National Advisory Committee for Neurological Conditions minutes: August 2022

Attendees and apologies

• Stephanie Fraser (Chair) (SF), Cerebral Palsy Scotland
• Dr David Breen, (DB), Consultant Neurologist, NHS Lothian
• Dr Callum Duncan (CD), Consultant Neurologist, NHS Grampian
• Dr Maggie Whyte (MW), Consultant Clinical Neuropsychologist, NHS Grampian
• Gail Smith (GS), National Chief Officer Group
• Wendy Forrest (WF), Clackmannanshire and Stirling Health and Social Care Partnership
• Diane Fraser (DF), Social Work Scotland
• Tanith Muller (TM), Neurological Alliance of Scotland (NAoS) / Parkinson’s UK Scotland
• Richard Brewster (RB), SG - Clinical Priorities Policy, Framework Delivery
• Claire Mellor (CM), SG - Clinical Priorities Policy, Neurological Conditions
• Gerard Gahagan (GG), SG – Clinical Priorities Policy, Neurological Conditions
• Anissa Tonberg (AT), SG – Clinical Priorities Policy, Neurological Conditions
• Declan Doherty (DD), SG – Clinical Priorities Policy, Neurological Conditions
• Euan Bailey (EB), SG – Clinical Priorities Policy, Neurological Conditions

In attendance

• Kevin Freeman-Ferguson (KF), NHS Healthcare Improvement Scotland (14:35-15:00)
• Josephine Elliot (JE), NHS Healthcare Improvement Scotland (14:35-15:00)
• Rachel Moss (RM), NHS Healthcare Improvement Scotland (14:35-15:00)

Apologies

• Susan Walker (Deputy Chair) (SW), NHS Greater Glasgow and Clyde
• Dr Jenny Preston (Deputy Chair) (JP), NHS Ayrshire and Arran
• Jamie Cochrane (JC), National Centre for Sustainable Delivery, NHS Golden Jubilee
• Judith Newton (JN), Clinical Nurse Specialist, NHS Lothian
• Morna Simpkins (MS), NAoS / MS Society Scotland

Items and actions

Welcome, introductions and apologies

SF welcomed the Committee and WF to her first Committee meeting. WF has joined the Committee as a service manager representative for Health and Social Care Partnerships (HSCP). SF noted that MS would also be joining the Committee as the recently appointed Vice Chair of the NAoS, but was unable to make this meeting.

SF introduced three guest presenters KF, JE and RM to the Committee. Apologies were noted as above.

Review of previous minutes and actions

The Committee confirmed that the minutes reflected an accurate record of the previous meeting in May.

There was one matter arising from the previous meeting, regarding the situation in the Western Isles where a decision was taken by the board not to replace MS and epilepsy nurse specialist vacancies, moving to a general Neurology Nurse Specialist model. Recent discussions have taken place with four neurological charities (Parkinson’s UK Scotland, Epilepsy Scotland, MS Society and Neuro Hebrides) who have held separate meetings with the Cabinet Secretary for Health and Social Care and Chief Executive of NHS Western Isles. The charities intend to continue pursuing this on-going matter.

Framework progress update/work plan progress

The Committee were asked to note progress updates provided in papers. Members were invited to provide feedback on progress made since the previous Committee meeting in May, with discussion on the following:

Commitment 12

Concern was expressed around the long timescale for publishing SPIRE prevalence data. Debbie Sagar (DS), Scottish Government analyst is analysing the findings and has suggested involvement of clinicians to support this before publishing. DB has agreed to be involved in this exercise. The analysis is expected to be ready for presentation at November’s NACNC meeting, but if available earlier, will be circulated to members via email.

Redesign Project Group

Commitment 16

Neuro-rehabilitation

A National AHP Conversations Webinar: Delivering a Person-Centred Approach to Rehabilitation in a post-COVID eras is scheduled on 8 September. The session is fully booked but the recording will be made available to those unable to attend. It was suggested that considering the demand for spaces that a second event should be arranged so that as many people as possible have an opportunity to contribute.

Clinical Nurse Specialists

Judy Newton will present on work to date on nurse specialist competencies to the Redesign Project Group. The committee noted that, historically, the clinical nurse specialist roles were developed by charities responding to the person’s needs. It is imperative that third sector organisations are involved in this work.

