NES
Item 4
March 2015
NES/15/14
(Enclosure)
CHIEF EXECUTIVE’S REPORT
Caroline Lamb, Acting Chief Executive
March 2015
Chief Executive’s Report to the NES Board March 2015 1
INTRODUCTION
The agenda for today’s Board meeting includes key strategic items such as the draft LDP for
2015/16; and supporting papers, the budget and 3 year financial plan; and the property and
asset management strategy; which together set the direction and deliverables of the
organisation for the next financial year.
The agenda also contains a substantive report from the Vale of Leven inquiry which
highlights education and training implications.
Board members will wish to welcome two new Board members Susan Stewart and Douglas
Hutchens to their first NES Board meeting.
ANNOUNCEMENTS
Board members will be pleased to hear that the NES/HIS/GG&C Sepsis Screening App has
been longlisted for the BMJ Awards 2015 under the Patient Safety category. This means
that Knowledge Services colleagues will be accompanying Professor Kevin Rooney to the
judging panel at BMA House in London on 31st March to make a presentation as part of the
final shortlisting. Details about the project will appear in the BMJ shortly.
The BMJ's recognition of the NEWS/Sepsis Screening App builds on the success of this
work at the Daily Record Scottish Health Awards 2014 where it won the Innovation Award.
The App also won the NHS Greater Glasgow & Clyde Chairman's Award and was a finalist
at the British Computing Society's Health Informatics Awards in 2014.
Board members will also be pleased to hear that having been shortlisted for two RCM
awards - for the Compassionate Connection work and the One out of Four work, we won the
RCM President's partnership award for the One out of Four project in London yesterday.
The One out of Four project was funded in two parts with initial internal funding of £10,000
from NES and then a further £10,000 from the CNOPP. We used the funding to create a
range of learning resources to support health professionals to provide high quality personcentred care to women survivors of sexual violence. The resources were developed through
a partnership between a range of health professionals and voluntary sector organisations,
including midwives, obstetricians, practice and sexual health nurses, Health Scotland, Rape
Crisis, Shakti women's aid and SAMH (Scottish Association for Mental Health). The One out
of four resources include a pre-workshop one hour elearning resource, a workshop
facilitators pack and four newly developed films which act as a spring board for discussions
and learning in local workshops. We have provided training for over 80 health professionals
and voluntary sector workers to become 'One out of Four' workshop facilitators all over
Scotland. The resources are of interest to all professionals who provide healthcare for
women, particularly where intimate examinations may be involved, this includes practice
nurses, GPs, sexual health teams, obstetric and gynaecology teams and midwives.
Further information about the elearning resource can be found at:
www.knowledge.scot.nhs.uk/midwifery/learning
Board members will wish to note that Professor Gillian Needham will be retiring later in 2015,
following over 15 years in post as postgraduate Dean in the North of Scotland. During her
time as Postgraduate Dean, Professor Needham has made an outstanding contribution to
medical education and training, in both undergraduate and postgraduate domains, within the
north and across Scotland, as well as at a UK and international level. In particular, she has
Chief Executive’s Report to the NES Board March 2015 2
championed the cause of remote and rural education and training, and of leadership training
within medicine and across the health professions. Steps are in hand to reappoint to this key
strategic leadership role.
Board members will also wish to note that Christine Patch, Head of Corporate
Communications will also be retiring in May 2015. Christine has steered our
communications strategy since joining NES in 2004, including overseeing the creation of an
in-house design team that has delivered significant savings since its formation. Christine
has been a regular in attendance at Board meetings and a great support to Board members
individually and collectively.
NES AND IRISS (INSTITUTE FOR RESEARCH AND INNOVATION IN SOCIAL
SERVICES) ‘MEMORANDUM OF UNDERSTANDING 2015-2018’
A revised NES and IRISS Memorandum of Understanding has recently been signed which
further builds on the well established partnership working over a number of years. This
includes work programmes with Knowledge Services and development of educational
resources for health and social care staff to support integration.
