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DIAGNOSTIC STEERING GROUP

CONSTITUTION AND TERMS OF REFERENCE

Purpose

The purpose of the DSG will be to ensure the continued coherent development and delivery of high quality diagnostic services; taking into account the strategic direction set by the Health and Social Care Delivery Plan and the National Clinical Strategy, in particular the effective and safe quality ambitions:

‘The most appropriate treatments, interventions, support and services will be provided at the right time to everyone who will benefit, with no wasteful or harmful variation.’

‘No avoidable injury or harm to people from the healthcare they receive, and that they are cared for in an appropriate, clean and safe environment at all times.’ DSG will also align with and deliver the needs of the Diagnostic Services Shared Services agenda. DSG REMIT

The remit of the DSG will be to:

Make recommendations to SGHSCD and NHS Boards on the strategic direction, planning and delivery of diagnostic services across NHS Scotland, taking account of relevant national and international evidence and advice as appropriate from relevant bodies/groups to ensure the continued coherent development of high quality diagnostic services. This will involve providing advice on the appropriate use of diagnostics, including new tests; and recommending investment in diagnostics that optimise clinical and cost effectiveness for the benefit of patients. Provide national strategic direction setting for all strands of healthcare science delivery

Approve the annual workplans of National Managed Diagnostic Networks.

Identify workstreams to progress the diagnostics agenda and commission groups (including NMDNs) to progress these.

Make recommendations on the data requirements for operational management and strategic planning of diagnostic services to ensure they are fit for purpose, practical and cost effective. Ensure robust benchmarking data are available and utilised to enable NHS boards improve productivity and efficiency.

Advise on the range of diagnostic processes that GPs can provide cost and clinically effectively in primary care and those GPs can access directly in secondary care

Advise on cost and clinically effective diagnostic element of care pathways; and the development of robust and equitable referral protocols for diagnostic testing in secondary care.

In partnership with NHS Healthcare Improvement Scotland (HIS) – in particular Scottish Health Technology Group and Scottish Medicines Consortium - advise on

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which diagnostic tests / processes are cost effective and should be routinely available in NHS Scotland, including developing clear processes to provide advice on companion diagnostics.

Provide governance and oversight on the implementation of DSG recommendations and/or approved business cases

Make recommendations on workforce development and planning, and work in partnership with NHS NES on educational requirements and provision.

1: Composition DSG Membership Advisory Group Membership Ratification Group Membership Working Groups/Project Subgroups

1.1 DSG Membership Chief Executive ( Chair)

Ms Aileen MacLennan Mr Cameron Matthew Mr Aris Tyrothoulakis

Regional Diagnostics Director, NHS Greater Glasgow & Clyde Regional Diagnostics Director, NHS Grampian Regional Diagnostics Director, NHS Lothian

Ms Deb Jones Mr Hugo van Woerden Ms Susan Myles

Director of Planning, NHS Highland Director of Public Health, NHS Highland Scottish Health Technology Group / Healthcare Improvement Scotland

Dr Angus Cameron NHS Board Medical Director & National Clinical Adviser on National Clinical Strategy

Scottish Government (Policy) Ms Liz Sadler Mr Gareth Brown

Strategic Planning and Clinical Priorities Team Health Protection and Public Health

Professional leads Karen Stewart Dr David Stirling

Healthcare Science Advisor, SG Director of Healthcare Science, NSS

Shared Services Dr Brian Montgomery

Director, National Shared Services Health Portfolio

National Managed Diagnostic Networks Advisory Group Chair Commissioned services Ms Fiona Murphy

Chair of advisory group (undertaken on a rotating basis in line with topic of the day) Director, NSD

Mrs Liz Blackman

Senior Programme Manager, National Managed Diagnostic Networks

Secretariat Joint secretariat

NSD/SG

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Advisors as required

Lead Clinicians (& network scientific managers)

