection to consider the benefits of establishing a similar

minimum data set across Scotland.


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48

30

818

5044

Q2 Q3 Q2 Q3 Q2 Q3

Grampian Highland Tayside

Number of Single Doctor

Examinations by Board

Figure 1

Expenditure

63 52

19 24

67 55

5 0

Q2 Q3 Q2 Q3 Q2 Q3 Q2 Q3

Grampian Highland Tayside Shetland

Numbers of referrals for

examination by Board

July 2014 -December 2014

8

37

0 0 1 111

18

2 07 3

2 paeds 1 paed & 1 FP 2 paeds 1 paed & 1 FP 2 paeds 1 paed & 1 FP

In hours Out of hours week Out of hours weekends

Total numbers of Joint Paediatric Forensic Medical Examinations

Q2 Q3

43

1219

46

0 0

36

17

1 0

34

8 9

36

1 0

3219

1 0

Total numbers of outcomes of examinations

Q2 Q3


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National Delivery Plan (NDP) revenue funding resources the network, a breakdown of this funding

is provided in Table 1. As mentioned above only 1 PA a week of clinical lead time has been

required from December 2014.

Table 1

Post Grade/

Band

WTE PAs £

Year 3

Regional

Network Manager 7 0.5 20,890

Lead Clinician 2 23,345

Admin support 4 0.5 11,725

Sub - Total 55,960

Total 55,960

Quality

The network continues to focus on priority areas which have been highlighted by individual Health

Boards or indicated as high risks on the risk register.

Particular significant developments in the work plan this year has been the collaboration between

NHS Grampian and NHS Orkney to establish training in Orkney provided by the lead child

protection doctor in NHS Grampian. This will deliver child protection support to clinicians in Orkney

and establish closer working relationships that will allow some medical examinations to be carried

out by GPs on the islands, thus allowing children and families to be cared for more locally than at

present.

In addition Health Boards have worked steadily towards manually collecting data in order to

provide a regional understanding of child protection medical examinations as described above.

Steps have also been taken to begin to address the outcome of a previous audit on the equity of

service provision within the region and likewise on an audit on the storage of intimate images

where a regional policy is being developed.

Members of the network have also continued to engage nationally in the Scottish Government’s

initiative to review child protection medical services and the development of a national work plan

to address sustainability and quality issues. As part of the solution to these issues the Clinical Lead

and Network Manager have developed close working relationships and joint initiatives with the

other regional child protection MCNs. Consequently a joint national training programme has been

developed which includes training on the clinical assessment of child sexual abuse. Plans are in

hand for other courses such as advanced court room skills; and national guidance for a number of

areas such as the criteria for out of hours’ medical forensic examinations.

As part of the concern for sustainability and quality the Child Protection Complex Cases Forum was

established as a pilot collaboration between the two MCNs in NoSPG and SEAT regions. Due to


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retirements throughout the country of very experienced specialists there was a lack of expertise to

provide advice on complex cases. The Forum aims to address this problem with the lead specialist

from each Health Board meeting virtually for an hour monthly, allowing the specialists to discuss

with their peers current complex cases for advice and support. Alongside this a package of

mentoring and support has been made available for Forum members. The pilot period ended in

December 2014 and was consequently evaluated as very successful. It has consequently been

established across the whole of Scotland.

Paediatric High Dependency Care Network


Significant investment has been provided to support paediatric high dependency care throughout

the region, via the National Development Plan for Children’s Specialist Services funding (NDP).

This has resulted in an increased capacity for children and young people to receive more locally

provided care (e.g. establishment of high dependency care beds at Raigmore Hospital in

Inverness).

A regional network was established in 2012, when it was agreed that the highest priority for co-

ordination through the network was the safe inter-hospital transfer of critically ill children across

the north of Scotland. Agreement to include this type of transfer in the wider consideration of

secondary transfer risks in the north of Scotland by Specialist Transport Service for Scotland

Review (ScotSTAR) has been reached.

The network carried out an audit of critical care transfer data during 6 months of 2014, to feed

into the business solutions of the review. This data was supplemented with transfer data from a

number of Rural General and Community Hospitals, gathered though the Paediatric Unscheduled

Care (PuC) Pilot and independently by NHS Shetland who were not involved in the PuC Pilot. A

further description of this work is reported further on in this document under ‘Safe and

Sustainable Transfer and Retrieval in the North of Scotland’.

In addition to regional networking there was increasing agreement that quality improvement and

training and education in high dependency care should be co-ordinated across Scotland in respect

to agreeing national audit, performance measurement indicators and organising training for staff.

Consequently an Inter-Regional HDU Group has been established, where the three regional

networks are working together to improve paediatric high dependency care in non-tertiary settings

i.e. District General Hospitals and Rural General Hospitals. Representatives from the NoSPG

network contribute and distribute information from this national group.


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Activity

Previously there was no nationally agreed definition of high dependency care and therefore the

collection of data within each Health Board was not consistent and accurate activity across the

region was unknown. The Inter-Regional Group during the year has agreed a Scottish definition of

high dependency care and further work will be required to establish a minimum data set.

Expenditure

The allocation below show the resources invested in each Health Board from the NDP funding.

Recurrent funding for staffing indicated:

Table 2

Health Board

Recurrent £ Staff

NHS Grampian

95,037

2x Band 5 nurses 0.5WTE Band 6 nurse

0.4WTE Band 4 admin

NHS Highland

83,363

2x Band 5 nurses

0.3WTE Band 6 nurse 0.2WTE Band 4 admin

NHS Tayside

95,037

2x Band 5 nurses 0.5WTE Band 6 nurse

0.4WTE Band 4 admin

NHS Shetland

NHS Orkney

NoSPG 17,333 NDP allocation previously held by NSD and reallocated in year to regions. Expenditure not

confirmed at present.

Quality

The last national audit of high dependency care was carried out in 2009. The recommendations in

the audit had previously been assessed within each of the region’s Health Boards and learning

points implemented. During the last year, however, the Inter-Regional Group has agreed a

national audit of the five most common conditions requiring high dependency care. This is

currently being carried out within the region and learning discussed when completed.

General Surgery for Childhood Network

NoSPG support – Mrs Anne-Marie Pitt (Child Health Network Manager)

NDP investment has been provided to support general surgery for childhood throughout the region

via the provision of a paediatric surgeon at the Royal Aberdeen Children’s Hospital and extra

sessions for general surgeons at Raigmore Hospital. The regional general surgery for childhood

network continues to provide services throughout the region and meet together to improve


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communication, the development of agreed patient pathways, regional guidelines and improved

training.

Activity

The NDP investment has enabled the implementation of the following extra clinics and operating

lists by paediatric surgeons thus allowing general surgery for childhood to be delivered as locally

as possible:

• Outpatient clinic x 2 / month in Inverness

• Outpatient clinic x 1/ month in Elgin

• Outpatient clinic x 4 / year in Shetland

• Outpatient clinic x 4 / year in Orkney

• Outpatient urology clinic x 1 / month in Inverness

• Operative sessions x 2 / month in Inverness

• Operative sessions x 4 / year in Shetland

Expenditure

NDP investment in general surgery for childhood has been:

Table 3

NHS Grampian NHS Highland

Consultant Paediatric Surgeon 1 WTE £117,587

General Surgery for Childhood Sessions 0.4WTE £35,018

Administration 0.5WTE £11,707

Non-Pay £5,624

This revenue sits within boards and is not administered by the regional team.

Quality

The network organised a multi-disciplinary Education Day in June 2014 which covered discussion

of common presentations, began to develop regional protocols and assess how to develop the

network structure.

The intention is to increase joint working between the visiting paediatric surgeons and local

surgeons by encouraging joint clinics and operating lists as well as increasing the teaching from

visiting surgeons locally. There is also the willingness to consider rural team members rotating

through the Royal Aberdeen Children’s Hospital (RACH) and ensuring referrals are made to local

services whenever feasible, rather than directly to the RACH.

The aim overall is to facilitate the development of local skills in anaesthetic and nursing staff, as

well as surgeons, and ensure new appointments in all these disciplines are competent in providing

a quality service to children and young people out with tertiary centres.


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Child & Adolescent Mental Health Network

Clinical Lead: Dr Sally Bonnar (Consultant, NHS Tayside)

Regional Network/Service Manager: Mrs Ruth Masson (NHS Tayside)

The key objectives of the Tier 4 Network are:

• 12 – 18 year olds with Tier 4 mental health need receive appropriate and timely care

that is equitable across boards, as local as possible as specialist as necessary;

• Continuity of care through step up and step down care;

• Peer support and training; and

• Governance and clinical pathway development in collaboration, as part of an obligate

network.

These will be achieved through the establishment of an Obligate Network consisting of a new

regional 12 bedded inpatient unit (replacing the existing 6 bedded unit) and a Network Team as

below:

• Regional CAMHS Network Manager (1wte)

• Network Support Officer (1wte temporary) funding for this post has now ended

• Network Liaison Nurse for Tayside (1wte)

• Network Liaison Nurse for Highland (1wte)

• Network Liaison Nurse for Grampian, Shetland and Orkney (1wte)

• Advanced Nurse Practitioner (1wte)

• Regional CAMHS Network Consultant (0.5)

Recruitment to The Network Team was completed in September 2013.

The new regional in-patient unit was finished on schedule with the keys being handed over on

March 6th 2015 and existing patients transferring to the new premises on 7th April 2015. All staff

has had the opportunity to be involved in team development, training and fitting out the new

facility, in house training was completed on 8th May.

The Network have been working across the North of Scotland to establish consistent data

reporting for all Tier 4 patients as well as working nationally with SEAT and the West of Scotland

to develop a national ISD database for Tier 4 patients. This work is driven by the Network

Support Officer who has provided the following data:


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Admission to the YPU for young people across the NoS:

Table 4

INPATIENT

UNIT

TOTAL

Admission

NHSG

NHSH NHSO NHSS NHST TOTAL

BED

DAYSc

YPU, Dundee 16 2

(498)a

1

(102)

0 1

(53)

12

(1550)

2203

Adult MH Ward 65 31

(571)

2

(15)

0 1

(16)

13

(641)b

1243

YPU, Edinburgh 3 2

(5)

0 0 0 1

(7)

12

Huntercombe 21 7

(715)

6

(1474)

0 0 8

(455)

2644

Skye House 1 0 0 0 0 1

(34)

34

Paediatric Ward 18 2

(6)

10

(120)

0 1

(24)

5

(59)

185

General Ward 11 7

(101)

2

(13)

1

(13)

0 0 127

TOTAL 135 51

(1896)

21

(1724)

1

(13)

3

(93)

40

(2746)

6448

a. The numbers displayed in ( ) are total bed days for the number of patients admitted. These

figures are prior to the unit becoming a regional service. b. 422 bed days were due to two patients that had special arrangements due to their level of

risk. c. To capture total bed days from 1st April 2014 – 31st March 2015 the totals above include

admissions that overlap 2013-14 and 2014-15.

