National Advisory Committee for Neurological Conditions minutes: February 2021

Attendees and apologies

Attendees:

• Stephanie Fraser (Chair) (SF), Cerebral Palsy Scotland
• Susan Walker (Deputy Chair) (SW), NHS Greater Glasgow and Clyde
• Dr Jenny Preston (Deputy Chair) (JP), NHS Ayrshire and Arran
• Dr Richard Davenport, (RD), Consultant Neurologist, NHS Lothian
• Dr Callum Duncan (CD), Consultant Neurologist, NHS Grampian
• Tanith Muller (TM), Neurological Alliance of Scotland (NAoS) / Parkinson’s UK Scotland 
• Rona Johnston (RJ), Neurological Alliance of Scotland (NAoS) / Epilepsy Scotland
• Diane Fraser (DF), Adult Social Work Services, NHS Lanarkshire
• Richard Brewster (RB), SG - Clinical Priorities Policy, Framework Delivery
• Gerard Gahagan (GG), SG – Clinical Priorities Policy, Team Leader
• Jamie Cochrane (JC), SG – Modernising Patient Pathways Programme
• Debbie Sagar (DS), SG – Senior Researcher, Health and Social Care Analysis
• Anissa Tonberg (AT), SG – Clinical Priorities Policy, Neurological Conditions
• Anita Stewart (AS), SG – Clinical Priorities Policy, Unit Head
• Declan Doherty (DD), SG – Clinical Priorities Policy, Neurological Conditions
• Euan Bailey (EB), SG – Clinical Priorities Policy, Neurological Conditions

Apologies:

• Gail Smith (GS), National Chief Officer Group

Items and actions

Welcome, introductions and apologies

SF welcomed the Committee and two new members DF and RJ. DF is representing Adult Social Care Scotland and RJ has recently been appointed Vice Chair of the NAoS. There was one apology noted as above. 

Review of previous minutes and actions

The previous minutes had been ratified electronically, however, a review of meeting actions identified some amendments, which will be updated and re-published to the Scottish Government website. It was agreed that Action 3 is not yet completed. Committee members remain concerned that there is a reported local target with face-to-face consultations in outpatient services. Ongoing actions will be covered as part of this agenda. 

Adult Social Care Reform – publication of the Feeley Report – verbal update

The Committee generally welcomed the 53 recommendations and acknowledged the quantity of work that would need to be progressed if all were implemented. The report resonates with the Framework on how people are supported in their communities and in recommending greater empowerment to people with social care support needs. Clinical Priorities Unit is keen to link in early with the report and recognise the value of neurological services being embedded throughout the recommendations. 

DF highlighted the broad range of stakeholders the review team engaged with in developing the report in a relatively short space of time. The report reflects the need for improved support to unpaid carers and continued work to the Carer and Support Strategy. Local commissioning and procurement for a National Care Service would shift accountability from Local Government to Scottish Ministers. This aligns to feedback from stakeholders who indicated the requirement of social care to be seen on parity with NHS services. The models of care demonstrated a powerful theme of involving carers and people with lived experience throughout the developing and prioritising of services but the committee noted the lack of specific inclusion of and commitment to third sector service provision and the fact that budgets would remain in the control of the revised Integrated Joint Boards (IJBs). 

Moving towards collaborative commissioning of services and away from competitive tendering will impact positively on the range of neurological services provided. It is about valuing social care services and how they begin to invest into supporting individuals. 

SF asked the committee to note the publication of the Scottish Parliament Health and Sport Committee’s Phase Two report ‘What should primary care look like for the next generation? Phase II’. AS advised the members can view the report on the Parliament’s Committee Reports page. (Update - the Cabinet Secretary for Health and Sport responded to this report on 1 March 2021). AS advised that Michelle Watts, Professional Adviser to the Scottish Government for Primary Care, has offered to become an interim NACNC member. The Committee welcomed this appointment.

Framework implementation

A) Progress on Framework projects

The Committee noted progress of the innovative projects. Discussions took place on projects that are considerably behind their projected milestones. Two projects were identified as a potential concern of not achieving their proposal’s outcomes. RB outlined mitigations discussed with the projects to ensure they get back on track. 

It was recognised that COVID-19 has reduced the speed that projects can progress. Limitations of IT capacity for digital projects has been a further factor.

SF reminded committee members that the deadline for round two funding of the Neurological Care and Support Framework (“Framework”) is 1 March 2021. SW suggested utilising the Redesign Project Group to look at ways of showcasing practice from round one funded projects of the Framework. In order to effectively showcase the projects’ positive impact at collaborative events, it may be worth aligning them under Framework commitments in order to better align common themes.

