Children and Young People S Health Support Group

CHILDREN AND YOUNG PEOPLE’S HEALTH SUPPORT GROUP MEETING: WEDNESDAY 11 SEPTEMBER 2013 MINUTES

Present: Malcolm Wright, Chief Executive, NHS Education for Scotland (NES) - Chair Safaa Baxter, Association of Directors of Social Work Michael Bisset, Consultant Paediatrician, Royal Aberdeen Hospital for Sick Children Mary Boyle, NES Jim Cannon, North of Scotland Regional Planning Group Jim Carle, CYPHSG Disability Champion Linda de Caestecker, Faculty of Public Health Sally Egan, Chair, Child Health Commissioners’ Group Rod Duncan, Scottish Committee of Children’ Surgical Services Andrew Eccleston, Consultant Paediatrician, NHS Dumfries and Galloway Deirdre Evans, Director, NSD Gwen Garner, Action for Sick Children (Scotland) Catherine Gorry, Speech and Language Therapy Neil Hunter, Principal Reporter, Scottish Children’s Reporter Administration Jacqueline Lamb representing Jackie Brock, Chief Executive, Children in Scotland Carrie Lindsay, Association of Directors of Education Rosemary Lyness, Directors of Nursing Jan McClean representing Jacqui Simpson, South East and Tayside Regional Planning Group Neil McKechnie, Education Scotland Jane Reid, Allied Health Professional Lead for Children and Young People Brenda Renz, Consultant Psychologist, NHS Greater Glasgow and Clyde Wendy Peacock, Head, Early Year’s Team, NHS Health Scotland Judy Thomson, Director of Training for Psychology Services, NES Rachael Wood, Information Statistics Division

Scottish Government Julia Egan, Chief Nursing Officer Directorate John Froggatt, Deputy Director, Child and Maternal Health Division Kate McKay, Senior Medical Officer Mary Sloan, Policy Manager, Child and Maternal Health Division

Apologies: Sharon Adamson, West of Scotland Regional Planning Group Karen Anderson, Care Inspectorate Jim Beattie, Paediatric Consultant, NHS Greater Glasgow and Clyde Jean Davies, Strategic Paediatric Educationalists and Nurses in Scotland (SPENS) Andrew Deans, Member of the Scottish Youth Parliament Peter Fowlie, Royal College of Paediatrics and Child Health Bob Fraser, Integrated Children’s Services, Scottish Government Health Directorate Gavin Fergie, Professional Officer for Scotland, Community Practitioners and Health Visitors’ Association Arlene Kyle, Quarriers, Community Care Providers Kathy Leighton, Royal College of Psychiatrists Bernie McCulloch, Improvement Adviser, Healthcare Improvement Scotland

1 Caroline Selkirk, Deputy Chief Executive, NHS Tayside Karen Wilson, Scottish Ambulance Service George Youngson, Emeritus Professor, University of Aberdeen

In attendance (for part of the meeting): Helen Maitland, Scottish Government’s National Lead for Unscheduled Care Daniel MacDonald, Scottish Government’s Medical Workforce Adviser Rowan Parks, NHS Education for Scotland Linda McColl, Action for Sick Children Scotland Family Facilities Survey

ITEM 1 WELCOME AND APOLOGIES

1. Malcolm Wright welcomed everyone to the meeting and apologies were noted.

ITEM 2 CONSTITUTIONAL CHANGE

2. John Froggatt outlined the timetable towards the Independence Referendum: the White Paper will be published in the autumn and the Referendum will take place on 18 September 2014. John is keen for stakeholders to be involved and to ask questions regarding the process and on how they may be affected. He invited the Group to raise issues and concerns, saying if he is unable to answer the query, he would ask colleagues in Scottish Government.

3. During discussion the following points were made:

 Whether there is a Yes or No vote, things will change  The NHS in England is moving differently from Scotland  There is concern over continuing access to services in England but the Department of Health has confirmed access will be the same  What about the UK Screening Committee etc?  It will be more difficult to retain the small, specialised workforce – retention will be a problem  There will be procurement implications eg vaccinations.

4. Malcolm concluded by saying this was an information gathering exercise. Action: members to let Mary Sloan know their concerns. John Froggatt to check UK Screening Committee position with Donald Henderson.

