National Advisory Committee for Neurological Conditions minutes: May 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 (present between 14:00 and 14:30)
• Dr Callum Duncan (CD), Consultant Neurologist, NHS Grampian
• Dr Judith Newton (JN), Clinical Nurse Specialist, NHS Lothian (present between 14:00 and 14:30)
• 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
• 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

Apologies:

• Gail Smith (GS), National Chief Officer Group
• Michelle Watts (MW), Primary Care Clinical Adviser

In attendance:

• Belinda Henshaw-Brunton (BH), Senior Inspector, NHS Healthcare Improvement Scotland (HIS)
• Jane Robertson (DS), SG – Principal Social Researcher

Items and actions

Welcome, introductions and apologies

SF welcomed the Committee and introduced two guest presenters JR and BHB to the Committee. SF congratulated RD on his appointment as President of the Association of British Neurologists (ABN).

Review of previous minutes and actions

The Committee confirmed that the minutes reflected an accurate record of the last meeting in February. There were no matters arising, ongoing actions will be covered as part of this agenda. 

Measuring improvement

Given the inter-related nature of this item and Item 6 (HIS Quality Assurance), items 3 & 6 were combined into one discussion. 

Scottish Government colleagues recently met to discuss the Patient Reported Outcome Measures / Patient Reported Experience Measures (PROMS / PREMS) measures as metrics for progress on Framework delivery. These enable comparability across different conditions and there was support for this approach. It was acknowledged that more needed to be done to look at cross-condition applicability of PROMS/PREMS to determine which ones are most workable. NAoS is also looking at The Neurological Alliance of England PREMS. Generic metrics such as National Care Standards were also discussed. Further discussion is also needed around theory of change that will identify what change we want to see the Framework commitments and how this could be measured.

Recent discussions have taken place between Healthcare Improvement Scotland (HIS) and the Clinical Priorities Team regarding commissioning Quality Assurance of how  Health and Social Care services are meeting Standards for Neurological Care. A business case has been submitted to BHB’s Directorate Management Team for discussion on 27 May. NACNC were asked to bear in mind that what is proposed is not an independent national review of the Neurological Framework, rather a self-assessed, peer review of progress against the Standards that will identify recommendation for improvement. 

It was noted that a range of considerations need to be reviewed, including datasets, governance arrangements and methodology. Governance arrangements will be a key component in undertaking this work and stimulate outputs that coordinate with the neurological and health and social care standards. There were some concerns around appropriate resources for completion of a self-assessment. It was agreed that a phased implementation approach is needed both to ensure organisations are prepared and to ensure self-assessment is manageable. There is a need to emphasise support for improvement rather than scrutiny and comparison across boards.

Alignment of both pieces of work was identified as essential in minimising duplication. The Committee agreed to establish a group to consider next steps. At a follow up meeting of the NACNC this was discussed further and it was agreed the group would consist of SG colleagues and BHB and JR. The Committee stressed the need of reporting back to the NACNC on progress and if further guidance is required.

Progress on funded projects

The Committee noted progress of the funded projects. The paper of the progress with funded projects demonstrated the funded projects’ continuous commitment and engagement in implementing the Framework. In summary of round two of the funding process; six projects have been awarded funding to continue their work from round one into round two, three projects who re-applied for funding in round one have secured further funding in round two, seven new successful projects for round two have been announced and a final six applications are awaiting approval from the Minister. 

TM shared feedback she had received regarding the length of time to provide confirmation on the six projects that required further clarification. However, the constraints of the election period were recognised and the necessity of thorough clarification before awarding funding. 

RB updated the committee on the NHS Tayside Quality Improvement Learning event on the 19 May 2021 which he had attended. The event had been very well attended with representation and participation from third sector, voluntary sector, acute and primary care services.

Practice sharing overview

Once the remaining round 2 projects have been announced , RB emphasised the priority of facilitating a practice sharing event. The Committee agreed with the importance of funded projects disseminating and emphasised that all sectors must be involved.

It was recognised that a separate discussion is required to review the administration process for the award of funding with the aim of adapting and improving the funding process. 

HIS update on quality assurance

Minuted under item 3.

Progress of redesign project group

Guidance is being developed on use of virtual vs face to face appointments for people living with neurological conditions, The Near Me team has provided a template to complete guidance for different professional disciplines. 

The group is currently developing guidance for medical staff on consultations on headaches, movement disorder and epilepsy. A separate meeting has been organised to discuss the development of guidance for Allied Health Professionals. 

SW reiterated that current practice in some areas with virtual appointments includes the choice for a patient to use telephone or Near Me and this should be incorporated in the guidance documents. Assurances were given around third sector opportunity to comment on draft guidance once it has been developed.

The workforce survey has been circulated to representatives a range of colleagues representing different professions within neurological care and support. SW will meet with members of the Clinical Priorities Team to review responses and provide initial feedback at the next Redesign Group Meeting on the 2 June 2021.

Overview of framework progress

The Committee were satisfied with the outputs in the RAG report. 

AOCB

SF confirmed the ministerial update within the Scottish Government. Humza Yousaf has been appointed as the Cabinet Secretary for Health and Social Care and Maree Todd has been appointed as Minister for Public Health, Women’s Health and Sport. The Committee asked Clinical Priorities colleagues to ensure that new Ministers are mindful of the Neurological Framework and agreed  priorities for this year at the earliest opportunity.  The Committee confirmed that they would be happy to meet the new Ministers to discuss further at their convenience.

Agreed actions 

• to publish NACNC minutes for NACNC meeting in February on Scottish Government website - Declan Doherty - completed
• to circulate a draft version of the virtual vs face-to-face appointment guidance - Callum Duncan - in progress
• to convene two groups for follow up and to report back to the next meeting: a) a group that consists of SG colleagues and BHB to discuss aligning Measuring Improvement and HIS work - Clinical Priorities Team - in progress; b) administration of project funding - Clinical Priorities Team - in progress

Date/time and location of next meeting 

NACNC members are invited to join the next full NACNC virtual meeting on Wednesday, 18 August 2021 2.00pm – 4.00pm.