B) Year 1 RAG/ summary of achievements/ progress 

The Committee noted progress against the RAG early priorities report. 
Members welcomed the update provided by AT about NHS Inform, noting NHS24 has allocated a content designer to undertake the updates for neurology (with work commencing in early March 2021). Governance arrangements will be put in place between NHS24 and NACNC, with supplementary arrangements between NACNC and individual organisations involved in updating information. TM advised the NAoS members’ survey returns should be available from 6 March to assist with prioritising conditions for update. The Committee supported RB in his perseverance to remain sighted on the development of Scottish Government’s updated Digital Health and Social Care Strategy, which is due to be published at the end of 2021. JC agreed the importance is to ensure neurological framework activities take account of wider digital developments and are factored into work programmes and timelines where possible. JC recommended we should not wait for this document to be published.

Healthcare Improvement Scotland (HIS) has agreed in principle to explore a proposal to establish quality assurance arrangements for the HIS general standards for neurological care. This proposal has been discussed with the NAoS Executive in 2019 and was due to be discussed with the neurological standards development group in March 2020 (but was postponed when pandemic restrictions were put in place). The aim is for HIS to re-convene a virtual meeting with the neurological standards development group that will inform the scope of this project and enable it to be added to the HIS programme of work for 2021-22 (and beyond). It is envisaged that it will be phased over a few years, in order to develop, consult, test, evaluate and ensure necessary resources are available if the assurance arrangements are adopted by organisations involved in neurological care.

C) Priorities for 2021-2022

The Committee considered a discussion paper by the Chair setting out questions against the framework aims and highlighting priority areas for 2021-22. In addition policy officials provided examples of outputs against these areas and asked the Committee to indicate if these are the right priorities for next year (in light of the impact of the pandemic and changes to the health and social care systems).

The Committee agreed the priorities proposed are the right ones to focus on. The Committee did highlight that the importance of building a sustainable workforce and ensuring equitable and timely access to health and social care support (Aim D and Aim E of the Framework) are closely linked, and advised policy officials that it would be beneficial to merge sub-groups planned on workforce and system re-design into one strategic project group focussed on these two aims. This had been considered by Scottish Government and the NACNC Executive previously. SW talked through the discussion paper provided to members and there was a consensus that the approach proposed was sensible. Scottish Government reported a planned meeting would scope a joint approach to these aims.
The Committee noted the Programme for Government commitment about the use of Near Me technology for remote consultations but remained concerned about the variation in use across neurology services. SW noted that the ratio of virtual and face to face appointments might be subject to different local targets.  It was recognised that these targets could vary depending on Boards’ demographic circumstances. The Committee recommended the Government commissions clinical guidance to inform operational use of virtual appointments (Near Me/telephone) for neurological consultations. CD offered to be involved in drafting this guidance. AS agreed it would be helpful for the new sub-group to consider this as part of its remit around re-design, with RB liaising with digital policy colleagues to ensure guidance would align with wider materials and resources. 

The Committee discussed the importance of regional and local leadership groups to drive implementation of the framework and ultimately improvements to care and support for people with neurological conditions. Members felt it would be important to ensure these groups had representation from across sectors. RB reminded the Committee that GS had contacted Health and Social Care Partnership networks to identify people to provide leadership in form local networks, but this approach has had limited success due to other priorities. It will be revisited. 

D) Driver diagram 

The diagram conveys a simple visual concept of drivers to deliver the neurological framework.  It can be adapted as progress is made. The Committee supported the creation of this diagram and agreed to share any comments with the secretariat.

Prevalence data request 

The chair of the SPIRE prioritisation committee has agreed the prevalence request can be submitted. As it is automated there is no limit on the number of conditions that can be included and members offered recommendations of further conditions to include and members were asked to provide comment by an agreed date as recorded in action list. 

AOCB

AT noted that the Minister for Public Health, Well-being and Sport will meet with NACNC on the 18 March 2021. Committee members were asked to comment on the agenda items (introductions and opportunity for the Minister to hear and respond to views from stakeholders) and flag any other matters that might be tabled. Comments to be sent to the secretariat by 10 March.

Agreed actions 

• to publish NACNC minutes for NACNC meeting in September on Scottish Government website - Declan Doherty
• to update the minutes of November 2020, to reflect amendments to Action 3. As well as a revised action for this meeting - Declan Doherty
• to follow-up with Judith Newton on arrangements for an introductory call between her and SF - Declan Doherty
• to circulate an update to the Committee of the implementation of Quality Management Systems in NHS Tayside - Richard Brewster
• to update on any notification of the report into Primary Care - Anita Stewart
• reporting and utilising the Redesign Project Group to draft national recommendations and guidelines on the usage of virtual and face to face appointments - Callum Duncan
• the Redesign Project Group will report progress to each NACNC as a standing item - Susan Walker
• to update the Committee on progression of Quality Assurance work within Tayside and also the delivery of future work with HIS - Gail Smith/Richard Brewster
• to provide an update of a more defined proposal to NHS Inform, for the Committee’s input - Anissa Tonberg
• to provide any further conditions recommended for the SPIRE request by 26 February 2021 - Callum Duncan/Richard Davenport

Date/time and location of next meeting 

NACNC members are invited to join the next full NACNC virtual meeting on Wednesday, 26th May 2021 2.00pm – 4.00pm.