Scottish Government Health Directorates
EMERGENCY ACCESS DELIVERY TEAM
Minute of meeting held on 6 September 2010, Conference Room D,
St Andrews House, Edinburgh
Present: Mr Tim Davison (Chair)
Ms Jackie Britton
Prof Derek Bell
Mr Martin Hopkins
Ms Fiona Mackenzie
Dr Marion Storrie
Dr William Morrison
Dr Catriona Hayes
Dr Graeme Walker
Mr Drew Wemyss
Mr Duncan Miller
Dr Anne Hendry
Dr Robert Williams
Dr Stephen Potts
Ms Gill Stillie
Ms Sheena Cochrane
Mr Nigel Pacitti
Mr Graeme Aitken
1.Welcome and Apologies
Tim Davison welcomed everyone to the meeting. Apologies were received from
Dr Dan Beckett, Ms Phillipa Haxton and Ms Heather Kenney was represented by
Mr Drew Wemyss.
2.Note of previous meeting
The minute from the previous meeting of 5 July 2010 wasapproved.
3. (i) Reducing Attendances – update on current position
FMack reported that the trends remained constant for the previous 2 years, with a slight decrease in figures for July.
(ii) Next Steps
KB gave a brief update indicating that both the Quality Ambitions and the Quality Outcome Measures were currently being looked at with a view to aligning these with future HEAT targets for 2011/12 and that work would continue to focus on this area.
With regard to T10 KB indicated that discussions had taken place considering linkages with other HEAT targets. KB indicated that Derek Feeley,Director of Healthcare Strategy is keen to keep a focus on improvements in A&E attendances in light of the Audit Report into Emergency Departments.
RW stated that feedback on proposals for the 2011/2012 HEAT targets have been sought from the service. Responses are to be submitted by Wednesday 8 September. The proposals will be considered by the Scottish Government Health Management Board, with a view to taking the output to the Chief Executives’ meeting in October. 2010 LDP Guidance will follow thereafter.
TD highlighted the need to be mindful of the financial constraints within the NHS and partner organisations, notably local authorities, in the development of HEAT targets.
In relation to linking the HEAT targets to the Quality Framework CH suggested that colleagues may wish to provide input to the feedback exercise on the quality outcome measures. CH would forward details to GA for circulation.
Action CH to forward details to GA for circulation
4. Progress on Milestones
(i) Milestone 1
CH updated the meeting and stated that work on this Milestone had progressed well
however there were still issues with the electronic data in Orkney and Highland Health Boards. A summary paper detailing the points to be progressed has been sent to each Board. It was hoped to have this information by end of November. This information will enable analysis of the differences across Scotland.
(ii) Milestone 4
JB reported that the work on information packs had been well received by GP Practices. The information includes a range of data includingA&E attendances, diagnostic services, emergency admissions and OOH activity. The challenge for Boards now is to engage with Practices in taking forward the desired actions. JB suggested this step may require a degree of facilitating for Practices. GW suggested that Practices would wish to use the information –and would be keen to undertake analysis.
MS indicated that in Lothian Health Board GPs are requesting time to analyse the information. DM suggested that there may be opportunities within the new contract framework to support such work. DM then indicated that in Lothian the 17C practices are planning to undertake an audit agreed with the Board of activity in relation to acute care in the near future. DM outlined the potential cost of such work across the whole of Lothian.
AH suggested there may be an opportunity to engage with practices with a view to improving the usage of community hospitals and minor injuries units
(iii) Milestone 5
KB indicated that the paper outlining the proposed meeting on 21st October has been circulated. KB indicated that there had been a very positive discussion with NHS 24 senior management team in the preparation for this event.
GS indicated that presentations to aid the discussion are being prepared within NHS 24. GS also indicated that the discussion on 21st October would seek to build on the discussions currently taking place with Board Chief Executives.
BM suggested it would be important to include in the discussion the issue of how to inform individuals who do not use NHS24 and choose to self present at A&E; usage of minor injuries units as well as A&E Departments should be covered. BM indicated that Tayside has data available to share in relation to individuals who have disengaged.