DEMENTIA CHAMPIONS GRADUATION AND CELEBRATION EVENT – January 2015
Improving the care and experience of people with dementia in acute general hospitals was a
priority area in Scotland’s first dementia strategy, and continues as a priority in the 20132016 refreshed strategy. On Wednesday 28th January 2015 the 5th cohort of 100 healthcare
and social services professionals, from across NHSScotland and the social services sector,
graduated to become the latest additions to the NES commissioned Scotland’s Dementia
Champions Programme. This brings the number of people trained as Dementia Champions
in Scotland to over 500 including nurses, AHPs, paramedics, pharmacists and a range of
social services staff.
The event was co hosted by NES, SSSC the Scottish Government and Alzheimer Scotland
and opened with a key note address from the Cabinet Secretary for Health and Wellbeing,
Shona Robison, MSP. Following the graduation, the remainder of the day brought an
opportunity to showcase and celebrate the work of: Alzheimer Scotland Dementia Nurses
and AHP Dementia Consultants; previous cohorts of Health and Social Services Dementia
Champions; and Social Services Dementia Ambassadors, via a series of poster and
concurrent session presentations. Importantly this was an opportunity to show case and
share the improvements in the care and treatment and support of people with dementia and
their families/carers that this programme has supported.
For further information please see the update on the February 2015 NES Current Channel
which includes a video celebrating the day.
http://us2.campaignarchive2.com/?u=5391ceba312d6f81e0430a42b&id=713a6c57cf&e=%5bUNIQID
SHAPE OF TRAINING
Following publication in late 2013 of the Greenaway Report into the future shape of medical
education and training, work has been ongoing under the auspices of a 4-nation shape of
training steering group to provide advice to ministers. This ultimately resulted in the
publication of a UK consensus statement on the way forward being published on 17th
Chief Executive’s Report to the NES Board March 2015 3
February 20151. Implementation groups will now be established in each of the 4 nations,
overseen by the UK Steering Group, to take this important work forward.
GMC REGISTRATION
One of the key, but controversial, recommendations of the Greenaway report was that full
registration with the General Medical Council should be aligned with graduation from medical
school. Currently, graduates receive provisional registration at graduation, and full
registration following one year or post-graduate training. However, legal responsibility for this
first year of post-graduate training sits with medical schools, although it is funded and
managed by post-graduate Deans, and may take place many hundreds of miles away from
the graduating medical school. This creates a governance dilemma, which Greenaway
recommended be resolved. An engagement exercise is therefore underway during March
2015 across the UK, to provide the basis for advice to Ministers. NES will be leading the
engagement event in Scotland. There are diverse and strongly held views on this issue, and
any change would require primary legislation at a UK level.
OVERSEAS MEDICAL UNDERGRADUATES
Again, at a UK level, work is underway to review the current position regarding overseas
medical undergraduates. Currently, there is a notional cap on overseas student numbers set
at 7.5% of intake, although there is evidence that this is variably observed by schools across
the UK. Clinical placement costs for these students are met by HEE (through SIFT) in
England and NES (through ACT) in Scotland, and all have the right to compete for
foundation training in the UK under tier 4 visa arrangements. There are a number of drivers
for this work, including the emergence of private medical schools in England, which are not
subject to the normal controls on student numbers.
GMC STANDARDS FOR EDUCATION AND TRAINING
The GMC is currently consulting on new standards for education and training, as part of their
review of quality assurance2. For the first time, there will be a single set of standards for
undergraduate and postgraduate medical education. It is anticipated that these new
standards will be implemented in late 2015/early 2016, and will be in place by the time of the
GMC review of Scotland in 2017.
SCOTTISH MEDICAL EDUCATION CONFERENCE
Building on the growing success of this event, we will be hosting the 5th National Scottish
Medical Education Conference as a two day event at the Edinburgh International
Conference Centre (incorporating the Annual Medical Appraisal Conference and Practice
Nurse Conference) from 27th – 28th April 20153. This meeting will be of interest to all those
involved in medical education, training and appraisal, including students, trainees, trainers,
appraisees, appraisers, managers, those working in primary care, secondary care,
Universities, Deaneries and Medical Royal Colleges. The meeting will aim to outline recent
developments and explore the many challenges facing undergraduate and postgraduate
1
http://www.shapeoftraining.co.uk/static/documents/content/Shape_of_Training___UK_Steeri
ng_Group_statement___Approved_version_16_2_15.pdf_59780421.pdf
2
http://www.gmc-uk.org/education/26040.asp
3
http://events.nes.scot.nhs.uk/5th-national-scottish-medical-educationconference/?alttemplate=Overview
Chief Executive’s Report to the NES Board March 2015 4
medical education, training and appraisal, in a time of tightening resources and evolving
regulatory requirements.
