National Advisory Committee for Neurological Conditions minutes: September 2020

Attendees and apologies

Attendees

• Stephanie Fraser (Chair) (SF), Cerebral Palsy Scotland
• Susan Walker (Deputy Chair) (SW), NHS Greater Glasgow and Clyde
• Tanith Muller (TM), Neurological Alliance of Scotland/ Parkinsons UK Scotland
• Anissa Tonberg (BD), Neurological Alliance of Scotland (NAoS)
• Anita Stewart (AS), SG – Clinical Priorities Policy, Team Leader
• Gerard Gahagan (GG), SG – Clinical Priorities Policy, National Framework Lead
• Jamie Cochrane (JC), SG – Modernising Patient Pathways Programme
• Gail Smith (GS), Angus Health & Social Care Partnership
• Amanda Cronin (AC), SG - Leading Improvement Team, Improvement Advisor
• Jemma McGuffie (JM), SG – Clinical Priorities Policy, Secretariat

Apologies

• Dr Jenny Preston (Deputy Chair) (JP), NHS Ayrshire and Arran
• Dr Callum Duncan (CD), Consultant Neurologist, NHS Grampian
• Dr Richard Davenport, (RD), Consultant Neurologist, NHS Lothian

Items and actions

1. Welcome, Introductions and Apologies

• SF welcomed the Committee, and there were three apologies noted as above. It was also noted that Becky Duff is no longer a member of the Committee as she has taken on a new role as chief executive at U-Evolve, an Edinburgh based youth mental health charity. SF informed the Committee that Tanith Muller has replaced Becky Duff as chair of the NAoS and Anissa Tonberg is the new vice chair of the NAoS and welcomed AT to the committee.

2. Review of previous minutes and actions

• The Committee confirmed that the minutes reflected an accurate record of the last meeting in June. Ongoing actions will be covered as part of this agenda.
• SF asked for an update on action number 4 ‘To ask NHS boards to share their plans to remobilise neurology services to SG’. GG informed the Committee that the planning team who were dealing with the remobilisation plans have advised him to be sensitive in how he approaches them for the additional information around the remobilisation plans and that the update meetings with Boards would take place soon. He also advised that the planning team are supportive of it however it is the practicalities of asking for mobilisation plans from the NHS. They understand what we are asking for is not for additional work but existing Neurology specific information that feeds into the Boards’ overall remobilisation plans . It was also highlighted that the existing remobilisation plans don’t go into condition specific detail so if there is a need for that information we may need to ask for it independently outwith the remobilisation work. SW suggested using the existing network of contacts of managers and clinicians within neurology to get that information if unable to get through the other route. 

3. Update on Covid-19 situation (from SG, NHS, LA and 3rd Sector perspectives)

• AS and GG provided a Scottish Government update:
  • Initial meeting in Government with key partners; HIS, the Royal Colleges, some of SG policy and Chief Scientist office to start to identify the various strands of work underway around people experiencing symptoms of COVID-19 beyond the initial onset of the virus (over three weeks). There is caution in referring to COVID-19 as a long-term condition; this was felt to be premature until more findings from studies/ research are known.

• Clinical Priorities Unit is expected to undertake a co-ordination role for long COVID-19 symptoms. Scottish Government is keen to ensure activity is cohesive and evidence is used to inform clinical guidance and operational practice. Long COVID-19 symptoms relate to complications for many of the Unit’s long term conditions: cardio, fatigue, renal, respiratory, pain and neuro. AS/GG confirmed this will not detract from implementation of the Neurological Framework. NACNC members provided an update on the challenges the neurological community are facing during the pandemic:
  • The Neurological community (NC) are still reporting issues with access to services and routine treatment.
  • SW reported that within GGC access to Neurology services has been maintained through a combination of F2F and virtual consultations (telephone and Attend Anywhere).  The Board is also developing plans for the introduction of patient initiated reviews (PIR). She noted that AHP consultations remain largely virtual, and further work is required on recovery of this and other predominantly F2F services. SW noted that this local position may not reflect the impact on neurology departments across the country.
  • It was highlighted that how care is being delivered is changing in most of the Health and Social Care Partnerships, which includes utilising technology and digital innovations to improve how care services are being delivered.

4. Clinical Leadership Advisory Group on Shielding

• As of 1 August shielding has been paused in Scotland. GG recognised that in practice some people with neurological conditions may continue to shield of their own choice. This will include people previously shielding because they were identified as being in the highest risk group of severe illness from COVID-19 and those that decided to shield even though they did not meet the criteria. The recent meeting between the Neurological Alliance executive and relevant policy officials leading on shielding was helpful to ensure the lived experience of neurological conditions was captured and used to inform policy development.   GG advised he would continue to liaise with this policy area and ensure neurological stakeholders are included in opportunities regarding ongoing engagement.

5. Scottish Access Collaborative update including funding

• JC updated the Committee following the event on 30th June 2020, which reflected on the progress made regarding Active Clinical Referral Triage (ACRT) and Patient Initiated Review (PIR) since the previous event in March. 
• JC provided an update on his action from the last meeting. There has been a group working on addressing the counting and coding of ACRT going forward through the development of a paper that is due to go to the Waiting Times Information group on the 30th of September. Once this group has approved the paper it will be available to be shared with the Committee. The paper establishes 6 new national codes, which will record the outcome of ACRT. The group will also be developing guidelines to support the implementation.