BM also raised concerns about the level of knowledge call handlers can have on all local services when working at a national level. He raised the issue of moving to regionalisation – recognising this is not in NHS 24 organisational plans.
MS and SP raised issues in relation the difficulty faced by NHS 24 often in terms of to effective signposting/directing to mental health services where the provision varies greatly across the country and often service provision has been changed at very short notice
DB stated that information needs to be developed locally and distributed throughout NHS24.
AH noted the work being led by Malcolm Alexander in relation to 65+ years and the electronic ACPlans. She asked that this be included in the programme.
MS reminded those present that the current information system do not lend themselves to sharing information as described.
TD requested that all issues raised be captured on the day. A note of the discussion and actions would be compiled and circulated, including to EADT members.
The discussion then moved on to the development of the Common Triage Tool across NHS 24 and the Scottish Ambulance Service. TD noted that Dr. G Crooks would give a presentation on this at the next meeting. Referring to the paper which had been circulated GS indicated that the tool will be the strategic frontline application providing a triage function for NHS 24 and SAS. The tool will seek to improve internal routing. The paper outlined details the governance arrangements and milestones. GS confirmed that Dr. Crooks had been in touch with MS and BM regarding nominations for the Clinical Assurance Group GS indicated representation from EADT is being sought for the Programme Board. GS agreed to send brief details of the remit to GA – who would in turn circulate this to EADT members.
Action GS to send paper to GA for circulation
(iv) Milestone 6
KB gave a short update regarding this Milestone. The paper circulated summarised the key points from the engagement event which took place on 4 March 2010
regarding SAS and NHS Boards’ engagement. The paper has been distributed widely.
SP enquired about the comment in the paper in relation to developing alternatives to A&E for SAS for patients with mental health problems. DW indicated that this was a point discussed at the meeting. DW indicated that SAS would see no difference between the role of technicians and paramedics.
(v) Milestone 8
JB feedback on a recent meeting with Dr.Denise Coia, SG mental health lead in relation to the different points in milestone 8. The point in relation to age bands seemed to be more an issue for child & adolescent services and Dr. Coia agreed to raise this point again with colleagues.
NHS Education is linking with the Mental Health Directorate in relation to a range of training tools, building on work already developed nationally and by individual Board areas.
SP gave feedback on the recent meetings held to discuss the position in relation to mental health breaches and frequent attenders.
In relation to the issue of mental health breaches the information received from Boards suggested that there was not a concern at a national level. Asked Boards where there appeared to be some issues would be contacted and for information on the proposed actions to address the issues. The exercise would be repeated in 6 months’ time.
With regard to frequent attenders SP noted that mental health colleagues wish to be engaged with this work. The number of patients identified at some sites is large and there may be an issue about case management. It was noted that a number of Boards have recently begun to introduce measures to identify and better case manage individuals who are frequently attending A&E. All Boards would be contacted and requested to provide information on the current position. Good practice will be shared.
SP then referred to the point in Milestone 8 on alcohol and mental health services. He indicated that there is significant variability in current service provision across the country and engagement in some areas has been slow. A further complication is the variation in age bandings which the range of services work to and how the services interface at a local level.
RW enquired about the future plans for the milestones overall. KB indicated that the intention is to refresh these for inclusion in the updated target, assuming this proceeds. KB sought comments from EADT on the items for inclusion, paying attention to areas where it is possible to make a difference. The comments made were noted. The aim is to link the milestones with the quality outcome measures.
KB reminded those present that Boards provide routine updates on progress on the milestones and these are shared through the network.
Action:JB update draft milestones and circulcate
5. Information Issues
(i) Feedback from Network Meeting 31 August 2010
JB gave a brief update stating that all feedback has been place on the Shared Space webpage. Training for A&E staff in coding had been identified by Boards as a key issue and FMack had offered support. JB encouraged Boards to take up the offer as this would ensure greater consistency and improve data quality across Boards .
In relation to the work around milestone 1 – patient pathways ISD had given a presentation at the meeting outlining the plan to support this work through ISD. This method would be less labour intensive for Boards – but required good quality data, therefore the work to date in cleaning up data will prove to be invaluable in the future.