NMDNs for biochemistry, microbiology, pathology and clinical imaging, together with representatives of immunology, haematology (transfusion medicine), health protection (PH microbiology) & genetics Attendance as required when relevant topics in agenda / members of operational group

Dr Bill Bartlett Dr Hamish McRitchie

Shared Services SME for Laboratory Services Shared Services SME for Clinical Imaging Services

Attendance as required

Clinical Users Invited as required

Users of / Referrers to diagnostic services/ reference laboratories/ public health (Microbiology) / screening/ oncology eHealth Leads

1.2 Advisory Group Membership

Lead Clinicians and Network Scientific Managers Nominations required Senior Programme Manager and Programme Managers Secretariat

NMDNs for biochemistry, microbiology, pathology and clinical imaging Immunology, haematology (transfusion medicine), health protection (PH microbiology), medical physics & genetics National Network Management Service NSD

1.3 Ratification Group Membership

Nominations required x 15 Diagnostics Director/senior manager to represent each providing NHS Board

The three regional directors/leads who will be members of DSG will represent their own NHS Boards on this group.

1.4 Working Groups/Project Subgroups Project subgroups will be set up as required to work on specific projects as requested by the DSG. These will consist of interested parties with experience and expertise relevant to the project concerned.

2. Meetings

2.1 DSG Meetings The DSG shall meet quarterly or as required, chaired by Mr Jeff Ace.

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Meetings will follow a standard agenda which will include:

Topic of the Day

Presentation of Business Cases

Progress updates on approved Business Cases

Progress updates from DSG Working Groups/Project Subgroups

Discussion on emerging relevant policy/strategy The quarterly meetings will have a set topic of the day for discussion as part of the agenda at each meeting. This will allow discussion on the strategic direction for that topic area and approval of the relevant workplans to progress this, including the NMDN workplans. However, this does not in any way preclude the presentation of business cases or other significant papers from other diagnostic disciplines at any time. Topics of the day are as follows:- Quarter one Cellular pathology, molecular pathology, genetics and relevant screening

labs Quarter two Biochemistry, immunology, haematology and relevant screening labs Quarter three Microbiology, virology and reference labs Quarter four Imaging, Medical Physics and eHealth There will be an expectation for members to attend the meetings. DSG will be considered to be quorate if eight members are in attendance, representing Scottish Government, regional diagnostic services and the National Managed Diagnostic Networks. Meetings will be timetabled well in advance. The agenda and associated papers shall be circulated by email to Group members at least two weeks in advance of the meeting date. Individual representatives will have equal say in decisions. Decisions will be based upon the consensus of members. Where consensus is not reached by the group a decision may be deferred. The chair’s role will be to facilitate a group consensus so that a decision can be made. Ultimate decision making sits with the NHS Board Chief Executives however the status of DSG advice would be such that it would be likely to be approved. Meeting minutes detailing decisions and work to be carried out as a result of the meeting will be circulated by e-mail to members in draft form no later than three weeks from the date of the meeting and will be ratified at the subsequent DSG meeting. This does not preclude DSG communication detailing the progress of current initiatives between meetings. National Services Division will provide administrative support to meetings.

2.2 Advisory Group Meetings The advisory group will meet quarterly, four weeks in advance of DSG meetings. Meetings will be chaired by the relevant Lead Clinician as follows :- Quarter one SPAN Lead Quarter two SCBMDN Lead

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Quarter three SMVN Lead Quarter four SCIN Lead Meetings will follow a standard agenda which will include:

Topics relevant across networks, to agree pan-network approaches, e.g. o Shared Services o Demand Optimisation

Business Cases for presentation

Synergies between networks, for example in workforce planning

Preparation for Topic of the Day

Horizon scanning

Devising strategies for the implementation of national guidance, for example from outputs of short life working groups such as demand optimisation

Prioritisation of network workplans to meet the needs of the DSG and the shared services agenda

Reports from companion diagnostic test evaluation panels Meetings will identify key areas where DSG can provide support to networks and non-network disciplines. Meetings will consider the DSG agenda, agree relevant topics for each meeting and identify lead presenters for each topic. Discussion will identify what work requires input from the ratification group prior to DSG submission. The advisory group will be considered to be quorate if all networks are represented. Meetings will be timetabled well in advance. The agenda and associated papers shall be circulated by email to Group members at least one week in advance of the meeting date. An action log detailing required actions and any decisions taken will be circulated by e-mail to members in draft form on the working day following the meeting. The National Network Management Service will provide administrative support to meetings.