ITEM 3 CHILDREN’S WORKFORCE

5. John Froggatt began by saying discussions on children’s workforce issues were continuing. At a meeting with the RCPCH, the Cabinet Secretary requested a draft paediatric workforce vision by end of October, with a final version by the end of the year. John went on to say a lot of work was underway, not just about the numbers but about who does what, training, the Children and Young People Bill, the Early Years Collaborative etc. These initiatives are all driving in the one direction. There is an opportunity now, with the Bill etc, to position children’s and young people’s health more centrally. The Scottish Government (SG) is working

2 with NHS Education for Scotland (NES) to pull the strands together and to inform the discussions that are taking place.

6. He stated there is a need for continuing investment in children’s health, not just in the workforce but in initiatives such as the Family Nurse Partnership, Triple P etc. He felt children’s and young people’s health was in a positive place and SG officials would continue to make sure Ministers are aware of the workforce needed to deliver services.

7. Work is ongoing on scheduled and unscheduled care, health visitors, GPs, A&E attendances etc. These all need to be brought together in a cohesive vision to develop robust child health systems.

8. Daniel MacDonald, SG Medical Workforce Adviser, then highlighted the 2020 workforce vision and tabled a leaflet http://sh45inta/Resource/0042/00424225.pdf. The vision is for safe, effective, person-centred care, at home or in a homely setting. There will be national, regional and local activity to take this forward.

9. He went on to say there had been a rise of 38.5% in the medical workforce establishment since 2006 but that there was a worrying trend – 22 WTE paediatric consultant posts were vacant in June 2013, a rise from 12 in March 2013. The Group pointed out:  not all specialties are included in these statistics  better data is needed  consultant paediatrician training takes a long time  not all surgical paediatricians are included as they do both adult and children’s surgery  the RCPCH has census returns from 2011. This is different from the ISD stats. There needs to be a wider audit  adult specialties are recorded in detail but paediatrics are lumped together  AHP workforce and AHP advanced practitioners aren’t included in the data Action: Rachael Wood to take this back to ISD.  community child health has a slightly older workforce and it is difficult to fill these posts  some consultants are leaving early due to pension concerns  usually there are only 0-2 applicants for each vacancy, because of: demographics; the high attrition rate in trainees; and the GP contract is more attractive because there is no out-of-hours. Out-of-hours is crucial for paediatrics  Action for Sick Children Scotland pushed for a lead paediatric GP in every practice  young trainees are looking at where services will be in 5-10 years’ time. They don’t want to go into on-call posts that aren’t sustainable  remote areas have recruitment difficulties  no centre is meeting the RCPCH guidelines for consultant emergency care  it is easier for England to run remote rotas as DGHs are closer to major hospitals.

3 10. Daniel continued by saying he was aware of the junior and middle grade rota problems. Discussions are ongoing about paediatric training with talks about the correct trainee ratio. There has been an increase in child health nurses – 2471 WTE paediatric nurses up to 2700 but this is probably due to better data collection rather than more people in post. There has been a significant rise in nursing vacancies in a short period of time but he doesn’t have details on the vacancies.

11. There has been an increase in the number of Health Visitors/School Nurses (281 increased from 266 in June 2012) and Public Health Nurses have increased from 208 to 237.

12. Further comments included:  Concerns about Health Visitor capacity with the introduction of the 27-30 month review, the Children and Young People’s Bill and with England recruiting from Scotland to increase its numbers  There is overlap – Public Health Nurses include Health Visitors and School Nurses but also child protection nurses  Skill mix staff nurses are invisible in the data  Vacancy data is available from ISD  Some vacancies have been long term because of Health Board efficiency savings and cost pressures  Data is critical  The SG need to know the numbers to inform Ministers. The Cabinet Secretary for Finance must have robust information  There is some recruitment from Health Visitors into the Family Nurse Partnership (FNP)  Not all those recruited to FNP who had a Health Visitor qualification had been working as Health Visitors but their posts have been backfilled by Health Visitors  Health and wellbeing is the responsibility of all staff, not just health professionals  The SG has recruited someone to get a broader picture. The 2020 vision will be taken into account. Integration isn’t so imminent for children  The Finance Committee is asking how the Children and Young People’s Bill will be delivered  There is concern about the level of GP exposure/training in paediatrics – 60% have no additional paediatric training  There has been an increase in early referral to secondary care  A draft paediatric workforce vision will be available for the 4 December meeting. It won’t just be about numbers but will concentrate on who should do what. It should be a picture of what is happening and of effective action.

