Managed Service Network for Neurosurgery

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Managed Service Network

for

Neurosurgery

Business Plan

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Page

1. Vision of the MSN for Neurosurgery

2 2. Key Customers / Stakeholders

2 3. Aims of Network

2 4. Strategic Objectives 2012 - 2015

3 5. Business Objectives 2012/13

4 6. Business Objectives 2013/14

12 7. Business Objectives 2014/15

16

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1. Vision for the Managed Service Network for Neurosurgery

Our vision is the creation of a ‘virtual’ single neurosurgical service achieved through facilitated collaboration between the four centres in Scotland to ensure the delivery of a safe and sustainable national service for adults and children in Scotland.

2. Key Stakeholders

Patients and their carers

Multidisciplinary neurosurgical teams The Neuroscience Council

The Territorial Boards The Special Boards

The Neurological Alliance (association of 3rd sector groups) The Scottish Government (sponsor)

3. Aims

• To establish the network as the ‘hub’ for neurosurgical services and activities;

• To fulfil the MSN’s responsibility to ensure workforce issues are addressed in a coherent and consistent manner;

• To facilitate the development and delivery of sub-specialty services while ensuring the agreed national service provision requirements are met

• To provide expert advice to stakeholders;

• To ensure neurosurgical service provision in Scotland is assessed against international standards of care and service delivery in the developed world;

• To complete the audit of Standards compliance in all four adult/mixed centres and in the two paediatric centres, identifying areas for improvement and ensuring that appropriate action is taken;

• To develop quality performance indicators incorporating meaningful outcome measures;

• To work with clinical colleagues from non-neurosurgical specialties to develop patient-focused care pathways;

• To provide accurate activity data on the management of patients requiring neurosurgical intervention; and

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4. Strategic Objectives 2012 – 2015

The purpose of the Managed Service Network (MSN) for Neurosurgery is to develop a national neurosurgical service which supports a safe and sustainable service and contributes to improvement in the health and wellbeing of the people of Scotland. The MSN has identified four strategic objectives which provide a focus for the 3 year Business Plan. The four objectives and associated outcomes are:

1. Improve Service Delivery 2. Enhance Stakeholder Engagement 3. Create a Neurosurgical Hub 4. Build the evidence base

Outcomes:

A safe and sustainable

neurosurgical service delivered in four units, each providing a combination of core and nationally agreed sub-specialty services that continues to improve outcomes for patients. Robust evidence-based workforce planning that

addresses the balance between trained and trainee

neurosurgeons, anticipates neurosurgical developments and related training needs, and emphasises the need for a strong clinical academic workforce.

Outcomes:

Effective collaboration between the Scottish Government, the NHS Boards, Universities and their medical schools, patients, the third sector and public interest groups to ensure that neurosurgical services are person-centred.

Foster existing partnerships and create new international partnerships to share and promote understanding of best practice.

Outcomes:

An inter-active website that is

recognised by patients, staff and other stakeholders as the ‘one-stop-shop’ for information about neurosurgical services in Scotland and beyond. The MSN fulfils its advisory role acting as a national forum for resolution of issues raised by stakeholders and the dispersal of relevant, timely information.

Outcomes:

A quality-assured evidence base consisting of a combination of routinely collected and specialist data capable of improving the quality of care for patients, informing strategic planning, audit and quality improvement cycles, and forming the basis for robust, associated

research.

Provide information and outputs that reflect the needs of the

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5. Business Objectives 2012/13

Objective Outcome Performance Measure Impact MSN

Strategy

Risk

5.1

Create the MSN physical environment

A recognised central office for the MSN that is an accessible location and provides a geographical central presence for the network

Fixture and fittings 30.09.12 - achieved Connectivity

30.09.12 – achieved Signage

30.09.12 – achieved Relocation of the audit facilitator

30.09.12 - achieved

• Improved communication with the host site.

