EADT Note of Meeting Held on Monday 3Rd November 2008

Item 2 Scottish Government Health Directorates

EMERGENCY ACCESS DELIVERY TEAM

Minute of meeting held on 5 July 2010, Conference Room D, St Andrews House, Edinburgh

Present: Mr Tim Davison (Chair) Ms Jackie Britton Prof Derek Bell Mr Martin Hopkins Ms Fiona Mackenzie Dr Marion Storrie Dr Catriona Hayes Ms Heather Kenny Dr Graeme Walker Mr Duncan Miller Ms Phillipa Haxton Dr Anne Hendry Mr Stuart Low Mr Graeme Aitken Ms Nikki Christie

1. Welcome and Apologies

Tim Davison welcomed everyone to the meeting. Apologies were received from Mrs Kathleen Bessos, Dr Stephen Potts, Dr Shobhan Thakore, Dr Dan Beckett, Dr William Morrison and Ms Gill Stillie. Dr Robert Williams was represented by Mr Stuart Low.

2. Note of previous meeting

The note of the previous meeting was approved with the following amendments : DB noted Item 5 –milestone 1 – should mention that one of the main reasons for this work is to develop trends at Board level. Item 6 SB had noted the plans for a joint meeting on 4 June.

Matters arising

3. Reducing Attendances - update

NHS Scotland and Board performance: May 2010 FMack gave an update from the May activity and stated that the figures had shown an increase in activity when comparing the same month in 2009. During discussion it was noted that the level and nature (major/minor flows) differed across Boards. TD

. 1 suggested that trends in the activity are important, together with variations in the rates of attendances. The issue would be discussed again at the next meeting.

4. Feedback from information network – 4th June

(i) Information issues JB gave feedback from the information networking session which had been held on 4th June. The morning session had covered HEAT targets with common interests – T6,T8, T10 and T12. Feedback from Boards had been very positive. It is proposed to hold the next meeting in autumn. The afternoon session focussed on T10 information/analytical work.

FMack indicated that the Public Audit Committee’s recent meeting had sought information on alcohol related attendances at A&E for young people. The variations in recording and interpretations of ‘alcohol related’ does not support robust information being available at present. EADT noted the challenges . FMacK indicated that ISD is seeking to engage with the College of Emergency Medicine in relation to recording data collection.

(ii) Update from ISD FMack indicated that the new datamart (data set) is going live in the near future. A&E figures have been received and FMacK stated that for 2 Board areas there was a need to clarify the figures.

In relation to the development of the national file linking unscheduled care activity, data had recently been received from SAS and NHS24. TD enquired about the aim of developing this file. FMacK indicated that, within the privacy/confidentiality rules, the file will seek to provide information at patient level, enabling clinicians and managers to better understand patient flows/journeys. FMacK indicated that initial information should be available within the next 2/3 months and would be pleased to bring this to EADT. Action FMacK

5. Progress on Milestone

(i) Milestone 8 – Mental Health JB gave feedback on the recent meeting with the national mental health medical managers’ group. At that meeting it was acknowledged that the overall achievement of the 4 hour wait standard in relation to mental health patients was good. The meeting had agreed, however there would be value in doing some further work with sites where issues had been identified. It had been agreed that questions should be developed to gain further information from these sites. The mental health medical managers were also keen to engage with EADT in relation to the issue of ‘frequent attenders’. JB sought support from members of EADT to take forward these 2 areas of work. JB indicated that S. Potts and B Morrison had indicated their willingness to assist. Others agreed to assist, as requested. Kevin Begbie from GG&C would also be asked to assist with the exercise in relation to ‘frequent attenders’.

. 2 DB suggested that one of the issues worthy of further investigation is coding of alcohol/ addition. He also suggested that local service configuration should be raised as this may impact on service delivery and response times. MS volunteered to look at frequent attenders in Primary Care within Lothian and TD asked that BM and ST to be asked to get involved in this process. Action: JB to organise meetings to progress both issues

(ii) Milestone 1 - Patient Flows PH gave an update on the development of patient flow diagrams by Boards. She indicated that 5 Boards had been signed off and that this information had been posted on the Shared Space. Orkney, Highland and Lothian there were issues to be progressed.

PH had circulated a note of the meetings of clinical representatives of EADT held on 7th and 28th June. 4 main strands of work identified were as follows - The need to move further analysis to that of the clinical case mix of the patients comprising the major flows - Increasing the amount of activity seen in minor injuries units (primarily those in rural locations) to be in proportion to the level of resource - Analysis of the factors behind variation in OOH walk in rates across Boards - Additional breakdown by age for specified flows. This work could be done by Boards, with selected flows and the associated age profile reported on more regularly if required. AH asked that the age bands over 65 years be broken down further.

DB enquired about the frequency and timing for updating the information. CH suggested that the frequency may be dependent on the usage and suggested that specific flows could be pulled off on a monthly basis. TD enquired about how much of the information is already generated by Boards. , that there could be a 6 month snap shot report, that trends at 6, 12, 24 months be looked at and also age segmentation analysis is required. Action: PH to update for next meeting

(iii) Milestone 5 and Milestone 6 JB referred to the papers which had been circulated with the agenda. EADT noted the common strands across these. With regard to the CEL (21 ) 2010 and the SAS strategic framework, HK agreed to provide an update at a future meeting.