2.3 Ratification Group The Ratification Group will be a virtual group, designed to provide a wider NHS Board view/advice to complement the advisory group view on topics/Business Cases to be presented to DSG. This is likely to include items for discussion whether there are significant resource implications, where major service change is required and where a proposal has implications beyond diagnostic services. The Advisory Group will identify topics that require input from the Ratification Group. Any papers requiring comment, with identified questions, will be circulated to the Ratification Group for comment on the working day following the Advisory Group meeting. One week will be allocated for comments, which will be collated for DSG meetings. National Services Division will provide administrative support to this function. The three regional directors/leads will be responsible for highlighting Ratification Group discussion/opinion/concern to DSG.

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The Ratification Group would bring together NHS Board level staff responsible for managing diagnostics (and likely other) services in their Board to consider how Boards could work internally, or collaboratively, to ensure implementation of proposals which are demonstrably beneficial (financially and clinically). This might involve:

Funding development through efficiency gains within overall Board diagnostic budgets e.g. on the basis of more cost effective test pathways

Developing collaborative agreement across Boards to invest in a shared diagnostic service at regional or national level to achieve savings for all Boards e.g. new expensive tests only developed on one agreed site in Scotland.

Where the group agree with a proposed development but cannot resource from existing Diagnostic Budgets, a business case will be developed for approval by DSG and onwards to Board Chief Executives. This may propose

A single site option for expensive/rare tests – either funded through a Board Allocation top slice or on a cost/test basis

An agreement to invest in multiple sites for new/changed diagnostics on the basis of a cost saving elsewhere within the NHS budget.

2.4 Working Groups/Project Subgroups Working Groups/Project subgroups shall be convened at the request of DSG. Working Groups/Project subgroups will have a designated lead responsible for coordinating the work and for feedback to the Advisory Group and to DSG. Working Groups/Project subgroups shall determine the frequency of their meetings according to the objectives and timescale of the work to be undertaken. Meetings shall be timetabled in advance, where possible to enable coordinated reporting to the Advisory Group meetings. The agenda and associated papers shall be circulated to members of the working group/project subgroup at least five working days in advance of the meeting date. DSG will agree and assign the most appropriate administrative support to Working Groups/Project subgroups.

3. Accountability

At present the DSG reports through the National Specialist Services Committee because it has predominately had a role in oversight of the national managed diagnostic networks and specialist diagnostics.

The proposed new wider role might be more appropriately achieved through a direct line of accountability to the NHS Board Chief Executives’ Group because the DSG would span all aspects of diagnostics – not just specialist elements. If this is agreed the DSG would make its recommendations for investment/ disinvestment in diagnostic services to the NHS Board CEs’ Group and, through BCEs, to SGHSCD. (Given the pressure on BCEs agendas, NHS

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Boards may still want to use NSSC as a scrutiny body on behalf of the NHS Board Chief Executives’ Group because it brings together all territorial Boards at a senior level in NHS Scotland.)

DSG is a national group and will engage with national groups with an interest in diagnostics, directors of planning / workforce at Board and regional level, within primary and community care, the National Specialist Services Committee (NSSC), NHS Boards and Scottish Government.