These figures were collected in order to compare number of patients admitted and length of bed

days associated. There is evidence to suggest that where there are dedicated community Tier 4

services the length of admission is reduced.

NHS Tayside has the largest dedicated Tier 4 community service, followed by NHS Grampian. NHS

Highland has very limited Tier 4 community services. Shetland and Orkney manage their Tier 4

work within their generic CAMHS teams. It should be noted that areas with a large rural

population are faced with additional challenges when developing Tier 4 community services and

that all areas support Tier 4 community care within the generic CAMHS teams.


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Waiting Times

Tier 4 patients will have out-patient CAMHS professionals involved, due to the level of clinical need

they will be prioritised for urgent appointments so do not have a lengthy wait for treatment.

The in-patient unit is measured as part of the Medicine Directorate within NHS Tayside, which has

a 12 week target of referral to treatment, which has not been breached over the last year.

Budget

Table 5

Actual Direct Costs 2014/2015

Young

Persons

Unit

CAMHs

Network Total

Medical & Dental 155,196 71,753 226,949

Nursing & Midwifery 853,933 166,753 1,020,686

Allied Health Professionals 117,965 0 117,965

Other Therapeutic 40,609 0 40,609

Admin & Clerical 38,046 13,793 51,839

Total Pay 1,205,749 252,299 1,458,048

Drugs 4,859 0 4,859

Equipment 856 164 1,020

Other Admin Supplies 1,847 14,383 16,230

Hotel Services 161 0 161

Property 460 100 560

Other Supplies 645 90,224 90,869

Total Non Pay 8,828 104,871 113,699

Income (273,087)

Grand Total 1,214,577 357,170 1,298,660

The above details the total of direct costs incurred across the Young Persons' Unit & CAMHs

Network. The income represents the share of costs recovered from other NoS Boards associated

with the full cost of CAMHs network and the additional costs incurred in moving forward with the

expansion of the existing YPU.

Priorities for 2014 – 2015

• Developing the strategic role for the Network Team

• Embedding the governance strategy into the Network

• Enhancing the provision of consultation for Tier 4 patient across the Network

• Building enhanced working relationships with the new regional inpatient unit

• Reporting data collected from the Integrated Care Pathway

• Developing research relevant to the Network


21

Achievements

The Network has developed monthly Clinical Governance meetings held in Tayside with

representation from the multidisciplinary team and the Network Liaison Nurses, this Group has

developed a reporting scorecard and action plan based around the benefits realisation and is

gathering data to populate the documents. A paper outlining the structure for governance has

been submitted to and agreed by the project board. Ongoing work between the Steering Group,

the North of Scotland Planning Group and NHS Tayside will determine the process for assurance

around governance.

The consultant for the network has been working with the network staff to provide consultation

and second opinions for patients referred to the inpatient unit. All network staff support outpatient

services who work with young people with Tier 4 need.

The role of the Network Liaison Nurses has developed over the last year, with the increase in beds

for the NoS they have been focussing on education, prevention of admission and transitions into

and out of hospital. During this Year 1 Network Liaison Nurse left the Network, the post was

vacant from 1st March till 10th June.

Data gathering has continued over this year and a report was presented at A PDP event for the

North of Scotland on 25th September 2014. The Network Support Officer post terminated in

February, there is scope for the band 5 Admin manager to take up the data collection. However,

they have been heavily involved in the setting up of new systems for the new unit and have been

covering sickness which has hindered their ability to continue the data analysis. A proposal has

been submitted to the Scottish Government for a part time data coordinator.

The Consultant in the Network has a special interest in research and is developing a research

group to take projects forward. They have recently taken on the role of Principal Investigator for

the CostED study that is looking at the cost effectiveness of treatments for anorexia nervosa.


22

North of Scotland Oral and Dental Health

Following the retirement of Ray Watkins the clinical leadership of this network now sits with Dr

Jonathan Iloya, in his capacity as NHS Grampian's Consultant in Dental Public Health. The new

Chair of the network is yet to be agreed. The project manager post supporting this network has

remained vacant for the year but Keith Farrer, Programme Manager, has provided some support.

The network consists of the following MCNs and groups:

• Orthodontics

• Restorative Dentistry

• Oral and Maxillofacial Surgery (OMFS)

These networks aim to provide a single service across the north (excluding Tayside) by employing

joint network posts, collecting robust standardised data and reducing variation of access.

Orthodontic Network

NoSPG support: Regional Project Manager - vacant

Mr. Keith Farrer (Regional Programme Manager)

Activity for Orthodontics has remains relatively static over the last 3 years throughout the North.

Benchmarking across the region has shown that new activity for Orthodontics remains between 3

and 7 per 1000 population, which is broadly in line with previous year’s activity and national

benchmarking. Over the year the network has been progressing joint guidelines and referral

guidance for primary care.

Restorative Dentistry Network

NoSPG support: Mr. Keith Farrer (Regional Programme Manager)

The restorative dentistry service is in its 2nd year of existence. This year has seen successful

recruitment to the 2nd North of Scotland Restorative Dentistry post. The network has also been

developing training plans to support provision of community based restorative dentistry. There

were significant challenges to aspects of restorative dentistry due to technical problems in relation

to decontamination of equipment. This has now been resolved and allows the network to regain

normal functions.


23

Oral and Maxillofacial Surgery (OMFS) Network

NoSPG support: Mr. Keith Farrer (Regional Programme Manager)

The OMFS specialist service in the North (excluding Tayside) is provided through a network

arrangement between NHS Highland and NHS Grampian. There remain acute workforce issues in

relation to Consultant recruitment in both NHS Highland and NHS Grampian. Despite numerous

recruitment attempts the North of Scotland has not attracted any interest in the vacant posts -

this is compounded by a shortage of OMFS consultants nationally.

Some patients requiring urgent complex surgery are being treated out with the North of Scotland

and there is a growing waiting list for non-urgent cases. Due to the severity of the challenge of

providing a OMFS surgical service in the North, there is a national group that has been set up to

examine future service provision across Scotland.

North of Scotland Paediatric Gastroenterology, Hepatology and

Nutrition Network (NOSPGHANN)

Clinical Lead: Dr. Michael Bisset (Consultant Gastroenterologist, NHS Grampian)

NoSPG support: Mrs. Carolyn Duncan (Child Health Network Manager)

The North of Scotland Paediatric Gastroenterology, Hepatology and Nutrition Network

(NOSPGHANN) has been in existence since 2003 however the network was set up more formally

over 4 years’ ago following investment from the National Delivery Plan from 2008-11.

Clinicians support children and young people with problems of the gastrointestinal tract, the liver

and complex nutritional issues across 5 North of Scotland Health Boards. Many of these children

have complex health issues and rely on network clinicians to support them. Multi-disciplinary

teams are based in Royal Aberdeen Children’s Hospital, Tayside Children’s Hospital, Dundee and

Raigmore Hospital, Inverness.

Staff work in a collaborative environment across health board boundaries and are proud of the

excellent team working, communication and relationships that have been built up across the

region over the past 11 years. They continue to drive up standards and to ensure they provide

consistency of care across the North of Scotland whilst working in partnership with patients and

families to enable them to better manage their conditions. Provision of a highly trained workforce

continues to be very important and the network encourages staff training and education through

formal and informal educational opportunities, case discussions and cross boundary working.

The network has experienced a temporary reduction in staffing during the year in dietetics and

psychology due to maternity leave absences however where possible partial cover has been

provided.


24

The appointment of a third Consultant in RACH has proved a great benefit to the network and

monthly clinics have also been undertaken in Elgin and twice yearly in Shetland and the new

biologics and genetics and feeding clinics have been a very positive asset for patients and families.

Another development which has proven very successful has been the appointment in August 2014

of a part-time Clinical Associate in Applied Psychology at Ninewells. Discussions over a period of

months with the CAMHs service resulted in 1 day per week dedicated psychology funding for

gastro from NDP being used to enable 1:1 direct clinical work with families and close liaison with

the gastro team at a weekly clinic. Typical referral reasons include chronic pain, adjustment,

anxiety and difficulties with adherence to their medical regimen.

Due to numbers of chronically ill gastro & hepatology patients continuing to rise year on year (up

to a 100% increase seen in Aberdeen, Dundee and Inverness over the last 5 years) many with

Inflammatory Bowel Disease (IBD) are now on biologics therapies which are very time consuming

for professionals to administer.

There is an increasing need for endoscopy procedures, which are carried out in Aberdeen, Dundee

and Inverness operating theatres. Numbers dictate that there is now a need to hold an additional

theatre list per month in Ninewells and where theatre capacity allows, additional theatre sessions

have been able to be undertaken by Consultant staff so that children do not have to travel out

with their home Board.

Strong links and collaboration with paediatric surgeon colleagues continues across the region

meaning they can often carry out endoscopy or surgical procedures for network patients in

Inverness and Shetland if urgently required. Endoscopy figures for procedures undertaken in

2014 are:

• Aberdeen 181 (an increase of 19%)

• Dundee 170 (an increase of 132%)

Network staff worked hard to collect and submit data in the UK IBD audit during 2014. The first

round of the UK IBD audit took place in 2006 and examined in-patient care of with Inflammatory

Bowel Disease at each participating site and the organisation and structure of IBD services.

Paediatric services were included in round 2, and the safe use of biological therapies and inpatient

experiences were added in round 3.

The audit has helped to improve IBD services and to deliver higher quality care nationally and

locally. There remains a gap in having a fit-for-purpose data collection system for the network

and for other North of Scotland child health networks however discussions are ongoing at the NoS

e-Health Leads. In the meantime a network data collection template was agreed in Spring 2015

and activity data will start to be collected from April 2015.


25

It has been an extremely busy year for the multi-disciplinary teams however the work has been

carried out by a flexible workforce and the network is well positioned to take the network forward

positively. The excellent team collaborations across the north of Scotland continue to ensure

provision of safe and sustainable services for patients.

North East Scotland Child & Adolescent Neurology Network (NeSCANN)

Clinical Lead: Dr. Martin Kirkpatrick (Consultant Neurologist, NHS Tayside)

NoSPG support: Mrs. Carolyn Duncan (Child Health Network Manager)

Over the past year services have been delivered and enhanced by the dedication and collaboration

of the network’s multi-disciplinary teams of tertiary and secondary care clinicians across 5 north

Health Board areas, supporting children with epilepsy, neurological and neurodisability conditions.

The network is committed to ensuring the sustainability of the network in providing patients and

families with patient-centred, safe, effective, efficient, timely equitable access to services.

Clinicians collaborate across health board boundaries on a daily basis to deliver the best quality

care as close to patients’ home as possible.

Like NoSPGHANN (North of Scotland Paediatric Gastroenterology, Hepatology and Nutrition

Network), NeSCANN has been in existence for the past 11 years and also received investment

from the National Delivery Plan from 2008-2011. Multi-disciplinary teams of clinicians involved in

NeSCANN are based in Royal Aberdeen Children’s Hospital, Tayside Children’s Hospital, Dundee

and Raigmore Hospital, Inverness.

