The requester asked for Clinical Advisory Group (CAG) minutes, membership details, and specific information regarding discussions on COVID vaccine injuries. The authority, Manx Care, disclosed all requested information, providing 96 documents totaling 402 pages, including agendas and a detailed NHS plan on Long COVID.
Key Facts
Manx Care released all requested information regarding the Clinical Advisory Group.
The disclosure included 96 documents spanning 402 pages.
Meeting agendas from 2021 and 2022 cover topics such as Long COVID, vaccine allergies, and dementia prevalence.
A specific document titled 'Long COVID: the NHS plan for 2021/22' was included in the response.
The group discusses clinical pathways and capacity bills, reporting to various departments.
Data Disclosed
402 pages
96 documents
2024-04-01
2025-01-15
12 August 2021
23 June 2021
30th March 2022
89 clinics
1500 referrals
1.5 million visits
50 million
2019
2050
Original Request
Hello,
1. Please can you provide all meeting minutes including relevant documents discussed or circulated to be discussed for CAG meetings to current date.
2. Please state the purpose of this group and when it was created
3. Please provide the members of this group, or departments represented
4. Who does this group report to and advise? If more than one, please state all.
5. Does this group discuss covid vaccine injuries. If so, please specify how many times this was discussed.
Thanks
Data Tables (224)
Item No.
Subject
Discussion
Lead
Document(s)
Attached
07/21
Apologies
SA
08/21
CATCH Sites
Verbal presentation by Juan Corkill
JC
09/21
Covid-19 Pathways
SA
10/21
Any Other Business
a) Results Acknowledgement
SA
11/21
Next meeting: Wednesday 18 August 2021 at
4.30 pm on MS Teams.
Discussion
Lead
Item No.
Subject
Discussion
Lead
Document(s)
Attached
01/21
Apologies
SA
02/21
Improving the Quality of Electronic Discharge
Summaries
SA
03/21
Covid 19 Vaccines/Allergies
SK
04/21
Long Covid; the NHS Plan for 2021/22
SA/JS
05/21
Any Other Business
All
06/21
Date of Next Meeting if appropriate
SA
Discussion
Lead
Item
Subject
Discussion
Lead
Document(s)
No.
Attached
15/22
Apologies
SA
16/22
Matters Arising From Last Meeting
SA
17/22
Global Burden of Disease Study on Dementia
Prevalence - implications for population health
Please read link to the paper below.
Estimation of the global prevalence of dementia in
2019 and forecasted prevalence in 2050: an analysis
for the Global Burden of Disease Study 2019 - The
Lancet Public Health
SA
18/22
Capacity Bill - Advance Consent
Department meeting
6 December - Capacit
SA
19/22
Updates on Transformation
SA
20/22
ANP Referrals
SA
21/22
Any Other Business
SA
22/22
Date of next meeting:
Wednesday 27th April 2022 at 4.30 pm
Discussion
Lead
Actions
Delivery Date
Owner
1. Invest a further £70 million to expand Long COVID treatment and rehabilitation
21/22
NHS England
and NHS
Improvement
2.
Invest £30 million in the rollout of an enhanced service for general practice to
21/22
support patients in primary care
3.
Publish information about waiting times of post-COVID assessment services to
September
2021
ensure transparency
4. Evaluate post-COVID Assessment Clinics to obtain the lessons learned from
set up
Ongoing
5. Ongoing review of the Long COVID clinical pathway to reflect the latest
research evidence and operational experience
Ongoing
6. Extend the use of the Your COVID Recovery online rehabilitation platform
August 2021
7. Use data tools showing take up by gender, ethnicity and deprivation, against
expected prevalence.
July 2021
8. Partner with National Voices, Asthma UK/British Lung Foundation and other
Voluntary, Community and Social Enterprise Sector organisations to engage
with communities more likely to be impacted by health inequalities.
Summer 2021
9. Appoint six Patient and Public Voice Partners to provide advice on lived
experience to the programme
May 2021
10. Carry out a Health Equity Audit to assess the degree to which we achieve our
vision of equitable access, excellent experience and optimal outcomes for all
communities.
Summer 2021
11. To improve accessibility of information we will ensure ‘easy read’ and printed
versions of Your COVID Recovery materials are accessible, and that
translations in over 100 languages will be available.
August 2021
12. Promote good clinical practice through the national learning network on Long
COVID for healthcare professionals
Ongoing
13. Further develop resources on FutureNHS platform to provide educational
materials and enable information sharing across healthcare organisations and
staff
Ongoing
14. For NHS staff, comprehensive support for health and wellbeing including
mental health hubs, rapid referral to services, local occupational health and
online wellbeing resources will be available.
June 2021
15. All local NHS systems will have submitted to NHS Regions, fully staffed Long
COVID service plans covering the whole pathway from primary to specialist
care
12 July 2021
Integrated
Care Systems
16. Local NHS systems will include planning to ramp up Your COVID Recovery
supported patient-self management in their Long COVID service plans
July 2021
Local NHS systems will include planning to ramp up Your COVID Recovery
supported patient-self management in their Long COVID service plans
17. Long COVID services will nominate care coordinators to manage complex
cases
July 2021
18. Develop standard rehabilitation pathway packages to treat the commonest
symptoms of Long COVID
July 2021
19. Establish 15 Post COVID assessment paediatric hubs across England
July 2021
20. NHS Long COVID activity data on referral, assessments and waiting times for
post-COVID assessment clinics and the onward patient journey including use of
Your COVID Recovery will be published monthly
September
2021
NHS England
and NHS
Improvement
and NHS
Digital
21. A Long COVID digital code will be added to the psychological therapies
Minimum Data Set.
Summer 2021
22. A Long COVID registry for patients attending the Post COVID Assessment
Clinic will be established
July 2021
Long COVID services will nominate care coordinators to manage complex
cases
Develop standard rehabilitation pathway packages to treat the commonest
symptoms of Long COVID
Figure 1: Number of people with self-reported long COVID by duration,
UK: 6 March 2021 and 2 May 2021
Period
Duration
Estimate
Data to 6 March 2021
Less than 12 weeks
309
At least 12 weeks
697
At least 12 months
70
Data to 2 May 2021
Less than 12 weeks
66
At least 12 weeks
869
At least 12 months
376
Source: Office for National Statistics
NHS England and NHS Improvement will provide a further £70 million to
expand Long COVID services beyond Post-COVID Assessment Clinics to
strengthen treatment and rehabilitation for Long COVID. Additional funding will
be provided to ICSs adding to the £24 million already provided to 89 specialist
Post-COVID Assessment Clinics around England, bringing the total investmen
in 2021/22 to £94 million.
To increase knowledge on identifying, assessing, referring and
supporting patients with Long COVID:
evolves
this may involve learning at different levels of expertise within the team
different professionals in the team are likely to have different learning needs
prescriber or the health and wellbeing coach)
participation in educational sessions and sharing of learning with system
Educational materials available to all healthcare workers can be found in the
‘Useful information’ section.
history
obtain data, that can be cut by demographic, to understand which groups or
communities are most affected and to identify potential inequities
obtain activity data that can help to guide future service planning
include:
Diagnosis code:
Ongoing symptomatic COVID-19 (4-12 weeks after infection)
Post-COVID-19 syndrome (12 weeks plus)
Signposting to Your COVID Recovery: when signposting patients
to the publicly available Your COVID Recovery website (phase 1)
Referral to post-COVID assessment clinic
Post-COVID-19 syndrome resolved (available from May 2021): to
be used at the patient and clinician discretion when all symptoms
are fully resolved and there is no evidence of persisting organ
impairment or if an alternative diagnosis has been made to
account for all symptoms
assessment services or other specialist services
continuing to code demographic information including ethnicity
By working with the practice Patient Participation Group (PPG) to help
raise awareness of support (such as Your COVID Recovery website)
By working with system partners to help raise awareness of support and
understand any potential barriers to support
Local NHS systems should include a rehabilitation pathway programme in
their Long COVID service plans due mid-July 2021. It should be based on the
principles in the RightCare: Community Rehabilitation Toolkit.
Local NHS systems should include planning to ramp up Your COVID
Recovery supported patient-self management in their Long COVID
service plans due by mid-July 2021.
The Faculty of Occupational Medicine has produced guidance for return to work for
patients with long-COVID
REPE
ALS
Short title
Powers of Attorney Act 1983
Extent of repeal
The whole Act
Powers of Attorney Act 1987
The whole Act
Mental Health Act 1998
Part 7
******
******
******
******
Jurisdiction
Age to which
capacity
determination apply
Legal Status
Relevant Legislation
Scope – Key Points
Isle of Man
Proposed
18+ years
Legislation
proposed but not
enacted
The Capacity Bill 2021
There is an exception in the MCA where
the age is 16+ years is the making of
ADRT.
Having the age set to 18+ years does
present some problems which will need to
be addressed. Certain provisions in the
Children & Young Persons Act 2001,
namely private law orders and care
orders, do not apply to children over the
age of 16 years and 17 years respectively.
This could result in a young person falling
into gap between the two pieces of
legislation.
England/Wales
16+ years
Legally binding
Mental Capacity Act 2005
Exceptions in the MCA where the age is
18+ years include making:
• LPAs
• Statutory Wills
• ADRT
In most situations, the care and welfare of
children under 16 years will continue to
be dealt with under the Children Act 1989.
There are, however, two exceptions to
this:
Where the MCA Applies to Children under
the age of 16:
• The Court of Protection can make
decisions about a child’s property or
finances, (of can appoint a deputy to
make these decisions), if the child lacks
capacity to make to make such decisions
within section 2(1) of the Act and is likely
to still lack capacity to make financial
decisions when they reach the age of 18.
• The criminal offence of ill treatment or
wilful neglect of a person who lacks
capacity applies to children under 16 as no
lower age limit is specified for the person
caused harm/victim
Scotland
16 + years
Legally binding in
respect of age to
which capacity
determination
applies
Adults with Incapacity Act 2000
“adult” means a person who has attained
the age of 16 years.
Exceptions in the Adult with Incapacity Act
2000: -
Section 79A “Sections 57 to 79 apply in
relation to a child who will become an
adult within 3 months as they
apply in relation to an adult; but no
guardianship order made in relation to a
child shall have effect until the child
becomes an adult.”
Northern
Ireland
16 + years
Legally binding in
respect of age to
which capacity
Mental Capacity Act (Northern Ireland)
2016
Refusal of specific treatment(s) in
specified circumstances (can be made by
those with capacity, age 18+)
Can extend to life-sustaining treatment
determination
applies
Legislation partially
in force
(N.B. Part 9 “Power of police to remove
person to place of safety” provisions
(which have not yet been brought in)
defines “children” as persons under 18
years)
Jersey
16 + years
Legally binding
Capacity and Self-Determination (Jersey)
Law 2016
Exceptions:
LPA’s – a person has to be 18+ years
Guernsey
16+ years
Legislation not yet
in force
Capacity (Bailiwick of Guernsey) Law 2020
Court may exercise powers for children
under 16 if the Court considers it likely
that P will still lack capacity to make
decisions in respect of that matter when P
reaches 16.
Republic of
Ireland
18 + years
Legally binding in
respect of age to
which capacity
determination
applies.
Legislation partially
in force
The Assisted-Decision Making (Capacity)
Act 2015 was signed into law in 2015 but
has not yet come fully into force. The
legislation is currently being used as a
“best practise” guideline.
Jurisdiction
Type of Advance
Decision/ Age which
it applies
Legal Status of
Advance Decision
Relevant Legislation
Scope – Key Points
Isle of Man
Advance Decision to
Refuse Treatment
(ADRT)
Current law
18+ years
-------------------------
Proposed law
16+ years
Legally binding
-----------------------
Legislation
proposed but not
enacted
Common law
---------------------------------------------------------
Capacity Bill 2021
--------------------------------------------------------
The age in which a person can make an
ADRT was originally proposed 18+ years,
however a policy decision was made to
change the age to 16+ years to align with
provisions in the Family Law Reform (Isle
of Man) Act 1971, which recognises
consent of a person aged 16 and 17 years.
England/Wales
Advance Decision to
Refuse Treatment
(ADRT)
18+ years
-------------------------
MCA 2005 applies to those age 16+
(ADRTs can be made by those with
capacity, age 18+)
Refusal of specific treatment(s) in
specified circumstances
Can extend to life-sustaining treatment
(must be in writing)
--------------------------------------------------------
Scotland
Advance
Directive/Decision
16+ years
--------------------------
Legally binding
--------------------------
No statute, but Adults with Incapacity Act
2000 – account must be taken of present
and past wishes of the adult as far as they
can be ascertained by any means of
communication (Section 1(4a))
--------------------------------------------------------
Refusal of specific treatment(s) in specific
circumstances (can be made by those with
capacity, age 16+)
Can extend to life-sustaining treatment
-------------------------------------------------------
Northern
Ireland
Advance Decision
(current law)
18+ years
-------------------------
Advance Decision
(proposed law)
18+ years
No statutory provision (case law applies)
-----------------------------------------------------
Case law continues to apply - no statutory
provision, but statutory recognition in
Mental Capacity Act (Northern Ireland) Act
2016
Refusal of specific treatment(s) in
specified circumstances (can be made by
those with capacity, age 18+)
Can extend to life-sustaining treatment
--------------------------------------------------------
As above
Jersey
Advance Decision
(current law)
16+ years
----------------------------
Legally binding
--------------------------
Capacity and Self-Determination (Jersey)
Law 2016
---------------------------------------------------------
Can extend to life sustaining treatment
--------------------------------------------------------
Guernsey
Advance decision
16+ years
Legislation not yet
in force
Capacity (Bailiwick of Guernsey) Law 2020
Can extend to life sustaining treatment
If the assessment of the patient’s
allergy history falls does not fit into
the categories in the referral form
If the assessment of the patient’s
allergy history falls meets the
criteria
• GP to inform patient
that it is safe for them
to receive mRNA
vaccination and the
patient can register to
be vaccinated with
mRNA vaccine
• send completed form by
email to vaccination team
vaccinations@gov.im
• GP to inform patient that
member of 111 team will
contact them
Patient previously received OAZ in ED
setting but did not have Anaphylaxis.
In all cases where vaccination is
requested by GP outside of allergy
criteria IE another medical reason.
Refer to Dr Keeling for further
assessment
• Appointment
booked to receive
OAZ by 111
• Can be vaccinated in hub
setting.
• Appointment booked to
receive OAZ in hub setting by
hub team
Patient’s name
Date of birth
Address of patient
Daytime telephone number
Name of patient’s GP
Name of GP Practice
Signature of Medical Clinician completing
assessment (print name below)
Date:
Item
Subject
Discussion
Document (s)
No.
Lead
Attached
76/23
Apologies for Absence
Chair
77/23
Review notes/Matters arising from previous meeting
Chair
Draft notes
CAG.docx
78/23
Review of Action Log
Chair
CAG Action Log
2023.xlsx
79/23
IT and operational performance data analytics
Chair/JV
Verbal
80/23
Urgent/non urgent pathways for discussion
Chair
Verbal
81/23
Updated TOR for review
Chair
DRAFT Terms of
Reference Clinical Ad
82/23
Referrals
Chair
Verbal
83/23
Medicines Policy for information/review
Chair
23-11 Medicines
Policy - V5 All chang
84/23
AOB
Chair
85/23
Date of next meeting:
Wednesday, 20 December 2023 @ 1600 hrs
Chair
Topic
Page No.
General Guidance
2
Patient Access to Services
2
Staff – Returning to Work following Travel
2
Visiting Staff/Keyworkers
3
Close Contacts – Patients and Staff
3
Lateral Flow Devices
4
Providing treatment to patients
5
Dental Services
5
Orthodontics (Hospital)
6
Orthodontics (Primary Care)
6
Dental Laboratories
7
Opticians
7
General Medical Services
7
Community Nursing
8
Diabetes and Endocrine Service
9
Prison Healthcare Service
9
Pharmacy
10
Primary Care Back Office Function
10
Covid-19 Questions
Appendix 1
Covid-19 Guide for Staff if identified as a ‘close contact’
Appendix 2
Staff Guide – Positive for Covid-19
Appendix 3
Root Cause Analysis
Appendix 4
Staff High/Low Risk Contact Record Sheet
Appendix 5
Lateral Flow Device Stock Order Form
Appendix 6
GP Consultations (F2F)
Appendix 7
PPE Recommendations – Primary, Community, Social Care
PDF
PPE and Lateral Flow Device Stock Order Form (Manx Care)
PDF
Lateral Flow Device Stock Order Form
PDF
Terms of Reference
This RCA is being undertaken to:
Records Reviewed:
Date of Incident:
Incident Type:
Brief Description
Reported By:
Date Reported:
Roles of Individuals Involved:
Summary of Events
IPC Support Summary
Date
Person(s) Involved
Action
Contributing Factors
Root Cause
Recommendations
RCA Completed By:
Date:
Name of Reporting Manager:
Care Group:
Integrated Primary and Community Care
Area/Service:
Contact Number for Area/Service:
Name
Area
High/Low
Risk
Date
Advised to
Follow
Flow Chart
Date of End of
Isolation
Item
Pack Size
Qty Requested
Qty Supplied
Comments
Lateral Flow Device
Each
Positive blood culture report received by Infection
Prevention Nurses, initial information obtained
Consultant Microbiologist emails the details of results to the responsible
Consultant / GP within 1 working day requesting the provision of a root
cause analysis (RCA) within (3 working days)
Consultant to organise a review with clinical teams with IPCT
support and complete the report with lessons learnt and action
plans within 3 working days
Datix to be immediately updated with outcome of investigation and
actions attaching Root Cause analysis/PIR documents by incident
manager
Review to be discussed at the care group’s next triumvirate meeting
and reported into the Patient Safety and Quality Committee
assurance report and the Infection Prevention and Control
Committee
Action
Yes
No
Date
completed
Reason for
Variance
1
Lead Nurse Infection Prevention and
Control ( IPC ) informed of incident of
a positive blood culture result upon
receipt of result by medical team
2
Email request for post infection
review(PIR) /Root cause Analysis
(RCA) sent by the Consultant
Microbiologist within one working
day of positive result
3
Datix completed when result received
Datix reference (insert here)
4
Post infection review/root cause
analysis completed within 3 working
days of the result
5
A member of the IPC team attended
to support review
6
Datix updated immediately following
review by Incident manager attaching
the PIR/RCA documents
7
Lessons learnt and action plan
discussed at Care Group Triumvirate
Meeting
8
PIR/RCA Reports submitted to PSQ
and IPC team
9
Audit completed within one month of
reviews being undertaken
10
Compliance audit reported to the IPC
Committee
Item No.
