Meeting: NoSPG Date: 25 th February 2015 Item: 03/15 (ii) NORTH OF SCOTLAND PLANNING GROUP Safe and Sustainable Transfer and Retrieval in the North of Scotland NoSPG is asked to agree: Support the project as outlined in the PID; Identify stakeholders from within their Health Boards to participate in the information gathering and participate on the Steering Group when required Support part-funding a project manager from the NoSPG team budget as referenced in the Funding Regional Activity/Position and Options paper to be found later on the agenda.. Synopsis: A risk assessment was presented at the December 2014 NoSPG meeting which showed a high risk for both patients and services related to adult and paediatric transfers and retrievals in the north of Scotland. Consequently the development of a Project Initiation Document (PID) was requested which is presented here. The PID outlines the objectives, scope, milestones and budget implications and seeks agreement to take this project forward. Boards representation / contact: NHS Grampian NHS Highland NHS Orkney NHS Shetland Name Dr Richard Brooker Lindsay Cameron Graeme Smith Dr David Noble Dr Salim Ghayyda Aaron Carr Marie O Sullivan Dr Marek Wolenski Dr Catriona Barr Dr Roger Diggle Role Consultant Paediatrician Charge Nurse HDU Director of Modernisation Consultant Anaesthetist and Intensive Care Medicine Consultant Paediatrician Paediatric HDU Nurse Child Health Commissioner Consultant Anaesthetist Consultant Anaesthetist Medical Director NHS Tayside Dr Linda Clerihew Consultant Paediatrician NHS Western Isles NoSPG ScotSTAR/SAS Jim Cannon Anne-Marie Pitt Andrew McIntyre Carole Morton Milne Weir Regional Director Child Health Network Manager Associate Medical Director Head of Service, ScotSTAR General Manager, North Division North of Scotland Planning Group is a collaboration between NHS Grampian, NHS Highland, NHS Orkney, NHS Shetland, NHS Tayside and NHS Western Isles 1
NORTH OF SCOTLAND PLANNING GROUP Safe and Sustainable Transfer and Retrieval in the North of Scotland 1. Background A risk assessment was presented at the December 2014 NoSPG meeting which showed a high risk for both patients and services related to adult and paediatric transfers and retrievals in the north of Scotland. Consequently the development of a Project Initiation Document was requested which outlined the scope of the potential project, the timelines expected and budget considerations. 2. Project Initiation Document (PID) The PID is attached at Appendix 1. As a brief synopsis the aim of the project is to provide a safe and sustainable transport and retrieval service to meet the needs of the north of Scotland patients. The objectives are: To identify the gaps within the north of Scotland in relation to the transfer and retrieval of patients (all age cohorts) Meet and consult with key stakeholders to identify potential solutions to address these gaps. Identify priority areas requiring short/medium/long term solutions Develop a business case making efficient use of available resources and integrating services to provide most sustainable and cost-effective solution. The scope of the project covers the following services: Neonatal transport service in the north; Paediatric inter-hospital transfers for patients requiring high dependency care in the north and; Inter-hospital transfer of critically ill adults in the north. The suggested milestones are: Milestone Date Gather evidence of risks from stakeholders February 2015 May 2015 Stakeholder event/s and patient/public consultation May/June 2015 Steering group established and option appraisal development and Autumn 2015 recommendations reached Agreement by NoSPG and development of a Business Plan End of 2015 For implementation into LDPs 2016/2017 Completion 2017/2018 Financial aspects of possible solutions will be identified as part of the business case, while ensuring existing resources for transport and retrieval are reviewed in relation to the north workload. Taking forward this project makes no commitment to agree the Business Case and its cost implications until it is presented for debate and decision to NoSPG and the ScotSTAR Divisional Group. North of Scotland Planning Group is a collaboration between NHS Grampian, NHS Highland, NHS Orkney, NHS Shetland, NHS Tayside and NHS Western Isles 2
For the project itself the requirement to provide project management and administrative support will need to be sourced from ScotSTAR and NoSPG team budgets, including the cost of holding stakeholder and public and patient engagement events. Specifically a fixed term 2 year band 6 project manager post is proposed to be jointly funded between the two organisations. 3. Recommendations It is recommended that members: Support the project as outlined in the PID; Identify stakeholders from within their Health Boards to participate in the information gathering and participate on the Steering Group when required Support part-funding a project manager from the NoSPG team budget as referenced in the Funding Regional Activity/Position and Options paper to be found later on the agenda. Anne-Marie Pitt, Child Health Network Manager Carole Morton, Head of Service, ScotSTAR North of Scotland Planning Group is a collaboration between NHS Grampian, NHS Highland, NHS Orkney, NHS Shetland, NHS Tayside and NHS Western Isles 3