6. 4 Hour Wait Standard

(i) Update on performance MH gave an update on the performance, noting that there remained issues in relation to Stirling Royal Infirmary, Dr Grays Hospital in Grampian and the Royal Infirmary of Edinburgh.

DB reflected on the developments in England around performance measures, and the shifting focus from time for wait. He reminded the meeting that the 98% wait target had been more demanding in Scotland as it had included trolley areas, for legitimate reason.

. 3 TD referred to the recent correspondence from W Morrison on behalf of the College of Emergency Medicine in Scotland to R Williams. TD suggested EADT would wish to continue monitoring performance closely and keep pressure on the system in relation to performance on the 4 hour wait standard.

(iii) Guidance – Boarding FMack issued a draft paper setting out the definition of boarder and borrowed beds and asked for comments and feedback. DB asked that guidance be straightforward and simple to understand. DB was also keen to capture patients’ and staff experiences in relation to boarding. TD sought to check out that the guidance was clear about transferring from one ward to another and FMack confirmed that it would be. AH raised some points about language – requesting that the term ‘boarder’ be changed.

In summarising TD asked that there be a tightening up and simplifying of the definition and guidance produced. He was also keen to Boards have plans which set out alternatives to boarding.

With regard to the issue of patient and staff experiences of the impact of boarding, why it happens and understanding the hierarchy of alternatives TD requested that a proposal be developed scoping out the proposed study, timescale and other details. MH agreed to take this forward.

Actions: FMacK finalise guidance; M H draft research proposal

7. Winter Planning

(i) Feedback from National Conference TD referred to the recent national winter planning conference indicating that the message was that last year winter was well managed especially in the light of the very bad weather conditions.

It was noted that at the NHS Chairs’ meeting on 28 June, John Connaghan underlined that winter planning should be planned as early as possible and that across Boards this was done well last year.

(ii) Guidance and Regional Events SL indicated the plan is to circulate a draft programme for the regional events and draft guidance to EADT by end August – for comment and discussion at the September meeting. Thereafter the draft guidance would be issued to Board CEOs by 10th September. The draft guidance would also be discussed at the regional events later in September.

SL indicated that work is progressing in relation to norovirus and this should be available for sharing at the regional events. Other topics for consideration at the regional events were Boards links with Councils in relation to discharges and older people services and the wider range of community and social work services. AH

. 4 noted events organised through the JIT which are taking place which may provide opportunities for engagement.

MS enquired if SG sought to address the issue of the 4 day weekends at the festive period. She noted that the public holiday arrangements for general practice and community pharmacy placed pressure on other parts of the system. TD requested DM/JB to contact F Strang, Deputy Director for Primary Care.

With regard to the wider issue of engagement with local authorities in relation to their winter plans TD indicated that the Health and Community Care Committee may be an appropriate forum to seek a dialogue. SL agreed to raise this with M Martin.

TD noted the dates for the regional events. TD to attend 21st and DB to attend 23rd September.

Actions SL prepare draft papers and contact MM, DM/JB contact FS

8. Special Health Boards

(i) SAS HK indicated that work is progressing in conjunction with NHS 24 on the common triage tool. HK indicated that she and G Stillie could provide a short presentation at the next meeting. HK indicated that SAS has an unscheduled care programme board – and offered to circulate the membership of this to EADT

Actions HK

(ii) NHS 24 In the absence of a representative from NHS 24, JB indicated that KB/JB together with Ian Williamson, Primary Care Directorate had met recently with J Turner and G Crooks to talk through the proposal for a networking session. It was anticipated this would be held late September. MS noted the tables which had been received from G Stillie. In the absence of a representative from NHS 24 it was agreed to defer until the next meeting. It was noted that common themes are developing through the work around the patient flows, ISD’s national file and NHS 24’s own reports. DB suggested it is important to join all of this up.

9. Items for Information; Feedback/updates

(i) Audit Scotland – draft report JB indicated that the draft report on Emergency Departments has been received by Scottish Government and initial comments have been fed back to Audit Scotland. TD reminded the meeting that Audit Scotland had attended EADT in 2009 to talk through the proposed terms of reference and had offered to return at a future date. TD envisaged that members of EADT would be requested to respond to the Report, in due course. He suggested it would be appropriate to invite Audit Scotland to attend the next meeting and have an opportunity to talk through the findings and recommendations. TD asked JB to clear this with D Feeley.

. 5 Action: JB

(ii) Guidance on Improving Access to General Practice DM stated that the RCGP toolkit is ready to be issued. The toolkit will be discussed with SGPC at the meeting to be held the following day (6th July). DM also indicated that it was envisaged that the Patient Experience survey would be more targeted in the future.

(iii) Unscheduled Care Conference – 25 June 2010 TD gave brief feedback from the Unscheduled Care conference held in Dundee.

(iv) T10 Networking Event – 1 July 2010 JB outlined the main feedback from the networking event held on 1st July. The focus of the session had been around Milestone 8 – mental health and engagement with GPs in/with A&E Departments.

10. Date of next meeting

Date of Next Meeting: The next meeting will be held on Monday 6th September in conference room D, St Andrews House at 10.30am.