MINUTE OF MEETING HELD ON 3 NOVEMBER 2008, ST ANDREW S HOUSE, EDINBURGH

Transcription

1 Scottish Government Health Department EMERGENCY ACCESS DELIVERY TEAM MINUTE OF MEETING HELD ON 3 NOVEMBER 2008, ST ANDREW S HOUSE, EDINBURGH Present: Tim Davison (Chair) Kathleen Bessos Dr. Anne Hendry Dr. Stephen Potts Prof. Derek Bell Jackie Britton Steve Kendrick Fiona McKenzie Catriona Hayes Susan Bishop Dr. Marion Storrie Gill Stillie Dr. Jonathan Pryce 1. Apologies Apologies were received from Alex Bowerman and Helen Maitland. 2. Note of Previous Meeting The note of the previous meeting was approved. 3. Matters arising (i) Pharmacy walk-in centres: Jackie Britton reported that the pilots comprised different service models. Marion Storrie raised an issue in relation to data capture and I/T systems. Jonathan Pryce confirmed that the evaluation would be made available to EADT in due course. Action: Jackie build feedback into EADT action plan (ii) Enhanced Services: Jackie reported on the enhanced services for 2008/09 and proposals for 2009/10. Jonathan indicated that there was limited opportunity for development for 2009/10. Marion was keen that future developments took into account the possible impact on out of hours services. Jonathan indicated that the Primary Care Leads network was the vehicle for development of enhanced services. Anne Hendry was keen to ensure that there was shared learning from the development of local services. This would be built into the strategy paper for EADT. Action: Jackie to incorporate comments into strategy paper

2 (iii) SAS: Impact on Avoidable A&E Attendances: In Calum Kerr s absence this item was carried over to the next meeting. (iv) Consensus Conference: T1 Target: Anne reported that the recommendations from the conference had been circulated. These included a stronger focus on bed days, less on re-admissions. Kathleen Bessos agreed to circulate the papers once finalised and indicated that there was learning from the event in relation to the work required in developing an A7 performance target. Action: Kathleen to circulate T1 conference papers 4. Development of Trajectory: Kathleen referred to the papers which had been circulated, and introduced the issues including the revised timescale for the development of the HEAT target for A&E attendances. It was noted that Board s had submitted their original trajectory based on a one month snapshot of activity. It was agreed that a more accurate baseline measure was required. 5. Derek Bell raised concerns regarding data collection and the need to manage variability. Catriona indicated that NHS Boards would be encouraged to consider seasonal variations. Derek enquired if success would be considered as an improvement on the average 3 month performance at the end quarter of each year and this was agreed. 6. Tim was keen to develop an in house monitoring tool similar to that for cancer services. Catriona agreed to draft a tool incorporating Board aggregate data and all -Scotland data. This would enable EADT to monitor performance on a rolling basis and highlight any outliers. 7. Discussion moved to the proposal to change the 4-hour wait from a target to a standard. Stephen Potts enquired about the status of standards. He also noted that sites were challenged to achieve the target in relation to young teenagers with mental health problems. Derek expressed concern that monitoring had been at a Board, rather than site level and not all sites had been achieving the target. There was a sense from clinicians and managers that the focus may shift to other targets It was agreed EADT would wish the 4-hour waiting time target to remain. It was agreed that if the change was not accepted then further narrative should be included in the covering letter, similar to the proposed monitoring of sickness absence. 8. It was noted that the overarching target for A&E would be moved from access to treatment. With regard to T4, Stephen Potts noted this should state psychiatric readmissions. Kathleen agreed to feedback on all points agreed to the Directorate of Delivery. Action: Catriona Hayes to develop draft EADT monitoring report and Kathleen to feedback EADT discussion to the Director of Delivery. 9. Reducing Attendances (i) Update from Board meetings: Jackie reported on her recent visits to NHS Boards which had been positive. All Boards were keen to develop a network to

3 share experiences. NHS Tayside, Lanarkshire and Lothian wanted clarification on the aims of the target and frequency and process for monitoring and feedback. Grampian had given a comprehensive presentation, which had included the challenges being experienced in relation to the 4-hour wait target. NHS Borders was progressing work to engage GP Practices in ownership of the HEAT targets. (ii) A number of Boards raised the problem of engagement of local authorities. In addition, there were issues with Information systems and their design in relation to supporting clinical practices (e g shifting work from A&E to PCEC or minor injuries units and not being able to demonstrate changes). There were workforce issues notably in relation to MMC and EWTD. (iii) Meetings with NHS Forth Valley, Highland and Greater Glasgow & Clyde were due to take place shortly. Jackie indicated that plans were progressing to organise a meeting of NHS Board leads for December. Derek suggested that peer pressure and review had worked well for the 4-hour waiting target. He suggested that dialogue with the Service was important in ensuring delivery. (iv) Strategy Paper: Jackie thanked those who had commented on the draft paper which had been circulated. It was agreed that the draft should be further developed and circulated, setting out the information that would be requested from NHS Boards to support their LDPs in February Tim suggested that the next draft of the paper should be shared with a few colleagues across the Service for feedback before being circulated widely to NHS Board Chief Executives and Winter Planning contacts, mental health leads and others. (v) Jackie indicated that she was developing an Action Plan for EADT. It was noted that NHS Boards would be requested as part of their LDP planning process to prepare an action plan for HEAT A7. There was discussion about the capacity at Board level. Kathleen indicated that the aim was to identify at the December meeting with A7 leads what support was required to take forward local innovation/learning. (vi) Susan Bishop raised concerns about the level of capacity available at a national level. Tim asked Kathleen to identify the resources required at national/regional/board level. Derek suggested the key was to support sustainable improvements at Board level. Gill suggested it was important that Boards identify the dependencies on partners in their LDP action plan similar to the work developed for the winter planning self assessment tool. Actions: Jackie to redraft and test out the strategy paper and organise a leads meeting. Kathleen to identify resources required at each level of the system. (vii) 7-14 day challenge: Steve indicated he would complete and bring the final version of his paper to the next meeting. Action: Steve: finalise the 7-14 summary paper (viii) Social Marketing: Steve indicated that a meeting had taken place in Grampian to progress the work. The background research would take place over the next few months. Tim suggested it would be good to circulate a brief communication