Appendix 1 NORTH OF SCOTLAND PLANNING GROUP Project Initiation Document Safe and Sustainable Transfer and Retrieval in the North of Scotland Author: Carole Morton and Anne-Marie Pitt Date: 18/02/15 Version: 1.5 4
Contents 1. Document Control... 6 2. Background... 7 3. Key Aims and Objectives... 7 4. Project Scope (and any exclusions)... 7 5. Expected Outcomes... 8 6. Roles and responsibilities... 8 7. Outline Project Plan... 9 8. Project Budget... 9 9. Key Stakeholders and Types of Communication... 10 10. Risk Register... 10 11. Equality & Diversity Impact Assessment... 10 5
1. Document Control Key Personnel Title: Author: Approver: Owner: Safe and Sustainable Transfer and Retrieval in the North of Scotland Carole Morton and Anne-Marie Pitt Jim Cannon and Daren Mochrie NoSPG Executive and the ScotSTAR Divisional Group Version History Version Date Summary of changes Initials Changes v1.0 5/02/15 1 st draft AMP/CM V1.1 6/02/15 Section 6/7/9 AMP V1.2 09/02/15 Section 6 & 9 CM V1.3 13/02/15 Section 4 AMP V1.4 16/02/15 Section1/3/5 CM V1.5 18/02/15 Section 4 AMP Distribution Name Division Title Board NoSPG Executive North of Scotland 6
2. Background ScotSTAR provides a single harmonised transport retrieval service governed by the Scottish Ambulance Service and covers the following retrieval services: the Emergency Medical Retrieval Service based in Glasgow, the Paediatric Intensive Care Transport Service based in Edinburgh and Glasgow, and the Scottish Neonatal Transport Service currently based in Glasgow, Edinburgh, Aberdeen and Dundee. The transfer of critically ill children, other than requiring intensive care, is not included in the above services and neither is the transportation of critically ill psychiatric patients. The provision of retrieval services from these predominantly central 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 scope. Consequently a risk analysis was carried out and assessed as high. This was presented to the North of Scotland Planning Group (NoSPG) Executive meeting where the recommendations to produce a project initiation document was agreed. This would outline the process to obtain a more detailed understanding of the risks from stakeholders, look at possible options for mitigation and make recommendations on a way forward. 3. Key Aims and Objectives The key aim of the project is to: To provide a safe and sustainable transport and retrieval service to meet the needs of the north of Scotland patients. Objectives: To identify the gaps within the north of Scotland in relation to the transfer and retrieval of patients (all age cohorts) Meet and consult with key stakeholders to identify potential solutions to address these gaps. Identify priority areas requiring short/medium/long term solutions. Develop a business case making efficient use of available resources and integrating services to provide most sustainable and cost-effective solution. 4. Project Scope (and any exclusions) The scope of this review is focussed on the following areas: North neonatal transport service has been provided for a number of years through a combined rota between NHS Grampian and NHS Tayside, with cross cover from the teams based in Edinburgh and Glasgow when required. The sustainability of the north service due to workforce shortages has been a risk for a number of years. Following discussion between ScotSTAR management and NHS Tayside it has been agreed that neonatal transport from Tayside will cease as a base from April 2015. This is due to longterm vacancies in both medical and nursing workforce and unsuccessful attempts to appoint to vacancies. There are ongoing workforce issues within the Aberdeen base with vacancies in the nursing rota and currently long-term sick leave. An interim solution until a more sustainable solution is identified will be necessary and is currently being discussed with the relevant teams. 7
Paediatric transfers for patients requiring high dependency care. This has been an ongoing risk within the north identified in the independent review of paediatric services by Dr ZoЀ Dunhill. The recommendations highlight the need for timely and safe transfers of paediatrics. The paediatric retrieval service transfers children requiring intensive care; the issue is when children and young people do not require this level of specialist care but still require a higher level of clinical care that cannot currently be provided by paramedics. A number of negative impacts ensue from the response to this scenario. These include: o extensive time of local staff required to escort patients, sourced from either the referring or receiving hospital, away from their bases leaving the