Criteria for Model of Delivering Neurosurgery in Scotland Action Team on Neurosciences 19 th November 2004

The ‘Youngson’ Report A managed clinical network (MCN) with a single lead site, co-located with an adult neurosurgical service is the preferred, long-term configuration to the service of paediatric neurosurgery in Scotland. The working party endorses the importance of a paediatric environment for childcare with the appropriately trained staff involved in treatment at all sites. Existing neurosurgical units should continue to admit and treat children. Facilities for the emergency care of life-threatening neurosurgical conditions will continue to be provided locally. Retention of paediatric neurology, neuroradiology and neuropathology is an essential feature of Scottish paediatric neurosurgical services.

The ‘Teasdale’ Report High Importance –Co-location of neuroscience specialties –Co-location of paediatric neurosurgery –Achievement of high standards of delivery and care –Feasibility of 24 hour a day, 7 day, two level neurosurgical cover –Training opportunities –Provision of Acute neurosurgical services Moderately high importance –Volume of work to support sub-specialisation –Concentration of expensive technologies –Provision of elective neurosurgical services –University Research –Geography / access

Safe Neurosurgery 2000 Neurosurgical units should be situated within a multi- disciplinary Neurosciences centre and on a General Hospital site. Each unit must provide a full core neurosurgical service before any sub-specialities are developed For maintenance of neurosurgical expertise and satisfactory training there must be an adequate volume and diversity of work and sufficient population to generate this. Whilst this must be reconciled with equity of access a 1million catchments population should be the minimum (NB Aberdeen catchment 0.75M, Dundee 0.7M) Where amalgamation of units is proposed the criteria against which any decision is made should include equity of access and maintenance of local infrastructures. All neurosurgical units must provide a full twenty-four hour consultant led service and be staffed accordingly, i.e. a minimum of 6 WTE consultant surgeons increasing with populations of more than 1.5million.

Safe Neurosurgery 2000 (2) Thirty neurosurgical beds and four dedicated neurosurgical intensive therapy beds per million population are needed to deliver safe practice. Every neurosurgical unit should have at least two fully resourced operating theatres; those serving a population of more than two million need three. With the implementation of new training regimes and policies on reducing junior doctors hours, a unit serving a population of 1.5 million needs five intermediate grade neurosurgical staff, i.e. qualified, non consultant, staff working under supervision. The process of strategic specialty planning should be encouraged to start at unit level in order to inform regional and national plans. Concerted effort must be made to ensure neurosurgery is regarded as a strategic planning priority and to bring units up to minimum standards of investment. The co-ordination of academic neurosurgery, service neurosurgery and research and development in respect of planning and financing needs to improved. Additionally, increased impetus should be given to implementing the priority recommendations of the Report of the Independent Task Force – Clinical Academic Academic Careers”.

Key Criteria Co located with a general hospital Adult and paediatric co-location All neuroscience specialties Specialist provision for beds/ theatres and multidisciplinary staff Catchment population of 1m + Minimum of 6 WTE consultants 24 hour care Equity of access

Neurosurgery PaediatricsAdult Neuroscience Specialties Neurology Neuroradiology Neuropathology Neurophysiology Neuroanaesthesia General Hospital Specialist provision Beds ITU / HDU Theatres Consultants Junior Staff Nursing AHP Specialist Provision Beds ITU / HDU Theatres Consultants Junior Staff Nursing AHP MCN

Options 1.Continuation of the provision of service from the four current sites 2.Provision of services from three sites. 3.Provision of services from two sites 4.Provision from one of the existing four sites 5.Provision of services from a new single site, located to take into account amongst other factors, geographical considerations.

CRITERIA / OPTIONS Option General Hospital Paed. / Adult co location Neuro specialities Catchment Population 1M Min Cons No.s 24 hour cover Equity of Access Specialist Provision 1 ???????? 2 ???????? 3 ???????? 4 ???????? 5 ????????

Objective Assessment Evidence Weighting of each criterion Scoring of each option to meet each criterion Result = Objective quantitative ranking to inform decision making process

Example