• Retention, efficiency and productivity of staff to provide the core functions of the network: supporting the service.

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Objective Outcome Performance Measure Impact MSN Strategy

Risk

5.2

The organisational structure of the network is fit for purpose.

The configuration of the various groups and sub-groups is appropriate with minimal duplication of membership and activity. There are clearly defined outcomes for each group incorporated in the MSN project plan and groups will work to agreed terms of reference, have a clear understanding of their purpose, and how success will be measured.

The network staffing structure is configured for optimum efficiency.

Review of the output of the groups.

31.08.12 - achieved

Review of the membership of groups.

30.11.12 - achieved Review of the remit of the groups.

30.11.12 - achieved

Organisation of group meetings in order of priority for 2012/13. 31.10.12 - achieved

Skills and experience of team members is assessed, key result areas of job descriptions are reviewed.

31.08.12 - achieved Objective setting and

professional development plans are agreed.

31.10.12 - achieved

• Increased efficiency and reduced duplication.

• Improved monitoring of progress.

• Inclusivity of stakeholders

• Increased ownership of the network by the service.

• Increased efficiency.

• Realistic expectations contribute to improved project planning.

• Increased staff satisfaction.

1,2 Confusion amongst stakeholders. Potential for disengagement. Significant grade gap (8A

 5) limits delegation which results in delays. The network manager becomes a rate limiting step. Note: the appointment of a B7 Clinical Co-ordinator in 2014

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Risk

5.3

The network will provide a framework of accountability for its activities to the sponsor.

Provision of a 3 year business plan that clearly sets out what the network achieve and by when.

Draft for consultation with the SG will be completed. 24.10.12 - achieved

• The network can be held to account and can clearly demonstrate its

achievements.

• The sponsor will have confidence in the

management of the network.

• The network can manage its risks and issues effectively.

1 None

5.4

The network achieves the relevant objectives agreed in the Final Report of the Neuroscience

Implementation Group 2008.

The MSN provides evidence of achievements to date, identifies and evaluates the outstanding objectives and incorporates them into the business and project plans. Through the process of horizon scanning, the MSN remains alert to the

opportunity to integrate additional objectives into the plan.

Review of progress against objectives.

31.08.12 - achieved Evaluation of outstanding achievements.

30.11.12 - achieved

Incorporation into the business and project plans.

12.12.12 - achieved

• Credibility of the network is increased amongst

stakeholders.

• The network can

demonstrate how and where it adds value. 1,2,3,4 Much of the network’s role is diffuse and intangible. The efficacy of facilitation can be difficult to evidence.

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Risk

5.5

The network has clearly defined goals, timelines and outcomes.

A dynamic, comprehensive project plan will direct the activities of the network and help all participants

understand their roles and responsibilities.

Project plan will be completed. 25.08.12 - achieved

Project plan will be updated each month and presented at the OMG meetings.

No longer relevant – OMF disbanded – plan on website

• Increased efficiency.

• Timely delivery of output.

• Clear direction for network staff.

• Better services for patients are available across Scotland. 1 Factors outwith the network’s control may be rate-limiting. 5.6

The governance structure is established.

Demarcation of responsibilities and boundaries between the network and the service are explicit.

Action plans arising from Standards visits will be reviewed.

Documentation of governance (clinical, information, staff and financial) will be available on the new website.

Evolving to reflect the new structure of MSN Hubs Action plans will be reviewed within 4 weeks of receipt. Achieved with the exception of GG&C (long term absence)

• Network contribution to patient safety will be demonstrable.

• Accountability of the network will be transparent. 1,2,3,4 Demonstrating the network’s contribution to patient safety may be open to misinterpretation.

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Risk

5.7

The quality of care provided to neurosurgical patients will be audited and areas for improvement identified.

The compliance with the MSN Standards will be audited in each centre by a

multidisciplinary team. Areas for improvement will be identified and an action plan will be created to address these in a timely manner.

