Item 2 MSISG 6/12/06 DRAFT NHS Greater & Clyde

Maternity Strategy Implementation Steering Group (MSISG )

Notes of a Meeting of the MSISG held on Wednesday 15 th November 2006 at 2.00 p.m. in Meeting Room B, Dalian House, NHS Greater Glasgow & Clyde, Glasgow

Present: Helen Byrne, Director Acute Services Strategy, Implementation and Planning (Chair) Rosslyn Crocket, Director Women’s & Children’s Directorate (Co-Chair) Iain Wallace, Associate Medical Director, Women’s & Children’s Directorate Alan Mathers, Clinical Director, Obstetrics & Gynaecology Tom Turner, Chair – Neonatal Sub-Committee Jonathan Coutts, Clinical Director Neonatology Stein Bjornsson, Chair - Obstetric Sub-Committee Willie Frame, Consultant Anaesthetist, Area Anaesthetics Sub-Committee Stewart Pringle, Chair – Antenatal Sub-Group Lesley McIlrath, General Manager, Obstetrics, Gynaecology and Neonatology Ann Davidson, RCM Steward Fiona Wade, Head of Finance, Capital Finance Dorothy Cafferty, Planning /Women’s & Children’s Acute Services Jamie Redfern, General Manager, Hospital Paediatrics Sue Forsyth, Unison Representative Kate Munro, Community Engagement manager Ann Holmes, Consultant Midwife Mairi McLeod, Planning Manager New Children’s Hospital

1 Apologies

Apologies were received from Brian Cowan, Douglas Colville, Ally McLaws, Tony Curran, Eleanor Stenhouse, Anne MacPherson and Noreen Sheilds.

2 Notes of MSISG Meeting held on 19/09/06

The notes were agreed. The notes will be posted on the organisation’s web page. Action: DC 3 Matters Arising

3.1 Gynaecology and Neonatal Bed Models: Lesley McIlrath advised that work is currently being undertaken with Joe Clancy of the Board’s planning function to identify the appropriate bed models for gynaecology and neonatal services. Using the CHKS data, Lesley has held discussions with clinicians to understand the benchmarking information and to define an appropriate in-patient model for Glasgow’s gynaecology service, which is currently assumed to be a 70 in-patient bed capacity.

The CHKS bed model assumes that all day patients would transfer to the new ACAD facilities. However, medical terminations require to be treated within an in-patient facility and the beds required to deliver the service are included in the current service proposal for 70 beds. Work is also required to define the service and capacity requirements for delivering services from the new ACAD facilities and this will be progressed in tandem with the work for the acute services bed model.

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Lesley made a visit to Little France, Edinburgh, in order to compare the gynaecology service provided from the Edinburgh site and which will be used as a source of comparative information. Further detail of the activity is being sourced from CHKS to support the ongoing work for the in- patient model and a paper outlining the proposed bed model will be discussed at the next meeting of the steering group.

An internal exercise has also been undertaken to establish the number of neonatal costs required. This has been supported by a “table-top” meeting which Lesley and Jonathan Coutts attended chaired by Patricia Leiser of the West of Regional Planning Group. A further meeting is planned with Heather Knox and the neonatal bed model will also be discussed at the December meeting of the WOS Regional Planning Group. It was noted that the national project planned to define cot numbers does not take place until the autumn of 2007. An update on progress will be made to the next steering group meeting. Action: LMcI/JC/DC/JC

3.2 Work Streams: Dorothy Cafferty referred to the draft steering group work plan indicating that the draft plan outlines key work streams for the steering group and its sub-groups and invited comments. The plan is divided into quarterly reporting timescales with each sub-group required to develop detailed action plans and associated risk plans to inform the plan. Rosslyn Crocket welcomed the plan and requested that specific target timescales be added to the document. Steering group members were asked to review and amend the draft plan and to notify Dorothy of amendments. Action: ALL/DC

3.3 Key Issues – Risk Log: Dorothy Cafferty advised that to date no key risks had emerged from the work of the sub-groups in order to populate a risk log. Dorothy added that this could be attributed to the fact that some sub-groups were still engaged in initial work to develop their work plans and while risks are discussed as part of the work of the groups these had not yet been fully articulated. It was agreed that the steering group required assurance that risk analysis is being undertaken and the risk analysis model will be reissued to sub-groups to facilitate risk management. Action: DC/Sub-Groups

3.4 Workforce Planning/Organisational Development: In order to take forward the workforce and organisational development component of the steering group’s work plan it was agreed that Ann Crumley should be invited to join the steering Group. Ann will be invited to attend the next meeting of the MSISG. Action:DC

4 Inequalities in Health: NHSGG&C Inequalities Scheme: Unfortunately Dr. Sheilds was unable to attend the meeting. However, it was agreed that the organisation’s inequalities agenda should be embedded into the work of the sub-groups and Dorothy will contact Dr. Sheilds to discuss how this can be taken forward as part of sub-group action plans. Sub-Groups will thereafter be required to incorporate progress as part of their regular progress reports. Action:DC/Sub-Groups

5 Performance Framework - Progress Reports

a) High Risk Transfers: Alan Mathers advised that the planned closure of the ward at the QMH and the opening of the new ward at the PRM had been successfully achieved within target timescales. Also, that the service protocol and patient flows are working well, and that staff are settling into their new location. Helen Byrne congratulated all staff in their efforts and participation to secure the smooth transfer of services, and in particular delivering the transfer of service within the target deadline.