GP RECRUITMENT
Board members may be aware that we face recurring challenges across the UK in recruiting
into training programmes in a number of specialties and locations. Early indications are that
this year, recruitment into GP training will be particularly challenging. There has been a
significant fall (6-10%) in the numbers of doctors applying to GP training, coupled with a
significant increase in available places in other parts of the UK. We are currently working to
estimate the extent of the likely shortfall, and considering what mitigation strategies may be
open to us.
PUBLICATION OF MEDICAL STUDENT AND TRAINEE PROGRESSION DATA
We have been collaborating with colleagues in the GMC and across the UK to bring together
data on the progression of medical students and trainees through the education and training
pathway. The first results of this work will be published electronically by the GMC on 10th
March 2015, and will allow interested parties to examine progression from medical school,
through foundation training, and into the early years of specialty training. This has become
possible following the development of co-ordinated UK-wide recruitment into training in the
majority of specialties. Three years of data is now available, and work is currently underway
to extend this data into the higher years of specialty training.
PUBLICATION OF MEDICAL ROYAL COLLEGE EXAM DATA
For the first time, 2015 will see the publication by the GMC of data on outcomes of medical
royal college examinations. This data will be in the public domain, and able to be analysed
by medical school of graduation, and postgraduate deanery of training, as well as by
specialty.
NHS GRAMPIAN
Following the publication of the reports by Healthcare Improvement Scotland and the Royal
College of Surgeons of England relating to Aberdeen Royal Infirmary, NES hosted an
extraordinary visit by the GMC, and led a triggered visit to one particular specialty at the end
of January. The GMC visit was out-with normal rules of engagement, and no formal report
will be published.
STREAM 2 COMPLAINTS
The role of the Responsible Officer continues to grow and develop. The GMC have recently
announced that ROs will be required to take on responsibility for the management of socalled Stream 2 complaints against doctors4. These are complaints which the GMC feels are
unlikely to require them to restrict or remove a doctor’s registration. In future the GMC will
share these complaints with the doctor’s responsible officer, and will also tell the doctor to
pass the complaint to local complaints procedures and consider what implications it might
have for their practice, as part of their revalidation.
4
http://www.gmc-uk.org/concerns/making_a_complaint/referrals.asp
Chief Executive’s Report to the NES Board March 2015 5
HEALTHCARE SCIENCE
In late January 2015 we ran our postgraduate scientist trainees event at COSLA,
Haymarket. With over 100 attendees, this was our third event and this year focused on the
new training curricula for Clinical Scientists, alternative ‘equivalence’ pathways for
registration, and development of expert practice with further registration.
We have now established three Knowledge Services Healthcare Science communities of
practice. These cover: a site for trainees and supervisors – in particular postgraduates; a site
for NES Healthcare Science course resources and alumni; and a site for the community of
Board Healthcare Science Leads in support of the Government’s HCS Delivery Plan.
In late January 2015 we began recruiting to postgraduate Clinical Scientist supernumerary
appointments, with an intake of around 20 anticipated for September 2015. Most of our
trainees will be on Scientist Training Programme (STP) schemes, the exception being
medical physics where we are supporting existing approaches to training. We negotiate by
specialty on training appointments with separate recruitment by the Boards, all supported by
a NES SLA. In mid February 2015 we also launched our scheme for practitioner-level NHS
scientific staff to bid for postgraduate support – for example to undertake an MSc. Typically
we support 30-40 bids; we will know the final numbers supported by mid May at which point
we will revise our postgraduate scientist training register.