Subject
Discussion
Lead
Document(s)
Attached
12/21
Apologies
Annmarie Cubbon
John Snelling
SA
13/21
Minutes of the meeting held on 12 August 2021
All
14/21
Impact of new Clinical Pathways on Patient Care in
Community – MSK / Frailty/Diabetes
15/21
Establishing Joint Prescribing Committee to
Underpin Shared Care Guidance
16/21
Advice and Guidance Support on LTCs
17/21
Updates from GPs on Transformation Programmes
18/21
End of Life Care and Advance Planning
19/21
Bloods/Forms and Primary Care undertaking
Secondary Bloods
AC/MP
20/21
Date of Next Meeting: TBA
Discussion
Lead
Item No.
Subject
Discussion
Lead
Document(s)
Attached
21/21
Apologies
SA
22/21
Guidance to Care and Residential Homes: Community
Geriatricians
SA
23/21
Primary Care Winter Pressures (SOPs)
a) Primary Care Guidance
b) GP Living with Covid (SOP)
c) GP Winter Workload Pressures (SOP)
JS
24/21
Cranial Arteritis Pathway
25/21
Date of next meeting:
Wednesday 27 October 2021 at 4.30 pm
Discussion
Lead
Item
Subject
Discussion
Lead
Document(s)
No.
Attached
08/22
Apologies
John Snelling
Ishaku Pam
SA
09/22
Matters Arising From Last Meeting
SA
10/22
Global Burden of Disease Study on Dementia
Prevalence - implications for population health
Please read link to the paper below.
Estimation of the global prevalence of dementia in
2019 and forecasted prevalence in 2050: an analysis
for the Global Burden of Disease Study 2019 - The
Lancet Public Health
SA
11/22
Capacity Bill - Advance Consent
Department meeting
6 December - Capacit
SA
12/22
Updates on Transformation
SA
13/22
Any Other Business
SA
14/22
Date of next meeting:
Wednesday 30 March 2022 at 4.30 pm
Discussion
Lead
Item
Subject
Discussion
Lead
Document(s)
No.
Attached
35/21
Apologies
SA
36/21
Minutes of the meeting held on 28 October 2021
SA
37/21
Matters Arising
SA
38/21
Primary Care Winter Workload Pressures Standard
Operating Procedure (SOP) (deferred from the
October 2021 meeting)
a) Workable definition to be agreed for the trigger
point for implementing the SOP
b) Primary Care and Urgent Care liaison when the
SOP is implemented
SA
39/21
Manx Care Patient Access Policy
40/21
Second doses of Covid vaccines to adolescents (12-
17 years)
MR
41/21
Updates on Transformation
SA
42/21
CQC Updates
SA
43/21
New Updates on Appointments
SA
44/21
New Models of Care
SA
45/21
Any Other Business
SA
46/21
Date of next meeting:
Wednesday 22 December 2021 at 4.30 pm
Discussion
Lead
Item
Subject
Discussion
Lead
Document(s)
No.
Attached
01/22
Apologies
Martin Rankin
John Snelling
Ishaku Pam
Juan Corkill
SA
02/22
Matters Arising From Last Meeting
SA
03/22
Global Burden of Disease Study on Dementia
Prevalence - implications for population health
Please read link to the paper below.
Estimation of the global prevalence of dementia in
2019 and forecasted prevalence in 2050: an analysis
for the Global Burden of Disease Study 2019 - The
Lancet Public Health
SA
04/22
Capacity Bill - Advance Consent
Department meeting
6 December - Capacit
SA
05/22
Updates on Transformation
SA
06/22
Any Other Business
SA
07/22
Date of next meeting:
Wednesday 23 February 2022 at 4.30 pm
Discussion
Lead
Item
Subject
Discussion
Lead
Document(s)
No.
Attached
27/21
Apologies
SA
28/21
Minutes of the meeting held on 20 September
2021
One amendment requested by JS.
Minute reference 23/21(b)
Last sentence; replace consolation with
consultation.
SA
29/21
Matters Arising
SA
30/21
Primary Care Winter Workload Pressures
Standard Operating Procedure (SOP)
a) Workable definition to be agreed for the
trigger point for implementing the SOP
b) Primary Care and Urgent Care liaison when
the SOP is implemented
SA
31/21
NHS UKHSA Recommendations to reduce
physical distancing and changing pre-procedure
testing elective and planned care
SA/
32/21
COVID - 19 Pathways
a) Surveillance screening for COVID-19 in
Hospitals
b) Covid-19 swabbing pathway for discharge
planning
33/21
Any Other Business
a) Positive Blood Culture Incident Review
Process
34/21
Date of next meeting:
Wednesday 24 November 2021 at 4.30 pm
Discussion
Lead
Reader Information
Primary Author / Contact Details
Original Publication Date
3.03.21
Last Review Date
Next Review Date
3.03.22
Target Audience
All Emergency Department staff
All Ambulance staff
Infection Control Team
Hospital staff
Description
This SOP standardises and outlines the way we care for
patients who Covid-19 immunisations in the ED for people with
significant allergy history at risk of severe allergic reaction to
vaccine.
Changes
New document
Version
Changes
Release Date
1.0
O riginal
3/3/2021
1.1
Update to numbers & area of observation
3.4
of the nurse in charge
Item
Number
Subject
Action
General
SA advised that the structure and membership/attendance is to be discussed as
attendance at CAG meetings by Clinical Directors (CDs) is low. It was noted that due to
busy clinical commitments it was understandable CDs were not able to attend all
meetings though the lack of clinical ‘buy in’ was a concern.
JS stated that clinical ‘buy in’ is important and suggested consideration is given to an
honest discussion on low attendance with the days and timing of the meetings to be
agreed.
JC joined the meeting
SA provided an update on the above discussion to JC; JC agreed with the comments
made.
SA decided to continue with the meeting despite the absence of CDs.
07/21
Apologies
Apologies received are noted above.
08/21
CATCH Sites
Verbal presentation by Juan Corkill
JC reported the following.
Covid Assessment and Treatment Community Hub (CATCH) sites were established in
March 2020 for Covid and high risk patients to be seen outside of a GP surgery.
Covid Assessment Treatment Unit (CATU) was established in the Emergency
Department of Nobles at the same time.
GP contractual obligations were ‘turned off’. In hindsight this may not have needed
to happen.
July 2020, no Covid restrictions apart from borders remaining closed, primary care
services resumed normal service.
An outbreak on 31 December 2020 did not result in CATU being resurrected. At that
time no GP had had any contact with a Covid patient.
GP infrastructure at that time was affected due to various staffing levels and the
possibility that surgeries would have to close. Ballasalla surgery closed for two days
in order that a deep clean could take place.
Catch sites initiated again during a short lockdown.
Discussions on going with Mental Health Services in relation to a shared care
arrangement for Child and Adolescent Mental Health Service (CAMHS). GPs will be paid
£150 pa for each shared care case.
SA asked;
1. Are the number of patient’s attending hot sites increasing?
Problems are not GP or Nobles; Manx Care to work as a team with clients/patients at
the heart.
Establishment of a joint prescribing committee to be discussed at the next CAG.
Discuss at the next CAG the suggestion that GPs and Specialties are rotated. Begin
to work together to get to the strategy stage.
Any operational delivery of care will be underpinned by finance.
09/21
Covid-19 Pathways
Not discussed due to time constraints.
10/21
Any Other Business
a) Results Acknowledgement
Not discussed due to time constraints.
There being no further business the meeting closed at 5.34 pm.
11/21
Next meeting: Wednesday 18 August 2021 at
4.30 pm on MS Teams.
Item
Subject
Action By
No.
54/22
Apologies for Absence
•
• Michele Moroney
•
• Andre Risha
•
55/22
Universal mask wearing in healthcare settings
Update
• Ongoing discussions
56/22
CQC and Safe Prescribing- DMARDS/Cytotoxic in particular
• To be discussed by SA/JS/OE and brought back to CAG
next month.
SA/JS/OE
57/22
AOB
• None
58/22
Date of Next Meeting
29/06/22 @ 1630 hrs via Teams
Item
Subject
Discussion Lead
Document (s)
No.
Attached
104/22
Apologies for Absence
• Martin Bracewell
•
•
• Lakshman Paudyal
•
SA
105/22
Matters arising from previous meeting
SA
NOTES CAG
Agenda 05Oct22.V2.
106/22
Advice and guidance lines
SA
107/22
Shared care
SA
108/22
Job planning update
SA
109/22
Testicular Torsion protocol for approval
AR
Manx care SOP for
suspected Testicular T
110/22
PICC Policies – updated
Review and ratification sought by Matthew
Mustain & Graham Lloyd Brandrick
SA
PICC (Cook) policy
2022.doc
PICC (Bard
Groshong) policy 20
111/22
AOB
SA
112/22
Date of Next Meeting:
Wednesday, 7th December 2022 @ 1600 hrs
SA
Item
No.
Subject
Discussion
Lead
Document
(s)
Attached
97/22
Apologies for Absence
• Balakrishnan Venkitasamy
• Lakshman Paudyal
•
• Martin Rankin
SA
98/22
Matters arising from previous meeting
SA
99/22
Guidance on how to manage patients who cannot
have a mRNA vaccine as a booster
SA
100/22
Interpretation of JCVI Guidance re children 5/11yrs
SA
101/22
Draft Policy – Testing for COVID in ICU
102/22
Alteplase
EV
102/22
AOB
Medicinal Cannabis - update
SA
103/22
Date of Next Meeting:
Wednesday, 2nd November 2022 @ 0800 hrs
SA
Item
No.
Discussion
Lead
Item
Subject
Discussion
Document (s)
No.
Lead
Attached
23/22
Apologies for Absence
• Venkitasamy Balakrishnan
• Maria Bell
•
•
•
• Michele Moroney
SA
24/22
Matters Arising from last meeting
SA
25/22
Policy – Clinical guidelines for seeking
second opinion
SA
26/22
Policy – Open & Upright MRI prior
approval
SA
27/22
AOB
SA
28/22
Date of Next Meeting
27/04/22 @ 1600 hrs via Teams?
SA
Item
Subject
Discussion
Document (s)
No.
Lead
Attached
63/22
Apologies for Absence
•
•
SA
64/22
Matters arising from previous meeting
(Notes/Actions attached)
SA
65/22
AOB
SA
66/22
Date of Next Meeting
TBC
SA
Item
Subject
Discussion
Document (s)
No.
Lead
Attached
45/22
Apologies for Absence
Lakshman Paudyal
SA
45/22
Matters Arising from last meeting
(No minutes taken)
SA
46/22
Monkeypox update
47/22
NICE/TA update
SA
48/22
AOB
SA
49/22
Date of Next Meeting
29/06/22 @ 1630 hrs via Teams
SA
Item
Subject
Discussion
Document (s)
No.
Lead
Attached
67/22
Apologies for Absence
• Venkitasamy Balakrishnan
• Michele Moroney
•
SA
68/22
Matters arising from previous meeting
(No notes taken)
69/22
NICE TA Access Scheme Commissioning Policy and
SOP
SA/
NICE TA Access
Scheme Commissioni
NICE TA Access
Scheme Standard Ope
70/22
Universal mask wearing
SA
71/22
Monkeypox update
72/22
AOB
SA
72/22
Date of Next Meeting
Wednesday, 20 July @1700 hrs
SA
Item
Subject
Discussion
Document (s)
No.
Lead
Attached
90/22
Apologies for Absence
•
• Balakrishnan Venkitasamy
SA
91/22
Matters arising from previous meeting
SA
CAG notes
24Aug22.docx
92/22
Regular asymptomatic testing - to consider and
provide advice on Covid testing and also universal
mask wearing.
93/22
Cannabis paper
MB
To follow
94/22
Update on NICE TA Drugs
SA
95/22
AOB
SA
89/22
Date of Next Meeting:
Wednesday, 5th October @ 1600 hrs
SA
Item
Subject
Discussion
Document (s)
No.
Lead
Attached
01/24
Apologies for Absence
Chair
02/24
Review notes/Matters arising from previous meeting
Chair
CAG DRAFT Notes
December23.docx
03/24
Review of Action Log
Chair
CAG Action Log
2024.xlsx
04/24
Final DN CRP Policy
Provided by for information – he is unable to
attend this meeting but advises the wording has been
amended in 2.9
Chair
Final 2023 DNACPR
policyV2.docx
05/24
Advice & Guidance Policy
Update to be provided by
Verbal
06/24
AOB
Chair
Verbal
07/24
Date of next meeting:
Wednesday, 14 February 2024 @ 1600 hrs
Chair
Item
Subject
Discussion
Document (s)
No.
Lead
Attached
08/24
Apologies for Absence
Chair
09/24
Review notes/Matters arising from previous meeting
Chair
CAG DRAFT Notes
16.1.24.docx
10/24
Review of Action Log
Chair
CAG Action Log
2024.xlsx
11/24
Immunisation Committee
Covid vaccination associated ribosomal frameshifting &
Influence of seasonality vs PHIs on Covid
Attached to be presented by
for discussion/action
COVID
vaccination-associat
influence of
seasonality vs PHIs o
12/24
Pathology Audit Report
Report presented by for
discussion/action
055SEP22 3YC PATH
2022-25 Core Audit -
13/24
TLS Policy
Presented by Dr V B Krishnan (VBK) for
agreement/ratification
VBK
Noble's TLS Policy
Jan 2024.docx
14/24
End of Life Care CQC Actions
Discussion following circulation of attached Action Log
Chair
End of Life Care CQC
Actions January 2024.
15/24
DNA CPR Policy – for information
advises:
This is not an interim policy it is Manx Cares existing
DNACPR policy which has been in place since 2011/12
The process for its review is through Resuscitation
Committee and Operational Clinical Quality Group’s for
Health & Social Care. I have taken on board the
comments from CAG and amended the policy in line
with the request. The policy is on the agenda for the
resus committee on Monday 12th February and it will
then be taken to the next Operational Clinical Quality
Group’s for Health & Social Care. The wording used in
this policy is taken directly from ‘Decisions Relating to
Cardiopulmonary Resuscitation’. Guidance from the
British medical Association the Resuscitation Council
(UK) and the Royal College of Nursing (RCN) 3rd Edition
published by The Resuscitation Council (UK) (2016)
(attached).
Feedback & comments attached.
Chair
Final 2023 DNACPR
policyV2.pdf
Decisions Relating
To CPR.pdf
16/24
Radiology on call policy – For discussion
Radiology On Call
Policy.docx
17/24
AOB
Chair
Verbal
18/24
Date of next meeting:
Tuesday, 12th March 2024 @ 1700 hrs
Chair
Item
Subject
Discussion
Document (s)
No.
Lead
Attached
26/24
Apologies for Absence
Chair
27/24
Review notes/Matters arising from previous meeting
Chair
CAG Agenda DRAFT
notes.pdf
28/24
Review of Action Log
Chair
CAG Action Log
2024.xlsx
29/24
Emergency Brain Pathway Policy
Update of Primary Care Pathway by
& Markie Chestnut (MC)
/MC
Emergency brain
pathway FINAL draft 2
30/24
Amendment to Waiting List validation letter – to
include questions regarding patient current medical
status to assist Harm Review process
Presented by
31/24
Immunisation Committee
Covid vaccination associated ribosomal frameshifting &
Influence of seasonality vs PHIs on Covid
As per previous meetings this to be represented by
for discussion/action.
(Circulated in advance to CAG membership for feedback
with attendance from Public Health requested)
Public Health invited to CAG meeting.
COVID
vaccination-associated
influence of
seasonality vs PHIs o
COVID-19 vaccines &
AESI.pdf
32/24
Recommended Guidelines for Primary and Secondary
Care Interface
OE/JC
66.24b Interface
report.pdf
33/24
AOB
Chair
34/24
Date of next meeting:
Tuesday, 14th May 2024 @ 1700 hrs
Chair
Item
Subject
Discussion
Document (s)
No.