It is the aim of network staff to continually make improvements to the way care is delivered to

patients and families so that standards and the best quality care are consistent across the region.

At the same time clinicians from each of the centres work in partnership with families on a daily

basis to enable them to better manage their child’s condition.

NeSCANN is committed to ensuring a highly skilled and trained workforce and again during the

year a large number of learning and educational opportunities were provided. An excellent

network study day incorporating topics on neurogenetics and neuromuscular conditions was held

in September in Aberdeen.

Professional support is regularly available by way of formal and informal training opportunities and

case discussions. Monthly multi-disciplinary meetings take place in the 3 main centres providing

teaching and education sessions, i.e.

• Brainwave (Ninewells) – now available across the region by VC

• Neurology Open Day (Royal Aberdeen Children’s Hospital)


26

• Raigmore Hospital, Inverness – lunchtime sessions alongside the visiting Consultant

Neurologist clinics.

In March, a CHaT (Childhood Headache Training) course run by the British Paediatric Neurology

Association was held in the Suttie Centre, Aberdeen with several network clinicians providing the

teaching. Network clinicians are also involved in teaching the Paediatric Epilepsy Training (PET)

courses both in the UK and internationally.

There continues to be close links by network clinicians with the Scottish Paediatric Epilepsy

Network (SPEN) and the Scottish Muscle Network on topics such as education and training, audit,

road shows and family days. Dr Kirkpatrick continues to attend the Scottish Paediatric Epilepsy

Surgery MDT on behalf of NoS patients who are being discussed for potential surgery to improve

their epilepsy.

Good progress was made during the year on the network work plan. There have been positive

developments in the delivery of epilepsy clinics in Dr Gray’s Elgin, the ITB service (Intrathecal

Baclofen), neuropsychology involvement in NHS standards for paediatric brain injury, care

pathways and audits. A fit-for-purpose data collection system and accompanying data officer

support remain as gaps for the network (as well as for other regional paediatric networks). It has

been recognised for a number of years that there could be clinical governance issues at times

regarding access to patient information and the ability to make clinical decisions on patients’

outwith their home Board.

NeSCANN clinicians have continued to participate in the national Epilepsy 12 audit, second round -

3 audit units in Aberdeen, Dundee and Inverness have contributed. The results for the

performance indicators demonstrate that NeSCANN fairs well in comparison to the rest of the UK

and in many of the 12 performance indicators the network is at the top of the range of data

results.

The network has had another extremely busy year. Cross-boundary working brings many

challenges however multi-disciplinary teams of conscientious, hardworking network staff continue

to deliver the best quality care and service as close to patients’ homes as possible. NeSCANN will

continue to develop services where practically possible, to ensure a highly skilled workforce and to

build on the very good collaborative work that has been carried out across the region over the

past 11 years.

North of Scotland Paediatric Respiratory Network

Clinical Lead: Dr. Jonathan McCormick

(Consultant in Paediatric Respiratory Medicine, NHS Tayside)

NoSPG support: Mrs Carolyn Duncan (Child Health Network Manager)


27

The North of Scotland Paediatric Respiratory Network delivers specialist inpatient and outpatient

care including the diagnostic testing and monitoring of respiratory patients across the 5 NHS

boards in the North of Scotland.

Tertiary and secondary care multi-disciplinary clinicians work collaboratively to deliver, to develop,

and to sustain services for children with respiratory conditions as close to their homes as possible.

The NOSPRN has helped link the teams delivering these services with the aim of providing mutual

support and further professional development for the benefit of patients.

In 2014, the network continued collaborative working to harmonise patient protocols and patient

information leaflets, with small groups of individuals tackling different projects. The possibility of

developing a third Scottish paediatric ventilation initiation centre in Aberdeen was explored, but

staff and patients in Dundee and Inverness were content with current service provision from

Edinburgh and Glasgow.

Specialist visiting clinics were run in Portree (CF only), Raigmore (CF and Respiratory), Orkney

(Respiratory) and Shetland (Respiratory) with respiratory clinics continuing in Dundee, Aberdeen,

Elgin and Perth. The network has endeavoured to maintain lay representation at meetings and

now has input from British Lung Foundation Scotland.

National Delivery Plan (NDP) recurring funding is embedded in existing paediatric services for

complex respiratory and CF patients in Aberdeen, Dundee and Inverness.

Staffing challenges were greater in 2014 than in previous years, due to absences and departures

for career progression, sick leave, maternity leave, and difficulties recruiting to vacancies. There

was additional pressure on CF teams with a significant increase in newly diagnosed babies through

2014 – 2015 in all areas. However, we welcomed a number of new appointees to positions within

the network in permanent and temporary positions, which helped maintain services for patients.

The advantages of the NOSPRN include enhanced training opportunities for staff, more efficient

use of resources, an increased capacity for service delivery, and the management of complex

patients resulting in improved services for children with respiratory conditions. A successful CF

Away Day was run in Aberdeen attended by the multidisciplinary teams from the three major

centres.

The integration of teams through shared working in clinics, or through collaborative peer

educational initiatives via videoconference such as the Complex Respiratory Cases meeting, CF

Annual Review meetings, or network respiratory teaching has helped to negate barriers and

promote professional support amongst all grades of staff who might previously have worked in

isolation.


28

Monitoring network activity continued through the collection of quarterly activity reports that

forms the measurement of progress reported in the annual report.

Neonatal Network

Clinical Lead: Dr. Nikolaus Kau (Consultant Neonatologist, NHS Grampian)

NoSPG Support: Mrs. Marie Gardiner (Neonatal Clinical Facilitator)

Mr Keith Farrer (Programme Manager)

The North of Scotland neonatal network has continued to deliver a programme of work during the

year, against a national backdrop of increasing pressure on cot availability.

Reporting has continued against the Neonatal Quality Framework and some progress has been

noted, although a number of areas of action are outstanding, or are behind trajectory. As the

smallest of the three regional neonatal networks, securing wide-ranging clinical input to the

network and the activities driven by the network remains challenging, and the absence of a

substantive MCN Manager for a portion of the year has undoubtedly held up some work streams.

The MCN Steering Group has not met during the year, for a number of reasons. Limited availability

of clinical leadership within NHS Grampian has contributed to this delay, as have issues with

succession planning within the regional clinical leadership role. Re-focussing of the MCN Steering

Group membership and objectives is being delivered by the interim MCN Management now in

place and recruitment to a substantive post holder is underway. The Network is on track to deliver

the next planned update of the Quality Framework in the autumn of 2015.

Intra-regional links remain strong and the North of Scotland is participating in the development of

a national cot capacity framework, and ensuring these links are maintained in the Steering Group

going forwards.

The network has actively contributed the planning of the new Maternity Hospital in Aberdeen and

will continue to support where necessary.

This remains a challenging area for the north as key network roles are filled and cot capacity and

staffing pressures are reduced within boards.

North of Scotland Cancer Network (NOSCAN)

Chair: Mr. Richard Carey (CEO, NHS Grampian)

Ms. Lesley McLay (CEO, NHS Tayside)

Clinical Lead: Mr. Peter King (Consultant Surgeon, NHS Grampian)

Mr. Sami Shimi (Consultant Surgeon, NHS Tayside)

NOSCAN Manager: Vacant during the period of reporting


29

Introduction

The role of NOSCAN is to communicate, inform and facilitate cancer excellence across the North of

Scotland. There is a new leadership team in place with Lesley McLay taking over from Richard

Carey the chairmanship and Mr Sami Shimi replacing Mr King in the clinical lead role.

NOSCAN Team Structure

The re-structure of the team started in 2014 is now complete, with the appointment of a new

NOSCAN manager and confirmation of the cancer MCN manager. The new NOSCAN Manager (Mr

Keith Farrer) takes up post during Q1 2015 / 2016. In addition to these posts there has been

appointment to a fixed term cancer data and quality manager and more recently we have

successfully recruited a clinical lead and project manager for the TCAT programme.

Cancer Quality Performance (QPI) Programme

As part of a Scottish Government programme of cancer quality improvement, the cancer networks

have a responsibility to co-ordinate, analyse and report the QPI data for all tumor/cancer specific

QPIs.

Following the appointment of a Cancer Audit & Information Manager in August 2014, NOSCAN

have made considerable steps to improve reporting of QPIs in the North of Scotland and action

planning as a result of these results. This is not only to meet the requirements of CEL06 but also

to improve cancer care across the region. Whilst generally the QPI results have confirmed

excellent clinical practice across many areas, there are some pathways that will require significant

effort and re-design to improve performance.

To date the following progress has been made:

• A timetable for regional reporting for 2014/15 and 2015/16 has been developed and

a QPI Audit Governance paper drafted, outlining the procedure for QPI reporting in

NOSCAN.

• Reports summarising the QPI results from NOSCAN Boards have been produced for

6 tumour groups to date and will be produced annually for all tumour groups. When

required, these data have been submitted to ISD in a timely manner.

• Regional Comparative reports will be published in all years where QPI results are not

reported nationally. To date one Regional Comparative Report has been published

and a further three are being drafted.

• Action Planning processes have been agreed and Action Plans have been produced

for breast cancer and upper GI cancer. Compliance against these will be monitored

by the MCN and reported to RCAF annually.

• NOSCAN have been involved in the HIS pilot QPI Review for Breast Cancer.


30

As well as ongoing reporting of 18 QPI tumour groups per year, NOSCAN will continue to work to

engage NHS Boards and MCNs in the QPI process and to support both Board audit staff and

national review processes.

Detecting Cancer Early (DCE) programme

The purpose of this programme has been to improve the early detection of cancer and has been a

combination of national and locally led initiatives. The network has continued to support the

Board programmes around this throughout 2014. The Scottish Government has just announced a

further funding round which Boards have been invited to bid against.

Regional Managed Clinical Network (MCNs)

There are 7 well established regional cancer MCNs (breast, colorectal, gynaecology, upper GI,

lung, haematology, urology) in the North network, and a further two regional clinical groups (head

and neck and skin cancer) are presently being established. Each of these groups has a major role

in engaging clinical staff in the review and development of patient pathways and supporting

clinical management guidelines. All these regional MCNs now have clinical leads in place and

management support. The terms of reference for the MCNs have been updated and the NOSCAN

office is currently reviewing its membership.

The focus of the work for all the MCN has been to provide peer review of the board QPI results

and action plans and the development of the regional clinical management guidelines (CMGs).

The latter requires considerable effort and co-ordination to ensure that CMGs are in place and up

to date for all tumour groups.

NOSCAN Chemotherapy Advisory Group (NCAG)

In 2011 the North of Scotland Planning Group endorsed the function of a regional chemotherapy

group to progress regional clinical management plans (CMGs) and associated protocols and

guidance. This work is important to minimise clinical variation in relation to cancer treatment and

to reduce the risks associated with this.