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b) Normality Steering Group: Midwife Led Managed Care: Ann Holmes reported that the group had met for the second time and that the Clyde component of the service is being incorporated into the work of the group. All key stakeholders have now been agreed and the pregnancy year pathway has been discussed and finalised. The group’s work plan covers an 18-month period. It will work to develop a hub and spoke model, outline the patient’s journey and continue to feed into the national agenda. The group will also align its work to other sub- groups, in particular sourcing HR/Communications and organisational development participation to take its work plan forward.

Rosslyn Crocket indicated that it was important that the group ensure that expectations are not raised in taking forward its work. In particular the impacts for premises and accommodation, workforce and financial affordability would need to be fully addressed and understood. Rosslyn added that an option appraisal would require to be carried out, with recommendations to the steering group in order that a policy decision can be considered and made. The group’s work should also take account CHP/CHCP and GP services in tackling service issues on a locality basis. Ann agreed to highlight these issues and impacts at the group’s January meeting and to report to the February meeting of the steering group. Action: AH

Helen Byrne advised that following discussions regarding Clyde’s health and service strategies that Clyde maternity services discussions would be linked to the work of the steering group. An item for Clyde maternity will be added to the December agenda. Action:DC

Antenatal Services - Stewart Pringle reported that the antenatal sub-group continues to meet as a West Glasgow group and specifically to scope the provision of a West Glasgow Maternity Care Centre, including developing an accommodation schedule for a new facility. The clinically led group is currently working with the organisation’s estates department to identify suitable accommodation for the service with options currently being explored. The group is also developing the service model.

A diagnostics group has also been set up to discuss requirements from radiology services. A number of public involvement sessions are planned in order to gauge the requirements of the local users of the service in relation to antenatal care provision. Action:SP

c) Neonatal Sub-Group: Jonathan Coutts reported that the sub-group continues to meet regularly to scope service requirements and the number of neonatal cots required. A tabletop exercise took place on 25 October 2006 with representatives from some West of Scotland Health Boards in order that the regional planning dimension can be incorporated into the service model requirements, and further work is now being progressed to establish future requirements for neonatal services.

Work is also progressing to determine the location of the new neonatal unit that will be built as part of the relocation of service on the closure of the QMH and Sick Children’s Hospital. This work will be dovetailed with planning for the New Children’s Hospital in the hope that an integrated service in the new build facility at the maternity unit at the SGH can be achieved.

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Service continuity and contingency plans for neonatal intensive care are also being addressed in order that sustainability of service is maintained during the interim period between commissioning of the new facilities at the SGH and closure of the existing facilities at the site. Proposals for the refurbishment of Ward 2B at the Sick Children’s Hospital to support an integrated medical and surgical intensive care unit are now being developed for consideration and the decant arrangements required during any refurbishment programme. A review of staffing requirements will also be undertaken as part of that work programme.

The work undertaken has identified that out-patient facilities would be required at the SGH to follow up neonates in the period between closure of QMH and the opening of the new children’s hospital because the current “child friendly” outpatient facility at SGH is planned for demolition in 2007 as part of the new building programme for the New South Glasgow Hospital. Discussions are ongoing to identify a suitable area for these clinics to take place.

Jonathan confirmed that the sub-group considered risks as an ongoing part of its work and in future risk assessment would be a core item on the group’s agenda in order that risk assessment is formally recorded. He drew attention to a report issued concerning the Northwick Park Hospital that highlights both clinical and non-clinical risks associated with developing and implementing new building and refurbishment of premises while simultaneously delivering services. It was agreed that the report would serve as a useful information source for lessons that could be learned from the NPH experience. Action: JC/JR

d) Capital and Finance Sub-Group: Fiona Wade reported that detailed work continues to be taken forward to cost options for the capital programme and that a business case is being prepared for consideration by the Board for submission to the SEHD’s Capital Investment Group (CIG) early in 2007. Lesley McIlrath added that following several meetings and discussions with clinical staff the sub-group had taken account of the clinical advice provided and two additional options were now being explored to provide better key adjacencies and functionality of services. Working with an architect design consultancy, schedules of accommodation are now being finalised to better underpin the capital and revenue implications for each option.

An option appraisal will require to be undertaken as part of the business case process, which will take into account operational impacts, best clinical options and affordability. Clinical staff continue to be involved in the development of the service options. The option appraisal process will be considered at the next meeting of the steering group in order that the steering group’s views are incorporated into the processes, and to obtain the steering group’s recommendations and approval to the next stage of the business case development.