13. Malcolm summed up by noting the rise in medical/nursing vacancies, the issue of data collection, the need for a high level vision which would include education staff and pressure points, eg community child health, paediatric training numbers, Health Visitor numbers, England recruiting from Scotland, advanced nurse practice which NES is focusing on, child protection gaps and GP training (which the Greenaway presentation may address). The Group wants to be

4 actively involved and be a reference point. Consideration should be given to the attractiveness of building a career in Scotland, eg terms and conditions, distinction awards, contracts. Action: CYPHSG to let Daniel know, through Mary Sloan, what data should be collected and how it should be broken down (paediatrics is not broken down to specialties). Daniel to share data with the CYPHSG. Paediatric workforce vision to be an agenda item on 4 December.

ITEM 4 UNSCHEDULED CARE

14. Helen Maitland, the Scottish Government’s National Lead for Unscheduled Care, presented slides which are available at http://www.sehd.scot.nhs.uk/cyphsg/Presentation.htm.

15. She highlighted that the 4 hour emergency access standard included paediatrics; the NHS is gearing up for this winter; focusing on unscheduled care can impact on scheduled care; £50 million is being invested over 3 years, £1.8 million of which is to recruit A&E consultants; the public don’t want a 9-5 service; NHS Grampian is leading on triage for the islands, often using video conferencing which reduces travel and decreases mortality. She concluded by saying work on unscheduled care was focussing on systems, processes and on people accessing A&E for the right reasons.

16. During discussion it was pointed out:  An A&E workshop at the end of August had been well-attended. Under 1s are a particular problem. There is a lack of access to advice, lack of access to a GP etc. A GIRFEC approach must be taken for this service.  The workshop was asked to vote on the most important issue – parental support, Health Visitor support, information available on a community basis? The workshop will be written up and the top 3 issues will be put into an action plan by the beginning of 2014  Anticipatory care planning is not used well in paediatrics – many parents/carers bypass the GP and go direct to A&E. There are interesting differences between attendance and admission rates, because of NHS24, GP contracts, 4 hour waiting time?  There is a definite connection with the GP contract – there is no longer an out of hours service so children are taken to A&E  The issue is how to provide information, advice, support for parents/carers  A family information website is being developed  More information should be available on common childhood illnesses  A common childhood illness booklet is available but something should be done centrally. Ready, Steady, Toddler! should include this and it should be available electronically too  Support could be given through the use of phone apps, as is happening for maternity services  The Early Years Collaborative is including parenting for young children – thinking about communication, websites, texting etc – links could be made

5  Good practice should be shared, eg the NHS Lothian rapid response respiratory service  GPs don’t have the training to support parents/carers  The online pilot of recognising the sick child was well received, it is going live shortly. Recognising the sick child decreased A&E attendances. There are no courses for emergency nurse practitioners for children  Gill et al published English data – Scottish data is to be available soon. Scottish trends in emergency admissions and A&E attendances are very different  A&E attendances are not well recorded, admissions are  Data isn’t yet available on trends of children with disabilities and children with long term conditions  NHS Grampian and the islands interface has extended to a triage pilot, which includes video conferencing. Remote and rural areas are accessing. Action: Rachael Wood to circulate a letter sent to Archives of Disease in Childhood that describes trends in emergency admissions and A&E attendances in children in Scotland over recent years. Jim Cannon to update a future meeting?

ITEM 5 HEALTH VISITORS AND SCHOOL NURSES: CEL 13 (2013) – NEXT STEPS

17. Julia Egan presented the slides available at http://www.sehd.scot.nhs.uk/cyphsg/Presentation.htm highlighting that a letter had been sent to Chief Executives in June (CEL 13 (2013)) stating that the Public Health Nursing role had been refocused and the titles of Health Visitor – responsible for the under 5s – and School Nurse – responsible for ages 5-19 – had been reintroduced. She also informed the Group that she had undertaken a scoping exercise on core aspects of nursing practice within early years and children’s services (report available at http://www.sehd.scot.nhs.uk/cyphsg/Presentation.htm).

18. During discussion it was pointed out:  There are different universal services currently - too many differences  Health visiting could learn from midwifery  The balance between targeted and universal services is very important. The introduction of the 27-30 month review has meant fewer resources for targeted services  Skill mix is important too. Training, eg in the Solihull Approach, should become part of basic core training  A start has been made on education but there are regulations on what courses should include  Boards have done needs assessment training. Training for Family Nurse Partnership (FNP) and existing training is being looked at  FNP psychologists are looking at all services  Basic mental health should be included in training. NES is proposing to roll out Solihull Approach training for Health Visitors using the train the trainers model – the impact on attachment is promising  NES has long term plans for multi practitioner training

6  It had been a good time to do a scoping exercise before the introduction of the Children and Young People’s Bill  NHS Health Scotland endorses this much needed work  GPs should be engaged early  The nursing advisory group should include education and social work  The nursing advisory group is looking at who does what, where and at a multi- agency approach  The results of the scoping exercise should inform numbers of Health Visitors that need to be trained  The scoping exercise report will be sent to Nurse Directors at the end of September.