Whilst there has been some progress made to date, the lack of a regional pharmacist to provide

leadership and co-ordination is slowing progress. There is a need to provide a regional structure

to this work and senior leadership - currently being explored with the SACT clinical leads and the

Directors of Pharmacy

Transforming Care after Treatment (TCAT)

This is a national programme, supported by the cancer networks, to transform post treatment

cancer follow-up. To date NHS Tayside and NHS Western Isles have been successful in securing

bids to test new models of cancer follow -up. Although some boards have not been able to secure

national TCAT funding there are plans within the network to support further work throughout the

North.


31

Sustaining Oncology Services in the North of Scotland (SOSNoS)

NoSPG Support: Ms. Lesley Forsyth (Regional Programme Manager, Cancer)

Mrs. Grace Ball (Regional Programme Manager, Cancer)

Specialist Oncology services in the North of Scotland faced significant workforce shortfall pressures

during 2013/2014 with subsequent disruption to the quality of experience of some patients. Each

of the three specialist Oncology centres located in Aberdeen, Dundee and Inverness face long

term challenges from global Oncology workforce shortages, predicted rise in service demand,

increasing technological complexity of treatment delivery and pressures to support national

solutions in specialist Oncology provision. A programme of service redesign therefore commenced

in April 2014, led by the North of Scotland Planning Group.

Initial work streams included the development of a capacity shortfall regional escalation policy,

standard operating procedures for regional patient transfers and development of remote

radiotherapy treatment planning shared management processes.

A comprehensive range of data collation, intelligence gathering and research was undertaken to

underpin decision making on the scope and dimensions of future regional working - workforce

data, service capacity and activity data, financial expenditure historic and projected, future cancer

projections. Qualitative data included communications with clinical and managerial stakeholders

and partners at national, regional and local level from a range of disciplines.

National and international scoping of cancer services identified four potential service models that

could be considered to support future regional sustainability:

1. Status quo

2. Two centre regional collaboration

3. Three centre regional collaboration

4. Integrated regional managed service network

Each model was analysed through a process of multidisciplinary consensus and criterion

referenced option appraisal. The status quo and two centre collaborative models were considered

to offer no realistic opportunity for long term service sustainability and presented an increased

likelihood of amplifying existing challenges with subsequent detriment to patient care.

A three centre regional collaborative model offered the necessary infrastructure and governance to

provide cohesive regional sustainability in the medium term, whilst retaining the independence of

each centre. A regional managed service network (regional MSN) was identified both by

multidisciplinary consensus and option appraisal as the most sustainable and resilient long term

option for the North of Scotland. However, it is acknowledged that successful implementation of a


32

regional MSN would be a long term undertaking requiring significant organisational redevelopment

and cultural shift.

Therefore development of a three centre regional collaboration led by a regional oncology clinical

board (ROCB) was agreed by NoSPG Executive in December 2014, bringing together the three

specialist oncology centres and their peripheral provider sites. A Memorandum of Understanding

has been developed and agreed by all boards, setting out the nature of collaboration between

NHS Grampian, NHS Highland and NHS Tayside in the delivery of a regionally collaborative

oncology service.

The initial scope and priorities of the ROCB for 2015/2016 include:

• Provision of regional workforce cross cover during periods of capacity shortfall.

• Development of regional tumour specific oncology teams to support regional clinical

service cross cover.

• Harmonisation of the clinical systems and processes associated with shared patient

management.

• Regional workload activity planning and reporting.

• Regional workforce planning.

• Regional scoping and alignment of multidisciplinary skill mix.

• Regional alignment of relevant IT systems and networks.

• Development of a regional governance framework.


33

North of Scotland Public Health Network (NoSPHN)

Clinical Lead: Dr. Louise Wilson

Network Coordinator: Mrs. Pip Farman

Dr Louise Wilson, Director of Public Health for NHS Orkney has led NoSPHN since August 2014

following the retirement of Dr Margaret Somerville, Director of Public Health in NHS Highland. The

Lead role and network are supported by the Network Manager, Pip Farman a Public Health

Specialist. The work of NoSPHN is guided by a Steering Group comprising the NoS Directors of

Public Health, the NoSPG Director; representatives from regional working groups and

programmes; and national bodies for example the Scottish Public Health Network (ScotPHN).

NoSPHN supports NoSPG in agreed pieces of work to ensure that regional initiatives are informed

by the best available evidence and identified population need and using a range of relevant tools

so that we make the best possible decisions within the resources available for the people of the

North of Scotland. NoSPHN also develops regional approaches to Public Health services, activities

and continuing education (further details of this work are available on the NoSPHN website

www.nosphn.scot.nhs.uk).

This year NoSPG / NoSPHN work has focussed on:

Intelligent region developments

NoSPHN has worked with NoSPG colleagues continuing to develop the concept of the Intelligent

Region as part of NoSPG’s sustainability programme which has a focus on maximising how NoSPG

does its business and is informed by appropriate information. This has included development

sessions with NoSPG and Public Health colleagues across the North of Scotland and learning from

work being progressed within NoS NHS Boards.

Low Volumes, Outcomes and Sustainability project

The outcome for this work has been a resource focusing on the challenges of low volume activities

and supporting understanding of and a consistent approach to agreeing where best to improve,

secure and sustain services in the future in the NoS, for the benefit of NoS patients. The work

was shared with the NoS Medial Directors (or their representatives) at a meeting in September

2014. The outcome of which was agreement to further test and develop the resource; work on

this continues.

Population of 1.3 Million

As part of the NoSPG sustainability programme a number of discussions with NoS colleagues and

at NoSPG alluded to a piece(s) of work intended to support strategic thinking and regional

planning when focussing on the needs of and planning for a NoS population of 1.3 million.


34

Discussion has been ongoing throughout the year to find a clear focus for the work. As part of

this NoSPHN is now developing test health profiling and patient flow work.

...

NoSPHN also develops regional approaches to Public Health services, activities and continuing

education. This year key work has focussed on:

Continuing Professional Development (CPD)

A number of activities were held including:

• Hosting the Scottish Faculty of Public Health Conference November 2014

• Sharing Public Health Lunchtime CPD sessions – opening access to all NoS Boards

• CPD sessions on welfare reform and employability; and alcohol and drug services

• The facilitation of a 3 Horizons capability learning set and

• The testing of remote access technologies to support learning and wider work across

the NoS.

Workforce planning

Work has included:

• Promoting the NoS as a Public Health training destination - through the NoSPHN

website; development of materials; Twitter; and supporting work experience

placements

• Raising the profile of NoSPHN at conferences through the presentation and sharing

of NoSPHN work

• NoSPHN has welcomed this year Dr Hugo van Woerden as the new Director of Public

Health for NHS Highland and Jonathon Iloya Consultant in Dental Public Health NHS

Grampian with a wider NoS regional dental public health role.

Health protection

The NoS Memorandum for Surge Capacity has been updated; a number of sessions have been

held to understand practice and variation across Health Protection on call services in the NoS

Boards; share CPD sessions and ensure collaborative links to the national Health Protection

Oversight Group.

Health Improvement

The main focus for health improvement activity has been on CPD sharing and responding jointly to

national developments for example the Scottish Healthy Working Lives developments.


35

National developments

NoSPHN responded to the Public Health Review, a response that focussed very specifically on

highlighting the challenges of working in remote and rural areas and related impacts for public

health activities. Links have also been maintained to national organisations – for example the

Scottish Public Health Network (ScotPHN); the national public health service improvement group;

and the Scottish Health and inequalities Impact assessment Network in the development of a

resource looking at the Health Impacts of Rural Developments.

NoSPG/NoSPHN priorities for 2015-16

NoSPHN and NoSPG will continue to progress ongoing developments from the 2014/15 workplan

and discuss new and developing areas of support as required including:

• Develop a coordinated programme of work to support health service improvement at

regional and local levels including:

• Continued support to NOSCAN and the NoS Oncology Board.

• Support regional approaches to NoS Dental Public Health.

• Continuing work on low volumes / outcomes and sustainability in the NoS aligned to

wider NoSPG work on the sustainability of services in the North of Scotland.

• To promote and deliver activities in support of the ‘Intelligent Region’ and work with

Health Intelligence colleagues across the North to maximise local, regional and

national activities.

• To develop and deliver activities with a focus on the IFF 3 horizons thinking1

approaches to work.

• Continue to develop regional approaches to Public Health services, activities and

continuing professional education with a particular focus on remote and rural public

health practice.

NoSPHN recognises the challenges faced by those living and working in the north of Scotland in

the current world economic climate, the changing landscape of delivery in health and social care,

and the national public health review but would confirm to NoSPG that NoSPHN is agile and well

positioned to drive and influence the key agenda issues in public health in the north of Scotland.

1 International Futures Forum


36

Regional Services

Cardiothoracic Regional Service

Clinical Lead: Mr. Hussein El-Shafei (Consultant Surgeon, NHS Grampian)

NoSPG support: Project Manager - vacant post

Mr. Keith Farrer (Programme Manager)

The North of Scotland Cardiac Network is collaboration between 5 health boards in the North

(excludes Western Isles). Within this network is the regional cardiac surgery service and regional

electrophysiology service, both hosted by NHS Grampian.

Activity

The referrals to the North of Scotland Cardiac Surgery Service continue to reduce and if this trend

continues the viability of the service will be at risk. Following a major review of this service there

are a number of reasons for the falling activity. This includes changes in medical treatments

(specifically a move to less invasive procedures carried out in cardiac cath labs) and out-of-region

referrals. The review of the cardiac surgery service has highlighted a number of improvements

that are required to ensure that the North of Scotland Service can compete organisationally with

other centres in Scotland. NHS Grampian are considering these recommendations which if

implemented will result is shorter patient stays and a better co-ordinated service.

There have been some significant changes in the electrophysiology pathways in the last 12

months. These changes have been agreed by the NoSPG cardiac subgroup and include the

repatriation of some modalities (CRT) to local boards and an introduction of a new cost model for

the regional service, which treats the most complex cases. Work on implementation of these

agreements continues.

Quality

The cardiac surgery outcomes have been routinely recorded and reported to the Society for

Cardiac Surgery (UK and Northern Ireland) for a number of years. The latest data (April 2010 to

March 2013) shows that the risk adjusted mortality rate (the principle outcome measure) is 3.39%

- which compares very favourably with other centres in the UK. See

http://www.scts.org/patients/hospitals/centre.aspx?id=45&name=aberdeen_royal_infirmary for

further information.

Waiting times

Meeting the treatment time guarantees for cardiac surgery remains challenging, principally due to

available workforce and surgical ITU beds. NHS Grampian has successfully introduced the role of

the "physician associate" to help ease “middle grade” medical workforce pressures. The


37

recommendations arising from the review challenge some of the current pathways, which if

addressed will help free up inpatient bed capacity.

Regional Mohs micrographic surgery service

Lead Clinician: Dr Colin Fleming (Consultant Dermatologist, NHS Tayside)

Manager: Ms Lynn Smith (Clinical Services Manager)

MOHS surgery is a technique involving microscopically controlled surgery used to treat common

types of skin cancer. During the surgery, after each removal of tissue, while the patient waits, the

Mohs surgeon examines the tissue specimen for cancer cells, and that examination informs the

surgeon where to remove tissue next. The Macmillan Mohs micrographic surgery service is hosted

in NHS Tayside and has been funded regionally since 2007.

