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

2. 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.

3. 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

4. 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

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

6. 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.

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

8. 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.

9. 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

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

11. 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)

12. 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

13. 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

14. 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