Helen Byrne reminded the group that feasibility and affordability are the critical factors in deciding and recommending a preferred option and that the business case with recommendations will required to be considered at the January 2007 meeting of the Board’s Performance Review Group for approval to submit the case to the CIG. Action: TC/FW/LMcI/DC

e) HR Sub-Group – On Anne’s behalf Dorothy reported that staff transfers from QMH to PRM went smoothly. The meetings for staff set up by Anne and Eleanor Stenhouse had not been well attended and a further schedule of staff meetings is planned. Anne intends to obtain the views of transferred staff in December in order to ensure that no outstanding issues remain. The HR sub-group plan to populate the HR work stream of the steering group programme aligned with the next stages of strategy implementation. Action: AMacP

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f) Community Engagement: Kate Munro reported that in partnership with CHCPs and local Healthy Living Projects a series of meetings have been arranged in West and North Glasgow. Rather than running large, public meetings it was agreed that a series of smaller meetings that go out to where mothers with young children meet would be advantageous. This would ensure that the organisation goes out to directly meet with a wide group of mothers rather than only with those who have the time and confidence to attend public meetings, and second, these events can be located in hard-to-reach communities. This is a particular issue with maternity service users because mothers with young children rarely have the time to attend meetings.

The venues for the meetings will be nurseries, play schemes and family centres in , , Summerston, Germiston, Possil and Molindar. A possible venue in Clydebank is also being explored. Each meeting will be facilitated by a member of the MSSIG sub-groups on Normality and Antenatal Planning and Implementation, and a member of staff from the local CHCP/Healthy Living Community and the Community Engagement Team will attend. Materials are being developed to facilitate discussion about antenatal and day-care facilities, community maternity services, and feedback on the public health midwifery approach.

The meetings will also be used to identify and recruit women to the Maternity Strategy Implementation Steering Group and its sub-groups. Work is also being progressed for the implementation of a dedicated PFPI post for Maternity services. It is anticipated that these events will form the basis of a network for the PFPI post to build upon. Kate will report on progress and outcomes from the events at the next steering group meeting. Action: KM

g) New Children’s Hospital – Mairi Macleod reported that much of the work of the Adult and New Children’s Hospital Team has focussed on the workshops to facilitate decisions for the OBC.

A Risk Workshop was held on 5 October 2006 with senior management and the Board’s technical advisers. The purpose of the workshop was to evaluate the financial, construction and legal risks of the projects.

An Option Appraisal session was held on the evening of 10 October with the project team, senior clinical staff and the external advisers to consider three design options for the new hospitals. The options were considered in terms of clinical synergies, co-locations between each other (Children’s and adults) and the existing buildings on the site (with emphasis on the Institute of Neurosciences and Maternity), and cost. The 3 rd Option was considered to meet all the criteria and this design will now be furthered developed as the Public Sector Comparator (PSC).

A Procurement Workshop was held on 11 October 2006 to look at the options for procuring the new hospitals. Four options were explored: A greenfield site, building the 2 new hospitals and the existing SGH buildings on a green field site; separate procurement routes, PFI for the adult hospital and Treasury design & build for the children’s hospital; Joint PFI for both hospitals and a hybrid of this option. The criteria considered were: benefits; risks; cost; and deliverability An analysis of the options favoured a single PFI project for both hospitals with the Scottish Executive funding for the New Children’s hospital being injected into the project in a way to be agreed with the SE and finance colleagues.

The Outline Business Case is being drafted and finance colleagues are working on the costs and affordability. The schedule of accommodation for the OBC has been brought to a stage to enable finance colleagues to undertake costings. Work is continuing with clinical sub-groups and other staff to achieve an affordable building.

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Helen Byrne informed that urgent work is underway to test the adult and children’s hospitals bed models in terms of future proofing and affordability, and hospital staff are being connected into the NCH planning team work in order that service models and design can be taken forward in line with the bed modelling work. It was noted that a final bed model for the acute services is to be considered by the Board for ratification in December 2006. Action: MMacL

h) Key Messages to PRG: The outcome of the option appraisal and recommendations for the capital building programme will be presented as a business case to the January meeting of the PRG. Action: RC/Capital & Finance Sub-Group

i) Feedback from Routine Meeting with MSPs: Helen Byrne advised that a briefing report would be prepared for discussion to be sent to MSPS for discussion at the December Glasgow MSPs briefing.

Action: HB/DC

6 Any Other Business – There were no additional items of business.

7 Date and Time of Next Meeting - The next meeting takes place on Wednesday 6 th December 2006 at 11.30 a.m. in meeting room B, Dalian House, Glasgow.

Distribution : Members of the MSISG Robert Calderwood, Chief Operating Officer, Acute Division Graham Stewart – Clinical Director/Consultant Paediatrician, Clyde Andrew Quinn – Consultant Obstetrician/Gynaecologist, Clyde Deb den Herder, Director of Acute Services, Clyde Cathy MacGillivray, Head of Nursing, Clyde Acute Services Jacquie Campbell, General Manager, Women’s & Children’s Acute Services/Clyde NHSGG&C Internet

W&C Acute Services Planning/DC

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