Activity

Skin cancer continues to rise faster than any other cancer type, and the benefits of Mohs surgery

are being recognised more broadly across the region. We would predict a similar pattern of

increase in workload over the next 5 years as the past 5 years i.e. in excess of 300 -350 patients

per year.

Table 6

2007 2008 2009 2010 2011 2012 2013 2014

206 209 223 214 239 254 308 383

Mohs is a cost effective treatment, particularly for recurrent or aggressive tumours, which are one

of the main types of tumour treated in Dundee. This cost effectiveness comes from a reduction in

further operations and treatment in comparison with standard procedures; and from a reduction in

tissue removed in 4 out of 5 cases, which reduces reconstruction requirements.

Grampian and Tayside are the 2 largest referrers to the service. Dr Sanjay Rajpar, a Grampian

based consultant dermatologist, has joined the Mohs surgical rota to support the development of,

and increasing demand for, the service. A Grampian based pre and post operative clinic in ARI

commenced in September 2013, attended by both Grampian and Tayside Mohs surgeons, to

reduce patient travel and facilitate team working. The unit is supported by a post CCT fellow, part

of an accredited training programme for Mohs surgeons in the UK, and the only such Scottish

centre.

Waiting times

The introduction of a third operating day from April 2014 has had a considerable benefit on

waiting times, currently at 3 weeks. The reputation of the service has attracted successive post


38

CCT trainees from Singapore, at no cost to NHS Tayside, which assists in cost effective service

delivery.

Finance

Funding to provide the required third surgical list per week was supported by the NoS Boards and

commenced in April 2014.

Challenges for the service continue to be the rising incidence of skin cancer, ageing population,

increased recognition of Mohs technique, and increasing indications for Mohs.

Priorities for the service over next 12 months are to embed new consultant and working practices,

continue current level of waiting times for treatment, manage multiple retirements and training of

new colleagues in the biomedical scientist support group, and to continue to lead nationally on the

development of UK standards for Mohs surgery and development of an exam for UK Mohs histo-

technologists.

Managed Clinical Network for Eating Disorders (North Scotland)

Lead Clinician: Dr Jane Morris (Consultant Psychiatrist, NHS Grampian)

Manager: Mrs Linda Keenan (Manager MCN – Eating Disorders, NHS Grampian)

The Network continues to thrive and to pinpoint areas where improvements can be made. These

include the MARSIPAN protocol (Management of Really Sick Patients with Anorexia Nervosa,

Robinson et al, 2nd edition, Royal College of Psychiatrists 2014). This is an area we have

concentrated on this year and all areas are now potentially MARSIPAN compliant. Training was

delivered in Grampian, Tayside and Highland. Training will be repeated as necessary. In particular

there is a plan to repeat the training in NHS Tayside where medical wards have struggled to enact

the protocol.

The longstanding collaboration between Dr MacKinlay (Gastroenterology Consultant) and the Eden

Unit has resulted in them winning a SAGE Award (Shire Award for Gastrointestinal Excellence) for

producing a training pack in Eating Disorders. The award will be made shortly.

A funding bid for ACT Monies was successful. This has provided Dr Lesley Pillans, Staff Grade,

and Eden Unit with teaching time on Eating Disorders for medical students along with enabling the

MCN to develop teaching materials for students on placement.

The MCN held its annual Training event in Perth in November on the topic of Treatment Resistant

Eating Disorders. A new Royal College Guideline formed the basis of the training and informed

feedback on the document too. This event used Videoconferencing to reach to the Island Boards.


39

Our comprehensive Annual Report came out in September 2014 and can be found on our website

– www.eatingdisorder.nhsgrampian.org and our next Annual Report will be published in Autumn

2015.

A new innovation in the past year has been to send out a digest of news to all GP’s across the

regions electronically and this is something we will continue to do on a twice yearly basis. A copy

of the newsletter can also be found on our website.

This year has also seen several difficult staffing problems with long term sick leave and vacancies

impacting on service delivery. Despite efforts to find a locum, there has been no Consultant in

place – in NHS Highland - for over a year. Highland admissions to the Eden Unit have increased

sharply, with those from Tayside reduced to a similar degree. There has been a greater

expenditure in the Private Sector this year.

We were sad to see the retirement of a valued colleague in Dr Yvonne Edmonstone from NHS

Highland. She will be missed both professionally and personally.

NHS Tayside ED Team have also encountered problems recruiting to their Dietetic Post. Kareen

Taylor left the service in December 2014 and to date they have been unable to recruit to that

position.

The MCN core team, has also suffered staffing problems with the Network Manager being absent

for a period of time. This has meant that several programmed activities had to be postponed or

cancelled until her return in March 2015. We were grateful to remaining staff for their work in her

absence and are delighted to welcome her back.

Clinical Activity (Split by NHS Board of residence of patient)

A) Outpatient services:

Figure 2

(No figures available for Islands, as eating disorder patients usually seen within general services)

Apr May Jun Jul Aug Sep Oct Nov Dec Jan Feb Mar

Grampian 14 5 10 5 9 19 7 14 7 13 18 20

Highland 9 10 5 9 6 7 5 5 4 7 10 9

Tayside 14 17 14 12 13 15 9 17 11 14 11 15

05

10152025

Eating Disorders Outpatient Referrals (inc ReReferrals) Apr

2014 - Mar 2015


40

B) Inpatient and Day Programme Activity, Regional Unit (Eden Unit)

Admissions:

Figure 3

Day patients

Figure 4

Finance

(NB all expenditure is within Scotland, with no expenses south of the Border)

Budget/Efficiency savings: Regional Unit

There has in fact been an under spend on the Eden Unit budget of £71.2 due to unfilled posts but

the length of stay per patient has increased although the number of admissions has dropped.

Annual Review: The final risk share position, including qualifying OOA’S is as follows


Grampian 1 1 3 2 1 1

Highland 1 1 1 2 1 1

Tayside 1 1 1 1 1 1 1

Orkney 1

Shetland

W. Isles

012345

Admissions to the Eden Unit Apr 2014 - Mar 2015


Grampian 2 2 2 2 2 2 2 3 3 3 3 5

Shetland 1 1 1

0

1

2

3

4

5

6

Day Patient Activity by month - Apr 2014 - Mar 2015

North of Scotland Planning Group is a collaboration

Table 7

OOA Calculation Tayside

24.69%

Operational Under spend,

Eden Unit

Cost of Qualifying OOA referrals

It is likely that reduced staffing levels both in the Eden Unit and across outpatient services

corresponded directly with out of area spending on the risk share, for patients who could not be

admitted to Eden during this period of reduced staffing.

Quality

The Quality Assurance Group has developed a qualitative service feedback form which is still being

piloted across the regional services. Preliminary data is currently being evaluated and early

indications show the following:

Figure 5

Morbidity and Mortality reviews continue to take place, as and when appropriate (when

concerning issues arise with patients that involve more than one Health Board across the region).

These reviews give those involved in the patient’s care a chance to discuss/learn and im

areas where problems have been encountered and resolve any issues that have occurred. These

have been well received. Clinicians report that they are beneficial in improving patient care.

32%

19%

Overall Patient Satisfaction Rates on Eating Disorder Services in the


Tayside

24.69%

Highland

19.44%

Orkney

3.38%

Shetland

1.96%

£k £k £k £k

-17.6 -13.8 -2.4 -1.4

143.2 112.8 19.6 11.4

is likely that reduced staffing levels both in the Eden Unit and across outpatient services


admitted to Eden during this period of reduced staffing.



indications show the following:-

tality reviews continue to take place, as and when appropriate (when


These reviews give those involved in the patient’s care a chance to discuss/learn and im



4%

11%

34%

19%


North of Scotland (41 patients)

much less than expected

less than expected

as much as expected

more than expected

much more than expected

between NHS Grampian, NHS Highland, NHS Orkney, NHS Shetland, NHS Tayside and NHS Western Isles

41

Grampian

50.53%

TOTAL

£k £k

-36.0 -71.2

293.2 580.20

is likely that reduced staffing levels both in the Eden Unit and across outpatient services




tality reviews continue to take place, as and when appropriate (when


These reviews give those involved in the patient’s care a chance to discuss/learn and improve on




much less than expected

less than expected

as much as expected

more than expected

much more than expected


42

Training

EEATS (Eating Disorders Education and Training Scotland, operated from within the North of

Scotland MCN) continues to flourish and this year secured a small funding stream from NES which

allowed us to provide the first ever Scottish Eating Disorders CAMHS Conference. It has also

enabled EEATS to offer a total of 8 Scholarships to CAMHS Clinicians to undertake the EEATS

Accreditation.

We continue to build relationships with our CAMHS colleagues and consult with them regularly

when addressing issues that mainly affect over 18’s but could potentially have an impact on

CAMHS Services. In addition we work to ensure that difficult – and potentially fatal – issues

regarding transitions between services are addressed. These include crossing of age as well as

geographical boundaries.


43

Regional Medium Secure Care Services, Rohallion clinic

Rohallion Service Manager: Mrs Barbara Wilson, Regional Service Manager (Secure

Care, NHS Tayside)

Lead Clinician: Dr Stuart Doig (Consultant Psychiatrist, NHS Tayside)

The North of Scotland Medium Secure Care Service is collaboration between 5 Health Boards, NHS

Grampian, NHS Highland, NHS Tayside NHS Orkney and NHS Shetland. The service is hosted by

NHS Tayside at Rohallion Clinic on the Murray Royal Hospital site in Perth. The regional Medium

Secure service, which has 32 beds, shares the facility with NHS Tayside’s low secure services,

which has 35 beds.

Activity

Admission

There were a total of 15 admissions to medium secure Rohallion from April 2014 – March 2015.

Figure 6 below represents admission to the unit per Health Board.

Figure 6

0

1

2

3

4

5

Nu

mb

er

of

Ad

mis

sio

ns

Apr-14May-

14Jun-14 Jul-14 Aug-14 Sep-14 Oct-14 Nov-14 Dec-14 Jan-15 Feb-15 Mar-15

Glasgow 1 1 0 0 0 0 0 0 0 0 0 0

Grampian 0 1 0 0 1 1 0 0 1 0 1 0

Highland 0 0 1 0 0 0 0 0 0 0 0 1

Lothian 0 0 0 0 0 0 0 0 0 0 0 0

Tayside 0 1 0 0 1 1 0 0 1 0 2 0

Orkney 0 0 0 0 0 0 0 0 0 0 0 0

Shetland 0 0 0 0 0 0 0 0 0 0 0 0

Rohallion Medium Secure Clinic

Admission April 14 - March 15


44

Discharge

There were a total of 12 discharges from Medium Secure Rohallion from April 2014 – March 2015.

Figure 7 below represents discharge from the unit per Health Board.

Figure 7

Total Bed Day Occupancy April 2014 – March 2015

The table below sets out the overall annual number of bed day occupancy per Health Board from

a total of 11680 bed days (32 beds).