Areas of excellence or innovative practice will be identified to be shared with other centres.

Quality performance indicators (QPIs) will be developed in conjunction with the service and the patients.

Standards visits to the RHSC in both GG&C and Lothian will be undertaken.

Action plan from Grampian Audit cycle ongoing Action plan from Lothian Audit cycle 2 completed Action Plan from Tayside Audit cycle completed Action Plan from GG&C Stalled due to long term absence – new post-holder scheduled to start August 2014

Draft QPIs agreed for paediatric neurosurgery

31.03.14 - achieved

Dates to be agreed – decision to design a comprehensive national paediatric audit.

• This is the first national audit of clinical, administrative and management aspects of neurosurgical services in Scotland.

• The comprehensive, objective nature of the Standards audit should reassure service users and provide a ‘year zero’ benchmark against which year-on-year improvements can be measured.

• Centres can learn from each other and avoid duplication of effort.

• Patients and clinical staff will ‘own’ the QPIs.

• The move to proportional scrutiny will ease the burden on the neurosurgical teams.

1,2,3 The impact of evidence collection and creating an action plan on clinical teams is considerable. Teams can feel threatened by the process.

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Risk

5.8

The network will increase its involvement with stakeholders.

The network has a person-centred approach that addresses the principles of the Quality Strategy. There will be greater involvement with the 3rd sector at a national level. There will be greater involvement of nurses (in their capacity as patient advocates and the providers of continuity) and AHPs as the group most closely involved in the complex long-term rehabilitation of the patient group.

Patient reference group will meet to represent the patients’ needs and preferences for the website and agree their priorities for the sprint audits. 28.02.13 – achieved over course of 2013/14

Alignment of the design and reporting of information with the 6 quality ambitions of the Quality Strategy will ensure the information shared with clinical teams will inform their

contribution to the Scottish Patient Safety Programme.

1,2,3 There is a risk of raising expectations to an unrealistic level. The first responsibility of clinical staff is to their patients so time diverted to network activities is limited and deadlines must be flexible.

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Risk

5.9

The network will be

responsive to stakeholders and communicate

effectively in a timely and transparent manner.

The new website will be easy to access, contain accurate, up to date information and will host the activities of the network including: minutes of meetings, the project plan, information on service provision, data on

neurosurgical activity and links to partner organisations. Communication protocols and expected response times will be written and available on the website.

A rapid response protocol will be created to enable the Executive team to take decisions to be ratified at a later date by the Board.

First stage build of Phase 1 will be completed and tested. 31.12.12 - achieved

Second stage build agreed. 31.03.13 - achieved

Phase 1 launch. 28.02.13 - achieved

Communication protocols will be written.

30.11.12 - superseded

Rapid response protocol will be presented the Board.

16.12.12 - achieved

• The activities and

achievements of the network will be transparent.

• Stakeholders will have a useful information source.

• The network will listen to and act on feedback it receives from patients, their carers and other stakeholders to inform service development, quality improvement and ultimately, outcomes. 1,2,3,4 The activity is dependent on two critical factors: the resource availability at the SHOW team, and web design team in NSS.

The time

constraints on the network manager to write and edit content.

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Risk

5.10

The MSN will be the source of intelligence and

information on

neurosurgical services.

Regular activity reports based on quality assured SMR1 and OPCS data will be produced by ISD.

A series of time-limited sprint audits will be undertaken.

Existing datasets (pituitary and paediatric) will be analysed and reported.

eQUEST application submitted to ISD.

16.09.12 - achieved Neurosurgical extracts of routinely collected data will be reported and undergo QA by the MSN team.

31.12.12 - achieved The subject matter is to be agreed with stakeholder and is likely to be informed by the Standards site visits.

Achieved for identified issues in Standards visits

Reports will be completed. 31.01.13 – not achieved for GG&C – staffing issue

• The value of the network will be enhanced by its ability to produce valuable national information that is current.

