National Implementation Group for Terminal Illness meeting minutes: 10 November 2020

Attendees and apologies

• Dr Linda de Caestecker
• Sandra Campbell
• Dr Pat Carragher
• Susan Webster
• Helen Malo
• Donna O’Boyle
• Dr Teresa Cannavina
• Richard Gass
• Dr Mini Mishra
• Meg Sydney
• Margaret Grigor
• Shonagh Martin
• Jo McKay
• Gordon Dawson
• Clare Young
• Rod Finan
• Iain Macritchie

Apologies

• Claire McDermott
• Richard Meade
• Dr Jenny Bennison
• Claire Pullar
• Mark Hazelwood
• Dr Alison Potts

Items and actions

This meeting was due to take place in September 2020 but was postponed until November 2020 due to COVID-19.

Welcome

The Chair welcomed members to the fifth meeting of the National Implementation Group on Terminal Illness for Disability Assistance (NIG).

Update on actions from last meeting

Minutes from the previous NIG meeting and minutes from the harmful information meeting were both agreed and formally approved by the group.

The Chair asked for clarification on what the outcome of actions 1 and 2 were from the previous NIG meeting. Members were to let officials know if anything else needs to be done to the consent section in relation to children and young people and were to liaise with officials regarding FAQ’s relating to consent for children. Members confirmed that they will write to officials with regards to these actions however there are no red flags.

Officials confirmed that action 3 to have discussions regarding the network of 3rd sector organisations via email and update the communication plan is now complete.

Officials updated the group on areas that were not covered in the update.

• the Social Security Administration and Tribunal Membership Bill has been passed and it is expected that this will get royal assent in the following days
• Delphi research commenced the week beginning 12 Oct 2020 after being paused due to COVID-19. Officials are expecting an initial update on this research in the new year
• leaflets are awaiting design and infographics and then user testing
• a team has now been established to work on the Information Hub and they have completed some initial user research
• the new names of the Scottish Disability Benefits were announced
  • the replacement for Child DLA will be named Child Disability Payment
  • the replacement for PIP will be named Adult Disability Payment
  • the replacement for AA will be Pension Age Disability Payment

Update on harmful information

The Chair updated that following the meeting on 1 October 2020 and to ensure the CMO guidance/BASRiS form reflects the new legislation, both have been updated. These were circulated prior to the meeting giving a chance for comment. Small changes were made (marked in green) to take on board feedback and the updated section/BASRiS form is part of the CMO guidance.

Officials clarified that they have not yet formally asked members to provide examples of clinicians withholding harmful information. Officials will create a simple template for examples to ensure consistency.

Members discussed the process for informing Social Security Scotland that harmful information, which was initially being withheld from a patient, has now been disclosed. Officials welcomed feedback from members on this issue. Members agreed that a safe and secure email address would be ideal. However, Service Design colleagues advised that Social Security Scotland have concerns regarding managing an inbox for this purpose as it would require constant monitoring for a small number of emails. Officials suggested that call backs at a convenient time via the Clinician’s Helpline could be arranged. Members agreed that clinicians don’t have the time to be waiting on a phone but also raised practical difficulties for clinicians to receive call backs as they often can’t guarantee availability at a certain time.

Members raised the issue that clinicians will likely forget to contact Social Security Scotland as this could happen months after the BASRiS form was signed. Members agreed a prompt from Social Security Scotland would be helpful. Officials will look into whether providing a prompt would be possible and how this could be done.

Action point 1: officials to gather from members, examples of clinicians withholding harmful information.

Action point 2: officials to explore providing a prompt to clinicians to update Social Security Scotland on whether harmful information is still being withheld from a patient.

Updates to CMO guidance

The Chair updated members on the changes made in the CMO guidance which include:

• changes made to reflect the new legislation
• updated with the new benefit names
• consent section has been updated relating to third party representatives as they are now clearer on what Social Security Scotland will offer regarding this
• updates made to the harmful information section/consent part of BASRiS as a result of the meeting on harmful information

Officials noted that now that the Bill has been passed, the guidance and the BASRiS form should say ‘for Doctors and Nurses’ rather than just ‘for Doctors’.

Officials updated the group on the changes made to the BASRiS form.