Table 8

Health Boards

Grampian

Highland

Tayside

Orkney

Shetland

GGC

Highland

/ Argyll

Lothian

England

Annual Total 1548 1886 1653 77 0 570 365 266 1

Finance

The table below details the overall financial contribution per Health Board to the Rohallion Clinic,

the annual income returned to each health board as a result of ECR income and non recurring

efficiency savings. The savings in total for 2014/15 was £1,162,000.

012345

Apr-14 May-14 Jun-14 Jul-14 Aug-14 Sep-14 Oct-14 Nov-14 Dec-14 Jan-15 Feb-15 Mar-15

Tra

nsf

ers

/Dis

cha

rge

s

Apr-14 May-14 Jun-14 Jul-14 Aug-14 Sep-14 Oct-14 Nov-14 Dec-14 Jan-15 Feb-15 Mar-15

Glasgow 0 0 0 0 1 1 0 0 0 0 0 0

Grampian 0 1 0 0 1 0 1 0 1 0 0 0

Highland 0 0 0 0 0 0 0 0 0 0 0 1

Lothian 0 0 0 0 0 0 0 0 1 0 0 0

Tayside 0 0 1 0 0 0 0 0 0 0 1 0

TSH 0 0 0 0 1 0 0 0 0 0 0 0

Other 0 0 0 0 0 1 0 0 0 0 0 0

Orkney 0 0 0 0 0 0 0 0 0 0 0 0

Shetland 0 0 0 0 0 0 0 0 0 0 0 0

Discharges from Rohallion to Higher or Low secure services

April 14 - March 15


45

Table 9

Health Board

Contribution

Current

contribution

overall to Rohallion

per Health Board

Annual Income

returned as a

result of

providing beds

for

Other Scottish

Boards

Annual Income

returned as a

result of non

recurring

efficiency savings

Contribution

of net

income from

providing

beds for

other

Scottish

Boards and

efficiency

savings.

£k £k £k £k

NHS Grampian 3,180 -363 -174 2,643

NHS Tayside 2,604 -298 -143 2,163

NHS Highland 945 -108 -52 785

NHS Orkney 73 -8 -4 61

NHS Shetland 73 -8 -4 61

Total 6,875 -785 -377 5,713

Quality

Rohallion Clinic Medium Secure Care Services subscribes to the Royal College of Psychiatrist

FORENSIC Quality Network for Forensic Mental Health Services. Rohallion is the only Forensic

service in Scotland to subscribe to this quality network. The network was set up in 2006 at the

College Centre for Quality Improvement. Using a multi-disciplinary approach, the Network

facilitates quality improvement and change through a supportive peer-review process. The Quality

Network serves to identify areas of good practice and achievement as well as areas for

improvement by promoting a culture of openness and enquiry between peers. A fundamental

principle of the Quality Network is that patients, family/friends and frontline staff are central to

integral and sustainable quality improvement; this is reflected in the structures and processes

used by the project.

The Quality Network: -

• Develop and apply standards for forensic mental health services through a system of

self review and external peer-review.

• Produce reports for participating services that highlight areas of achievement and

areas for improvement.

• Provide a national “benchmarking” service to allow services to compare their activity

with other services.

• Facilitate information-sharing about best practice between members of the Network.


46

• Organise workshops to support services to share information and troubleshoot on

shared problem areas.

• Support routine data collection.

• Promote patients and family/friends involvement at all stages of the review process.

Cycle 9 peer review for 2014/15 was carried out in Rohallion Clinic in March 2015.

Overall, Rohallion Medium Secure Unit fully met 89% and partially met 11% of medium secure

standards. There were no unmet standards. The graph below details the percentage of criteria

met in each of the 11 standards.

Figure 8

The peer-review team commended several aspects of the service provided, in particular the unit

scored highly on areas such as Physical Security, Procedural Security, Relational Security,

Safeguarding, and Physical Healthcare and Governance meeting 100% of criteria in these areas.

Areas such as Patient Focus, Family and Friends, Environment and Facilities, Patient Pathways and

Outcomes and Workforce were identified as areas in need of improvement, and are now the

subject of a work plan that will be implemented over the coming year. Rohallion Clinic would be

happy to share the final report with readers, please contact [email protected] to obtain a

copy or for further details.

Waiting Times

The time from referral to assessment for acute patients is well within our standard of within 7

days. The time from referral to assessment for State Hospital patients is also within our standard

of 3 months. The time from referral to admission is sometimes delayed by the need to schedule

0

20

40

60

80

100

% Met

% Partly Met

% Unmet


47

court dates but there does not appear to be an unreasonable delay for most acute patients. This

delay is as a result of court processes.

The service has an excellent relationship with managers and clinicians across partner board areas;

this facilitates the smooth transfer of patients back to their home health boards within agreed time

standards.

The Government’s HEAT targets for the provision of Psychological Therapies apply to secure care.

These targets are currently being met within Rohallion Clinic. A full needs assessment was carried

out March 2014 to provide a benchmark for the unit. Now all new admissions to the unit have a

psychological needs assessment carried out as soon as is clinically appropriate with treatment

commencing shortly thereafter if clinically appropriate.


48

Regional Projects

Single Vascular Service

Clinical Leadership: Mr. John Duncan (Vascular Surgeon, NHS Highland)

Mr. Paul Bachoo (Vascular Surgeon, NHS Grampian)

Operational management: Mrs. Andrea Wilson / Mr. Neil Strachan

(Divisional General Manager NHS Grampian)

Mr Carl Hope

(Divisional General Manager, NHS Highland)

NoSPG Support: Mr. Keith Farrer / Mr. Jim Cannon

In October 2011 the report on the review of vascular services in Scotland was presented to the

National Planning Forum (NPF) - subsequently an agreement was reached between NHS

Grampian and NHS Highland to deliver vascular surgery as a “single service”. A network approach

is the mechanism being used to move to this single service.

Currently, the network is working on delivering an evidence-based approach to the management

of varicose veins across the north of Scotland. An option appraisal is underway to determine the

most effective clinical model for this service. It is anticipated that in some areas there will be

disinvestment from the traditional surgical approach to varicose vein treatments and a reduction in

the number of cases treated overall.

The core network group has also started to examine the Aortic Aneurysm Pathways in the North

and will be making recommendations on the optimum configuration of this service in the coming

months. Future discussions will also take place around the possibility of overlap between

Interventional Radiology and Vascular Surgical services, with a view to maximising “medical”

capacity in these hard to fill posts.

“A96 Corridor” (Paediatric services)

Operational Management: Dr. Jamie Hogg

(Clinical Lead for Modernisation, NHS Grampian)


Mr Jim Cannon (Director of Regional Planning)

The North of Scotland Paediatric Sustainability Review1 made a number of regional

recommendations for the north Boards, as well as Board specific ones. Of all the recommendations

in the report the highest level of urgency was to recommendation 12:


49

“NoS and the two health Boards concerned should review paediatric urgent care across

the A96 corridor to explore collaborations and reconfiguration in the best interests of the

children of Moray”

To this end NHS Highland and NHS Grampian agreed to take a phased approach to the feasibility

of reconfiguration across the area with a view to maximising the opportunities for improving care

of children in both Board areas.

Phase 1 was completed in 2013, which scoped the extent of service provision and activity across

the A96 corridor, along with potential service vulnerabilities. NHS Grampian was keen to progress

on the work carried out as part of Phase 1 to generate options for a Phase 2 with involvement of

the public. Discussions between the Chief Operating Officers in Grampian and Highland were

initiated and one of the issues highlighted was consultant-led obstetrics. Scoping work was carried

out during 2014 before moving into Phase 2 led by Dr Jamie Hogg.

Regional Sustainability Programme

The North of Scotland Regional Sustainability Programme has been underway throughout the

year. Led by the Regional Sustainability Programme Manager the programme has continued the

Intelligent Region thinking, and further developed both internal and external governance

frameworks for the Regional Planning Group.

The sustainability programme provided the focus for the Annual Event in November, which was

crucial in identifying a number of short, medium and long term priorities for the Regional Planning

Group.

The Programme has explored ways to enhance the risk based prioritisation of regional services,

and is developing ways to facilitate this. As part of this programme of work the Integrated

Planning Group has re-convened with a broader remit than before, and a regional planning

framework has been agreed to support this work.

A strong focus on ways to effectively align regional eHealth planning processes has had a number

of outcomes, including a ‘single point of contact’ approach to regional eHealth issues, and an

enhanced regional content in the updated National eHealth Strategy.

A regional governance framework is in development, which will support transparency of regional

planning decisions, horizon scanning and increased alignment with Board governance processes.

The Programme has supported several other regional and national programmes, projects and

work streams and continues to develop thinking around effective remote collaboration. Details of

these activities have been included in further detail in Regional Sustainability updates to the

NoSPG Executive during the year.


50

Neuromuscular

A Neuromuscular Care Advisor post was pump primed by Scottish government for 2 years. The

aim was to scope the coordination needs of a small group of patients with neuromuscular

conditions across the north of Scotland.

The post holder produced a report which recommended “signposting” and referral functions be

streamlined within pathways across the north.

The recommendations from the Neuromuscular Care Report (2014) currently await

implementation and have been delayed due to lack of capacity within the team. They will however

be allocated to a specific team member as they are recruited in Q1 / Q2 2015, for implementation

over the subsequent months.


51

Regional / National Projects

Paediatric Unscheduled Care (PUC) pilot project

Clinical Lead: Dr. Donald McGregor (Consultant Paediatrician NHS Tayside)

NoSPG support: Mrs. Anne-Marie Pitt (Child Health Network Manager)

Mr. Jim Cannon (Director of Regional Planning)

NHS 24 / SCTT: Mrs. Lynn Garrett (Project Manager)

Professor James Ferguson (SCTT Clinical Lead)

The Paediatric Unscheduled Care twelve-month pilot was launched in July 2013, finishing at the

end of the July 2014. Its aim was to provide a single point of consultant-led paediatric advice and

support for rural and community hospitals providing unscheduled care to children and young

people across the North of Scotland, via video conference. The PUC pilot was primarily instigated

by the Scottish Centre for Tele-health & Tele-care and governed by NHS 24. The North of Scotland

Planning Group agreed to implement and fund the pilot to evaluate the benefit for patients in the

north.

Rural and community hospitals in NHS Orkney, NHS Highland and NHS Western Isles have been

involved in using the decision support process, as part of the pilot, where referring calls were

made to a single telephone number managed by a dedicated team within NHS 24. The call

handlers aim was to set up a video call to a Consultant giving paediatric advice within 10 minutes

(the Consultants were available on a dedicated 24/7 rota) and arranging transfers as appropriate

to District General Hospitals (DGH) or Tertiary Centres.

The evaluation of the pilot consisted of four parts: an external evaluation after six months

commissioned from the Centre of Rural Health (CRH), University of Aberdeen; a further evaluation

by CRH of the referrers’ views; a report by the PuC Clinical Lead; and an expert peer review of 30

PuC referrals by an independent panel of experienced clinicians.

