Working Regionally Dr Michael Bisset Regional Medical Director North of Scotland Planning Group

INTRODUCTION OF MANAGED CLINICAL NETWORKS WITHIN THE NHS IN SCOTLAND NHS MEL (1999) 10 Local: equating, for example, to Local Health Care Co-operatives which could include MCNs for primary and community care; Health Board Area: equating to Health Board boundaries and concerned with networks within that territory, and, through use of the Joint Investment Fund, tackling the boundary between primary and secondary care; Regional: equating to aggregates of Health Boards, such as the regions currently recognised in the Management Executive for performance management purposes: west, east and north. There could also be networks for remote and rural communities concerned with a number of specialties rather than one single specialty or disease; National: which would be concerned with those diseases or services which are so rare or specialised that it only makes sense to organise them on a Scotland-wide basis.

NHS SCOTLAND: GUIDANCE ON REGIONAL PLANNING FOR HEALTH CARE SERVICES NHS HDL (2002) 10 Rebuilding Our National Health Service gave a commitment that a more systematic approach will be developed to planning health care services which are best provided on a regional or national basis. Changes are required in the way services are planned and delivered because of: developments in health care generally increased specialisation in some acute services legislation and guidance on hours of work of doctors and other professionals, and the desire to provide services as close to patients’ homes as possible

Regional Planning Groups (2003) North 1.2 million (24%) 61% of area East 1.4 million (27%) 10% of area West 2.5 million (49%) 29% of area

Where are we now in 2016 ? Over 20 Regional Networks Regional projects Cardiac Specialist Surgery Cancer Paediatric Mental Health Dental Public Health Regional projects

A NATIONAL CLINICAL STRATEGY FOR SCOTLAND February 2016 In summary, the clinical strategy sets out the case for: planning and delivery of primary care services around individuals and their communities planning hospital networks at a national, regional, or local level based on a population paradigm providing high value, proportionate, effective and sustainable health care transformational change supported by investment in e-health and technological advances.

Is the present model for the planning, delivery and governance of regional services in the North of Scotland fit for purpose?

Past Only when a service was about to ‘fall over’ was a regional model of delivery considered. Future The population paradigm would suggest that the population required to sustain a safe clinical service should determine whether a service is planned Nationally, Regionally or Locally.

Past Only specialised services were considered suitable for regional delivery Future Some core hospital services will only be sustained in the North with regional models of working

What are the barriers that make regional working more difficult and more complicated than it should be?

Regional Network Specialist Consultants Dundee Inverness Aberdeen (support for Orkney and Shetland) Consultant with an interest Specialist AHPs Specialist nurses Consultant with an interest Specialist AHPs Specialist nurses Consultant with an interest Specialist AHPs Specialist nurses Outreach (Peripheral Clinics, Community Nurses and AHPs)

Information Technology Limited compatibility across Health Boards National systems not truly national Password overload Human Resources All appointments made to a host Health Board Duplication of security and health checks Travel policies need to reflect model of care

Clinical Governance While each part of the network is managed, no one individual has responsibility for the day to day running of the entire clinical service Local managers may inadvertently make decisions which are favourable to one Health Board without being in any way accountable for the consequences which may affect another Board Networks rely on the individual members being team players. Where this behaviour is lacking, performance management across multiple boards can be challenging

Conclusions Many successes and many services have been retained in the North through collaborative working Very often too little is done too late and opportunities may be lost With likely changes in the planning landscape the future will be different and hopefully equally supportive of all services