NORTH WALES NEUROSCIENCES REVIEW
STAKEHOLDER MEETING 25th February 2009
EMERGING THEMES AND KEY ISSUES
Summary
The first stakeholder meeting was used to clarify the terms of reference and the
constitution of the group, to hear reports from review workstream chairs, and to
provide a constructive critical commentary on progress. This related predominantly
to the contribution of service user perspectives (in addition to those captured within
workstream programmes), service delivery issues, and cross-cutting themes which
emerged within the presentations.
Meeting evaluation
The meeting evaluated positively, however the importance of receiving material in
good time was highlighted. It was anticipated this would enable representatives from
participating organisations to canvass opinion prior to the meeting.
The information provided by workstream chairs was felt to be helpful in providing a
context for the consideration of the work planned within each workstream. It was
suggested that for further meetings, and in addition to a summary of progress, the
chairs identify two or three key issues which they feel would be particularly helpful
for the stakeholder group to consider. These should be provided 2/3 weeks before
the meeting. Given the focus of discussions within the first meeting, these may
relate to service user and public engagement issues, workforce development and
service re-design issues. In addition, the meeting provided a useful platform to share
ideas, challenges and good practice within each workstream. The opportunity for
cross-workstream learning which this provided was felt to be beneficial to the review
as a whole, and would be important in delivering the review recommendations. In
which case, workstream chairs could usefully consider including good practice and
challenges which are being addressed within their respective workstream in the
issues which they bring to the Stakeholder Meeting.
Emerging themes
Workforce capacity
All workstreams highlighted challenges with the recruitment and retention of
specialist neurological staff to the Region which was thought to be difficult. In
addition, staff from some professional groups who received elements of their prequalification training in the Region were being attracted to posts elsewhere. Few
specific recommendations to address these challenges were highlighted.
The meeting provided an opportunity to raise awareness of the range of education
and training opportunities that were available locally, regionally and elsewhere in the
United Kingdom. Some of these are sponsored / supported by service user
organisations, and stakeholders may be able to provide information on these to
workstream chairs.
Role re-design
Opportunities for the expansion and/or re-design of existing roles, and for new roles
were highlighted as having potential both to deliver the outcomes of the review, and
to address gaps in the existing workforce. A number of local and regional innovations
were mentioned. These included:
 the development of a ‘Specialist Neurological Nursing’ role which appears to
have increased patient access to interventions and services, and
 the expansion of one Consultant Orthopaedic Surgeon role to perform noncomplex spinal surgery.
It was recognised that a considerable programme of role re-design work has been
underway in other countries of the United Kingdom, and that these should be an
additional source of ‘intelligence’ for workstream chairs.
Specialist nurses
It was reported by a number of stakeholder organisations that specialist nurses were
valued by patients and carers. Discussions focused on variations in how these
different roles were funded or operated in practice, and the need to develop these
roles to meet the particular context of neuroscience services in North Wales. There
appeared to be some merit in pursuing a ‘generalist’ neurological nursing role
working across diagnostic related groups, with the potential for further specialisation
to address gaps in systems and population needs. The meeting was reminded of the
importance of developing appropriate neurological knowledge and skills across the
health and social care workforce as a whole to assure the patient and carer
experience.
Population needs
It was felt that stakeholder organisations had access to a wealth of knowledge about
the problems faced by particular patient groups, how these problems related to
needs for services, and how these services might best be delivered. It was felt this
information may be particularly helpful in informing the design of neurological
rehabilitation, long term care, palliative care, and end of life care. The consideration
of rehabilitation within its widest sense, and the identification of good practice in
other neurological centres by this workstream was commended.
Communication
The meeting highlighted the beneficial effects of the networking amongst and across
workstreams that had already occurred, including raising awareness of referral
criteria for existing clinical pathways. It was felt that this would be an important
aspect of informing governance arrangements as services were in ‘transition’.