The Evaluation Executive Summary was presented to the NoSPG Executive meeting in December

2014. The outcome was that Health Boards in the north of Scotland were expected to be

cognisant of the recommendations within the evaluation and report back on implementation of the

learning at the end of 2015. Consequently a PuC Short Life Working Group is being planned,

chaired by Dr Mike Bisset and supported by Anne-Marie Pitt, with the aim of bringing together

representatives from each of the north of Scotland Health Boards to establish if there are models

of collaboration across the region that can be implemented and identify key performance

indicators that could be developed to measure implementation of the learning from the PuC pilot.


52

Activity

Results from the evaluations show that 226 calls were made to the PUC service from 10 rural

hospital sites. One rural general hospital withdrew half way through the pilot due to concerns over

perceived governance issues. The distribution of calls shows the largest proportion of the calls

(n=73) were made from Caithness Hospital in Wick, and the busiest period was during the winter

months (Nov 2013 and January 2014).

At the end of the pilot the data showed, of the 226 children referred, 149 children were managed

locally with the support of the PuC Consultant, 56 were transferred to a DGH or Tertiary Centre

and 21 children required emergency retrieval. (Figure 9)

Figure 9

At the 6 month stage the telephony data shows that 61% of the PUC consultations were carried

out by using video conferencing and 33% were by teleconference, with the reasons for not using

video conferencing cited as challenges or inaccessibility to VC, or referrer preference. With regard

to the times of the calls, the data shows at the 6 month stage 55% of calls to the PUC service

were during the “out of hours” period.

Finance

Funding for the pilot was sourced from National Delivery Plan funding for Specialist Children’s

Services “slippage” held by the North of Scotland Planning Group. An envelope of resource was

agreed by the NoSPG Executive Group and expenditure at the end of February 2014 is shown

below:

Transfered= 56

25%

PICU Retreivals

= 21

9%

Maintained locally

= 149

66%

Total PuC Referrals = 226


53

Table 10

Paediatric Unscheduled Care Project

Financial Position, September 2014

Budget Spend Over/Under

Staff

Clinical Lead £59,000 £56,802 £2,198

Consultants £168,000 £216,433 -£48,433

Call Handlers - NHS 24 £24,400 £3,200 £21,200

Tech Support £0 £0 £0

Technology

VC Unit- Broadford Hospital £7,400 £6,566 £834

Evaluation £12,000 £16,677 -£4,677

Misc (travel, hospitality etc.) £2,000 £2,700 -£700

Contingency £77,200 £77,200

Total £350,000 £302,378 £47,622

Quality

There are a number of key performance indicators for NHS 24 during the PUC pilot and the table

below shows the performance against the indicators.

Table 11

VC calls progressed within 10 minutes 53.33%

Consultant handover initiated within 5 minutes 73.33%

Call handler connected to VCU within 10 minutes 68.33%

Call handler failure to connect to OCC 1st time 16.66%

The qualitative research carried out by CRH showed positive elements to the service such as the

pilot offered a more consistent pattern of support in comparison to previous communication

pathways and it was likely that VC support improved the quality of local care. Parents were

reassured by the availability of expert advice and VC support increased the confidence of staff

observing unwell children.

However, there were a number of important difficulties such as clinical governance responsibility

for the child, perceived disruption to pre-existing relationships at DGHs and Tertiary Centres, lack

of local knowledge (relationship) of PUC consultants, teething problems with “call handling” and

difficulties with observing children for lengthy periods in remote hospitals.

CRH’s survey of referrers showed the majority of referrers were positive about the service and

wished it to continue, with 82% agreeing that parents were satisfied. The expert peer review

panel gave very positive feedback on the outcomes of the service and all agreed that the pilot had

improved clinical outcomes due to the referral. The report from the PuC Clinical Lead particularly

pointed out that VC enhances the clinical assessment and decision support of children in remote


54

settings, which rapid access to senior advice is valuable and the pilot highlighted significant

variation in competences and services across the north of Scotland.

The Project Board and NoSPG Executive Group considered the evaluations and commissioned a

risk assessment by the north of Scotland Medical Directors of returning to the previous model of

care for those involved in the pilot, whilst the outcomes of the pilot were being considered. This

indicated that there was not a high risk to patients as improvements to unscheduled care services

had begun to be implemented. As mentioned above the NoSPG Executive Group, however, were

keen for this to continue and for Health Boards in the north to exploit the positive findings of the

pilot, which included:

• Clear communication to their remote and rural sites about ongoing care pathways;

• Promoting the increased use of VC;

• Reducing response times to calls from remote sites seeking advice;

• Mechanisms for rapid access to support from experienced paediatric doctors; and

• Data collection regarding volume and clinical appropriateness of telephone/VC

support and unscheduled care transfers.

Safe and Sustainable Secondary Transfer and Retrieval in the North of

Scotland

ScotSTAR: Carole Morton (Head of Service)


Mr Jim Cannon (Director of Regional Planning)

The provision of retrieval services from predominantly central Scotland locations to the remote

northern areas and islands of Scotland is thought to have led to a service which is not as

equitable, efficient or person-centred as it could be for patients living in the north. This is

compounded by the existing retrieval services not being resourced to cover the transfer

requirements of all critically ill patients requiring transfer, especially in the north. The risks relating

to children and young people who are critically ill (but not requiring intensive care) were

particularly raised by Dr Zoё Dunhill in her ‘Paediatric Sustainability Review’. Consequently a risk

analysis was carried out and assessed as high which was presented to the NoSPG Executive

meeting in December 2014. Further work was requested in order to ascertain the size and scope

of risks and this is ongoing.

Activity

Current numbers of secondary transfers for certain categories of patients below (adult and

paediatric critical care/HDU but not requiring intensive care) are difficult to ascertain as the any

existing electronic data collection does not appear to be accurate. Some estimates have been

made below, including manual data collection, but these will not be 100% accurate.


55

Table 12

Category of patients

in the north

Current transfer provided and

accompanied by

Numbers in the north

Paediatric Critical

Care/HDU (not PICU)

SAS and ward staff 74 (manual data collection 6

months 2014)

43% to RACH,

18% to Raigmore,

6% to Edinburgh,

6% to Yorkhill

30/40 HDU in addition to the

above retrieved by PICU to

central belt (NSD 2012

approximation)

5 ECMO to York Hill (2013)

Adult ITU (including

major trauma)

Central located

EMRS/Coastguard/SAS/RAF(?)

EMRS = 96 for Nov 2013 to

Oct 2014

Adult HDU and

specialist services

requiring escort

SAS and ward staff Unknown

10 ECMO in Aberdeen (2014)

Psychiatric critical care SAS and ward staff Unknown

Neonatal patients Neonatal Retrieval Service

(provided by 50% central base and

50% Aberdeen base)

270 Nov 2013 to Oct 2014

Children and young people requiring PICU retrievals out of scope for this piece of work due to

central locations of the PICUs.

Finance

Due to the difficulties in ascertaining the current number of secondary transfers for some of the

categories of patients above, the cost of providing the current service is unknown. If further work

to ascertain possible solutions to mitigate the risks identified is commissioned then the volume and

economic aspects of each option would be part of this work. ScotSTAR has indicated that possible

resources could be available for project management supported by the NoSPG team.

Quality

The risks relating to secondary transfers and retrievals are listed below and solutions to mitigate

the risks would be part of any option appraisal work in this area.


56

Table 13

Risks rated as High Hazards

Patient safety due to a lack

of timely response/skilled

staff availability to escort the

patient

• Extended lengths of time waiting due to retrieval teams

based in the central belt.

• Extended lengths of time travelling as air transfer not

available. • Unsustainable neonatal service in the north.

• EMRS not covering all parts of the north of Scotland.

• Staff not available to accompany patient.

• Accompanying staff are not maintaining appropriate transfer

skills.

Patients and families are

inappropriately travelling

and extended lengths of

stay at great distances from

home.

• PICU service retrieves HDC children to central belt rather than

taking to northern HDUs

• Repatriation from the central belt does not happen as

frequently as it should.

Inefficient use of resources,

both transport and staff

• Extended journeys to and around the north as retrieval based

in the central belt.

• Extensive time of local escorting staff being absent from ward

and unable to return to base. • Local equipment missing from wards as being used for

transfer and not returned.

Inability to deliver the

development of the new

Major Trauma Network

• The existing transfer and retrieval services available for patients in the north will not be able to meet the timeframes

of standards within the MT network

A Geospatial Evaluation of Systems (GEOS) of Trauma Care for Scotland

Lead: Dr Jan Jansen (Consultant Trauma Surgeon, NHS Grampian)

The GEOS study concluded during this period and early analysis is being fed into the Major

Trauma oversight Group where consideration of the findings is ongoing. The study will be written

up and reported more fully as part of the next annual report.


57

Radiology

Chair: Ms. Deborah Jones (Chief Operating Officer, NHS Highland)

NoSPG support: Mr. Jim Cannon (Director of Regional Planning)

Workforce pressures and increasing activity in Radiology instigated the Regional Radiology Group

during 2014, to assess the potential for collaborative work, specifically looking at two areas:

• Out of hours on call and the potential to share elements of these services across

board boundaries

• Load balancing of image reporting across boards

Activity data has been collected from each of the mainland boards and shows that activity levels

are very low, on average during the period 10pm – 7am. This evidence will be shared around

clinical teams and early indications show that if technical issues with image transfer and report

repatriation to host board are overcome then clinical teams would be confident in sharing

Radiologist capacity across boundaries during low activity periods or for specialist opinion

(Paediatrics, Neuro etc).

National work as part of the “Shared Services” portfolio and through the SCIN (Scottish Clinical

Imaging Network) indicates that the appetite for improving the IT infrastructure across Scotland

has increased and Radiology teams across the country are motivated to support a national

Radiology framework. Current regional work involves engaging and aligning regional imperatives

with national work, to reduce duplication. Regional discussions continue, to develop a collaborative

model, in anticipation of a national framework being developed to support it.


58

Priorities for 2015-16

The NoSPG team will continue to reflect board priorities by endeavouring to engage more in

planning discussions at board level. Regionally the newly reformed “Integrated Planning Group

(IPG)” will be the cornerstone of regional prioritisation and process as we work through strategic

planning pieces such as development of the Regional Clinical Strategy.

At national level the “Guiding Coalition” is working with Scottish Government on proposals for

changes within the health service. These changes are likely to include an incremental move

towards increased regionalisation of services. In addition the “Shared Services” agenda has raised

the likelihood of more regional elements of services such as Diagnostics, Finance, HR and other

Support services.

The regional team are well placed to tackle regionally prioritised work emerging from these

directions, working alongside our constituent board colleagues.

Key pieces of work described in more detail earlier will continue, such as:

• Oncology – Regional Oncology Clinical Board

• Cancer – Quality Performance Indicators (QPI) / Clinical Management Guidelines

(CMG) with associated work

• Vascular Surgery

• Transport

• Workforce initiatives

• Specific Surgical specialty work

• Radiology

Future work is likely to include Major Trauma network development and collaborative work on

Healthcare and Forensic Services to people in police custody.