Important changes to postgraduate registration and curricula at a UK level have introduced a
major and new requirement of NES Healthcare Science, which is to oversee the quality of
Admissions and Practice Placement. To establish this ‘deanery-like’ activity, we have been
in very close dialogue with our counterparts in England – the National School for Healthcare
Science (West Midlands Deanery) - and with the Academy for Healthcare Science, which is
the Health and Care Professions Council ‘education provider’ for Clinical Scientists in the
UK. Draft principles for our approach to Admissions, Practice Placement and a Special
Measures guide are in preparation in collaboration with senior scientific staff already
involved in our training schemes. The Principles we are considering borrow ideas from
Medicine and NMAHP, the National School and HCPC’s Standards of Education and
Training. NES Training and Development Support Unit has also readied an HCS trainees-indifficulty course to underpin our Special Measures guidance; the course is modelled on the
Medical Directorate approach.
Linked to our new oversight role, we will be recruiting additional sessional support into NES
Healthcare Science to underpin specialties. The appointments will contribute to existing
NES work and help implement our new quality assurance function. The appointments are
enabled by recurrent support from the Chief Health Professions Officer.
We continue with close and positive engagement with the UK Academy for Healthcare
Science. We have agreed to co-host the Academy’s UK Congress in Edinburgh in December
2015.
NES PHARMACY CONFERENCE - “PRESCRIPTION FOR EXCELLENCE AND
EDUCATION”
The fifth annual NES Pharmacy Conference was held at The Royal Society, in Edinburgh on
Wednesday 25th February 2015 attracting over 150 delegates from across the NHS in
Scotland. The theme of the event focussed on the Scottish Government’s Vision and Action
Plan “Prescription for Excellence (PfE)” and its explicit link with education.
Professor Sir Lewis Ritchie, Chair of the PfE Steering Board, set the scene by stressing that
professional competence is not sufficient - we must strive for excellence, and the need for
Chief Executive’s Report to the NES Board March 2015 6
collaboration between professionals by abolishing professional hierarchies within and
between professions so that the focus remains on the patient. Key note presentations were
given by the Pharmacy Regulator (GPhC) and the Professional Body (RPS) on the
importance of the links between education, integration, policy and professionalism in the
pursuit of excellence. The three Assistant Directors of NES (Pharmacy) outlined the
educational support delivered by NES around workforce development; independent
prescribing and clinical skills; and professional and clinical leadership; through a mixture of
presentations and workshops, which involved the whole of the NES Pharmacy team.
Delegates also had opportunity to discuss and reflect their views in workshop sessions.
The Director of NES Pharmacy, Professor Rose Marie Parr then brought the event to a
conclusion by outlining how education continues to help inspire, inform and shape
professional excellence in practice. She also outlined the issues that could impede progress
to bring the vision of PfE to reality – such as the challenges of workforce planning and skill
mix, integrated undergraduate programmes, innovations such as genomics, and the need for
ACT-type funding to benefit NHS improvement through embedding clinical pharmacist
prescribers in practice.
NES DIGITAL TRANSFORMATION PROGRAMME
Work under the auspices of the NES Digital Transformation Programme continues apace.
Turas version 1.1 went live on February 23rd delivering additional functionality for the
management of trainees. This was the first version delivered by the first NES Scrum Master
and a majority of NES staff developers, with support from PA Consulting moving much more
into the background. This release was a success, maintaining the quality of version 1.1. The
Product Backlog for version 1.2 has been agreed and work continues with the next release
set for the end of March.
On 25th February, three representatives from Health Education England made a site visit to
Westport to meet the Turas development team and see a demonstration of version 1.1. They
have expressed their appreciation of NES’ achievement and wish to continue to work closely
with us on the Agile methodology, cultural changes in support of the development, Turas
itself and potential commercial models.
Product Owner training for the e-Portfolio and Revalidation (SOAR) application will take
place on the 10th and 11th March. Work on the commencement of the Product Backlog for
these areas of functionality will start at the beginning of April, including input from NMAHP
colleagues with respect to nurse revalidation.
Product Owner training for the Family Nurse Partnership(FNP) pilot for the new virtual
learning environment will also take place on 10th and 11th March. The FNP have started the
process of identifying the digital resources necessary to migrate into the new environment.