• The network will request ideas for sprint audits from the various disciplines that provide the service and from the Patient Reference Group.

2,3,4 The ability to provide activity data and link datasets is entirely dependent on ISD and its resources. The MSN is paying ISD for this service.

5.11

The network represents the concerns of service by providing a conduit with the SG.

Issues raised by stakeholders are addressed by the network and progress with resolution is monitored.

Issues that have been escalated to the appropriate forum without successful resolution will be tracked and reported.

Progress will be mapped for all issues raised to the Board. 30.11.12 - achieved

Rate-limiting steps will be identified and reported. 30.11.12 - achieved

• Credibility of the network is increased amongst

stakeholders.

• Some ‘stalled’ or ‘parked’ issues may be progressed as a result of the review.

1,2 Some issues raised by stakeholders may have no resolution so the network could appear ineffectual.

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6. Business Objectives 2013/14

Objective Outcome Performance Measure Impact/update MSN

Strategy

Risk

6.1

The network progresses the relevant objectives agreed in the Final Report of the Neuroscience

Implementation Group 2008 and incorporates further objectives reflecting the needs of the service.

The MSN continues to review progress and provide

evidence of ongoing achievements.

New objectives are agreed by the Board.

The MSN will investigate the potential for national

purchasing of specialist equipment.

Patients will be involved in the design and delivery of the national neurosurgical service.

Review of progress against objectives. 30.06.13 - achieved Evaluation of achievements. 30.09.13 - achieved Achieved – agreement to restructure the MSN Meet with National Procurement at NSS 30.06.13 – superseded by direct links established between Board purchasers and NP Each Board will have their own patient reference group (Neurosurgical Voices) 31.01.14 - achieved

New objectives:The restructuring of the MSN (agreed September 13) will end the top-down approach that was inherent in the 2008 report. The establishment of local MSN Hubs will embed the MSN on each site and increase engagement.

The Neurosurgical Voices group have identified priorities for their areas and will be represented on the MSN Hubs

1,2,3,4 Risk of irrelevance - in the 5 years since the report was published, some objectives may be no longer relevant. The MSN is not a complaints or support group service so the focus must be on ensuring the patients’ own experiences are used to improve services for future users.

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Objective Outcome Performance Measure Impact/update MSN Strategy

Risk

6.2

The quality of care provided to neurosurgical patients will be audited and areas for improvement identified.

The national Standards report will aggregate the results of the four individual hospital reports to provide an essential component of quality assuring the service.

Paediatric services will be reviewed using proportional scrutiny of agreed quality performance indicators in addition to adapted MSN Standards (rather than only Standard 12).

Areas of excellence or innovative practice will be identified to be shared with other centres.

Adult Quality performance indicators (QPIs) will piloted.

National report published 30.06.13 - achieved

Standards visits will be undertaken and action plans reported

30.06.13 – delayed to

incorporate the requirements of the paediatric advisory group and secure the engagement of the paediatric neurosurgeons

Data collection for QPIs pilot will be trialled

30.06.13 – delayed as above

There should be a

demonstrable reduction in variation in process and outcome between centres. Comprehensive data collection provides a year-zero

benchmark from which

improvement can be measured. Strategic planning for paediatric service provision will be based on accurate information.

The network provides a valuable contribution to the governance strands (clinical, information and staff) within each centre.

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Risk

6.3

The network will be

responsive to stakeholders and communicate

effectively in a timely and transparent manner.

The website will have a password protected area to enable access to service details (staff and rosters) to available for shared services (eg interventional radiology).

Outcomes of the various group activities will be available.

Emergency transfer protocol will be written.

Phase 2 will be completed and tested.

31.03.13 - achieved Phase 2 launch.

31.05.13 – issues related to staff turnover and IT security prevented this development A national conference will be held jointly with the Scottish Neurosciences Council and the Neurological Alliance.