ITEM 6 SURGICAL SERVICES

19. Rod Duncan circulated a paper and presented the slides available at http://www.sehd.scot.nhs.uk/cyphsg/Presentation.htm pointing out that 400,000 children are treated by surgical services in Scotland each year. General surgery has become more specialised with fewer general surgeons choosing paediatrics as a subspecialty. In a recent draft report on the management of major trauma in Scotland, children were only mentioned briefly and there were no recommendations specific to paediatric care. It is important for groups such as the CYPHSG and the the Scottish Colleges Committee for Children’s Surgical Services (SCCCSS) to act as advocates for children needing surgical care. Rod also highlighted the fact that the recommendations in George Youngson’s report for the CYPHSG had only been implemented in part. All general surgical specialty trainees get paediatric surgical training in the North East rotation, but this doesn’t happen in other areas of the country, where it is more ad hoc. However, post CCT training is available in the teaching centres for those who wish it. Provision of a surgical service to children is not seen as a priority by Health Boards, who have priorities in other areas. The result is that many general surgeons appointed to DGHs do not have training in managing common surgical conditions in children and are not encouraged to provide this service. With the retirement of senior general surgeons who previously provided paediatric surgical services, the provision of general surgical care in DGHs is in danger of collapse.

20. The paper circulated contained 3 recommendations which are supported by SCCCSS and by the Royal College of Paediatrics and Child Health (RCPCH). Rod concluded by saying the loss of surgeons able to operate on children in DGHs will lead to increased centralisation (which the centres cannot cope with), delays in treatment – a particular concern with testicular torsion – an increased burden on the transport system, and increased anxiety and inconvenience for families.

21. The following points were raised during discussion:

 Discussion should take place with the Specialty Training Board in conjunction with NES  A Managed Service Network for general surgery should be resurrected

7  Leadership is needed from generalists, linking in with specialists in a local buy-in partnership  Aberdeen has good engagement but there are issues elsewhere  Scotland is in a better position than England. This is high on the agenda of the Specialist Training Board but Champions are needed. There are European Working Time (EWT) regulations pressures and Modernising Medical Careers (MMC) is rigid. Training is better in some areas but it isn’t excluded elsewhere. Proportionately Scotland has more paediatric surgeons than elsewhere in the UK.  Paediatrics is on the general surgery curriculum. There are ongoing discussions on torsion and a paper has been drafted regarding appropriate training, back up and support.  Job planning and job descriptions are very important  The challenge is that there are no general surgeons  Professor Youngson’s report was good – should implementation be monitored?  Support for Rod’s paper.

ITEM 7 GREENAWAY REVIEW

22. Professor Rowan Parks, NHS Education for Scotland, presented slides http://www.sehd.scot.nhs.uk/cyphsg/Presentation.htm on the Shape of Training Review, commonly referred to as the Greenaway Review. He mentioned that there had been Scottish input to the review which included site visits in Scotland during which staff, patients, trainers and lay representatives were consulted. Written evidence had been submitted on behalf of NHS Scotland and NHS Education for Scotland. Oral evidence was also taken from Colleges, Health Boards etc on some core principles and models presented by the Review Group. The emerging emphasis appeared to be on a more generalist approach to training augmented by modular training. There may be opportunities for retaining run through training where it works, but with opportunities to step on and step off training. It was also anticipated that there would be greater emphasis on providing more supervision, monitoring and apprenticeships. The review was about enhancing training and would report in early October 2013.

23. During discussion the following points were raised:The GMC consistently reports that Scottish training is good – ahead of the rest of the UK.  Foundation training works well  General practitioners need exposure to paediatrics, ie for up to one year.  The 4 year training might include more paediatrics and psychiatry.  RCPCH has said it will increase paediatric training  The RCPCH views have been taken into account in the Greenaway Review.  Managed Clinical Network leads want earlier diagnosis to put earlier intervention into place. Action: Shape of Training (Greenaway) Review to be revisited by the CYPHSG. ITEM 8 CHILD PROTECTION

8 24. Kate McKay reported that she had spoken with the Managed Clinical Networks and with Chief Executives who had produced an options paper for specialist tertiary child protection. She pointed out the West of Scotland MCN includes social work, health, education and the police, and has a new clinical manager.