Lead
Attached
54/22
Apologies for Absence
Michele Moroney
Bala Venkitasamy
Andre Risha
Tentative
SA
55/22
Universal mask wearing in healthcare settings
Update
SA
56/22
CQC and Safe Prescribing- DMARDS/Cytotoxic in
particular
AC/JC
57/22
AOB
SA
58/22
Date of Next Meeting
29/06/22 @ 1630 hrs via Teams
Date of Next Meeting:
Wednesday, 21st September @ 1600 hrs?
SA
Item
Subject
Discussion
Document (s)
No.
Lead
Attached
38/22
Apologies for Absence
Ishaku Pam
Martin Rankin
Maria Bell
Juan Corkhill
Partha Vaiude
SA
39/22
Matters Arising from last meeting
(No minutes taken)
SA
40/22
‘Bouncing’ of referrals
JS
41/22
Rheumatology referral for possible Axial SpA
JS
42/22
Preferred day & time for future meetings
SA
43/22
AOB
SA
44/22
Date of Next Meeting
29/06/22 @ 1630 hrs via Teams
SA
Item
Subject
Discussion
Document (s)
No.
Lead
Attached
29/22
Apologies for Absence
• Ishaku Pam
•
•
• Martin Rankin (partial attendance)
• John Snelling
SA
30/22
Matters Arising from last meeting
SA
DRAFT CAG Minutes-
06Apr22.docx
31/22
Policy – Clinical guidelines for seeking second
opinion
SA
DRAFT POLICY
Clinical Guidelines for
32/22
Policy – Open & Upright MRI prior approval
SA
DRAFT POLICY for
Open & Upright MRI r
33/22
Job Planning
SA
34/22
New roles – Medical Directorate
SA
35/22
CD Role for diagnostics
SA
36/22
AOB
Updated Covid guidance
37/22
Date of Next Meeting
25/05/22 @ 1630 hrs via Teams?
SA
Item
Subject
Discussion
Document (s)
No.
Lead
Attached
73/22
Apologies for Absence
•
• John Snelling
• Adrian Dashfield
• Martin Rankin
SA
74/22
Matters arising from previous meeting
SA
75/22
Revised AGP List
Draft amended AGP
list.docx
76/22
Referral to Tertiary Care by GPs
SA
78/22
Second Opinion Policy
Final review prior to EMC
SA
Second Opinion
Policy (Draft).pdf
79/22
Upright MRI Policy
Final review prior to EMC
SA
Upright MRI Policy
(Draft).pdf
77/22
Nuclear Medicine Proposal
PV
77.22 Nuclear Med
Paper.pdf
80/22
AOB
SA
81/22
Date of Next Meeting:
Wednesday, 24August @ 1600 hrs
SA
Item
Subject
Discussion
Document (s)
No.
Lead
Attached
59/22
Apologies for Absence
• Venkitasamy Balakrishnan
• Maria Bell
• Ishaku Pam
• Martin Rankin
•
Tentative
• Vanina Finocchi
SA
60/22
Matters arising from previous June meetings
(Notes/Actions attached)
SA
CAG Notes with
presentation 07Jun22
CAG Actions
22Jun22.docx
60/22
NHS Update – Changes to mask wearing in
hospitals
SA
Key NHS
Updates.docx
61/22
NICE TA Access Scheme Commissioning Policy
NICE TA Scheme Standard Operating Procedure
(includes application form at Appendix 1).
Comments required in advance of
operationalization and ratification.
SA
NICE TA Access
Scheme Commissionin
NICE TA Access
Scheme Standard Ope
62/22
AOB
SA
63/22
Date of Next Meeting
06/07/22 @ 08:00 hrs via Teams
SA
Item
Subject
Discussion
Document (s)
No.
Lead
Attached
24/23
Apologies for Absence
•
•
• Dr Martyn Bracewell
• Dr Lakshman Paudyal
•
•
•
Chair
25/23
Review notes/Matters arising from previous meeting
Chair
DRAFT CAG Notes
15Mar23.docx
26/23
Review of Action Log
Chair
CAG Action Log.pdf
27/23
Waiting list validation paper
Waiting List
Validation Paper for
28/23
Golden Rules for review
( /Andre Risha)
AR
Golden Rules
V3.pdf
29/23
AOB
Chair
30/23
Date of Next Meeting
Wednesday, 17th May @1600 hrs
Chair
Item
Subject
Discussion
Document (s)
No.
Lead
Attached
113/22
Apologies for Absence
• Vanina Finocchi
SA
114/22
Matters arising from previous meeting
SA
Draft Notes CAG
Agenda 02Nov22.doc
115/22
Review of Action Log
SA
CAG Action Log.xlsx
116/22
Non portable venflons
117/22
Shared care protocols for memory clinic
- the use and monitoring of anti-dementia drugs
118/22
MGUS Patients
VB
HAEM_014_MGUS_G
uideline.pdf
119/22
ANP Referrals (Annmarie Cubbon)
AC
120/22
PPCI Paper (Will Bellamy)
WB
PPCI COG Paper.docx
121/22
AOB
SA
122/22
Date of Next Meeting:
TBC
SA
Item
Subject
Discussion
Document (s)
No.
Lead
Attached
86/23
Apologies for Absence
Chair
87/23
Review notes/Matters arising from previous meeting
Chair
DRAFT Notes CAG
22November23.docx
88/23
Review of Action Log
Chair
CAG Action Log
2023.xlsx
89/23
Medicines Policy Working Group
For information & involvement
SH
Manx Care
medicines policy wo
90/23
Discharge Issue - E-Discharge & TTO’s
For discussion and agreement
Verbal
91/23
AOB
• Covid Treatment Guideline
(See attached)
Chair
SH
91.docx
92/23
Date of next meeting:
Tuesday, 16 January 2024 @ 1700 hrs
Chair
Item
Subject
Discussion
Document (s)
No.
Lead
Attached
07/23
Apologies for Absence
• John Snelling
• Lakshman Paudyal
•
•
• Ishaku Pam
•
SA
08/23
Review notes/Matters arising from previous meeting
SA
DRAFT CAG
Meeting notes 18Ja
09/23
Review of Action Log
SA
07Feb23 CAG
Action Log.pdf
10/23
Referral letter DF
SA/
Referral letter
FENTON, Daniel (Mr)
11/23
Delirium Policy
SA
Pharmacological
Management of Deli
12/23
AOB
SA
06/23
Date of Next Meeting:
Wednesday, 15th March @1600 hrs
SA
Item
Subject
Discussion
Document (s)
No.
Lead
Attached
01/23
Apologies for Absence
• Lakshman Paudyal
•
•
•
• Vanina Finocchi
• Martin Rankin
•
•
Ishaku Pam will be late joining due to another
commitment.
SA
02/23
Review notes/Matters arising from previous meeting
SA
DRAFT CAG Notes
Dec22.docx
03/23
Review of Action Log
SA
CAG Action Log
18Jan23.pdf
04/23
Covid-19 treatment pathways for update
SH
MSN_2022_104
Remdesivir 100mg po
22-11 Clinical Guide
Therapies for patien
22-11 Clinical Guide
therapies for patient
22-11 Clinical Guide
therapies for sympto
05/23
AOB
Care Home staff COVID Outbreak PCR testing
proposed change
06/23
Date of Next Meeting:
Wednesday, 15th February @1600 hrs
SA
Item
Subject
Discussion
Document (s)
No.
Lead
Attached
47/23
Apologies for Absence
• Dr Ishaku Pam
•
• Dr Venkitasamy Balakrishnan
Chair
48/23
Review notes/Matters arising from previous meeting
Chair
DRAFT CAG Notes
June23.docx
49/23
Review of Action Log
Chair
CAG Action Log
13Jul.23.pdf
50/23
Off island referrals policy
(Emma Dancer & Peter Hannay)
For information / discussion
ED/PH
Off Island Referrals
Software System.doc
51/23
Patient Access Policy
For final ratification
Manx Care's Patient
Access Policy for Elec
Clincal Advisory
Group 21.6.23.pptx
52/23
Covid-19 treatment guidelines
For discussion
SH/
23-05 COVID
Guidance 4-1.docx
53/23
Use of cannabis based medicines in acute care SOP
has provided some narrative ahead of
the meeting:-
In consideration of the document, would the Group
address the following specific questions:
1. I think the Controlled Drug Accountable Officer (CDAO)
should be informed when a patient is prescribed a licensed
cannabis based medicinal product. I think the CDAO role is
being undertaken by Marina. If Marina is to be informed of
these situations, how should the communication be made?
2. If a patient is self-medicating a non-licensed cannabis
based medicinal product (the final box in the flowchart),
should the CDAO also be informed of this?
3. Does the Group agree with the funding position as
described within the yellow box on p5? If not, could they
suggest a form of words to replace this line?
4. The position as described is that if a patient has their
own unlicensed product, the fact that they use it is
recorded (not prescribed) on the chart, and the patient will
be allowed to self-medicate if they wish. Do the Group
agree with this approach, and if not can they describe their
preferred mechanism to allow me to redraft it?
SH/
23-07 v2-1 Manx
Care Acute Approach
54/23
Result of vote for change of meeting day/time
10 responses received:
7 in favour and 3 against
Chair
55/23
Date of next meeting:
TBC
Item
Subject
Discussion
Document (s)
No.
Lead
Attached
40/23
Apologies for Absence
•
• Dr Lakshman Paudyal
•
• Sadha Punniyakodi
•
• Rehana Zaman
•
• Dr John Snelling (partial attendance)
•
Chair
41/23
Review notes/Matters arising from previous meeting
Chair
DRAFT CAG Notes
17May23.docx
42/23
Review of Action Log
Chair
CAG Action Log
19.06.23.pdf
43/23
Patient Access Policy
Manx Care's Patient
Access Policy for Elec
44/23
Private Practice referrals into Manx Care
(Marina Hudson)
MH
45/23
Kesimpta Pathway approval
(Heidi Morris)
Chair
Manx Care
ofatumumab (Kesimp
46/23
AOB
Proposal to change day/time to Thursdays at 5pm
Voting email to be distributed to CAG membership
Chair
Item
Subject
Discussion
Document (s)
No.
Lead
Attached
14/23
Apologies for Absence
•
•
•
• Lakshman Paudyal
•
•
•
• John Snelling (Tentative)
•
SA
15/23
Review notes/Matters arising from previous meeting
SA
DRAFT CAG Notes
Feb23.docx
16/23
Review of Action Log
SA
CAG Action Log.pdf
17/23
Advice & Guidance Policy
Advise and Guidance
Policy Manx Care.draf
18/23
Joint Protocol
SA
230104 Agenda Item
9.23 Joint Protocol.pdf
19/23
Off licence Tenectaplase use for Stroke Thrombolysis
Verbal
20/23
Child Death
Verbal
21/23
Biosimilar Policy
biosimilar-policy-doc
ument-ver-2.pdf
22/23
AOB
SA
23/23
Date of Next Meeting:
Wednesday, 19th April @1600 hrs
SA
Item
Subject
Discussion
Document (s)
No.
Lead
Attached
31/23
Apologies for Absence
•
• Dr Ventikasamy Balakrishnan
•
•
• Tammy Hewitt
Chair
32/23
Review notes/Matters arising from previous meeting
Chair
DRAFT CAG Notes
19Apr23.docx
33/23
Review of Action Log
Chair
CAG Action Log
15.05.23.pdf
34/23
Patient Access Policy
For introduction ahead of the meeting in June.
Narrative from to assist in her absence at this
meeting:
“You will know that each NHS Trust in England are required
to have an established Patient Access Policy, which outlines
the roles and responsibilities of each stakeholder involved in
a patient’s elective care pathway. Manx Care introduced its
first Patient Access Policy for Elective Care in October 2021,
with an initial review date of 2023. However with the
implementation of the Performance and Improvement
team, one of its first tasks was to review and update the
policy and bring it more in line with Manx Care and the Isle
of Man’s unique requirements.
I have built on the initial document (which I can provide if
required) and my intention is to show a patient’s referral
journey end to end, how Manx Care will manage referrals,
including referral routes, offering appointments, DNAs
etc. I have included information and links around how the
IOM’s legislation affects certain patients, eg veterans, non-
residents, private, patients being referred off-island, etc.
Manx Care's Patient
Access Policy for Elec
It has been reviewed by a myriad of people, with an
expectation that we will all start working towards its
implementation. In saying that, I am totally appreciative of
the issues we face at Manx Care, but we do need to show
our responsibilities and expectations around access to
elective care for all parties.
I have also created a quick read version (again, available if
you would like a copy), which has been through Comms and
MCALs, which needs a final review and which will be made
available publicly.
It is still a working document, so please do not share until is
it finalised.
has given me to have a slot at June’s Clinical Advisory
Group, so I would appreciate it if you could read through
this document before then, and let me have your feedback
in June. In the meantime, feel free to ask any questions or
queries.”
35/23
Isle of Man Ambulance and Aeromedical Services
EMC Draft paper for socialising ahead of EMC 26/5/23
(Tammy Hewitt)
TH
EMC Draft Paper
26052023 - Isle of Ma
36/23
Private Practice referrals into Manx Care
(Marina Hudson)
MH
37/23
Terms of Reference
Chair
Terms of Reference
Senior Clinical Advis
38/23
AOB
Updated Golden Rules for agreement
Chair
2023-05-15 Golden
Rules approved V3.d
39/23
Date of next meeting:
Wednesday, 21st June @ 1600 hrs
Item
Subject
Action by:
No.
19/24
Apologies for Absence
•
•
• Dr Rohit Peshin
• Dr Dave Hedley
• Dr Venkitasamy Balakrishnan
•
•
•
•
20/24
Review notes/Matters arising from previous meeting
Meeting notes approved
CAG Notes
14.02.24.pdf
21/24
Review of Action Log
Action log reviewed and updated:
Invite Caryn Cox of Public Health
CAG Action Log
2024.xlsx
23/24
Emergency Brain Pathway Policy
Presented by & Markie Chestnut (MC) for
agreement.
The pathway was created in conjunction with The Walton Centre and is
already approved by neurosurgeon
and also the Cancer Triumvirate in Manx Care. The aim of the pathway
is to provide a good standard of management for patients presenting
with suspected primary and secondary brain tumours in the acute
setting, ie A&E. The lack of a formalised pathway has resulted in delays
in appropriate MDT discussions and onward treatment.
MB feels the policy should be actioned in Primary Care, not just A&E. It
should be disseminated to colleagues in Primary Care.
For a policy to be agreed we should address the wider issues including
the use/interpretation of the 2-week wait pathway and neural tumours.
JS is in agreement with MB, as many patients present initially in primary
care. It would be an opportunity to broaden the presentation in
primary and community care.
MC acknowledged that there is a gap with Primary Care and are
currently trying to find a solution. This will be a topic under discussion at
GP cancer day meeting tomorrow (13Mar24)
requested clarification of the pathway referring to parenchymal and
not to be used for pituitatry/skull based. He also felt it was important
something was in place soon.
agreed that this would be addressed and advised that
from the Walton Centre will provide education for Emergency Dept
staff.
It was agreed in principal to roll pathway out in secondary care as it
specifically relates to secondary care. At the GP’s meeting 13Mar24 a
pathway will developed for primary care.
to update at next CAG meeting.
Emergency brain
pathway FINAL draft 2
24/24
Immunisation Committee
Covid vaccination associated ribosomal frameshifting & Influence of
seasonality vs PHIs on Covid
As per previous meeting this to be represented by
for discussion/action.
(Circulated in advance to CAG membership for feedback)
A detailed summary provided by regarding the 3 papers in question
that have appeared over last 3 months.
One is a collaborative study looking at possible mechanisms for side
effects of Covid 19 vaccines, i.e. off target immune responses. Publicity
influence of
seasonality vs PHIs o
COVID-19 vaccines &
AESI.pdf
COVID
vaccination-associat
around the paper is that the mechanism is to be improved in future
vaccines. This improvement not yet done. It is not publicised that up to
1/3 will be off target immune responses which may be auto immune
responses.
Another paper is an epidemiological study on how much seasonality
could affect morbidity and mortality from Covid-19.
The remaining paper is concerning evidence of vaccine safety and
efficacy however the data reports a number of serious adverse events of
interest including, myocarditis, pericarditis, brain damage and Guillain
Barre syndrome.
It was agreed to roll over to next meeting for further discussion
and bigger audience, including Public Health, to determine how
to use this information.
AOB
Heparin protocols
MH read out correspondence from
regarding unfractionated heparin prescription and administration charts
for information. The protocols are currently being updated and advice
is to search via Sharepoint for current information.
IMOG & Medicines Policy
MH requested participation and opinions on the Medicines Policy that
will be ratified at IMOG in the next 2 months. Volunteers needed from
Medicine to be involved in Medicines Management policy and these can
be Associate Specialist or non-medical prescribers.
IP to discuss further with Maria Bell and advise
IP
25/24
Date of next meeting:
Wednesday, 17th April 2024 @ 1600 hrs
Item
Subject
Discussion
Document (s)
No.