A prototype of the authentication system for the new single unified environment has been
built and is currently under initial testing. Further work in March and April will work to
integrate the NES network directory (this will allow direct access, with no requirement for
additional sign on if you access the new environment from the NES network).
The recruitment process for the new Cloud Transition Manager role has completed. Paul
Donnelly from NES Network Services will commence in this new role from April 1st.
The Head of Learning Management and Head of Virtual Learning roles will be advertised
internally by the end of March.
Chief Executive’s Report to the NES Board March 2015 7
CALENDAR
21st January : Management Steering Group Meeting (MSG)
I represent the Chief Executives Group on MSG as Interim Chief Executive. Items for
discussion included Medical and Dental issues, Equal Pay Litigation, Recruitment and
Retention Policy and Variation Orders.
22nd January: Everyone Matters Implementation Group
I attended this meeting and also presented a paper updating on progress with reviewing the
KSF. Other papers presented at the meeting included updates on ‘Setting the Direction’,
monitoring and reporting on progress against the 2014-15 Plan and an update on the
2015/16 Implementation Plan.
26th January: Health and Care Professions Council Meeting
NES colleagues and I met with colleagues from Health and Care Professions Council
(HCPC), for a regular update. We had helpful discussions with regard to developments
across Health Care Professions in Scotland and in the wider UK.
28th January: Dementia Champions Event
I attended the graduation ceremony for the Dementia Champions which is covered in more
detail on page 2 above. This was an extremely successful event and it was particularly
encouraging to see the increasingly broad range of backgrounds of those graduating.
28th January : Centre for the Advancement of Interprofessional Education (CAIPE)
In June 2014 CAIPE published a nationwide review of interprofessional education (IPE)
during pre-qualifying courses for health and social care professions, based on findings from
a 2012/13 survey and reflective accounts by experienced interprofessional teachers followed
by indepth interviews. Recommendations based on the findings, and calling for
improvements in organisation and delivery are addressed to the universities and service
organisations providing the IPE and to bodies commissioning and regulating it.
Colleagues from NES and CAIPE had an introductory meeting to discuss the IPE Review
and associated recommendations within the Scottish context and to explore the role that
NES can play in promoting a coordinated approach to IPE in Scotland and also to explore
how IPE can be supported across sectors and with service users and cares.
30th January : Health and Social Care Leadership Advisory Board
I attended the first meeting of the newly constituted Health and Social Care Leadership
Advisory Board meeting which was Chaired by Paul Gray, Director General Health and
Social Care and Chief Executive of NHSScotland. The first meeting focussed on the Terms
of Reference for the Board and the five focus action themes (Health Workforce) which are:
-
Cross Sector Working
Adopting Values Based Approaches
Making space for honest dialogue to improve performance, sustain good
performance and tackle poor performance
Strengthening management at all levels with a particular focus on middle
management, talent management and succession planning
Chief Executive’s Report to the NES Board March 2015 8
-
Leading Teams and Engaging People
2nd February : Meeting with Kathleen Bessos, Deputy Director, Integration and
Reshaping Care Division, Scottish Government meeting
Colleagues and I met with Kathleen Bessos. This introductory meeting provided an
opportunity to gain a further understanding of the Public Bodies (Joint Working) Scotland Act
2014 and its implementation. It was also an opportunity to inform the NES strategic role in
supporting health and social care integration as well as detailing what NES; and NES in
partnership with others, namely, SSSC, and other third sector organisations; contributes to
support health and social care integration.
4th February: NES /SSSC Partnership Group Meeting
I attended this meeting with the Chair, Carole Wilkinson, Non-Executive Director and Bob
Parry, Associate Director. This quarterly meeting provided an opportunity to strategically
discuss the NES/SSSC partnership work programme. The group received an update on
work supported by NES/SSC engaging Health and Social Care Partnerships in a process of
Appreciative Inquiry. To date over two thirds of the 31 Health and Social Care Partnership
have now engaged in the process to support their transformational change.
Sandy Riddle the recently appointed Director of Health and Social Care, Fife attended the
meeting and shared personal experiences, and the challenges and opportunities that are
being highlighted in establishing health and social care partnerships. Sandy has since
accepted an invitation to come to speak to the NES Executive Team in April.