25. Kate has discussed the options paper with the MCN Leads but the paper needs additional support from the regions, and from the National Planning Forum. It suggests 7 options, including what could be done in the interim for paediatricians in District General Hospitals who deal with physical or sexual abuse, and how to support them without risk, eg having a panel of people to phone for advice. The number of highly competent clinicians is decreasing – there needs to be a broad constituency of clinicians. An event is being planned before Christmas [NB now being planned for January]. The clinicians need to be engaged in planning rotas.

26. Kate then tabled a National Network for Forensic and Healthcare services for people in police care newsletter (http://www.sehd.scot.nhs.uk/cyphsg/Presentation.htm) and pointed out that Deirdre Evans is looking at the strategic and operational structure which the child protection work could feed into. Examiners of children who have been abused have to produce a medical report for the judicial system – they could feed into Deirdre’s work too.

27. A re-write of the National Guidance for Child Protection will be discussed by the Child Protection Committee Chairs Forum in October.

28. The British Association for the Study and Prevention of Child Abuse and Neglect (BASPCAN) is holding an international congress in Edinburgh in 2015 at which child protection in Scotland could be showcased. The congress is being hosted by Edinburgh City Council. Kate and Scottish Government representatives are on the organising committee. Kate reported she has spoken with colleagues involved in the previous congress which took place in Belfast and the congress had impacted a lot in Northern Ireland – better interagency working, strategic and national buy in.

29. Kate concluded by saying the RCPCH is hosting a child protection day on 24 September 2014.

30. During discussion it was pointed out:

 There has to be clinician buy-in for any interim solution: there should be a clinicians’ meeting to discuss longer term solutions  The north and east are planning to provide cover to mitigate risks: the West of Scotland has it in place now  General paediatricians should be at level 5 or 6 to deliver the service. They would give advice during the daytime, not out of hours  Dumfries and Galloway has sorted level 3 cover. Level 4 is also sorted but the clinicians need to gain more confidence. They aren’t connected to an MCN and don’t have the guarantee of advice  Work is being done to create a core of professional advisers

9  The West of Scotland Network isn’t at the same level of maturity and is different from the other MCNs. South East and Tayside (SEAT) and the North of Scotland are keen to get an interim system in place  The southeast MCN is for sexual abuse, not child protection  The aim is for children to get access to the same quality of care across Scotland. The North doesn’t have a level 6 clinician, the SEAT level 6 is about to retire. People need to be empowered to give level 6 cover and they need to be supported. There are robust services in the big cities – they should be obliged to help smaller centres  The regional planning groups have discussed the options paper  A progress report will be submitted to the Specialist Services Monitoring Group on 25 September. Regional MCNs should be put in place and then the wider picture should be considered. The national meeting should take place in the New Year rather than before Christmas  The West of Scotland MCN is looking at how to build capacity and put in place succession planning but there needs to be a national plan. What is the role of child protection nurses? Child protection nurse consultants have an advisory role – this might not be the right model  It is unclear who is leading national work.

31. Malcolm Wright concluded by saying there needs to be a national approach. The Scottish Government should take the lead with the help of the Support Group. The National Planning Forum meets on 25 September, hopefully it will make decisions.

ITEM 9 LOOKED AFTER CHILDREN (LAC)

32. Kate reported a short-life working group is developing healthcare guidance which will be ready for a Looked After Children Strategic Implementation Group (LACSIG) event in October. NHS Boards aren’t being supported to implement CEL 16 (2009) www.sehd.scot.nhs.uk/mels/ CEL2009 _ 16 .pdf. Boards should be given a structure to deliver the same service. Currently the Education Committee is taking evidence on the Children and Young People Bill which will cover what health services should deliver for LAC. Who Cares? Scotland would like care delivered up to the age of 24 and not just until 18.

33. Kate went on to report that it had been agreed a LAC sub-group of the CYPHSG would be established to pull together all the ongoing strands of LAC work, eg mental health, health promotion, dental, data collection etc.

34. During discussion, it was pointed out:

 The Care Inspectorate has undertaken an inter-agency inspection in North Ayrshire. N Ayrshire needs help from health: a review of all current processes is needed  Research suggests 40-60% of children and young people in care or in the prison system may have fetal alcohol syndrome  NES has been approached by the Care Inspectorate about Child and Adolescent Mental Health Services (CAMHS). There is an online e-learning

10 resource and group-based training which consists of a series of modules. It is being piloted and will probably be rolled out across Scotland  Lothian has also been inspected: the Care Inspectorate isn’t necessarily looking at what it should be. Health Improvement Scotland should consider what the inspections should cover.