31.12.13 – cancelled due to staffing issues

Protocol will be presented the Board.

17.06.13 – achieved – Board sanctioned the use of ‘referapatient.org’

The MSN website will provide information for patients and staff.

The password protected section was an aspiration that could not be realised.

The original concept of an income generating conference organised by three groups could not be realised. The MSN will organise its own national conference in 2014/15. NHS GG&C to pilot the system in 2014

1,2,3,4

6.4

The MSN will be the source of intelligence and

information on

neurosurgical services

Activity reports based on quality assured SMR1 and OPCS data will be refined in response to end-users’ needs

Case listings will be produced on a monthly basis for QA Monthly- achieved

Activity reports will be produced on a quarterly basis

Consultants can judge the quality of the data and work with the MSN Audit Facilitators to improve deficiencies

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Risk

A minimum of 3 time-limited sprint audits will be

undertaken

Centre profile of staffing and sub-specialty work will be updated

The audit data will be linked to the activity data

30.09.13 – achieved for routinely collected data Report completion

31.05.13 – achieved for both adult and paediatric services

Improved communication: the profiles of each centre are shared to ensure each unit has up to date information and contact details for the whole service.

6.5

The network represents the concerns of service by providing a conduit with the SG.

Issues raised by stakeholders are addressed by the network and progress with resolution is monitored.

Issues that have been escalated to the appropriate forum without successful resolution will be tracked and reported.

Progress will be mapped for all issues raised to the Board. 30.11.13 - achieved

Rate-limiting steps will be identified and reported. 30.11.13 - achieved

The MSN is recognised as a mechanism for achieving results.

Stakeholders will be confident that the MSN will represent their concerns.

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7. Business Objectives 2014/15

The activities for 2014/15 are subject to change in response to the clinical and political environment that evolves over the next two years (October 2012)

Objective Outcome Performance Measure Impact MSN

Strategy

Risk

7.1 [new objective] The future of the MSN will be assured by securing funding for a further three years.

new objective

An appropriate mechanism for funding a service network will be identified and a further three years funding will be secured.

A proposal will be submitted to NSSC.

21.03.14 achieved

The neurosurgical service in Scotland continues to be delivered as a single service provided on multiple sites.

1,2,3,4 The MSN is not funded and the service

fragments.

7.2

The quality of care for neurosurgical patients is demonstrably improved as a result of the MSN’s activities.

Audit of person-centred QPIs will demonstrate

improvements in care.

The national paediatric audit will be the focus of the MSN’s activities in 2014/15. The audit incorporates standards, QPIs (Neuro-oncology and Traumatic Brain Injury), age-appropriate patient experience surveys and parent/carer surveys

01.06.14

Paediatric neurosurgical activity in Scotland will be documented and audited for the first time.

1,2,4 The design of a new national audit is a significant undertaking. The appointment of the Clinical Co-ordinator and GG&C AF are the rate limiting steps. 7.3

The network is perceived by stakeholders as an essential hub for neuroscience activities.

The network is a one stop shop of comprehensive, accurate, current information.

The appointment of an MSN lead consultant in each adult centre.

31.03.14 - achieved

Local ownership of the MSN. 1,2,3,4 This is new model of delivery that will take a period of time to bed in – it must

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Risk

The network is perceived by stakeholders as an essential hub for neuroscience activities (cont.)

The establishment of multidisciplinary MSN Hubs 30.06.14

Integration of the national reference groups within the Hubs.

30.09.14

Increased output (pathways, protocols etc) agreed by all centres with analysis of variance that permits cross- boundary audit. not duplicate existing governance structures 7.4

The network is recognised as a forum with the authority to fix problems.

Issues that are raised are recognisably fixed with the pathway and timelines evident for all to see and the rate limiting steps attributed to the relevant body.

The route from problem identification to solution is transparent and progress can be tracked real-time on the website.