11th February: NHS Chief Executives Meeting
I attended the NHS Chief Executives Meeting and items for discussion included, Health
Promoting Health Service and Prehospital medical response to major incidents.
11th February: Guiding Coalition Meeting
The Guiding Coalition meetings include NHS Board Chairs and Chief Executives together
with Paul Gray and his team from SGHSCD. The meeting on 11th February discussed the
immediate need to set balanced budgets and to improve and maintain performance
throughout 15/16 but also the opportunity to re-shape the delivery of health and social care
for the future to ensure sustainability and improved outcomes for those we serve.
A small sub-set of the guiding coalition membership had met with the Cabinet Secretary and
been given a clear steer to press on with work:
 Using the narrative developed by the 2020 refresh sub-group as the basis for
engagement around how we make clearer progress towards the 2020 vision but also
what success will look like towards 2025 and beyond
 Developing the national clinical strategy
 Pushing ahead with the shared services agenda
 Progress the effective prescribing workstream
There was caution from the Cabinet Sec around the service change agenda. However, we
also heard that the Cabinet Sec would be prepared to engage in discussions with individual
boards about service re-design and improvement that improve outcomes and sit well with
the 2020 vision.
Chief Executive’s Report to the NES Board March 2015 9
12th February: Scottish Government and NES Innovation Stakeholders
Donald Cameron, Associate Director (Acting) and I met with Andrew Fowlie and Verity
McCrum, from the Innovation and Health, Healthy Quality and Strategy Directorate.
The purpose of the meeting was to discuss the Innovation Champion role and how this can
be used to foster greater innovation in Boards. The NES Local Delivery Plan (LDP) for
2014/15 focussed our innovation aspirations around our digital strategy and this is echoed in
the draft LDP for 2015/16. This meeting therefore presented a good opportunity to discuss
the considerable progress that we have made in this area. Colleagues from Scottish
Government were impressed by the account we gave and have since followed up with more
detailed discussions with Christopher Wroath, Interim Director of Digital Transformation.
17th February: Board for Academic Dentistry
I attended this meeting and items for discussion included the interface between
undergraduate and vocational training programmes, dental ACT for overseas students,
postgraduate matters and research.
18th February: Strategic Review of Improvement Activity Event
I attended the first and final days of this three day event with colleagues from Scottish
Government, IHI and Healthcare Improvement Scotland to agree the strategic focus of work
going forward and to determine how Scotland and IHI will engage; covering our roles, high
level activities and ambitions. A number of action areas were discussed, and in relation to
areas where NEShas the lead, it was agreed that the priorities for capability and capacity
building were at board level (executives and non-executives) and middle management. NES
will now engage with IHI to take this work forwards on a collaborative basis.
25th February: TURAS
Colleagues from NES and PA Consulting met with colleagues from Healthcare Education
England, at their request, to provide them with a demonstration of the Turas system, and to
discuss the development. The meeting included an introduction to the work of NES, the
context for digital delivery at NES, agile methodology and technology, a demonstration of the
new system and details of the benefits it has delivered to date.
Feedback from the meeting indicates that HEE colleagues were extremely impressed with
the system and that all of the NES team presented extremely well, supported by PA. We
anticipate opportunities to work with HEE may emerge in due course.
25th February: NES Pharmacy Conference
I attended the pharmacy conference as covered in more detail on page 6. The conference
was extremely well attended and there was a very high level of engagement and discussion.
The hashtag for the conference: #nespharmconf was also trending in the top 10 in the UK
during the course of the meeting!
RISK REGISTER
There have been a number of updates made to the text provided alongside the assessment
of corporate risks. The ratings themselves have been amended for Risk 7, which relates to
our ability to successfully manage change. The likelihood rating for this one had been
Chief Executive’s Report to the NES Board March 2015 10
increased due to the number of change programmes running in parallel, but this has now
been reduced again to recognise measures taken to mitigate issues here.
Risk 10 (Risk that NES moves into a deficit position) has also been re-scored to reflect the
fact that we have managed to present a balanced budget for 2015/16.
Chief Executive’s Report to the NES Board March 2015 11