• slight changes have been made to part 2 following a conversation between officials and DWP. They raised concerns that clinicians wouldn’t input the details that they are looking for and so updated the wording to ensure that this is clear
• slight change to the first line of the declaration was made to ensure that the wording aligns with the regulations
• parts (highlighted green) were updated following suggestions made at the meeting on harmful information

Members agreed that the boxes on the BASRiS form need to be much bigger, as the form will be handwritten. Officials clarified that this is a paper form which will have to be posted to Social Security Scotland and scanned onto the system. The long term plan is to have a digital BASRiS but this will not be available before the launch of Child Disability Payment. Work on the digital BASRiS paused due to COVID-19 and has recently been restarted by officials in data sharing and integration but as yet there are no set times scales for when this will be available. Service Design colleagues are meeting with Social Security Scotland on 12 November 2020 to go through the terms of reference.

Members pointed out that the BASRiS form numbers are incorrect as the number 3 is missing. Officials will update this. Members also pointed out that from a usability point of view having a yes/no box for the statement ‘I have not disclosed the information included in this form to the patient’s legal representative’ could be confusing as this is a double negative. Officials clarified that it is worded this way as they need confirmation that information has not been disclosed.

Officials clarified that each BASRiS form will have its own number and batches of forms will be sent out when requested by practices. They also have a supplier and a site number when sending out batches. When filling in Fee Claim forms the only information required is the patient’s Community Health Index (CHI) number, their details and what fee they’re claiming.

Members agreed that all forms should require a practice email address rather than an individual’s email address to ensure enquiries can be picked up by someone else in a practice in the case that the clinician was on leave/retired etc. This will be added to the guidance as well as the forms.

Members agreed and formally signed off the changes that have been made to the BASRiS form.

Action point 3: officials to update the CMO guidance and the BASRiS form to say ‘for Doctors and Nurses’.

Action point 4: officials to revise the BASRiS form with bigger boxes.

Action point 5: officials to correct numbering on BASRiS form.

Action point 6: officials to update forms and guidance to specify that a practice email address must be used instead of a personal email address.

Fee for completion of the BASRiS form

Officials gave an update on fees for completion of the BASRiS form. Officials are aware that the position regarding eligibility to claim a fee needs to be made clear. Officials are considering eligibility to claim a fee which relates to those who are not publically funded to fulfil a role. They are aware that the completion of a DS1500/BASRiS form is not included in GP contract so are not planning to change GP’s position on claiming fees. They are also considering how fees will work with regards to 3rd sector organisations as 3rd sector workers are employed though different ways. Officials welcomed feedback and advice from members.

Some members suggested that if a GP can claim a fee, a nurse employed in a GP practice should also be able to claim and as practices are employing more advanced nurse practitioners (ANP) this will be increasingly relevant. ANPs are employed by the practice so if they claim the fee, it will go to the practice. Members highlighted the issue of 3rd sector employees claiming the fee on behalf of their organisations.

Members offered to gather feedback from Hospices on their position on fees and how they would prefer it is done. The majority of staff at hospices are employed by the hospice but some may be employed by the health board. Officials to contact members to request further feedback on fees issue.

Action point 7: members to gather feedback from Hospices on fees issue.

Auditing the implementation of the CMO guidance

Officials updated the group about auditing the implementation of the CMO guidance on behalf of Alison Potts who was unable to attend this meeting. There have been no changes to the paper since the last NIG meeting. Officials have had discussions with SG analysts who will be involved in undertaking the audit. They may suggest some slight changes to the paper and if there are any significant changes, the paper will be recirculated to members. Officials are hoping to have this signed off by the CMO soon.

Members noted that the review being undertaken by DWP on the 6 month rule has been completed and is with the treasury. Depending on the outcome of this review this could result in some small factual changes being required. 

Officials noted that this paper has been signed off by Social Security Scotland colleagues.

Service design update

Officials updated members on the clinician’s helpline and whether it could also accept email requests. Social Security Scotland have concerns as it would require constant monitoring of an inbox for a small number of emails. There are also concerns around the security of email as personal information will be included. Officials suggested having practitioners on a rota based system so that one is always available when a frontline clinician contacts the helpline.

Officials clarified that using a web chat is not a viable option because it involves licensing. This would mean only a small number of people would have access to this and the web chats would have to be constantly monitored for a small number of queries.

Agree priorities for future meetings

Officials highlighted that priorities for future meetings will be updates on the digital BASRiS and the information Hub, the leaflets, updates on the fees issue, work on the communications to be disseminated from the CMO / CNO to frontline clinicians and from the NIG to wider organisations.

AOB and close

Members and colleagues had a discussion with Derek Feely, Chair of the Social Care review regarding fast tracking people with palliative care needs to social care. As part of this discussion they are considering whether the process under which people who have had their disability assistance fast tracked under special rules can be helpful in determining who might require fast tracking to parts of social care. Officials will be having a meeting with Alison Taylor regarding this.

The Chair thanked members for attending and closed the meeting.