30.06.14 - achieved

The MSN works with units to support the in-house teams (clinical and managerial) and is perceived as the first port of call when issues arise. In so doing, the MSN becomes an essential component of the service and empowers stakeholders. 1,2,3 The demarcation between the Boards and MSN in terms of governance could become blurred. 7.5

Single service provision is working.

The neuroscience community works together to ensure the delivery of sub-specialty services is safe and sustainable.

A functional, efficient and effective model is in place and is transferable to other low volume specialties.

The right patient is managed in the right centre by the right surgeon.

31.12.14

Patient care is improved in the paediatric service.

The adult service will come under review as part of the condition-specific pathway development from 2015 onwards.

1,2,4 This will not be achieved across all conditions within one year but the

groundwork will be laid.

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Risk

7.6 [new objective] The MSN will contribute to meeting the educational requirements of staff and patients.

A graduate certificate neuroscience nursing will be developed.

Patient information leaflets will be standardised

The educational materials of the trainees’ national

programme will be adapted for the neuroscience nurse course. A host university will be

identified. 31.10.14

Two condition-specific leaflets will be produced.

A better educated nurse resource results in improved care for patients and staff satisfaction/retention. New graduate nurses are attracted to working in Neurosciences in Scotland

Standardised, up to date information will be provided.

1,2,3,4 Additional resource will be required to co-ordinate the course. 7.7 The MSN website is regarded as the most user-friendly, informative network website in NHS Scotland.

The web-site has an interactive area for staff hosting on-line, accredited, neurosurgical interactive learning tools for a variety of disciplines.

Patients and carers will be able to rate the quality of their interaction with the service.

eLearning tools will be developed.

31.12.14

On-line surveys will be reported 30.09.14

A single point of contact for everything the neurosurgical service needs benefits staff and patients. 1,2,3,4 The website becomes out of date. The resource required to keep the website current and its content

comprehensive is considerable.

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Appendix 1 Achievements to date

The remit of the Managed Service Network for Neurosurgery was provided in the Final Report of the Neuroscience Implementation Group in 2008. The achievements of the MSN since its inception in 2009 are outlined below.

2009/10 2010/11 2011/12

Appointment of MSN staff Review of current Consultant staffing

Development of standard operating procedures for

Consultant staffing appointments

Collaborated on the appointment of 2 consultant appointments across Scotland ensuring the service provision met the needs of the population

Collaborated on the appointment of 4 consultant appointments

Revision of the Network Manager’s job description. Staff posts brought into alignment with the Knowledge and Skills Framework

The MSN Chairman and Director’s terms of office, and MSN funding extended for a further three years until 2015

Establishment of governance structure

Development of the remit and responsibilities of each group

Quarterly meetings of the Board and Operational Management Group to address a range of issues surrounding local and national service provision.

Specific issues addressed:

Review of the increasing impact of non-complex lumbar spinal surgery caseload on neurosurgical services and collaboration with the orthopaedic 18 week task and Finish Group to develop the first national patient pathway for lumbar spine symptoms.

Review of issues surrounding the national PACS system and its applicability to acute neurosurgical care

Service mapping of paediatric services and collaboration with the ‘Safe and Sustainable Paediatric Services’ Programme in England

Review of issues surrounding vCJD and neurosurgical instrument tracking

Review of the management of patients with

Quarterly meetings of the Board and Operational Management Group to address a range of issues surrounding local and national service provision.