Lead
Attached
56/23
Apologies for Absence
• Dr Marina Hudson
•
• Dr Sadha Punniyakodi
Chair
57/23
Review notes/Matters arising from previous meeting
Chair
DRAFT CAG Notes
July23.docx
58/23
Review of Action Log
Chair
CAG Action Log
13Sep23.pdf
59/23
IT and operational performance data analytics
Verbal
60/23
Role, remit and responsibilities of the Clinical Service
Lead – for update & discussion
Verbal
61/23
Joint care arrangements – for update & discussion
Verbal
62/23
Medical Gas Policy
SH/
Medical Gas policy
2023 ManxCare ver d
63/23
Treatment Escalation Plan Standard Operating Policy
To Follow
64/23
AOB
65/23
Date of next meeting:
Wednesday, 18 October 2023 @ 1600 hrs
Item
Subject
Action By
No.
Apologies for Absence
•
•
•
• Vanina Finocchi
• Martin Rankin
•
•
•
•
•
02/23
Notes of last meeting approved
CAG Notes
Dec22.docx
03/23
Review of Action Log
Updates provided and Action Log revised accordingly
07Feb23 CAG
Action Log.pdf
04/23
Covid-19 treatment pathways for update
presented the attached recommended pathways for Covid-19 patients. One of
the hospitalised pathways requires use of the drug Baricitinib. CAG was requested
to approve holding stock of this drug specifically for Covid treatment in patients in
CCU developing pneumonia. The drug needs to be available should a consultant
decide to commence this treatment pathway, as per the guidelines.
MSN_2022_104
Remdesivir 100mg p
IP confirms this would only be for patients at critical care level. This is becoming
increasingly rare.
also highlighted that recommendations for treatment in the community have
changed. Sotrovimab is definitely fourth line but we did use quite a lot of this in
December. Molnupiravir is third line and was used more often over the xmas period
as patients did not need to come in for injection. (Not as effective as remdesivir.)
has circulated the Manx policy for feedback.
Actions/Agreed:
1 x dose Baricitinib to be held in stock (for Covid treatment only) to cover
possible weekend requirement.
Pharmacy will publish updated pathway guidelines unless feedback
received.
22-11 Clinical Guide
Therapies for patien
22-11 Clinical Guide
therapies for patien
22-11 Clinical Guide
therapies for sympto
SH/Pharmacy
/Pharmacy
05/23
AOB
Medical Gas Group
intends to resurrect this Group and she will Chair. Medical representation is
required so a volunteer would be appreciated. Meetings are quarterly.
Adrian Dashfield identified as a candidate.
Care Home staff COVID Outbreak PCR testing proposed change
The UKHSA guidelines state PCR testing for outbreaks in care homes but staff are not
complying. The IPCC team is therefore asking for approval to use LFTs instead.
in agreement.
agreed LFTs sufficient though it would beneficial to run this past who
does the PCRs.
Actions/Agreed:
LFTs can be used by staff in care homes
to be asked about false positive rates
raised concerns regarding an issue recently experienced with discharge
summaries and the suggestion to use Medivewer, just wanted to make sure this is
not CAG approved.
SA advised this has been passed on to and Chief Clinical Information
Officer (Gregor Peden) for investigation.
Action:
Update to WC upon response from Gregor Peden
Equality, Diversity & Inclusion (EDI)
SA provided an update regarding EDI strategy and request for EDI champions.
Intention to start reverse mentoring, start networks and establish network leads to
form a forum.
Workforce & Culture teams have been requesting completion of personal details on
PiP to have accurate data. Encourage all to complete personal details.
/IPCC
/IPCC
SA
06/23
Date of Next Meeting:
Wednesday, 15th February @1600 hrs
Item
Subject
Action by:
No.
8/24
Apologies for Absence
Dr Ishaku Pam
Dr Rohit Peshin
Dr Dave Hedley
Dr Lakshman Paudyal
Dr Sadha Punniyakodi
9/24
Review notes/Matters arising from previous meeting
Meeting notes approved
10/24
Review of Action Log
Action log reviewed and updated
CAG Action Log
2024.xlsx
11/24
Immunisation committee
Two papers presented by for information.
The summary of findings in the first paper is a projection that approx. 1/3
people who have been in receipt of an MRNA vaccine for Covid-19 have off
target immune responses. Therefore they propose a new way of designing
MRNA vaccines but this has not yet been implemented.
The second paper is a collaborative study that looked at factors influencing
prevalence of Covid-19 infection over the last 2-2.5 years. It shows that
vaccination had little impact regarding Covid infection.
In summary these papers show the vaccination:
A) Does not move needle of infection
B) One third people develop off target response
questions whether this gives grounds for re-thinking Covid-19
vaccination program?
commented that the vaccine is not as effective as expected. We have
always followed JCVI perhaps we should put this question to them?
advised that the Covid-19 review recommended that decisions regarding
vaccination are island specific with a group to be formed. We are ahead of
JCVI in considering this new data.
MH felt it would be better to have a wider view from the group
Carry over for next CAG
LC to ask people to bring comments.
COVID
vaccination-associate
influence of
seasonality vs PHIs on
12/24
Pathology Audit report
Presented by on behalf of the Clinical Audit
Committee. There were points raised in the report that were thought
worthy of being escalated to CAG on basis of patient safety. E.g. number of
rejected specimens and issue with histology reporting.
confirmed that this report was also presented at the Patient Safety
Summit by and some actions have been addressed. When
comparing against similar hospitals we are quite a way off in terms of
transfusion rejections – none in double figures and we are 11%.
MH advised that there is an action plan in place, with some actions already
undertaken.
will check with on the outstanding actions and
provide an update for the next meeting
055SEP22 3YC PATH
2022-25 Core Audit -
13/24
TLS Policy
Dr Balakrishnan (VB) presented the policy for agreement/ratification.
The policy has been updated and circulated. There have been discussions
with CCU and ITU who have agreed for these patients to be admitted firstly
to ICU, then ITU with last resort being a medical bed with telemetry
facilities.
All parties involved have been consulted and have agreed to the policy.
Apart from the document format there were no concerns and the policy
was approved by the group.
VB to arrange for the policy to be uploaded into Manx Care format
before being uploaded to the intranet.
Noble's TLS Policy
Jan 2024.docx
VB
14/24
End of Life Care CQC Actions
MH provided an update.
Dr Needham will be lead for Palliative Care and with her colleague, Cheryl
Young, will be setting up task and finish group to help and implement the
EoL CQC actions. CQC had been impressed with what hospice have put in
place.
Main action required is for Clinical Directors to ensure sure some of the
audits take place in the Care Groups. MH has recommended they work
with Associate Specialist and Specialist Doctors rather than over loading
consultants.
15/24
DNA/CPR Policy
Following additional information provided the group agreed this policy.
16/24
Radiology on call policy
requested comments on the Radiology On-
call policy. This has been drawn up collectively by Radiologists to avoid
unnecessary contact out of hours by Junior Doctors, so that the patients
Consultant must be fully aware and available.
MH agreed that compulsory consultant to consultant discussion is a
welcome decision.
advised the policy has been circulated to the CDs and the PCN
MM to put on intranet in Manx Care format.
Radiology On Call
Policy.docx
AOB
advised he is waiting to speak with Public Health about
Research.
MH confirmed she raised this at ELT but with the current funding
situation we may not be able to fund next year. However it’s
importance was agreed.
raised an issued relating to patient discharge, whereby
Consultants only issue a 7-day prescription, with follow up to GP-
however letter not received in time.
JS thought this related to a long standing, historical problem
to clarify and get support for GP’s to take to CD’s
SMc
17/24
Date of next meeting:
Wednesday, 12 March 2024 @ 1700 hrs
Review of Action Log
Updates provided:
011/23 Delirium Policy
IP to engage with other stakeholders – this is expected to take about 8
weeks for ratification
CAG Action Log.pdf
IP
012/23 GP Summit meeting
SA provided update of the work being done by Teresa, Annmarie &
Oliver Ellis for Primary Care at Scale. It was agreed that the proposed
Summit meeting should still go ahead.
SA
17/23
Advice & Guidance Policy
presented the draft policy. This had been drawn up to formalise the
approach of Advice & Guidance and to provide a uniform specialist
service to clinical problems to the non-specialist. The service will be
between primary and secondary care and will be embedded in a
governance structure.
Due to lack of representation at the meeting by GP’s JS requested that
this document be distributed to & Oliver Ellis for further
comment. Some concerns regarding legal responsibility already raised
and confirmed this will be written in to the policy.
MB suggested that some of the on-Island speciality consultants follow a
practice they have at the Walton Centre whereby dedicated time is
given by a consultant each lunch time when GP’s can make contact for
relevant advice/signposting.
IP raised possible issues with job planning/pa’s, audit trail and demand
management (particularly for single handed specialities).
To move the process forward it was agreed that JS will arrange for to
discuss at a GP discussion meeting.
SA noted the importance of getting this policy right, with time being
allocated accordingly in job planning.
Advise and
Guidance Policy Man
JS
18/23
Joint Protocol
SA presented the draft joint policy with police & coroner regarding
notification of deaths. This is still a work in progress so it is presented to
CAG for information purposes only.
suggested that for item #29 it would be beneficial to include a
clinician relevant to the case in the incident group.
IP clarified the thinking during the protocol meeting and felt there was
latitude to cover this concern.
After further discussion it was agreed to pursue this concern
230104 Agenda
Item 9.23 Joint Proto
SA
19/23
Off licence Tenectaplase use for Stroke Thrombolysis
outlined current situation regarding supply of Tenectaplase and
Altaplase. It has been identified that there is a risk to run out of
Altaplase in the next 3 months. There has been a discussion as to
whether Tenectaplase can be used for Ischemic strokes as a
thrombolytic agent. It was agreed this was a possibility with preferable
dosage of 0.25 mgs/kg. Studies now support this as effective and just as
safe as Altaplase. Liverpool Stroke are happy to authorise this use as
long as our CAG team approve the off licence use of Tenectaplase in
worst possible scenario and there is nothing else to use. Important that
we have this in mind as a policy in case we do run out of Altaplase.
20/23
Child Death
SA provided an update on the Child Death policy for information and
awareness to CAG.
Following 2 child deaths from asthma a few years ago the review panel
came up with a lot of recommendations.
We are in the process of implementing those recommendations with
90% now done with the Paediatric Department working to finalise.
21/23
Biosimilar Policy
presented this policy which is for alternatives to originated drugs
for cost savings. (Cost Improvement Program). The idea being
biosimilars are equally effective to biologics and people should be using
them more.
Asking CAG if they are happy with this policy or if amendments
required?
SA confirmed there is no opposition to the policy itself, it is mainly
operational barriers, with no one to lead on gastroenterology being the
biggest problem.
After discussions with IP it was identified that information for
Gastroenterolgy could be gathered through Dr Rakesh Aga and Nurse
Practitioner Greg Manning.
ACTION
Organise meeting between / SA/ IP with , Dr Aga
and Greg Manning.
biosimilar-policy-do
cument-ver-2.pdf
SA /
22/23
AOB
10/23 Referral letter DF
SA brought back to CAG this item from 15Feb23 meeting due to further
debate being required. He re-presented the issue and requested views
from CAG on whether they accept that Primary Care physicians cannot
refer patients directly to Tertiary Care without the approval of
Secondary care, especially if regarding patient choice rather than
clinical choice.
It was clarified that a second opinion should be sourced on island and
enabled by the first consultant. A GP should not be allowed to refer off
Island.
IP commented that the Second Opinion Policy should answer any
questions. He also informed that through the Off Island Referral Group
he has details from Jersey of a ‘referral management system’ that will
provide an audit trail for funding. An example was given by SA/ of a
referral issue in Opthalmology due to no audit trail.
ACTION
Information regarding ‘referral management system’ from Jersey to be
provided to SA
IP
23/23
Date of Next Meeting:
Wednesday, 19th April 2023
Item
Subject
Action by:
No.
1/24
Apologies for Absence
• Dr Ishaku Pam
•
•
2/24
Review notes/Matters arising from previous meeting
Meeting notes approved
3/24
Review of Action Log
Action log reviewed and updated
CAG Action Log
2024.xlsx
4/24
Final DN CRP Policy
Provided by for information – he is unable to attend this meeting
but advises the wording has been amended in 2.9
SMc asked for clarification if this is an interim policy. MH impressed that
this must first be agreed and signed off and then End of Life Care needed to
be looked at, of which this is part of.
Need to check the highlighted point 6.5 to ensure the correct edit.
It was agreed to recirculate, invite comments and bring it back to the next
meeting.
Circulate End of Life action Points
Final 2023 DNACPR
policyV2.docx
05/24
Advice & Guidance Policy
updated. Gregor Peden in the process of developing a Sharepoint which
is being used as a template. 3 groups (acute oncology, respiratory and
Michele Maroney) are going through a several month trial of using this.
Will be audited before being rolled out to the whole hospital.
RP questioned if Sharepoint is robust enough for everyone to access.
Expressed concerns that, Medway for example, is prone to crashing.
gave reassurance that it would be audited and feedback gained before
being rolled out which JS backed.
will update the group when she has more information.
06/24
AOB
MH: End of Life
Currently no Palliative Lead means we have been unable to make traction
which CQC requirements. Cancer Lead is Dr Needham.
JS identified the parallel between Hospice Cancer Lead and Palliative Care
Lead. JN: A number of meetings held between Hospice, Dr Pam and other
nominated members but the group is not yet at ‘next level’. Hospice have
provided documentation to help with CQC plan and it has been agreed that
Dr Pam would be taking the role of Palliative Lead within Nobles. JN
confirmed that she would be happy to take on Palliative Lead, but from May
she is taking over as Medical Director of Hospice and stepping back from GP
Cancer and palliative role. JN stated that her view is that currently Palliative
Care is in greater need than Cancer Services as there is nothing for this. MH
asked JN to consider taking in the role as Palliative Lead for Manx Care and
gave her backing. Hospice were outstanding in their CQC, Manx Care could
learn a lot from them, JN could bring the two together.
JN to discuss with Hospice CEO
JN and MH to take conversation offline
MH: Medicines Management
Encouraged all to think about what they wanted to bring to the policy as it
will be reviewed in 3 months. Active working group now looking at this
policy. Policy to come back to CAG before sign off.
Research.
Governance side needs to be addressed, something to think about. MH to
bring up at ELT next week and bring back to CAG for further discussion.
identified 2 urgent areas for Manx Care to focus on: 1) R&D Policy, 2) How
to handle Money which comes through commercial research. to
produce a draft of these for the next meeting. there is a research and
ethical committee, Rebecca Rowley runs RND side.
to draft 2 policies and bring back to CAG
to speak to Rebecca Rowley
JN
JN/MH
07/24
Date of next meeting:
Wednesday, 14 February 2024 @ 1600 hrs
Item No.
Subject
Action By:
31/23
Apologies for Absence
•
• Dr Ventikasamy Balakrishnan
•
•
32/23
Notes of last meeting approved
CAG Notes
19Apr23.docx
33/23
Action Log reviewed and updated
CAG Action Log
17.05.23.pdf
34/23
Patient Access Policy
Details presented for noting and discussion at the next meeting when
will be in attendance.
Manx Care's Patient
Access Policy for Elec
35/23
Isle of Man Ambulance and Aeromedical Services
OR presented the proposal to bring various patient transport services
(ambulance, Bus Vannin, Loganair for patient transfer, air ambulance,
GNAAS/HEMS) currently operating under different departments, into
one service area.
The aim is to develop relationships with tertiary centres and improve
the tracking of patients referred off island to assess whether some
EMC Draft Paper
26052023 - Isle of M
points of their care can be done here or virtually. (eg diagnostic testing,
follow up appointment via telemedicine).
Therefore this proposal will bring all these services under one roof and
will sit outside the formal care group structure. Tammy Hewitt will be
the manager with Will Bellamy as AHP with a new Clinical Lead to be
appointed.
WB explained one of the reasons for this combined service is to make it
more streamlined and fit for purpose with a good clinical governance
structure, due to interaction with all areas from primary care to tertiary
care.
OR further advised that any risks to services have been addressed
within the paper. The existing Urgent and Emergency Integrated Care
Board (UICC) is to be expanded to include other urgent services to
become an integrated group and mitigate risks.
TH explained that tertiary care would benefit as it will have closer links
to the air ambulance team/services with better, all rounded clinical
oversight. There is also the potential for economies of scale in terms of
resourcing.
In summary it won’t be a formal care group but It will have a
governance structure like a care group, with a triumvirate of
professional clinical director and a manager. This will actually
strengthen the position of the service within the organisation.
CAG is supportive of this paper/initiative and happy for this to be
taken forward.
36/23
Private Practice Referrals into Manx Care
Rolled forward to June meeting as Marina Hudson was unable to
attend.
37/23
Terms of Reference
The existing terms of reference were reviewed.
• Membership to be updated with correct terminology of titles
• Public Health to be represented
IP
38/23
AOB
Updated Golden Rules for agreement
After discussion at the previous CAG meeting amendment was needed
to incorporate the requirement that referrals from ED to Specialties
need to come from a senior decision maker so that they have been
vetted accordingly. has now added that provision.
CAG approved this amended paper
2023-05-15 Golden
Rules approved V3.d
39/23
Date of Next Meeting: Wednesday, 21st June 2023
Item No.