Neuropsychology

MW updated on the review of the ‘Enhanced Psychological Practice’ training model. The current position is that EPPP is suitable for neuropsychology but without referencing it specifically. MW will seek assurances from NES around inclusion of neuropsychology within their curriculum.

Secondly, there is an opportunity to engage with Primary Care colleagues in the Scottish Government to seek a more formalised approach on ways to work with GP committees at a localised level, to ensure that there is GP learning of psychology for people with neurological conditions.

The next Redesign Project Group (RPG) meeting is on 7 September. A number of developments have been made since the previous RPG meeting, the papers are being finalised and will reflect these developments.

Quality assurance of general standards for neurological care and support

KF of Healthcare Improvement Scotland (HIS) provided an overview. The Reference group formed to develop a self-evaluation process to review progress in relation to the standards of neurological care had its first meeting on 14 June. The group is chaired by Tracey Baird, a Consultant stroke physician in NHS Greater Glasgow and Clyde who chaired the group when the General Standards for Neurological Care and Support were developed in 2018.

A draft of the self-evaluation guidance will be discussed at the Reference Group’s next meeting on 15 September. HIS have aligned the General Standards for Neurological Care and HIS’ Quality Assurance Framework.

The self-evaluation tool is intended to be used by services to inform their own improvement work. It can also be used to inform regional and national discussions around service development and delivery. It was emphasised that this is not designed as an external inspection process.

The development of this work was welcomed by the committee. The importance of this and the need to get it right was acknowledged. Key points:

• are mechanisms to be built in by which service users can challenge services regarding quality of services?
• what are we measuring? Outcomes or outputs?
• uutcomes for service users will vary between NHS boards
• needs to be sensitive to challenges faced by a board the size of NHS Greater Glasgow and Clyde and the breadth and scope of services
• apacity to complete this when services are under pressure is significant challenge

Feedback on the self-evaluation tool is expected from stakeholders at the upcoming group meeting. All comments will be collated and any refinements will be made to the self-evaluation tool by December 2022. It is expected that the tool will be rolled out in early 2023, this would include facilitated training sessions on operating the tool.

Funded projects

Evaluation

The Committee agreed with the proposed approach to evaluating the funded projects. NACNC members were asked to volunteer to assess projects from Round 1 and 2. Projects will be evaluated assessing progress to date against their original application, reviewed by at least two people, Clinical Priorities team will also support this process. CD, DF and TM volunteered to participant in evaluating projects in addition to SF, DB, SW, JP and GS. Projects have been asked to submit latest evaluation updates by 2 September.

Practice sharing sessions

The planned approach for the practice sharing sessions was agreed by the Committee. A reflection on the approach was the inclusion to share learning on difficulties that projects have encountered, as well as the positives. WF asked that the NHS Forth Valley project be included. Recruitment for suitable candidates in to take forward project objectives has been a challenge for a few projects.

GS suggested inviting AHP and NHS Acute Directors to augment existing networks and maximise statutory sector attendance. The Clinical Priorities team are sourcing mechanisms to record these sessions for those individuals who will be unable to attend.

Round four options

CM outlined the existing financial pressures on the health and social care system and the impact this may have on the amount of funding available by the Scottish Government.

The Committee were asked to review and agree the best option to proceed with for 2023-24 funding. Option 6 was preferred by the committee, involving a more targeted funding round with the option to sustain and embed successful projects that have previously received funding, as well as targeting specific gaps in the implementation of the Framework, where there is still a need to deliver more work.

Any other competent business

SF notified the Committee that NACNC meeting dates for 2023 will be circulated by DD before November’s meeting.

Actions

• to publish NACNC minutes for NACNC meeting in August on Scottish Government website - Declan Doherty
• to review communication to NES regarding incorporation of neuropsychology to Enhanced Psychological Practice - Maggie White
• to engage with primary care colleagues around promoting, via local GP committees, neuropsychology awareness and training - Richard Brewster
• to link Debbie Sagar with clinicians on the SPIRE data and invite her to the next meeting to update NACNC of her analysis - Richard Brewster
• to circulate and report the Committee’s feedback on the self-evaluation template by the next HIS Reference group meeting on 15 September - Declan Doherty
• to allocate funded projects to TM, CD and DF to support evaluation - Richard Brewster
• to include AHP and NHS Acute Directors to the practice sharing sessions, which supports augmenting existing networks - Richard Brewster
• to circulate NACNC meeting dates for 2023 - Declan Doherty