(ii) ISD Update
FMack talked through the paper circulated on attendances/ admissions for different age groups. FMacK sought feedback. DB suggested that given the range of variables in each Board area it would be very helpful to have some text around the data. TD enquired about A&E attendances and figures for direct admissions/ admissions overall. SP stated that it would be useful to look at outliers and trend data. DB indicated that he had similar data to that in the paper for England which he
would share with FMacK . On the issue of seeking to divert patients away from A&E it would be important to have trend data , together with rates and numbers per Board detailed in the paper. AH asked that rates of admissions could be added.
Action: FMacK to update
6. 4 hour wait Maximum Wait Standard
MH gave a brief update on the current position. He indicated that in Scotland the recommendation from the Scottish Government Health Management Board is to keep the standard, while in England the Department of Health is looking to remove this target. BM indicated that in Scotland the Emergency Department community is keen to retain, and would infact welcome a relaunch of the standard as this is seen by the profession as an important driver of good quality standards. SP also expressed his support for retaining the standard. This has been a good measure for mental health services
Looking at the current performance across the country, it was noted the position in Grampian has improved for the last 4 months. The Board is aware that the challenge is sustaining this good performance.
(i) Guidance paper
F Mack stated that the paper previously circulated was approved and is on the website, links are below.
(ii) Research Study
MH stated that this work has been progressed.
DB indicated that data has been received, one of the items being length of stay for such patients , anda literature review is underway. He indicated that boarding is a marker for quality. DB indicated the timetable for the work is such that a presentation on Phase I will be available for the Regional Winter Planning events in September.
SP asked that mental health boarding be looked at a later date and also include 12- hour breaches. He suggested that, while small numbers, inter-Board activity occurs due to pressure on mental health beds.
8. Audit Scotland Report on Emergency Departments
TD noted that the final report has now been published and is available, with supporting documents, on Audit Scotland website.
TD envisaged that representatives from EADT may be invited to the Audit Committee in due course to respond to the report. No further information on this is available at this time.
9. Winter Planning
RW issued the draft Winter Planning guidance to the EADT and requested comments on this be forwarded to him by 10th September.
MS enquired about the Out of Hours Services being requested to complete the self- assessment, as in previous years. Out of Hours being the only part of the system which carries out this work.
DB enquired whether health and social care have robust plans for this year.
TD highlighted paragraphs11,12 and 17 and suggested that in view of the anticipated financial pressures in-year and next year these sections be revisited, with a view to local authority engagement.
DB agreed with the above comments and suggested that the solutions in relation to boarding and discharge planning again require engagement from partners.
TD asked that the urgency and importance of partner engagement and agreement to winter plans be strengthened in the Guidance. He also wished the issue raised at the forthcoming events. He suggested while it is important to learn from previous years the presentations at the regional events should focus on the year ahead and recognise there could be a different range of issues presenting.
In light of the issues raised KB suggested there should be engagement with the Ministerial Strategic Group on Health and Community Care.
GW enquired about the arrangements for GP Practice opening over the festive period. RW indicated his understanding was there would be no change to the arrangements for 2010/11.
Action: RW to update Guidance and to confirm whether separate self on OOH will be required this year. KB to share the draft guidance with the MSG.
11. Future remit – EADT and Unscheduled Care Advisory Group
KB informed the meetingofa proposal to streamlinethe two groups. She indicated that twice a year a new group would meet to consider strategic issues in relation to unscheduled care, comprising of some members in EADT and some members of the UCAG which would stand down. EADT would continue to operate as usual and remain focussed on its current remit.
Membership of the joint meeting has been reduced to keep numbers attending to a minimum and KB stated that letters would go out to all members.
Meeting scheduled for 10 January 2011 would be the next full EADT meeting.
12. Items for Information
The EADT was reminded about theGood Practice Guide
10. Date of next meeting
Date of Next Meeting: The next EADT meeting will be held on
Monday 10 January in conference room D, St Andrews House at 10.30am.