ITEM 10 CARE INSPECTORATE UPDATE

35. This item was not taken.

ITEM 11 ACTION FOR SICK CHILDREN SCOTLAND (ASCS) – FAMILY FACILITIES SURVEY

36. Gwen Garner, presented on the Executive Summary of the ASCS Family Facilities’ Survey http://www.ascscotland.org.uk/default.asp?page=19.

37. During discussion, the following points were raised:

 Important piece of work  Concerns that it is noted only 7 Child Health Commissioners responded. Most Commissioners have many different roles and job descriptions and ask others to respond rather than responding directly. CHCs don’t have the answer to every question and have to get information from a variety of people  NHS Lothian is working with the new hospital team on age appropriate care. The new hospital is due to open in 2017 but improvements are still being made to the present hospital  Children’s wards should all have at least basic facilities, ie age appropriate cutlery  Age appropriate care/facilities should be included in Care Inspections  Healthcare Improvement Scotland should have a role too as age appropriate care standards are not being picked up  Issues worse than the previous survey should be taken forward, perhaps through the Chief Executives’ group  The Support Group commissioned standards for District General Hospitals but they haven’t been circulated yet  Taken aback but the survey doesn’t show the whole picture  Interpretation of the figures showing the deteriorating issues is important. It should be clear the range of people surveyed, who responded etc  Directors of Nursing supplied the information of where there were children’s wards, young people’s specialist wards and adult wards which admit young people, and who to approach. The survey went to the wards and was mostly completed by ward managers or delegated to senior managers. Some play specialists and education therapists also responded  66 out of 85 wards responded  The raw data shows issues need to be tackled  Report gives an overview across Scotland and by ward type. It highlights different issues and themes. It was issued online and was followed up by a phone survey for some aspects

11  It is difficult to compare the results of the current survey with the previous one as the individuals completing and also the ward areas completing weren’t the same. Therefore it wasn’t comparing like with like  Need to be cautious in the interpretation of this, particularly given that it would appear some areas aren’t performing as well  The report needs to be robust and the issues should be dealt with  There should be a more consistent way of doing the survey  A denominator should be the number of children going into adult wards but children could be treated by a specialist paediatrician on an adult ward  Getting information at ward level was difficult: ISD has data on children up to age 14. Data for young people 15 and above is hard to get  Families were also questioned to get a feel for the issues. There were no complaints about care (NB there were no questions about care in the survey). Issues were lack of facilities, eg meals for parents, accommodation, information, laundry etc  Parents/carers get good information for elective admissions but there is a lack of information given for emergency admissions. Some ward packs are available but parents/carers often get information through word of mouth.  The report is being launched at the Scottish Parliament on 9 October. It is being sponsored by an MSP and will take place in a Committee Room where the findings will be presented. The report will be available on the website after the launch.  Scottish Government officials are meeting with ASCS on 19 September to discuss the concerns and to explore what the SG/ASCS can do to address them and to move to positive, pro-active solutions. With NHS Boards having tightly-managed budgets, they need to be able to respond appropriately and put resources into things that can be changed and make a difference – that will be easier in the new hospitals. The SG funded the project. Ministers will be briefed.  ASCS finds it helpful working with the SG. ASCS is a unique charity (the survey is also unique) influencing policy by reflecting the views of parents. The aim is to make the child’s/parents’ journey easier. Progress over the years has been good.  The next steps could be identifying at the launch 3 or 4 main recommendations which should be tackled first.  The SG will be responding again to the age appropriate care petition  The SG wrote recently to Chief Executives highlighting the Hospital Services for Young People in Scotland guidance. Action: Gwen Garner to send report to CYPHSG. CYPHSG to suggest who else the report should be sent to.

ITEM 12 MINUTES OF PREVIOUS MEETING: 1 MAY 2013

38. The minutes of the previous meeting were agreed.

12.1 MATTERS ARISING

39. There were no matters arising.

12 ITEM 13 AOCB

40. John Froggatt highlighted that there had been a re-draft of the Sensory Impairment Strategy and would be grateful for input from the Group. Action: Mary Sloan to circulate the Strategy, asking for responses by 26 September.

ITEM 14 DATE OF NEXT MEETING

41. The CYPHSG will next meet on Wednesday 4 December at 10.30am in Conference Room 3, Victoria Quay, Leith, Edinburgh.