wards rotas in difficulty and a poor experience for staff; o children being retrieved to the central belt PICUs by the paediatric retrieval service instead of being taken to more local HDUs causing unnecessary time and safety issues waiting for the retrieval service, unnecessary travel distance and remoteness from family support for patients and families; o patients and families experiencing extended lengths of stay in PICUs which is a great distance from their home because there is no suitable means of repatriation; An ongoing issue is the inter-hospital transfer of critically ill adults. This is a particular risk for the north given the significant journey times, the impact of denuding key staff from the units and the ad hoc nature of transfers undertaken by staff who are not adequately trained in transport medicine. This includes the safe transfer of emergency psychiatric patients and the transfer of adult ECMO patients. Additionally the Major Trauma Review will have significant impact on the requirements for the north where there will likely be a requirement for an expansion of the existing national retrieval service in order to support a safe and timely response for primary and secondary retrieval of major trauma patients (adult and paediatrics) to the most appropriate setting for definitive care. It should be noted that the project team will work with the North of Scotland Major Trauma Pre-Hospital, Transfer and Retrieval Group and the North of Scotland Adult In-Patient Psychiatry Group to co-ordinate solutions to risks. The retrievals carried out by the paediatric retrieval service based in Edinburgh and Glasgow are not included within the scope of this project due to the central locations of the PICUs. 5. Expected Outcomes A safe and sustainable transport and retrieval service in the north. This may be provided by a flexible north based ScotSTAR presence which was highlighted within the Full Business Case for ScotSTAR as an area to be reviewed. The benefits identified were equity of access to specialist transport across Scotland, increased capacity and capability for the North of Scotland and a more even share of the workload across the country, making the best use of skills and expertise available. 6. Roles and responsibilities Project Sponsor North of Scotland Planning Group Executive and the ScotSTAR Divisional Group Project Manager Carole Morton, ScotSTAR and Anne-Marie Pitt, NoSPG Clinical Lead Andrew Mcintyre, ScotSTAR 8
Steering Group Chair (to be decided) Andrew Mcintyre, ScotSTAR Mike Bisset, NoSPG Jim Cannon, NoSPG Carole Morton, ScotSTAR Anne-Marie Pitt, NoSPG Clinical representative from each Health Board Planning/management representative from each Health Board Patient/public representatives Paediatric HDC Network representative Neonatal retrieval team representative EMRS representative Finance representative SAS representative Air Ambulance (separate) Health Intelligence representative National Services Division (observer) Work Team Carole Morton, ScotSTAR Anne-Marie Pitt, NoSPG Mike Bisset, NoSPG Andrew Mcintyre, ScotSTAR Paediatric HDC Network representative Ann Marie Wilson, ScotSTAR Sandra Stark, ScotSTAR Stephen Hearns, EMRS 7. Outline Project Plan Summary of major milestones (indicative) Milestone Date Gather evidence of risks from stakeholders February 2015 May 2015 Stakeholder event and patient/public consultation May/June 2015 Steering group established and option appraisal development Autumn 2015 and recommendations reached Agreement by NoSPG and development of a Business Plan End of 2015 For implementation into LDPs 2016/2017 Completion 2017/2018 8. Project Budget Financial aspects of possible solutions will be identified as part of the business case, while ensuring existing resources for transport and retrieval are reviewed in relation to the north workload. For the project itself the requirement to provide project management and administrative support will need to be sourced from within ScotSTAR and NoSPG team budgets, including the cost of holding stakeholder and public and patient engagement events. 9
9. Key Stakeholders and Types of Communication Key Stakeholders Patient /Carer Health Board paediatric clinicians Neonatal Retrieval Service EMRS service Health Board Anaesthetists Health Board planning/management Health Board Executive and senior management teams ScotSTAR Executive and senior teams SAS Executive and senior teams Air Ambulance teams Communication (Stakeholder Event applies to all) Consult Scottish Health Council for support to engage with the public SAS patient representatives NoS Health Board patient representatives Stakeholder event Specific focus groups Regional HDC Network Specific focus groups NoSPG Executive and NoSPG Child Health Clinical Planning Group ScotSTAR Divisional Group SAS Executive meeting? 10. Risk Register To be completed following agreement to proceed. 11. Equality & Diversity Impact Assessment To be completed following agreement to proceed with Business Case 10