Subject
Action By:
24/23
Apologies for Absence
•
•
• Dr Martyn Bracewell
• Dr Lakshman Paudyal
•
•
•
25/23
Notes of last meeting approved
CAG Notes
15Mar23.docx
26/23
Review of Action Log
Updates provided and Action Log updated accordingly
19Apr23 CAG
Action Log.pdf
27/23
Waiting list validation paper
Paper presented by The Validation Team has been set
up as part of Restoration and Recovery. Their purpose is to
validate/baseline referrals on waiting lists as there are a lot that should
not be included. This also links in with harm review, for patients who
have waited over 52 weeks.
Data is obtained from the hospital dashboard. First of all the referral is
technically validated then the team writes to each patient to obtain
feedback as to whether they still need to be on the waiting list. The
Waiting List
Validation Paper for
reason for this presentation is to agree a clinical validation process
before removing any referrals from waiting lists.
• department is on top of waiting list issue so agreed not to
contact any patients on those lists.
• asked if anything in place to prevent the backlog building up
again. informed that there are work streams in place to take
this forward but these can only start once this first piece of the
jigsaw is completed.
• clarified with that the Validation Team were requesting
agreement from CAG for patients to be removed from lists
when they fall into the categories identified (Waiting List
Validation Team).
• confirmed appropriate governance and systems in place and
criteria can be tweaked by speciality if required. For DNA’s and
cancellations we will show reasonableness and if anyone
complains there will be a process in place where the patient can
go back to where they were.
• advised they (GP’s) do not need to know about cancelled
outpatient appointments only discharges. It would be useful to
use the NHS Spine system but advises it is a one way flow of
information though she will investigate further.
In conclusion CAG agrees the validation proposals – will make this a
more robust document with governance /SOP and return to CAG.
Clinical validation options were then discussed.
• in favour of additional clinics to get through the waiting lists
rather than to validate clinically.
• advised it is difficult to find an effective screening pathway in
orthopaedics as examination is required. Contacting all
patients on their lists would be a huge task.
• AR advised general surgery are doing a lot of extra weekend
clinics and virtual clinics and this seems to be successful
To conclude will send the question to care groups for discussion at
the care group triumvirate and obtain feedback. IP & will work on
wording offline.
28/23
Golden Rules for review
IP explained that the ED is set up to process approx. 80 patients a day.
Over 100 it is not possible to see any others in the waiting room for
prolonged periods, therefore causing delays. The Golden Rules were
agreed to help improve flow through ED and are used as a guide for
doctors, particularly when out of hours. One of the main points is
regarding speciality referral and reviews with expectation that on call
doctors see referrals within half an hour. Whoever has received the
referral then has responsibility to refer to another speciality of not
appropriate to them.
AR requested this be discussed at CAG. Problems are arising when
Junior Doctors are referring unnecessarily. This should be a referral
from a Senior ED Doctor (Middle Grade or above) who has examined
the patient.
It was agreed that a separate point on the Golden Rules should state
that ED referrals are seen or vetted by the Senior Decision Maker in
the Emergency Department.
Item to be kept on the agenda as IP to discuss with
before finalising.
29/23
AOB
asked if it was time to re-visit the Terms of Reference for the CAG as
there have been changes to purpose and format over the last few years.
to circulate the existing TOR for consideration before discussion at
the next CAG meeting.
30/23
Date of Next Meeting:
Wednesday, 17th May @ 1600 hrs
Item
Subject
Action by:
No.
19/24
Apologies for Absence
Dr Rohit Peshin
Dr Dave Hedley
Dr Venkitasamy Balakrishnan
20/24
Review notes/Matters arising from previous meeting
Meeting notes approved
CAG Notes
14.02.24.pdf
21/24
Review of Action Log
Action log reviewed and updated:
Invite Caryn Cox of Public Health
CAG Action Log
2024.xlsx
LC
23/24
Emergency Brain Pathway Policy
Presented by & Markie Chestnut (MC) for
agreement.
The pathway was created in conjunction with The Walton Centre and is
already approved by neurosurgeon (Walton Centre)
and also the Cancer Triumvirate in Manx Care. The aim of the pathway
is to provide a good standard of management for patients presenting
with suspected primary and secondary brain tumours in the acute
setting, ie A&E. The lack of a formalised pathway has resulted in delays
in appropriate MDT discussions and onward treatment.
MB feels the policy should be actioned in Primary Care, not just A&E. It
should be disseminated to colleagues in Primary Care.
For a policy to be agreed we should address the wider issues including
the use/interpretation of the 2-week wait pathway and neural tumours.
JS is in agreement with MB, as many patients present initially in primary
care. It would be an opportunity to broaden the presentation in
primary and community care.
MC acknowledged that there is a gap with Primary Care and are
currently trying to find a solution. This will be a topic under discussion at
GP cancer day meeting tomorrow (13Mar24)
requested clarification of the pathway referring to parenchymal and
not to be used for pituitatry/skull based. He also felt it was important
something was in place soon.
agreed that this would be addressed and advised that
from the Walton Centre will provide education for Emergency Dept
staff.
It was agreed in principal to roll pathway out in secondary care as it
specifically relates to secondary care. At the GP’s meeting 13Mar24 a
pathway will developed for primary care.
MT to update at next CAG meeting.
Emergency brain
pathway FINAL draft 2 023.
24/24
Immunisation Committee
Covid vaccination associated ribosomal frameshifting & Influence of
seasonality vs PHIs on Covid
As per previous meeting this to be represented by
for discussion/action.
(Circulated in advance to CAG membership for feedback)
A detailed summary provided by regarding the 3 papers in question
that have appeared over last 3 months.
One is a collaborative study looking at possible mechanisms for side
effects of Covid 19 vaccines, i.e. off target immune responses. Publicity
influence of
seasonality vs PHIs on
COVID-19 vaccines &
AESI.pdf
COVID
vaccination-associate
around the paper is that the mechanism is to be improved in future
vaccines. This improvement not yet done. It is not publicised that up to
1/3 will be off target immune responses which may be auto immune
responses.
Another paper is an epidemiological study on how much seasonality
could affect morbidity and mortality from Covid-19.
The remaining paper is concerning evidence of vaccine safety and
efficacy however the data reports a number of serious adverse events of
interest including, myocarditis, pericarditis, brain damage and Guillain
Barre syndrome.
It was agreed to roll over to next meeting for further discussion
and bigger audience, including Public Health, to determine how
to use this information.
AOB
Heparin protocols
MH read out correspondence from
regarding unfractionated heparin prescription and administration charts
for information. The protocols are currently being updated and advice
is to search via Sharepoint for current information.
IMOG & Medicines Policy
MH requested participation and opinions on the Medicines Policy that
will be ratified at IMOG in the next 2 months. Volunteers needed from
Medicine to be involved in Medicines Management policy and these can
be Associate Specialist or non-medical prescribers.
IP to discuss further with Maria Bell and advise
IP
25/24
Date of next meeting:
Wednesday, 17th April 2024 @ 1600 hrs
Matters arising from previous meeting
MM present but not recorded - corrected minutes attached
SA – extend invitation to CAG to other colleagues?
Yes all in agreement
CAG Notes
27Jul22.docx
84/22
85/22
GP Prescribing
CQC and Safe Prescribing- DMARDS/Cytotoxic in particular
&
Shared Care
https://www.england.nhs.uk/medicines-2/regional-medicines-
optimisation-committees-advice/shared-care-protocols/
SA outlined the issue with shared care where certain drugs initiated by
secondary care need to be continued in the community by primary care.
BMA guidance attached for reference together with a link to the most
relevant section provided by
Fundamentally, primary and secondary care need to work together but the
pathways are not very clear.
New pathway work is being done and hopefully when complete this will
help.
In meantime this should not be a reason why we cannot work with our
primary care colleagues and why we cannot work towards the pathway.
SA proposed that individual specialists, with specialist drugs send their
pathways to CAG for ratification.
- Important issue is safe prescribing. We need a monitoring timescale
and the ability to go back if there are issues. GMC guidelines very clear. CQC
monitoring these situations.
Shared care is great but it needs to be agreed and understood. We are
raring to go as long as safe, appropriate and resourced.
SA - Propose we select individual drugs where shared care is available.
Clinician or specialist who wants a shared care policy to write up pathway
and bring to CAG on individual basis.
MB – offered assistance of her team as they have experience and existing
documentation to help.
JS - Principle of shared care good and we all agree that it can work. Agree
CAG should be conduit through which drawn up pathways are passed.
Needs to be looked in a representative way by GP body - is the way
through.
After discussion it was agreed that suggested pathways could be brought to
CAG and then signposted to the relevant Group/Committee.
ACTION – pathways
All CAG
members
86/22
Decision making pathway for management of patients being tested for
MPX
DM presented pathways for ratification – as per attached
1) Process for positive MPx result from lab.
2) Decision making pathway for management of patients being tested
positive for MPx
also informed they are due to launch vaccination programme and will
keep CAG updated.
Agreed unanimously.
Decision Making
Pathway for Managem
87/22
Cannabis
SA – Expressed his concerns on issues that could arise now that IOM
Government has agreed to license the use of medicinal cannabis. What will
happen for example if patients are admitted and then ask for their
cannabis? We do not know the rules, how to monitor, if any SOP in place.
We need to be aware. How do we deal with this risk? Please discuss in your
own forums.
MB advised a paper has been prepared and is with Manx Care Execs, ie
whether to allow in patient settings, residential/care homes etc.
Also working on some overview guidance for clinicians. Pilot project due to
start in Karsons Pharmacy to dispense private prescriptions only. Somewhat
surprised that a private medicinal cannabis clinic is opening – this issue
sitting with DHSC as to how to engage and manage that organisation.
ACTIONS: Update at the next meeting.
MB
88/22
AOB
• Withdrawal of mandatory mask wearing
SA felt time is right to step down from mandatory aspect of mask wearing -
no real rise of infections here or UK
supported this argument - we are doing 300-350 swabs per week with
return of around 10 positives and under 50 positives in last 6 weeks.
Objections received from IP in relation to MGP visitors, and with
concerns of staff sickness.
It was therefore agreed to continue with mandatory mask wearing and
review again in a few weeks’ time.
• Regular meeting day/time
No objections to late afternoon on Wednesdays so this will continue
SA
89/22
Date of Next Meeting:
Wednesday, 5th October @ 1600 hrs
Item
Subject
Actions
Document (s)
No.
Attached
73/22
Apologies for Absence
•
• John Snelling
• Adrian Dashfield
• Martin Rankin
•
• Adrian Dashfield
74/22
Matters arising from previous meeting
/ provided an update on Monkeypox
• 2500 UK cases
• Diagnostics being performed
• Some changes in case definitions
• No cases to date in IOM
• Update of pathway will be sent to CAG for distribution.
• Downgrade of biological samples & waste to be treated
same as other contagions
• Vaccines – 40 available with 20 reserved for staff (GUM)
75/22
Revised AGP List
- advised that had revisited the list In line with direction
from UKHSA as to what is included/removed from list.
There has been removal of certain procedures so our list here
has been reviewed. In general this guidance will be followed.
However, conclusion states local assessments should be made.
Most trusts agreed to follow.
Draft amended AGP
list.docx
Any problems thrown up can be discussed with IPC
76/22
Referral to Tertiary Care by GPs
SA - opened discussions on this subject.
It would save time for GP’s to refer directly to tertiary care. It
was initially thought a policy was available. Proposed that we
should ask primary care colleagues if and when appropriate to
refer to secondary care. What do you think?
– it may be possible in some scenarios but not feasible for
Paediatrics. Consistently received messages back from Alder Hey
etc., that the first port of call should be hospital team in Nobel’s.
PV – With cancer hat on I can see certain disadvantages. We are
trying to get geared up for more holistic care so if secondary
care are not aware of a diagnosis/when patient comes back to
hospital there is a risk the patient will not be supported when
secondary care involved at later stage. Not all elements are
available in primary care.
- historically GPs not able to refer due to funding, logistics,
patient transfer. Now we do have patients having tertiary care
and we often receive requests. Medical records fully available so
don’t accept the argument. In favour of book and select service.
- in favour of referring directly for his dept as there is nothing
on island.
MB - Not common but we do get involved in primary care and
when no secondary team to refer back to can cause a bit of
chaos.
PV - agree & Brain tumour referrals often have to wait
for specialists to be on island so agree there are certainly cases
and groups that would benefit from direct access.
–GPs in UK can refer across different care groups in UK but
not IOM
Conclusion SA:
1) hasten process of referral from IOM to tertiary care
2) it should not go up in numbers
3) gap is a written policy unique to each speciality
Try to fast track our patients
– suggests anyone with wait over 18 weeks to be refererred
to another medical centre
Actions
• Bring back to next CAG meeting
• Clinical Leads to do policies
SA
Clinical
Leads
78/22
Second Opinion Policy
Final review prior to EMC
SA – Policy has been discussed in various forms including MSC
This is not a luxury but a necessity and right of patient
Does anything need to change?
– saw concerns from thought missing point.
My suggestion is it should go to CD then MD
SA - often only single handed specialities, so will need to go off
island
Agreed to go to EMC
Second Opinion
Policy (Draft).pdf
79/22
Upright MRI Policy
Final review prior to EMC
SA - discussed previously again this will go to EMC.
No objections
Upright MRI Policy
(Draft).pdf
77/22
Nuclear Medicine Proposal
SA – Introduced the paper.
At the end of last year HSWI judged our facility not fit for
purpose. Paper prepared for the two options:
1) Increase investment in on-Island services
2) Close on-Island service and send patients off island
(Liverpool)
When this service is requested you need to know if it is the best
scan option. Acquiring isotopes on IOM is difficult.
My preference to relocate to Liverpool
PV - to support the paper discussions held with and
. Some patient opinions support the arrangement
with Liverpool. is disappointed as not enough
governance/patients in place though understands why.
happy - since Dec 2021 he has been sending patients to
Liverpool and this has gone smoothly. Some pathways changed
to accommodate on IOM.
Based on numbers and costing it doesn’t make sense to retain
service on island.
SA - very helpful, thank you
- Paediatrics only 2-4% historically important scans done in
Liverpool. Carry on with Liverpool.
77.22 Nuclear Med
Paper.pdf
SA – In conclusion ok for option 2 (Liverpool)
80/22
AOB
None raised
81/22
Date of Next Meeting:
Wednesday, 24August @ 1600 hrs
Matters arising from previous meeting
provided an update on Covid boosters – it’s felt appropriate to
follow lead of Florida and not give boosters below age 15.
SA Cannabis – waiting for policy
MB advised this is with to finalise
Draft Notes CAG
Agenda 02Nov22.docx
115/22
Review of Action Log
JS met with & VF so policy for Advice & Guidance is progressing
SA Job plan update – c96% published
Thinking of new software (Allocate)
CAG Action Log.xlsx
116/22
Non ported venflons
Presented by – Non ported venflons introduced two years ago.
Anaesthetic dept advised these not fit for purpose due to patient
safety concerns. However, it was introduced and given to every
department in the hospital except ICU & theatres. Our opinion as
vascular experts was ignored and the process was not correctly
followed. Evidence shows it is 3-5 times more expensive, higher
infection rate. We have produced a paper to show, especially in
emergency situations, non-ported cannulas are not fit for purpose.
We therefore proposed to stop use of non-portable venflons.
SA – Given the clinical risk we now have it was decided to stop using
non-portable venflons and only use the original, portable venflons.
– it has going on for 2 years - has been datixed many times and is
on the risk register. All CDs agree we should move to ported
cannulas. SA sent email instructing that non-portable cannulas be
phased out from 12th November 2022 which has not been followed.
The producing company also advise these cannulas should not be
used on labour wards & emergency trolleys. Very frustrating.
WB – Possibly a wider issue as from ED & Ambulance perspective
we go to central stores and are provided with these cannulas – so
perhaps not filtering down past clinicians to support services team.
Happy to work with you and use the ported cannula as per Medical
Directors instruction.
ACTION:
- Instruction to confirm no phasing out but to stop using the
non-ported venflons with immediate effect.
- Stock to be physically cleared
SA /
117/22
Shared care protocols for memory clinic
Item deferred to next meeting ( not able to attend)
118/22
MGUS Patients
Item deferred to next meeting ( not able to attend)
HAEM_014_MGUS_G
uideline.pdf
119/22
ANP Referrals (Annmarie Cubbon)
SA – One surgery here is not run by Doctors and there have been
instances where consultants have refused to accept the referral
from an ANP. The question therefore is
1) is it right for us to refuse ANP referrals
2) what are the standards the ANP’s are expected to adhere to
3) If they are not allowed to refer who should do the referral
to consultants? Where does the clinical pathway originate
and end?
Discussion followed regarding specific cases.
– if a referral is refused purely on the basis that it is not from a
doctor then that is wrong. However it is important that the
healthcare professional makes use of their internal hierarchy first.
SA – advised for the case in question the communicated refusal was
because the referral was from an ANP. Discussing it at CAG will
show that there is support.
SA - discussed further with & JS to obtain their thoughts and
viewpoints as GP’s.
JS - suggested that any a HP's working as employees of partners in
surgeries should have a discussion with the partners. If partners
agree they have a particular skill set which allows them to refer
independently, then the principle should be that we be sympathetic
to that. This general principal that multi-disciplinary referrals are
accepted, should be communicated throughout Manx Care.