Specific issues addressed:

Successful approval from the Scottish Parliament for 12 month derogation from the 18 week RTT for spinal surgery to allow implementation of the national pathway

Review of EWTD rota compliance with option for reconfiguration of the workforce

Consideration of the impact of relocation of paediatric services to Yorkhill

Agreement that Consultant job descriptions should incorporate a specific commitment to the MSN

Collaboration with the Decontamination Policy Advisory Group (in relation to vCJD)

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2009/10 2010/11 2011/12

Review of the current medical staffing status in the context of the European Working Times Directive (EWTD)

Review of service provision for Deep Brain Stimulation (DBS)

Annual report to the Cabinet Secretary

Review of issues surrounding accessibility to national PACS with escalation to National Services Scotland and the eHealth Strategy Group

Review of the Board’s membership

Review of the current medical staffing status in the context of national service provision

Establishment of joint working between the RHSCs in Edinburgh and Glasgow

Review of progress of the National Planning Forum with the development of a hub and spoke model for spinal surgery Review of paediatric neurosurgical transfers across Scotland

Review of AHP staffing levels in the fours centres Annual report to the Cabinet Secretary

Review of current service provision

Established relationships with the National Services Division (NSD) of National Services Scotland

Needs assessment and planning for National Epilepsy Surgery Forum

Facilitated the establishment of a specialist paediatric epilepsy service at the RHSC Edinburgh

Collaboration with GG&C on the plan to transfer paediatric neurosurgical services from the SGH to Yorkhill

Participation with the UK ‘Safe and Sustainable’ review of paediatric services

Establishment of National Epilepsy Surgery Forum (meeting thrice yearly to assess patients for surgery) with the

development of a clinical pathway.

Further review of service provision for Deep Brain

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2009/10 2010/11 2011/12

Establishment of a Workforce and Training sub-group

Discussions (ongoing) with the four University Principals and four NHS provider Board Chief

Executive Officers about the importance of maintaining strong clinical academic neurosurgery in Scotland.

Established a register of sub-speciality interests to inform strategic planning of services

Profile generated of consultant deployment to enable succession planning

Maintained an overview of neurosurgical training on Scotland with a view to providing a single national training programme

Developed guidelines for the replacement of consultant posts

Review of potential distribution of the neurosurgical workload

Review of emergency ‘out of hours’ provision

Provision of administrative support to the National Epilepsy Forum

Facilitated collaborative working to address the issues surrounding the Interventional Neuroradiology service

Discussions with the University of Edinburgh in relation to academic neurosurgery and a replacement for the Professor of Neurosurgery (retiring)

Collaborated with NES in the establishment of a single training programme for neurosurgery.

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2009/10

2010/11

2011/12

Establishment of a Data and

Audit Group.

Research and testing potential on-line data entry and reporting tools.

Established test sets of neurosurgical data using MIDIS(data management system).

Completion of MIDIS user acceptance testing.

Cancer: data collected on over 400 patients for the Scottish Adult Neuro-oncology Network (SANON).

Pituitary Tumours: detailed data collection on over 60 patients.

Paediatrics: data collection on over 400 children managed by neurosurgeons.

National Epilepsy Forum: case review and treatment plans agreement for patients with epilepsy resistant to drug treatment.

UK Shunt Registry: submission of data on shunt insertion and revision.

Decision to use Excel for data entry and approach ISD for analytical support.

Pituitary Tumours: detailed data collection on over 40 patients*

Paediatrics: data collection on over 130 children managed by neurosurgeons*.

National Epilepsy Forum: case review and treatment plans agreement for patients with epilepsy resistant to drug treatment.

* audit facilitator post in GG&C vacant for 5 months – data being collected retrospectively

Establishment of a Clinical Standards Group.

Evidence base researched and agreed.

Design and publication of comprehensive evidence-based national standards for neurosurgery.

Completion of the Lothian and Grampian Standards review of evidence and site visits (November 2011 and January 2012 respectively).

Identification of partner organisations.

Collaborative working with partner organisations: Epilepsy Scotland: National Epilepsy Forum.

Spina Bifida Association: participation in Standards visits, representation on the Board and Operational Management Group.

UK Shunt Registry: review of shunt registry procedures in

Collaborative working with partner organisations: ISD: alternative data collection models.

National Planning Forum: spinal surgery service provision in Scotland.

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Managed Service Network for Neurosurgery