4 on progress to date to NHS Boards with follow up briefings at a later. Marion enquired if NHS Board Directors of Communication were sighted on the work. Derek suggested that this project required close monitoring. (ix) Expert workshop: It was noted that this was being planned for January Kathleen referred to a recent session hosted by the 18 weeks RTT Programme. This had provided an opportunity for learning from others. Marion indicated that representatives from Adastra and Pathways to Health demonstration project are visiting Lothian on 13 November. EADT members are welcome to attend. Action: Jackie to organise workshop. (x) Mental Health Services. Stephen Potts reported on the Joint UK Academy of Medical Colleges meeting. The Scottish Report on A&E services was being prepared. In relation to the target for reducing attendances he indicated it was important that communication with the key groups was not seen as top down. There was wide variability in input from psychiatric services into A&E. Anne outlined the benefits of developing digital stories. She suggested that, with resources, Karen Maney at ISD could assist to develop these. Tim suggested it would be good to have a note of relevant conferences/events for EADT members. Stephen suggested such a programme would be available through the College. It would also be important to link with Geoff Huggins in Mental Health Division. Actions: Anne to liaise with Stephen and ISD; Jackie to liaise with the College. 10. Information: (i) A&E Dataset: Fiona McKenzie outlined the key issues in the paper which was previously circulated. The paper included feedback from NHS Boards on the exercise presented at the winter planning conference. Fiona indicated that the Data Development Group was keen to have input to the process. The most commonly requested developments to the dataset were noted. Steve suggested it was important to consider desirability and practicability and that it was important to know what was already being recorded locally. Steve suggested a further issue was in relation to current coding - giving examples of local variation on usage of the referral route and diagnosis. Steve suggested that snapshot studies were required at local sites. (ii) Anne suggested that the dataset could be used as an improvement. Fiona indicated that if Boards were collecting items requested this development could be accepted now. Gill suggested caution in including the issue of on child protection register due to the complex range of issues involved. It was agreed the other suggestions would be progressed at this time. It was also noted that the exercise was developmental. Fiona indicated that the A&E Executive Group consultant led was keen that requests were routed through them. Tim and Derek both enquired about the role/status of that Group. Actions: Fiona to progress dataset; Steve to progress snapshot studies

5 (iii) Information Strategy: Steve indicated that he was progressing this work. The first meeting of the Information Network was proposed for early December. Steve also indicated he was optimistic that the analyst post to support EADT would be in post for January This post would liaise with NHS Boards in taking the work forward. 7. Winter Planning (i) Submissions from NHS Boards: Jackie referred to the paper which had been circulated summarising the submissions from NHS Boards. It was noted that the total submissions were in excess of the funding available. Consideration was given to the proposals in respect of their ability to deliver on the aims of reducing pressures at the festive period. It was agreed Jonathan and Jackie would meet to consider these in detail. Action: Jonathan and Jackie (ii) Media Campaign: Gill outlined the issues in respect of the presentation which had been circulated. EADT noted that the media campaign was being launched that day by the Cabinet Secretary. It was noted that the materials would be posted at key locations including community pharmacies, libraries, and transport routes to encourage the public to Be Ready for Winter. The campaign was building on lessons from 2007/08 and covers issues right through until Easter. 8. Maximum 4-hour wait: The reports circulated for the period to September 2008 were noted. There was brief discussion on pan-board achievement and site achievement of the target, notably in respect of Lothian and Grampian. Tim suggested it was important to continue to monitor site achievements. Gill suggested that there had been a period of call volume being lower, resulting in onward referrals also reducing. 9. AOCB (i) Urgent Care Conference: The programme for the conference to be held in January had been circulated. It was agreed EADT would fund 3 places. (ii) EADT Membership: Tim indicated Kathleen had received a request from Dr Morrison, Chair of The College of Emergency Medicine for representation on EADT and this was supported. Action: Jackie to contact Dr Morrison. 10. Date of Next Meeting: The next meeting will be held on Monday 8 th December. The dates for meetings for 2009 have been circulated.