ACTION: send out communication as per JS suggestion.
SA
120/22
PPCI Paper (Will Bellamy)
WB introduced the paper on PPCI which has arisen as part of the Air
Bridge Service for continuation of care, accessing of tertiary services
and working with Liverpool. This is the start of a new clinical
pathway SOP. Presenting to CAG first for advice, guidance and
approval before going before EMC.
SA requested further clarification from WB regarding current
pathway and if for all heart attack patients.
WB confirmed current pathway is for all heart attack patients to go
straight to Nobles. The new pathway suggested would be for a
specific group of patients experiencing ST Segment Elevation
Myocardial Infarction (STEMI) would go directly to Ronaldsway for
immediate transfer to Liverpool.
SA – No objections it is a big yes from the CAG
ACTION – Present to EMC
PPCI COG Paper.docx
WB
121/22
AOB
A-Streptococcal infections
Update by due to current situation - Invasive Group A
Streptococcal (IGAS) has seen a rise in scarlet fever cases. They are
working closely with Public Health. Information has been cascaded
to Primary & Secondary Care. General advice is that GP’s should
have a low threshold for antibiotics. Strep A is sensitive to penicillin
but in case of allergies Macrolides and Clindamycin are alternatives.
For Secondary Care there should be a low threshold for pulmonary,
skin & soft tissue complications leading to necrotizing fasciitis or
toxic shock syndrome. Samples will be required.
There has been a small outbreak in a children’s nursery in the
North, with cases of scarlet fever.
In the hospital there have been at least two cases of IGAS.
More and more positive throat swabs from community.
We are bound to notify public health of any clinical diagnosis of
scarlet fever. We appear to be mirroring the situation in the UK with
cases on the rise both in hospital and in the community.
questioned if the recommendations were for early antibiotic
treatment.
confirmed to start antibiotics if there is a clinical suspicion, ie
high fever, throat, rash as recommended by UKHSA, to prevent
developing into complicated infections.
In UK 8 children’s death so far
LP asked if there is a rapid antigen test available but advised not.
Best option is a throat swab.
At the end of the meeting had a few additions points:
1) A-Strep – the Green book state one of the vaccines offered
for Strep does cover 8 out of 10 that cause invasive disease.
to feed back to DHS.
2) ANP referrals - when saying that Non-medical colleagues
should avail themselves of their internal hierarchies in
judging whether referrals are appropriate and I don't want
this to be taken as meaning that that's their only recourse.
That's why we have specialist advice and guidance.
122/22
Date of Next Meeting:
Wednesday, 18th January 2023 at 1600 hrs
Item
Subject
Action by:
No.
86/23
Apologies for Absence
• Dr V Balakrishnan
• Dr M Bracewell
•
•
•
•
87/23
Review notes/Matters arising from previous meeting
Meeting notes approved
Notes CAG
22November23.docx
88/23
Review of Action Log
Action log reviewed and updated
CAG Action Log
2024.xlsx
89/23
Medicines Policy Working Group
For information & involvement
presented the policy. There is an opportunity for
interested parties to be involved with Medicines Policy Working Group.
Manx Care
medicines policy wo
Medical representation is welcomed on the prescribing section, unlicensed
medicines & high risk scenarios (contact if interested). The
aim is to break down the current interim policy in order to have separate
prescribing policy, medicines management etc. This will give an
administration policy rather than including everything in one document.
MH advised that this was also discussed at the recent QSE meeting and
assurance was being sought. A request for an update will be made from
and Maria Bell (MB) at the next meeting.
To be socialised via PCN for volunteers
MH suggest taking to the CD group to look for
volunteers/nominations from each area
SMc
90/23
Discharge Issue - E-Discharge & TTO’s
For discussion and agreement
MH referred to the Golden Patient issue as this is not being identified every
day.
advised e-discharge is usually a job completed by a junior doctor on the
ward however there is no junior doctor cover in ITU so this can cause a
delay.
MH informed that this is something discussed almost weekly at Clinical
Directors (CD) meetings. The key thing is to ensure the e-discharges and
TTO’s are completed. Part of the reason to raise the issue of discharges is in
relation to pushback received from GP’s because of concern over accuracy.
MR expressed concern as there appears to be an inefficient duplication of
work for both hospital and for GP. A handwritten TTO is emailed then
electronic discharge received much later. As this is something that has to
be done surely consultants should insist this has to be done on the day.
JS advised this has been discussed extensively at CD meetings and MH
confirmed currently we have to work with what we have as there are
technical issues with Pharmacy.
explained processing in pharmacy has to be on the paper copy.
However she will ask one of the pharmacists to re-look at the information
going to GPs to see if there have been any improvements, following
changes made by Gregor Peden to e-discharge summary.
This should provide a more accurate reflection of what is currently
happening.
MH added that deciphering the handwritten TTO was a big issue raised by
Doctors. Unfortunately there is no way to improve this until we have the
updated Manx Care Record.
Verbal
SH
SMc advised that the PCN intends to send back TTO’s with any issues and
SH requested that it would be helpful to know how many are coming back
so we have a better understanding.
After discussion on how best to do this it was agreed that SMc will take the
matter back to PCN, finalise form with a process to return to relevant
Clinical Director (with Medical Director in cc)
MH confirmed that the CD will have responsibility within their Care Group
to take up with the Consultant, who in turn will take it up with the Junior
Doctor, to obtain correct information and return to the GP.
suggested that CAG should instruct CD’s what needs to happen then this
can be de-escalated from CAG
MH to raise at the CD meeting group to request they share at
their Consultants meeting
SMc
MH/
91/23
AOB
• Covid Treatment Guideline
(See attached)
provided a reminder that these guidelines are on Sharepoint and
requested that junior staff are aware – especially the flow diagram.
91.docx
92/23
Date of next meeting:
Tuesday, 16 January 2024 @ 1700 hrs
Item No.
Subject
Action By:
07/23
Apologies for Absence
• John Snelling
• Lakshman Paudyal
•
•
• Ishaku Pam
•
08/23
Notes of last meeting approved
Updates provided:
provided a spot update of Covid situation.
It was observed that more cases of flu and RSV
UKHSA guidelines contine to be followed but these are due for review.
Action: Bring back to CAG in a couple of months
EDI – SA has taken on mantle to champion and shape this strategy and
will lead on reverse mentoring with workforce & culture team.
CAG Meeting notes
18Jan23.docx
/
09/23
Review of Action Log
No review
07Feb23 CAG
Action Log.pdf
10/23
Referral letter DF
SA summarised a GP query regarding a patient who has experienced
surgical complications and does not want to return to Noble’s.
It was agreed that normally a second opinion would be offered within
the same department with perhaps escalation to MDT if needed.
Patient is entitled to request a second opinion though cannot
necessarily dictate to whom they go to get a second opinion. Should try
to resolve in house.
There is a second opinion policy in place. The difficulty is in the many
single consultant specialities within Manx Care. A suggestion was put
forward by SA that Primary Care to refer direct to Tertiary Care in
certain cases.
However felt it was beneficial to have someone on Island, in
secondary care, to oversee in case something does go wrong.
Discussions followed on individual cases with advice being sought by
AR. This led to SA advising that the question to be asked is whether the
complaint is valid or not? If valid take further. If not valid reassure
patient and say not much we can do.
As emphasised by it is important to act in the best interests of the
patient and show reasonableness. Accountability is to GMC as well as
Manx Care.
Action: Further debate required
Referral letter
FENTON, Daniel (Mr
SA / All
11/23
Delirium Policy
New Delirium policy written up by SA however IP advised that the
existing policy on Medway is more comprehensive.
Action: The two policies to be reviewed and compared
Pharmacological
Management of Del
IP
12/23
AOB
Ballasalla practice/Primary Care
SA summarised the current situation with Ballasalla and highlighted the
issue that 1% decrease in primary care work will result in 10% increase
in hospital. Important that we support our primary care and look for
ideas for transformation. Very difficult situation due to the shortage of
GPs globally.
Action: Organise a summit/meeting for brainstorming with GPs
as we need to work together to find and seek solutions.
SA
13/23
Date of Next Meeting:
Wednesday, 15th March @1600 hrs
Item No.
Subject
Action By:
47/23
Apologies for Absence
•
•
• Dr Venkitasamy Balakrishnan
•
• Dr Lakshman Paudyal
•
• Miss Rehana Zaman
• Dr Ishaku Pam
48/23
Notes of last meeting approved
CAG Notes
June23.docx
49/23
Action Log reviewed and updated
CAG Action Log
19Jul.23.pdf
50/23
Off Island referrals policy
Presented by Peter Hannay & Emma Dancer
Overview given of the new off island referral policy/data base that
should be in place this winter. Essentially this will give control with a
Off Island Referrals
Software System.doc
central referral point for authorisation. Principal aim of presenting at
CAG was for information and to answer any questions.
It was agreed that control and oversight is needed to avoid unnecessary
referrals off island. Confirmation was given that GP’s will continue to
refer firstly on island (or to visiting consultant), and then off island
directly if no on island presence (checks in place) but within the scope
of existing SLA’s.
PH advised the proposals are based on the Jersey model who refer 1/3
of the number of IOM and with a larger population. There will be a full
time clinician to look at all cases
Peter & Emma will keep the group updated and come back later in the
year.
51/23
Patient Access Policy
Brought back to CAG for ratification.
Various Issues raised for clarification, including:
• Secondary care referrals to another speciality or back through
the GP?
• Grading of referrals
• Costs/services covered by Manx Care after private
treatment?/Private Patient Policy
• Clarification of internal referrals to be provided for Private
Treatment once Private Policy produced
Group agreed that Patient Access Policy ratified
Actions:
Meeting to discuss Private Patients Policy with Tammy Hewitt
Urgent/non urgent pathways to be put on next CAG agenda
Manx Care's Patient
Access Policy for Elec
MH
LC
52/23
Covid-19 treatment guidelines
Introduced by for information purposes.
The guidelines were presented to IMOG earlier this week and basically
bring together the separate guidance notes in one document, reflecting
the treatment pathways as per NICE guidelines.
23-05 COVID
Guidance 4-1.docx
53/23
Use of cannabis based medicines in acute care SOP
Presented by who explained this is to be a practical
document around cannabis based medicinal products in acute care. I.e.,
patients initiated on cannabis being admitted to hospital. This SOP
allows continuance of cannabis treatment should the clinician think it
appropriate. There is a flow diagram to show when and when not to
consider allowing patient to self-administer.
23-07 v2-1 Manx
Care Acute Approach
clarified that this relates purely to unlicensed products (that hold a
specials license) supplied by the patient. It would not be supplied or
prescribed by Manx Care.
Requesting feedback from the group to the questions posed by
The Group had no objections to the policy
In answer to the specific questions:
• MH as CDAO confirmed she would like to be informed when a
patient has a prescribed cannabis based medicine and it was
agreed to use DATIX as a way to capture this data for review at
IMOG
• Wording re funding position to be changed slightly to: ‘The
Manx Care position remains that these products would only be
funded when a case is made and accepted by a specialist NHS
centre.’
• Agreed patients are to self-administer.
54/23
Meeting day/time
To facilitate Clinical Directors joining on their scheduled CD day, an
alternative day of Tuesday at 5pm was put forward.. From those
present it was agreed to stay with Wednesdays at 4pm
55/23
Date of Next Meeting: 16th August 2023 @ 1600 hrs
Item No.
Subject
Action By:
40/23
Apologies for Absence
•
•
•
• Dr Sadha Punniyakodi
•
• Miss Rehana Zaman
•
41/23
Notes of last meeting approved
CAG Notes
17May23.docx
42/23
Action Log reviewed and updated
Job Plans – MH provided an update:
• It possible GP’s may, in the future, require job plans
• MH requesting all Speciality Doctors have 2.5 SPA in order to
get clinical engagement.
• Job planning to be transparent and follow BMA policy
• Aim is to have all job plans done prior to summer break
• Aim is to support Primary Care same as Nobles
Actions:
CAG Action Log
19.06.23.xlsx
Meeting to be held with MH/JS/Care Group Manager to discuss
further
Check Job Plan Policy regarding inclusion of Primary Care
MH/
43/23
Patient Access Policy
Policy presented by who explained this will be a public
document based around roles and responsibilities. TC & OR have
approved so she has brought to CAG to obtain engagement with
clinicians.
Opportunity to discuss and raise queries/concerns. would like to
ensure that all parties have had time to review the policy and raise any
queries.
Actions:
Policy to be left with the group to further review then finalise at
the July meeting.
Policy to be circulated to consultants to obtain their views
Manx Care's Patient
Access Policy for Elec
IP
44/23
Private Practice referrals into Manx Care (Marina Hudson)
MH outlined a psychiatry issue (ADHD referrals) where there is no
pathway in Manx Care and no shared care arrangements from private
assessments.
Is there a procedure or SOP for referrals into the system from private
practitioners or should it be from the GP where patients go on the
waiting list? If patients stay private they continue to pay for private
prescription. There is a shared care agreement in place for under 18’s
but not for adults. Therefore there is no way of private patient
accessing prescription through NHS. Question raised by Mental Health
is if the patient decides to go on the NHS should this come from the GP
or from the private provider?
put forward an example of Opticians referring directly to Nobles
who then send a referral to GP’s for note. GP’s not required to do
anything unless something else required after being seen at Nobles.
Therefore a mechanism is in place that could be followed for other
areas of private practice.
VB advised that it is not encouraged the mix and match of private and
NHS treatment.
suggested speaking with Tammy Hewitt to try to link in with the
Private Patient policy.
45/23
Kesimpta Pathway approval (Heidi Morris)
In Heidi’s absence advised that this pathway has been adapted from
the Walton and has already been through IMOG.
Pathway approved by CAG
Manx Care
ofatumumab (Kesimp
46/23
AOB
Proposal to change day/time to Thursdays at 5pm
Voting email to be distributed to CAG membership
47/23
Date of Next Meeting: 19th July 2023 @ 1600 hrs
Item
Subject
Discussion
No.
Lead
45/22
Apologies for Absence
• Lakshman Paudyal
SA
45/22
Matters Arising from last meeting
(No minutes taken)
SA
46/22
Monkeypox update
Presentation by “Introduction and suggested
action plan for Monkeypox”
Copy presentation attached for reference.
Monkeypox and IOM
Sexual Health A.pptx
Q&A session followed.
addressed concern raised by regarding paediatric
population. Virus categorised as high consequence because
we don’t know which way it will go. Three main risks:
Pregnant women, immune compromised and children under
12. So far no concern just need to be prepared.
SA: What is chance of seeing cases on IOM?
Communications going out from Public Health & Manx
Care. With high level of alertness most cases will be diverted
to GUM. Pathways are in place. The department has been on
standby with triage system over weekends.
Service ctc Mon-Fri 9-5pm 650710
47/22
NICE/TA update
Not discussed
48/22
AOB
Bouncing of referals
Making good progress on clinical referrals, pathways with
each department, especially with diabetes and endocrinology.
overarching principals should be same ...
SA: I will put this forward again and keep you informed.
Job plans
SA: pleased with the progress. Individual meetings planned
with each Clinical Director.
49/22
Date of Next Meeting
29/06/22 @ 1630 hrs via Teams
Title
The Capacity Bill (Phase One) – Direction on policy for the purposes of revised
drafting instructions
Paper No xx
DHSC Official Sensitive: Commercial
☐ Check the box if paper contains commercial information which may be damaging
to the DHSC, IOMG or a third sector organisation if improperly accessed.
DHSC Official Sensitive Personal
☐ Check the box if paper contains personal information relating to an identifiable
individual where inappropriate access could have damaging consequences.
Data
Decision ☒ Approval ☒ Discussion ☐ Assurance ☐ Information only ☐
Purpose* (click
appropriate box)
Responsible director and job title
Director signature
Author and job title
The director is signing to indicate their approval of the paper and to confirm that any EQIA, QIA or DPIA has been approved.
/ (AGC)
Karen Malone (Deputy CEO)
/
(AGC)
Short summary of paper
The capacity programme to date, has comprised of two public consultations – the
first on policy and principles, and the second on the draft Bill itself. A number of the
submissions received in the second consultation, highlighted some complex and
legally technical points that have required further work.
In addition to the points raised as a result of the consultations, a line by line analysis
of the draft Bill is currently being undertaken, and any further policy questions that
have arisen, have been examined in detail.
This paper reviews the issues from the Bill analysis and also the consultation that we
have to date worked through; and conclude with recommendations for the
Department to consider and decisions for discussion.
Once the Department have considered the points reviewed and recommendations
made in this paper, work will continue on the remaining line by line analysis of Parts
3 and 4 together with Schedules 1 – 6 of the Bill.
Crucially, this will include representations put forward by the Attorney General. The
Attorney General has raised questions regarding his role and the proposed functions
of his Office. Work is underway to address these questions, the outcomes of which,
together with recommendations, will be put forward in the next Department paper.
Recommendation(s)
That the Department approve the recommendations set out in paragraph 6 of this
paper (recommendations).
Engagement with patients/
public/ staff and other
stakeholders
a) Public consultation on the Capacity Bill 2021 Principles: 21st August 2020 to 2nd
October 2020.
b) Public consultation on the Capacity Bill: 25th February 2021 to 8th April 2021
c) Lastly, due to the immediate and direct impact that the draft Bill will have on the
lives of those who have lost capacity a further consultation ran concurrently to
the general consultation on the Bill, specifically aimed at “Hard to Reach” groups.