59

Finance

NoSPG Funding by NoS NHS Boards

The core NoSPG team is funded by the NoS Boards through an NRAC share each year. Total

expenditure is shown in Table 14 below.

Table 14


Regional Planning expenditure

2014/15

£

Staff Costs 159,941

Non-pay costs 18,607

Total 178,548

This is then demonstrated by Board split with planned versus actual spend during 2014/15:

Table 15

Regional Planning Expenditure 2014/15

by NHS Board

NRAC Proposed Actual

% £ £

Grampian 37.16 70,859 66,348

Highland 25.24 48,129 45,066

Orkney 1.72 3,280 3,071

Shetland 1.90 3,623 3,392

Tayside 30.99 59,094 55,332

Western Isles 2.99 5,702 5,339

100.0 190,687 178,548


60

Regional Neonatal Network

Table 16

Neonatal Services MCN 2014/15

£

Funding available

SGHD Funding 131,304

Slippage from previous year 82,424

213,728

Estimated Expenditure

Lead Clinician (3 PAs) 19,893

Network Manager 21,123

Admin Support 11,700

Travel/Accommodation/Training 1,258

Misc 1,030

55,004

NoSPG Team Slippage 158,724

Neuromuscular Clinical Facilitator

Table 17

Muscle Specialist Advisor Post 2014/15

£

Funding available

2014/15 Allocation (not yet received) 47,210

2013/14 Allocation 27,500


102,441


Neuromuscular Care Advisor 38,662

Admin 3,690

Travel/Accommodation/Training 1,150

Training 40

Misc 48

43,590



61

NOSCAN

Table 18

NOSCAN 2014/15

£

Funding available

NHS Board Allocation 169,673

Slippage from previous year

169,673


Clinical Lead 9682

Admin Support 26,649

Management 58,280

Equipment 845

Travel 5,000

Misc 6,402

106,858

Slippage carried forward to following year 62,815

Table 19

Macmillan 2014/15

£

Funding available

Income from McMillan 53,115

53,115


Pharmacist 42691

Travel 394

43,085



62

Table 20

Cancer Modernisation 2014/15 2015/16

£ £

Funding available

Allocation 100,000 100,000

100,000 100,000


eCase license 16,166

0 16,166

Slippage carried forward 100,000 83,834

Eating Disorders

Table 21

Eden Unit Over/(Under) Spends 2014/15

£

Tayside 17,600

Highland 13,800

Orkney 2,400

Shetland 1,400

Grampian 36,000

TOTAL 71,200

CAMHS Specialist Funding

Table 22

CAMHS Specialist Funding £

Funding Available

SGHD funding 59,432

Grampian 22,117

Highland 15,732

Orkney 1,020

Shetland 1,190

Tayside 19,373

Slippage from previous years 327,048

445,912


Project Team 54,192

Clinical Leader 28,353

Travel/Accommodation & Event 1,712

84,257

Slippage to be split between Boards 361,655


63

Table 23

CAMHS Development Post 2014/15

£

Funding available


39,582


Network Support Officer 25,511

Travel 138

Computer 1,146

26,795

Slippage 12,787

Table 24

Young Persons Unit & CAMHS Regional

Network

2014/15

£

Funding available

Pay Budget 1,458,048

Supplies Budget 113,699

Income Budget -273,087

1,298,660


Nursing Pay 1,020,686

Medical Pay 226,949

AHP Pay 117,965

Other Therapeutic Pay 40,609

Admin Pay 51,839

Drugs 4,859

Equipment 1,020

Other Admin Supplies 16,230

Hotel Services 161

Property 560

Other Supplies 90,869

Income from other Boards -273,087

1,298,660

Slippage carried forward to following year 0


64

Restorative Dentistry

Table 25

Restorative Dentistry 2014/15 2015/16

£ £

Funding available

Grampian 117,098 117,098

Highland 103,390 103,390

Shetland 6,360 6,360

Orkney 5,760 5,760

Western Isles 7,392 7,392

Academic (NES) 116,000 116,000

Slippage from previous year 304,308 429,077

660,308 785,077


Consultant (NHS Highland) 155,076 120,000

Consultant (NHS Grampian) 76,155 120,000

Nurse 40,000

Technician 30,000

Materials 46,000

231,231 356,000

Slippage carried forward to following year 429,077 429,077


65

Child Health Funding

Table 26

Child Health

2014/15

£

Funding available 448,679

NDP Clinical Leaders 93,507

NOSCAN Telephone Triage 14,200

556,386


Manager 70,277

Support Costs 21,983

Clinical leader - Gastroenterology 18,162

Clinical leader - Neurology 18,162

Clinical leader - Respiratory & CF 18,162

Clinical leader - Infrastructure 18,162

Clinical leader - Child Protection 23,345

Gastro/Neurology Network Manager 41,579

Regional Physiotherapist/Neuromuscular 20,961

Child Protection - Network Manager 28,281

Child Protection - Admin support 11,725

Remote & Rural 50,240

Regional Dietetic Support - Ketogenic 20,859

Misc 2,313

Travel 8,134

372,345

NoSPG Team Under spend 184,041


66

Table 27

Child Health Slippage 2014/15 2015/16

£ £

Funding available

Balance from previous years 1,091,325 912,769

SOSNOS Allocation 65,000

Paediatric Unscheduled Care 169,928 18,822

1,326,253 931,591


Programme Manager 72,000 72,000

Programme Manager (SONOS) (SG Matched

Funded) 62,843 72,000

NOSCAN Programme Manager 63,978 6,000

Data Audit Manager 29,371 41,781

SOSNOS Clinical Lead 15,364

Medical Director 174,000

Critical Care Equipment & Training (NHS

Tayside)

Critical Care Equipment (NHS Grampian)

Paediatric Unscheduled Care2 169,928

413,484 365,781

Slippage to be split between Boards 912,769 565,810

2 £18,822 from original PUC budget agreed to be spent in 2015-16


67

Financial Commitments

Table 28

2015-16 Projected Costs 2015/16

£

Director 96,300

Executive Assistant 34,741

PA Support 51,262

Travel 12,000

194,303

Table 29

Table 29: Projected Cost Shares for 2015/16 by NoS

Board

Grampian £73,272 37.71%

Highland £48,848 25.14%

Orkney £3,342 1.72%

Shetland £3,653 1.88%

Tayside £59,456 30.60%

Western Isles £5,732 2.95%

£194,303

Jim Cannon

Director of Regional Planning



68

Appendices

North of Scotland Planning Group Executive

Ms Elaine Mead (Chair)

Chief Executive

NHS Highland

Assynt House

Beechwood Park

Inverness

IV2 3HG

Tel: 01463 704838

[email protected]

Mr Malcolm Wright

Interim Chief Executive

NHS Grampian

Summerfield House

2 Eday Road

Aberdeen

AB15 6RE

Tel: 01224 558508

[email protected]

Mrs Cathie Cowan

Chief Executive

NHS Orkney

Garden House

New Scapa Road

Kirkwall

Orkney KW15 1BQ

Tel: 01856 888223

[email protected]

Mr Gordon Jamieson

Chief Executive

NHS Western Isles

37 South Beach Road

Stornoway

Isle of Lewis

Tel: 01851 708005

[email protected]

Ms Lesley McLay

Chief Executive

NHS Tayside

Ninewells

Dundee

DD1 9SY

Tel: 01382 660111

[email protected]

Mr Ralph Roberts

Chief Executive

NHS Shetland

Upper Floor Montfield

Burgh Road

Lerwick

Shetland ZE1 0LA

Tel: 01595 743063

[email protected]

Mr Jim Cannon

Director of Regional Planning

NoSPG Office

Kings Cross

Clepington Road

Dundee

DD1 3EA

Tel: 01382 596960

[email protected]

Website:

www.nospg.nhsscotland.com


69

Appendix II – New (Substantive) Team Structure

* This chart indicates the main line management responsibilities relevant to particular roles. A number of

other roles, including “Clinical leads”, are central to the delivery of the regional agenda by guiding and

supporting regional work / staff. These are too numerous to be identified individually here.

Title

Name

Director Jim Cannon

Associate Director Kerry Russell

NOSCAN Manager Keith Farrer

Programme Manager (Child Health) Ken Mitchell

MCN Managers

Anne Marie Pitt Carolyn Duncan

Cathie Grieve Neil McLachlan

Project Manager Alan Connor

Project Support Julie Gowans

Executive Assistant Martha Hay

Admin / PA

Sonja Goodwin Eva Hopkins

Carol Mayo Vacancy

NOSCAN Admin / PA Ruth Nisbet

NoSPG Executive

Director Regional Planning*

Associate Director*

Executive Assistant (X1)

Admin / PA (x4)

Programme Manager* (Child Health)

NOSCAN Manager*

MCN Manager* (x1)

Project Support (x1)

Project Manager (x1)

NOSCAN Admin / PA (x1)

MCN Manager* (x2) MCN Manager* (x1)


70

Appendix III – Workstream Contacts

ESTABLISHED REGIONAL "NETWORKS" (MCN/CLINICAL/LEARNING)

Workstream Key NoSPG Contact

for further information

Child Protection Mrs Anne-Marie Pitt [email protected]

Paediatric Critical Care Mrs Anne-Marie Pitt [email protected]

Neurology (NeSCANN) Mrs Carolyn Duncan [email protected]

Gastroenterology (NoSPGHANN) Mrs Carolyn Duncan [email protected]

Complex Respiratory (PRISM) Mrs Carolyn Duncan [email protected]

Neonatal Ms Kerry Russell [email protected]

Workforce Planning Learning Network Mrs Geraldine Lawrie [email protected]

NOSCAN Mr Jim Cannon [email protected]

Child & Adolescent Mental Health Services

(CAMHS) Mrs Ruth Masson [email protected]

REGIONALLY FUNDED SERVICES

Workstream Key NoSPG Contact For further information

MOHS Surgery Mr K Farrer [email protected]

Electrophysiology Mr K Farrer [email protected]

Adult Medium Secure Forensic Services Ms Barbara Wilson [email protected]

Eating Disorders Mrs Linda Keenan [email protected]

Cardiothoracic Surgery Mr K Farrer [email protected]

REGIONAL PROJECTS &

REGIONAL / NATIONAL PROJECTS

Workstream Key NoSPG Contact

for further information

Paediatric Unscheduled Care (PUC) Project Mrs Anne-Marie Pitt [email protected]

Paediatric Sustainability Review Mrs Anne-Marie Pitt [email protected]

“A96 Corridor” Mrs Anne-Marie Pitt [email protected]

General Surgery of Childhood Mrs Anne-Marie Pitt [email protected]

Oral & Dental Health Mr K Farrer [email protected]

Cardiology Mr K Farrer [email protected]

Vascular Surgery Mr K Farrer [email protected]

Neuromuscular Mr K Farrer [email protected]

Radiology Mr Jim Cannon [email protected]

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