The diagram below seeks to show the range of existing and proposed groups that have a diagnostic interest, and will therefore be affected by and have an interest in the work of the Diagnostics Steering Group (DSG). It outlines how the groups might relate to each other. Mapping of Groups with Diagnostic Interest

The DSG should, as a priority, maintain awareness of the agendas of other influential groups, including the NHS Scotland Shared Services Board, the Scottish Cancer Task Force, the Scottish Medical and Scientific Advisory Committee (SMASAC), the Scottish Screening Committee and the developing governance structure for Public Health Microbiology. The DSG should also have a means to act upon any relevant outputs from these groups, or provide any required inputs to these groups.

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Appendix One – Business Case Process

Diagnostic Steering Group

DSG

1. Introduction The Diagnostic Steering Group (DSG) exists to ensure the continued coherent development of high quality diagnostic services in order to contribute to the delivery of the National Clinical Strategy effective and safe quality ambitions.

It is responsible for making recommendations to NHS Boards on appropriate investment in diagnostic services, to ensure a service that is equitable, reduces waste and provides value for money.

In order to achieve this function it will consider Business Cases (BCs) from a range of diagnostic disciplines. The process for this is outlined and illustrated below. 2. Agreeing a Mandate to Produce a Business Case It is anticipated that the majority of BCs will emerge from discussion by one of the NMDNs. As part of their work programme, a diagnostic network will identify a need for service improvement. This might be due to the emergence of a new test, changes in technology, workforce development or policy direction. The first step would be for a network Steering Group to agree a BC should be produced and assign appropriate resource to develop a brief proposal, outlining the work the network intend to produce and how this realises current policy aims, such as Realistic Medicine, the Clinical Strategy, 20:20 Vision or Shared Services. The proposal would be presented back to the DSG Advisory Group. The Ratification Group would be notified of this and given opportunity to raise questions. The proposal would then be presented to DSG and, if approved, a mandate given for the network to develop a Business Case. Timelines and reporting would be agreed at this stage, alongside any support that needed to be assigned to the work. The DSG mandate to undertake the work would be communicated back to the network Steering Group, who would then assign appropriate resource to develop the Business Case. 3. Preparation of a Business Case The draft Business Case would then be worked up and presented back to the network Steering Group. Once the network Steering Group has approved it, it should be discussed by the Advisory Group, who will have discussion on it to identify how it should be progressed. If the BC is relatively straightforward, has broad agreement from NHS Boards, only impacts on one discipline and is cost neutral within that discipline; it could then be presented to DSG.

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If however there are implications across disciplines or beyond labs, or there are significant resource requirements of the need for major service change is proposed, it should be referred to the Ratification Group for discussion to ensure a holistic view is presented to DSG. BCs might also emerge from non-network diagnostic disciplines. In this instance, they would notify NNMS of the production of the BC who would add it to the agenda for the Advisory Group. Thereafter, the same process would be followed as indicated above. BCs directly related to screening programmes would be progressed via the Scottish Screening Committee; however where there are implication on diagnostic services these may be discussed at DSG, noting that decision-making rests with the screening committee. 4. Ratification of a Business Case

If the Advisory Group agree that a BC should be referred to the Ratification Group for further discussion, they will identify any questions arising from their own discussion and aspects of the BC that require further input. Secretariat will then issue the BC to the Ratification Group alongside highlight areas for discussion, requesting a response within one week. Ratification Group discussion will be facilitated virtually and secretariat will provide feedback to the Ratification Group on any additional action that might be required. The ratification Group would give guidance on what would be required for implementation of the Business Case, including:-

Could change be implemented from current resource

What investment might be required now/future

How implementation should be managed eg local/regional/national

BCs would then be presented to DSG with comments from the Advisory Group and the Ratification group incorporated into the cover paper. The BC would be presented to the DSG by a representative from the most relevant discipline, with the chair of the Advisory Group responsible for feeding in their views and the three regional directors/managers responsible for input from the Ratification Group. In this manner, it is expected that BCs will be presented to DSG with a clear understanding of wider service implications. DSG will be asked to debate any key issues that have arisen from the process.

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