Has legal advice been
received/to be sought (only
if required)?
For the purposes of this paper, regarding the inherent jurisdiction of the Court in
relation to minors the Department has sought the advice of the Children and Families
Division of the Attorney General’s Chambers.
Further, subject to the Department agreeing the recommendations proposed, legal
advice will be sought by way of revised drafting instructions; upon being submitted
to the Legislative Drafting Division of the Attorney General’s Chambers.
Links to DHSC Strategic Objectives from 5 year Strategy (click on all boxes that apply)
Greater responsibility; We will help everyone to take greater responsibility for their own health, encouraging
☐
good lifestyle choices.
More care in the community; We will help people to stay well in their own homes and communities, avoiding
☐
hospital or residential care whenever possible.
Improve hospital care; We will improve services for people who really need care in hospital.
☐
Protect vulnerable people; We will provide safeguards for people who cannot protect themselves.
Protect vulnerable people; We will provide safeguards for people who cannot protect themselves.
☒
Value for money; We will work to ensure that everyone receives good value health and social care services.
☒
Engagement with patients/
public/ staff and other
stakeholders
Has legal advice been
received/to be sought (only
if required)?
Risk Register
n/a
New strategic risks identified by this report
Resource
implications
n/a
(Note: The Capacity Bill 2022 will have financial implications. The
Department will therefore be submitting a paper outlining the
financial and personnel implications together with a copy of the Bill
to Treasury for approval before it is submitted to the Council of
Ministers to seek approval to introduce it into the Legislature.)
Finance Signature
Resource
implications
n/a
Financial
Exemptions
Required?
None
Potential conflicts
of interest
Are there any
potential
stakeholder (e.g.
political, PR)
considerations?
Mental capacity potentially effects everyone in the Island; but particularly the key stakeholders
are those that may have lost capacity to make decisions for themselves, health and care
practitioners, private sector organisations, voluntary and community sector organisations that
provide services to people who may lack the capacity to make decisions as well as the family
members of those individuals.
Additionally there is, and has been for some time, clear political will to establish a statutory
framework for mental capacity. Most recently the Independent Health and Social Care Review
Report by Sir Jonathan Michael (18 April 2019) noted that a legislative framework for Capacity
should be brought forward without further delay.
Are there any
potential
stakeholder (e.g.
political, PR)
considerations?
Equality Impact
Assessment (EIA)
n/a (for the purposes of this paper)
(Note: an equality impact assessment will be a part of the documentation submitted to the
Department seeking approval for the Capacity Bill to be introduced into the Branches of
Tynwald.)
Equality Impact
Assessment (EIA)
N/A
Quality Impact
Assessment (QIA)
Data Protection
Impact
Assessment
(DPIA)
n/a (for the purposes of this paper).
(Note: Engagement with the ICO upon the draft Bill in February 2021)
Data Protection
Impact
Assessment
(DPIA)
Report history
a) Capacity Bill – Policy Direction: Next Steps and Publication of the Summary of Responses to
the Consultation – 26 January 2021;
b) Capacity Bill – Summary of Responses to the Consultation – 11 June 2021.
Appendices
(1) Draft Capacity Bill 2021 (v.7);
(2) Jurisdiction Table – General age;
(3) Jurisdiction Table – Advance Decisions to Refuse Treatment;
(4) Jurisdiction Table – Lasting Powers of Attorney.
Departmental or
Ministerial
Decisions
V.1
Version Control
1. Business Objectives
1. Purpose of this paper
a) The purpose of this paper is to recommend to the Department certain amendments to the Bill which, if
agreed, will inform revised drafting instructions for submission to the Attorney General’s Chambers and
ultimately a revised Bill for introduction into the Legislature.
b) Specifically regarding the general points detailed below concerning “age” a workshop was convened that
included from Manx Care, the Executive Director of Social Care, the Safeguarding Lead, the Head of Adult
Social Care, the Principal Social Worker for Children and Families, the Principal Social Worker and the Matron
for Mental Health. Regarding the role of Public Health and the provisions of the draft Bill relating to research,
communications have been held with the Interim Head and then the Head of Research and Development.
Regarding the jurisdiction of the Court in relation to minors, particularly those aged 16 and 17, the advice of
the Children and Families Division at the Attorney General’s Chambers has been sought.
c) Broadly speaking the proposed amendments are:
i. to lower the age to whom the Bill will generally apply to; from 18 to 16;
ii. to update the wording regarding personal welfare Lasting Powers of Attorney’s (“LPAs”) to better reflect
the scope of their authority;
iii. to include statutory provision permitting the Court to make decisions relating to certain property and
financial affairs matters for persons under the age of 16, where the Court considers it likely they will still
lack capacity in respect of that matter when they reach 18;
iv. to set the age at which a person can enter into an advance decision to refuse treatment at 18 (rather
than 16);
v. to omit those provisions in the draft Bill relating to advance consent to treatment;
vi. given that the Public Health Directorate no longer sits within the Department to accordingly update
certain regulation making powers in relation to research;
2. Strategic Alignment
The creation of a modern and clear legal framework which safeguards the rights, dignity and wellbeing of
individuals who have lost the capacity to make decisions for themselves is integral to the Department’s strategic
objective of developing a five year modern, comprehensive legislative programme.
3. Options
n/a (to consider the recommendations set out in paragraph 6 below)
4. Estimated cost and proposed funding source
n/a
5. Benefits
To improve the legal framework for people who may have lost the capacity to make decisions for themselves.
6. Recommendations
The Department is being asked to consider the following recommendations:
a) One: that the Capacity Bill should in general apply to those aged 16 and over.
b) Two: All references in the Bill to “personal welfare” to be amended to “health and welfare”.
c) Three: That the draft Bill should include a provision akin to section 18(3) of the MCA 05, permitting the
court to make decisions relating to the property and financial affairs of someone under the age of 16
years, if it considers it likely that the person will still lack capacity in respect of that matter when they
reach 18 years.
d) Four: That the age at which a person can enter into an advance decision to refuse treatment be 18.
e) Five: that the provisions of the draft Bill relating to advance consent to treatment be omitted.
f) Six:
Cabinet Office (Public Health) be responsible for making the regulations under clause 42(7) of the
draft Bill; and
Cabinet Office (Public Health) be required to consult the Department of Health and Social Care
before doing so.
g) Seven: that the Cabinet Office “shall” be under a duty to make regulations (rather than a discretionary
“may”).
Item No.
Subject
Action
23/22
Apologies for Absence
• Venkitasamy Balakrishnan
• Maria Bell
•
•
•
• Michele Moroney
•
24/22
Matters Arising from last meeting
Not discussed
25/22
Policy – Clinical guidelines for seeking second opinion
Not fully discussed or approved
Roll forward
26/22
Policy – Open & Upright MRI prior approval
Not fully discussed or approved
Roll forward
27/22
AOB
SA started discussion on function & purpose of CAG
Important that the group is more effective and engaged.
To have shared responsibility and joint accountability
To produce effective policies and design new pathways.
General agreement that all parties need to be part of
processes and policies and be motivated to do so.
Maybe include Matrons/Nursing
.
Action: TOI to be recirculated for review and clarification
Action: Investigate cascade of information/communication
with
SA/
SA
28/22
Date of Next Meeting
27/04/22 @ 1600 hrs via Teams?
Item
Subject
Action by:
No.
26/24
• Apologies for Absence
•
• Toyin Amusan
•
• Dr Alison Hool
• Maria Bell
• Dr Martin Rankin
•
• Dr John Snelling
• Dr Ishaku Pam
27/24
Review notes/Matters arising from previous meeting
Meeting notes approved
CAG notes
2024.03.12.pdf
28/24
Review of Action Log
Action Log reviewed and updated
CAG Action Log
2024.xlsx
29/24
Emergency Brain Pathway Policy
Update of Primary Care Pathway by Markie Chestnut (MC). Brought back to CAG
for final approval.
MC confirmed updates made to the policy as per input provided by and
Pathway approved
30/24
Amendment to Waiting List validation letter – to include questions regarding
patient current medical status to assist Harm Review process
Presented by
advised that a waiting list validation letter is sent out to all patients on the
elective care waiting list after 18 weeks. They are trying to progress ‘Harm’ so the
CQC Team has made some suggestions in order to give more weight & framework,
with clinical ownership and buy in from the care group teams.
After consultation with it was agreed to include a few straight
forward questions to the waiting list validation letter. These are to help inform
whether to escalate for a more urgent clinical review.
RP queried why we writing to the patient to validate themselves?
explained it does help with administrative validation when asking has condition
improved, etc.
VB concerned there would be comeback if the patient requests to come off the
waiting list and then further down the line they develop issues. However
reassured that they are not taken off the waiting list as this can only be done at
clinical validation. Therefore they are sent to relevant clinician as a query, for
them to advise.
informed the questions being suggested are:
• Are you able to continue in your usual lifestyle?
• Are all the symptoms you were referred for better or worse?
There were no objections to these questions being included.
31/24
Immunisation Committee
Covid vaccination associated ribosomal frameshifting & Influence of seasonality vs
PHIs on Covid
As per previous meetings this to be represented by for
discussion/action.
(Circulated in advance to CAG membership for feedback with attendance from
Public Health requested)
Public Health invited to CAG meeting. But no representation forthcoming.
It was agreed to request Public Health to provide comments in writing.
These to be shared at the next CAG meeting.
COVID
vaccination-associate
influence of
seasonality vs PHIs
COVID-19 vaccines &
AESI.pdf
32/24
Recommended Guidelines for Primary and Secondary Care Interface
Item to be carried forward for presentation at a future meeting when Primary
Care can present the proposed policy.
advised that she has started another document that fits between the Access
policy and the interface document – MOU. She feels the Interface document is
very primary care focussed and needs to be more balanced. It needs to be looked
at operationally as well as clinically.
RP and VBK request that the comments raised by medical consultants from
reviewing the Access Policy in medical divisional meeting are collated by Ishaku
Pam and . This needs to be looked at before continuing with the
Interface Policy.
Report to be obtained for review at the next CAG meeting
66.24b Interface
report.pdf
MH/
33/24
AOB
NICE TA Drugs – RP
RP raised concerns about the process of having these approved and the time that
could be involved, so looking for an understanding.
MH confirmed that the plan is for NICE TA drugs to be approved provided they are
cost neutral. However the final decision will be taken after the discussion with
DHSC. We will then have a clear explicit communication of which NICE TA drugs
can be prescribed and pathway to be used.
34/24
Date of next meeting:
Tuesday, 14th May 2024 @ 1700 hrs
Matters arising from previous meeting
SA - in future we will put an action log in place
NOTES CAG
Agenda 05Oct22.V2.
106/22
Advice and guidance lines
SA –after Covid it has apparently been increasingly difficult for primary
care to contact some of the specialities. Are lines of communication still
open for GP’S & Primary care to use?
IP – Important we look at this and come up with a system. Currently no
audit trail and considerable amounts of time can be spent on
communication that is not allocated in Job Planning. We need a policy
and way of channelling enquiries that meets demand from Primary Care
but also gives Secondary Care support.
JS – Not aware the demand for guidance but we need to find a positive
solution. Understand the advice and guidance email addresses per
speciality are still available but perhaps not publicised. A variety of
contact methods are being used so inconsistent. Difficult to keep an
audit trail.
SA – recognise this process is not formalised. Asked to advise how his
department deals with advice & guidance.
– Most requests are now via email or phone calls. We have a
dedicated sim since 2021 and have been tracking numbers, etc with
information recorded on a spreadsheet. Some requests come through as
a letter – difficult to record and audit.
There needs to be one or two conduits so people know they will receive
an answer within a specified time frame.
JS – It would be helpful to work on this model. Advice and guidance at its
best and properly audited could be an efficient way to provide
collaborative care to the patient. Important we get this right.
SA – We don’t appear to have a policy on Advice & Guidance so I will
work with & to bring out a policy from what is already available.
(In conjunction with JS for Primary Care)
Sharing of information under GDPR to be taken into account to keep
legal.
ACTION – Advice & Guidance policy to be drafted and presented to CAG
next month
SA / /
107/22
Shared care
SA – this issue is ongoing. We need to take one speciality as a pilot and
roll out if it works. Too complex and too big to take on all specialities. I
suggest we take a speciality where the interaction can be straightforward
and use this to establish how it works and any issues.
– We need to have resources
SA - aware of resource needs
Action: SA bring back again with a plan/proposal
108/22
Job planning update
SA – this is mainly for secondary care, but I would like to give this update.
139 job plans to approve and publish - when we started at best 60 were
published.
Last week we had 137 published, so a huge improvement. Not all signed
off but it helps to map out capacity and demand. First step very
successful. I will update group when we do next steps of sign offs and
completion.
ACTION: Further update at future meetings
109/22
Testicular Torsion protocol for approval
SA – New protocal drafted following 3-4 torsion testes incidents in last 6
months.
AR – Following the recurrence of these incidents I’ve worked with Mr
Hussain, Consultant Urologist to draft this SOP.
BH – Simple one page SOP to make it easy for everyone. Any case with
age 12-25 to be considered as a torsion until proven otherwise. Nobody
will be criticised for exploring a negative testicle. Basically this is
universal protocol followed in all hospitals.
VF – raised concerns about not requesting an ultrasound.
BH – clarified pointers in the SOP regarding imaging. If presentation is
within the 1-12 hours of symptoms imaging should not be attempted.
Between 12-24 hrs ultrasound can be considered if readily available. It’s
a question of when it should be done.
SA questioned if all general surgeons are capable of doing the surgery.
BH/AR – confirmed yes
Policy approved.
Action – policy to be forwarded to EMC
Manx care SOP for
suspected Testicular T
SA /
110/22
PICC Policies – updated
Review and ratification sought by Matthew Mustain & Graham Lloyd
Brandrick
No objections - Policies approved
Action: to be forwarded to EMC
PICC (Bard
Groshong) policy 20
SA /
111/22
AOB
112/22
Date of Next Meeting:
Wednesday, 7th December 2022 @ 1600 hrs
Item
Subject
Discussion
Document (s)
No.
Lead
Attached
50/22
Apologies for Absence
Rohit Peshin
Bala Venkitasamy
Tentative
Michele Moroney
SA
51/22
Universal mask wearing in healthcare settings
SA
52/22
AOB
SA
53/22
Date of Next Meeting
29/06/22 @ 1630 hrs via Teams
SA
Item
Number
Subject
Action
21/21
Apologies
Apologies received are noted above.
A general discussion took place on the attendance at these meetings.
JS stated that he felt this was the only forum available for senior clinical leaders and it
would not function as an effective group if Manx Care was not fully represented. JC
agreed.
KW joined the meeting at 4.39 pm and explained that she had no camera or microphone available.
SA explained that it was important to meet and have the issues discussed. SA
suggested that he would look for consensus for future meeting dates and times,
perhaps via Doodle Poll.
SA
22/21
Guidance to Care and Residential Homes: Community Geriatricians
SA stated that the Care Quality Commission (CQC) England forwarded guidance
advising that visitors to care/residential homes should be double vaccinated prior to
entering the premises.
A general discussion followed.
The group agreed that it is strongly advised that visitors to care/residential homes
should be double vaccinated prior to entry as per CQC advice.
23/21
Primary Care Winter Pressures (Standard Operating Procedures (SOPs))
a) Primary Care Guidance
The document, circulated with the agenda, was noted.
b) GP Living with Covid (SOP)
The document, circulated with the agenda, was noted; it was recognised that the SOP
should be read alongside the Integrated Primary and Community Care ‘Living with
COVID’ Guidance which sets out relevant procedures to follow generically.
JS explained that the SOP relates to the triage of patients to determine on how best
they can be managed clinically. The SOP recommends triage is carried out via
telephone or triage platforms.
SA requested that the document is checked to clarify that telephone triage is not being
confused with telephone consolation.
JS
c) GP Winter Workload Pressures (SOP)
The document, circulated with the agenda, was noted.
A general discussion took place on the definition of significant workload pressures.
JS advised that the definition needs to be clear across Manx Care as this will be
significant to the delivery of primary care services. Input would therefore be required
from urgent care, respiratory and general medicine colleagues.
It was noted that colleagues were disappointed that no hospital clinical colleagues were
present today.
JS explained that paragraph 4.4 of the SOP refers to liaising with hospital colleagues
with the suggestion that protocols be established on how hospital colleagues are liaised
with should a clinician feel that a patient should be more appropriately seen in a
hospital setting.
It was agreed that a discussion would be held away from this meeting to agree a way
forward.
SA/JS
24/21
Cranial Arteritis Pathway
stated, via JS, that she raised the topic as RP and another Consultant both declined
to see patients who had been referred with a normal PV. explained that she was
advised by both Consultants that symptoms could not be related to Giant Cell Arteritis
(GCA) with a normal PV, but this was not supported by the neurologists and the
literature. KW requested advice on dealing with the less typical cases.
RP advised that the pathway was prepared three/four years ago. Guidelines were last
updated by the British Society for Rheumatology (BSR) in 2020. The pathway is still
valid and has no changes.