6. Early Priorities and Actions updates

Network developments (Tayside)

• GS is looking to re-engage with NHS Tayside around their networks and what they are doing, how they are focusing on the priorities and how they are aware of the early priorities and actions from the Neurological Framework. GS flagged up that some of group are not aware of the priorities and actions plan.
• GS has released three surveys asking patients what their views are and what Health and Social Care Partnership can do differently from a community hospital perspective and community perspective, although it was noted that these are not neurological specific. GS is happy to share the feedback that comes from this.  
• GG highlighted that there is a need to identify an appropriate individual with an interest in neurological conditions within Health and Social Care Partnerships and factor in the third sector through the Neurological Alliance then the Committee could have a core leadership linkages across different areas. GS advised asking Primary Care Managers. It was also suggested that through the Chief Officers group an individual with the relevant background highlighted could be identified.

Neurological Framework Funding

• The Scottish Government invited organisations to apply for funding to deliver innovative projects aligned to the aims, commitments and priorities set out within the Neurological Framework.
• The deadline for the first round of applications was the 6th of September 2020.
• The Committee were asked to provide feedback on the scoring matrix used to evaluate the applications.
• SF had highlighted in the previous NACNC meeting in June that it should be noted clearly that the Committee and Executive will have potential conflicts of interest when they provide advice on applications as part of the Scottish Government’s assessment process. This was highlighted again and GG confirmed that the SG is convening an assessment panel comprising relevant policy teams. A scoring matrix has also been devised using the application criteria to ensure the process is robust and consistent. NACNC executive will provide expert advice to inform decision making by SG (and declare any conflicts of interest as part of the process).

NAoS update  - Neurological Framework Funding Workshop

• The workshop was well attended; 52 people from across sectors participated, (predominantly third sector but also statutory with input from managers and clinicians). There is evidence that this workshop helped to stimulate collaborative efforts across sectors, with a number of cross sector applications being sent to SG for consideration. NAoS would be willing to facilitate a second event when the next funding round commences in 2021.
• Alice Struthers has been appointed to the role of Co-ordinator for NAoS until at least March 2021.
• NAoS is actively taking steps to expand its membership. The virtual AGM is on the 14th of September and Carolyn McDonald will be talking at the meeting about the Recovery and Rehabilitation Framework.  GG will also participate to speak about the Neurological Framework.

Update on Rehabilitation Framework

• JM highlighted that the Scottish Government are prioritising 3 things; the development of a ‘Framework for Recovery and Rehabilitation’, which was published on the 13th of August, a ‘Clinical Guideline for health care professionals’ and funding research into the long-term symptoms of COVID-19, which includes directly funding 56 rapid research projects to better understand the effects of the infection in order to inform and improve treatment and consequences of the virus. This will enable greater understanding of how people have been affected by the virus in Scotland and also develop recommendations on measures to support recovery.
• The next steps include setting up a National Advisory Board for Rehabilitation, which will address the public health aspect of early intervention.
• This work will closely align to existing rehabilitation pathways and strategies and a Once for Scotland Approach will be developed and provide a practical, accessible strategy to deliver quality rehabilitation to everyone who needs i

Additional items

• SF raised the potential of establishing a sub group on workforce matters, as part of the work to implement the Neurological Framework. GG will explore this possibility with SW/JC.

Quality Framework

• There was a discussion around the Quality Framework and how it can be used for the implementation of the actions of the Neurological Framework.
• AC informed the Committee that the purpose of using the Quality Management system approach from Healthcare Improvement Scotland enables the Committee to look at the questions in each of the areas listed within the diagram to improve the outcomes of the Commitments and aims within the Framework. 
• It was advised that Gail Smith be involved in future discussions around the QMS approach because of her academic background and current role in Angus Health & Social Care Partnership. GG and AC to have a follow up meeting to look at actions and then will run past the Committee and see who wants to connect in with the specific elements.

6. AOCB

• No AOCB noted.

7. Agree next steps and next meeting

NACNC Actions
No.	Action	For
1.	Make progress on data commitment and update at next NACNC meeting in November	Clinical Priorities Team and Debbie Sagar
2.	To publish NACNC minutes for NACNC meeting in June on Scottish Government website	Jemma McGuffie
3.	To share three Health and Social Care Partnerships surveys with the Committee	Gail Smith
4.	Follow up with Gail Smith on identifying an appropriate individual with an interest in neurological conditions within the Chief Officers group from each board or partnership	Gerard Gahagan and Stephanie Fraser
5.	Produce a Terms of Reference for the Workforce sub-group and identify potential membership	Gerard Gahagan, Susan Walker and Jamie Cochrane
6.	Organise a meeting to consider actions for the work going forward on the Quality Framework and feedback to the Committee.  Identify representatives to link in with specific elements of planned work	Amanda and Gerard
7.	To share ACRT counting and coding paper once it has been approved	Jamie Cochrane
8.	To make advised changes to the early priorities and action plan	Gerard Gahagan

 

8. Date/time and location of next meetin

NACNC members are invited to join the next full NACNC virtual meeting on 26 November, 1.30pm – 3.30pm.