RP explained that during the previous three months, two patients had been seen in the
Emergency Department (ED) and then on the Acute Medical Ward (AMU) via the
pathway. Biopsies were taken while in AMU, the report was received the next day with
RP seeing the patients within two weeks. In practice, the pathway is working well,
though this will only continue to work if colleagues in primary and secondary care pick
up signs and symptoms properly.
JC asked what the process was when a patient received a negative biopsy result. RP
explained that an alternative diagnosis should be considered. If the diagnosis is
strongly suspected and there are concerns/evidence of visual loss or concern thereof
then the patient should be referred to eye casualty or ophthalmology immediately.
RP advised that this pathway is predominately for GPs and other clinicians who are
strongly suspecting a diagnosis of GCA and especially if there are serious concerns
about vision being effected. For those patients with symptoms and visual loss this is
the pathway designed to prevent a delay in diagnosis; ultrasound of Temporal and
Axillary Arteries (USG) completed within 24/48 hours and Temporal Artery Biopsy (TAB)
within 7/14 days.
It was noted that GPs are within their rights to refer to other areas; essential that
biopsies and ultrasounds are completed in timeframes when positive diagnosis
suspected.
KW stated, via JS, that Consultants have refused to see patients when it may not be
GCA. RP advised that he can only see patients and grade the urgency of the
appointment on the clinical evidence he has. He cannot force another clinician to
complete a biopsy and will see patients in clinics but not necessarily the next day.
There is access to rapid access clinics post TAB or USG which confirms diagnosis or if
the ophthalmic team feel that there is evidence of GCA.
to see patients who had been referred with a normal PV.
explained that she was
advised by both Consultants that symptoms could not be related to
(GCA) with a normal PV, but this was not supported by the neurologists and the
literature. KW requested advice on dealing with the less typical cases.
It was noted that GPs are within their rights to refer to other areas; essential that
biopsies and ultrasounds are completed in timeframes when positive diagnosis
suspected.
KW stated, via JS, that Consultants have refused to see patients when it may not be
GCA. RP advised that he can only see patients and grade the urgency of the
appointment on the clinical evidence he has. He cannot force another clinician to
complete a biopsy and will see patients in clinics but not necessarily the next day.
There
asked RP how many symptoms (noted in the clinical suspicion of GCA box on the
pathway document) should the patient be displaying before commencing the pathway
process. RP stated at least two.
explained that there is no quick access to an inflammatory marker, blood test
results will not be carried out unless the patient is a hospital inpatient. is aware
that blood test results are taking up to six days at present.
RP advised that if an urgent sample is sent with a suspected diagnosis of GCA it will be
treated as urgent and done as soon as possible within a couple of hours; that is the
agreement in place, they will be prioritised as a medical emergency.
RP explained that the patient could be sent to ED, AMU and ophthalmology on call if
necessary; there is an agreement in place and ophthalmology will see patients
immediately. RP stated that ED have the flowchart, they can be contacted and patients
will be seen for urgent blood tests. stated that this is not recorded on the pathway.
SA suggested that GPs follow the pathway if comfortable but can always revert to
referring to ED if appropriate. RP agreed.
RP left the meeting at 5.31 pm.
Additional information noted after JC left the meeting: asked if all Clinical Directors
and Consultants had agreed to the pathway and the suggestion that patients can be
sent to ED for urgent blood tests. SA advised that it is the responsibility of RP to ensure
the hospital teams are aware of processes. Post meeting note: The updated protocol
has been forwarded to the Quality Assurance and Adult Safeguarding Lead who will
upload it on to the hospital system and update it.
25/21
Any Other Business
a) Care/Nursing/Residential Homes and Isolation Advice
JC asked for clarification on treating patients with Covid symptoms who go on to have
a negative PCR test with the GP then being asked for advice on self-isolation. JC
explained that it not the role of a GP to provide advice on self-isolation matters; this is
the responsibility of the 111 team.
JC explained that should a patient develop a cough, high temperature and/or shortness
of breath they will be treated by the GP though carers should also contact the 111
team to arrange a PCR test.
reiterated that GPs can provide a clinical assessment on a patient though it is not
within their remit to make any legal decision on self-isolation following a negative
result.
JC advised that following a negative result if the GP still suspected Covid they would
advise the 111 team to be contacted again.
SA stated that he would raise the issue of providing self-isolation advice to homes in
the Bronze and Silver Command meetings.
JS asked if a further issue could be raised also in the above meetings with the
Microbiology team in order to obtain advice as to when the patient should be tested
again should a negative Covid result be received, though the illness is still suggestive of
Covid by the GP. SA agreed to raise the issue.
JC stated that, in his opinion, the Infection Prevention and Control policy is very
hospital based.
JC left the meeting at 5.42 pm.
There being no further business the meeting closed at 5.45 pm.
SA
SA
asked RP how many symptoms (noted in the clinical suspicion of GCA box on the
pathway document) should the patient be displaying before commencing the pathway
process. RP stated at least two.
Item
Number
Subject
Action
27/21
Apologies
Apologies received are noted above.
28/21
Minutes of the meeting held on 20 September 2021
One amendment to the minutes from 20 September 2021 was requested by JS. Minute
23/21 (b) last sentence: SA requested that the document is checked to clarify that
telephone triage is not being confused with telephone consolation.
This should read: SA requested that the document is checked to clarify that
telephone triage is not being confused with telephone consultation.
The minutes will be amended and reissued.
The remainder of the minutes of the meeting held on 20 September 2021 were agreed
as a true account.
29/21
Matters Arising
Not discussed.
30/21
Primary Care Winter Workload Pressures Standard Operating Procedure
(SOP)
a) Workable definition to be agreed for the trigger point for implementing
the SOP
It was agreed to defer this item to the next meeting.
b) Primary Care and Urgent Care liaison when the SOP is implemented
It was agreed to defer this item to the next meeting.
31/21
NHS UKHSA Recommendations to reduce physical distancing and changing
pre-procedure testing elective and planned care
It was agreed that would draft a response for SA supporting proposed flexibility by
the UKHSA to the current NICE pre-elective patient testing protocols for specific patient
groups i.e. an on-the-day LFD test.
32/21
COVID - 19 Pathways
a) Surveillance screening for COVID-19 in Hospitals
The group agreed to the pathway.
b) Covid-19 swabbing pathway for discharge planning
The group agreed to the pathway.
33/21
Any Other Business
a) Positive Blood Culture Incident Review Process
The group agreed to the pathway.
34/21
Next meeting: Wednesday 24 November 2021 at 4.30 pm on MS Teams.
Version
Date
Purpose of Issue/Description of Change
Review
Date
1
25 10 21
This is the first iteration of the Manx Care Access Policy
following the inception of Manx Care on 01 04 2021
01 10 23
Status
Open
Publication Scheme
Our Policies and Procedures
FOI classification
Refer to author before release
Function/Activity
N/A
Project Name
N/A
Key words
Waiting lists, waiting times, admissions,
inpatient, outpatient, diagnostic, referral to
treatment, 18 weeks, DNA, cancellation,
access standard
Author
Approval and/or Ratification body
Manx Care Executive Management
Committee on 29/10/21
Item
Number
Subject
Action
General
SA advised that the structure and membership/attendance is to be discussed as
attendance at CAG meetings by Clinical Directors (CDs) is low. It was noted that due to
busy clinical commitments it was understandable CDs were not able to attend all
meetings though the lack of clinical ‘buy in’ was a concern.
JS stated that clinical ‘buy in’ is important and suggested consideration is given to an
honest discussion on low attendance with the days and timing of the meetings to be
agreed.
JC joined the meeting
SA provided an update on the above discussion to JC; JC agreed with the comments
made.
SA decided to continue with the meeting despite the absence of CDs.
07/21
Apologies
Apologies received are noted above.
08/21
CATCH Sites
Verbal presentation by Juan Corkill
JC reported the following.
Covid Assessment and Treatment Community Hub (CATCH) sites were established in
March 2020 for Covid and high risk patients to be seen outside of a GP surgery.
Covid Assessment Treatment Unit (CATU) was established in the Emergency
Department of Nobles at the same time.
GP contractual obligations were ‘turned off’. In hindsight this may not have needed
to happen.
July 2020, no Covid restrictions apart from borders remaining closed, primary care
services resumed normal service.
An outbreak on 31 December 2020 did not result in CATU being resurrected. At that
time no GP had had any contact with a Covid patient.
GP infrastructure at that time was affected due to various staffing levels and the
possibility that surgeries would have to close. Ballasalla surgery closed for two days
in order that a deep clean could take place.
Catch sites initiated again during a short lockdown.
Discussions on going with Mental Health Services in relation to a shared care
arrangement for Child and Adolescent Mental Health Service (CAMHS). GPs will be paid
£150 pa for each shared care case.
SA asked;
1. Are the number of patient’s attending hot sites increasing?
Problems are not GP or Nobles; Manx Care to work as a team with clients/patients at
the heart.
Establishment of a joint prescribing committee to be discussed at the next CAG.
Discuss at the next CAG the suggestion that GPs and Specialties are rotated. Begin
to work together to get to the strategy stage.
Any operational delivery of care will be underpinned by finance.
09/21
Covid-19 Pathways
Not discussed due to time constraints.
10/21
Any Other Business
a) Results Acknowledgement
Not discussed due to time constraints.
There being no further business the meeting closed at 5.34 pm.
11/21
Next meeting: Wednesday 18 August 2021 at
4.30 pm on MS Teams.
Item
Number
Subject
Action
27/21
Apologies
Apologies received are noted above.
28/21
Minutes of the meeting held on 20 September 2021
One amendment to the minutes from 20 September 2021 was requested by JS. Minute
23/21 (b) last sentence: SA requested that the document is checked to clarify that
telephone triage is not being confused with telephone consolation.
This should read: SA requested that the document is checked to clarify that
telephone triage is not being confused with telephone consultation.
The minutes will be amended and reissued.
The remainder of the minutes of the meeting held on 20 September 2021 were agreed
as a true account.
29/21
Matters Arising
Not discussed.
30/21
Primary Care Winter Workload Pressures Standard Operating Procedure
(SOP)
a) Workable definition to be agreed for the trigger point for implementing
the SOP
It was agreed to defer this item to the next meeting.
b) Primary Care and Urgent Care liaison when the SOP is implemented
It was agreed to defer this item to the next meeting.
31/21
NHS UKHSA Recommendations to reduce physical distancing and changing
pre-procedure testing elective and planned care
It was agreed that would draft a response for SA supporting proposed flexibility by
the UKHSA to the current NICE pre-elective patient testing protocols for specific patient
groups i.e. an on-the-day LFD test.
32/21
COVID - 19 Pathways
a) Surveillance screening for COVID-19 in Hospitals
The group agreed to the pathway.
b) Covid-19 swabbing pathway for discharge planning
The group agreed to the pathway.
33/21
Any Other Business
a) Positive Blood Culture Incident Review Process
The group agreed to the pathway.
34/21
Next meeting: Wednesday 24 November 2021 at 4.30 pm on MS Teams.
Item
Number
Subject
Action
21/21
Apologies
Apologies received are noted above.
A general discussion took place on the attendance at these meetings.
JS stated that he felt this was the only forum available for senior clinical leaders and it
would not function as an effective group if Manx Care was not fully represented. JC
agreed.
KW joined the meeting at 4.39 pm and explained that she had no camera or microphone available.
SA explained that it was important to meet and have the issues discussed. SA
suggested that he would look for consensus for future meeting dates and times,
perhaps via Doodle Poll.
SA
22/21
Guidance to Care and Residential Homes: Community Geriatricians
SA stated that the Care Quality Commission (CQC) England forwarded guidance
advising that visitors to care/residential homes should be double vaccinated prior to
entering the premises.
A general discussion followed.
The group agreed that it is strongly advised that visitors to care/residential homes
should be double vaccinated prior to entry as per CQC advice.
23/21
Primary Care Winter Pressures (Standard Operating Procedures (SOPs))
a) Primary Care Guidance
The document, circulated with the agenda, was noted.
b) GP Living with Covid (SOP)
The document, circulated with the agenda, was noted; it was recognised that the SOP
should be read alongside the Integrated Primary and Community Care ‘Living with
COVID’ Guidance which sets out relevant procedures to follow generically.
JS explained that the SOP relates to the triage of patients to determine on how best
they can be managed clinically. The SOP recommends triage is carried out via
telephone or triage platforms.
SA requested that the document is checked to clarify that telephone triage is not being
confused with telephone consolation.
JS
c) GP Winter Workload Pressures (SOP)
The document, circulated with the agenda, was noted.
A general discussion took place on the definition of significant workload pressures.
JS advised that the definition needs to be clear across Manx Care as this will be
significant to the delivery of primary care services. Input would therefore be required
from urgent care, respiratory and general medicine colleagues.
It was noted that colleagues were disappointed that no hospital clinical colleagues were
present today.
JS explained that paragraph 4.4 of the SOP refers to liaising with hospital colleagues
with the suggestion that protocols be established on how hospital colleagues are liaised
with should a clinician feel that a patient should be more appropriately seen in a
hospital setting.
It was agreed that a discussion would be held away from this meeting to agree a way
forward.
SA/JS
24/21
Cranial Arteritis Pathway
stated, via JS, that she raised the topic as RP and another Consultant both declined
to see patients who had been referred with a normal PV. explained that she was
advised by both Consultants that symptoms could not be related to GCA with a normal
PV, but this was not supported by the neurologists and the literature. KW requested
advice on dealing with the less typical cases.
RP advised that the pathway was prepared three/four years ago. Guidelines were last
updated in 2020. The pathway is still valid and has no changes.
RP explained that during the previous three months, two patients had been seen in the
Emergency Department (ED) and then on the Acute Medical Ward (AMU) via the
pathway. Biopsies were taken while in AMU, the report was received the next day with
RP seeing the patients within two weeks. In practice, the pathway is working well,
though this will only continue to work if colleagues in primary and secondary care pick
up signs and symptoms properly.
JC asked what the process was when a patient received a negative biopsy result. RP
explained that an alternative diagnosis should be considered. If vision is affected then
the patient should be referred to eye casualty or ophthalmology immediately.
RP advised that this pathway is predominately for GPs who feel that there is very high
risk associated with visual loss. For those patients with symptoms and visual loss this is
the pathway designed to prevent a delay in diagnosis; ultrasounds completed within
24/48 hours and DAB within 7/14 days.
It was noted that GPs are within their rights to refer to other areas; essential that
biopsies and ultrasounds are completed in timeframes when positive diagnosis
suspected.
KW stated, via JS, that Consultants have refused to see patients when it may not be
GCA. RP advised that he can only see patients and grade the urgency of the
appointment on the clinical evidence he has. He cannot force another clinician to
complete a biopsy and will see patients in clinics but not necessarily the next day.
asked RP how many symptoms (noted in the clinical suspicion of GCA box on the
pathway document) should the patient be displaying before commencing the pathway
process. RP stated at least two.
to see patients who had been referred with a normal PV.
explained that she was
advised by both Consultants that symptoms could not be related to GCA with a normal
PV, but this was not supported by the neurologists and the literature. KW requested
advice on dealing with the less typical cases.
RP advised that this pathway is predominately for GPs who feel that there is very high
risk associated with visual loss. For those patients with symptoms and visual loss this i
the pathway designed to prevent a delay in diagnosis; ultrasounds completed within
24/48 hours and DAB within 7/14 days.
It was noted that GPs are within their rights to refer to other areas; essential that
biopsies and ultrasounds are completed in timeframes when positive diagnosis
suspected.
KW stated, via JS, that Consultants have refused to see patients when it may not be
GCA. RP advised that he can only see patients and grade the urgency of the
appointment on the clinical evidence he has. He cannot force another clinician to
complete a biopsy and will see patients in clinics but not necessarily the next day.
asked RP how many symptoms (noted in the clinical suspicion of GCA box on the
pathway document) should the patient be displaying before commencing the pathway
process. RP stated at least two.
explained that there is no quick access to an inflammatory marker, blood test
results will not be carried out unless the patient is a hospital inpatient. WC is aware
that blood test results are taking up to six days at present.
RP advised that if an urgent sample is sent with a suspected diagnosis of GCA it will be
completed within the hour; that is the agreement in place, they will be prioritised as a
medical emergency.
RP explained that the patient could be sent to ED, AMU and ophthalmology on call if
necessary; there is an agreement in place and ophthalmology will see patients
immediately. RP stated that ED have the flowchart, they can be contacted and patients
will be seen for urgent blood tests. WC stated that this is not recorded on the pathway.
SA suggested that GPs follow the pathway if comfortable but can always revert to
referring to ED if appropriate. RP agreed.
RP left the meeting at 5.31 pm.
Additional information noted after JC left the meeting: asked if all Clinical Directors
and Consultants had agreed to the pathway and the suggestion that patients can be
sent to ED for urgent blood tests. SA advised that it is the responsibility of RP to ensure
the hospital teams are aware of processes. SA will speak with RP for clarification.
SA
25/21
Any Other Business
a) Care/Nursing/Residential Homes and Isolation Advice
JC asked for clarification on treating patients with Covid symptoms who go on to have
a negative PCR test with the GP then being asked for advice on self-isolation. JC
explained that it not the role of a GP to provide advice on self-isolation matters; this is
the responsibility of the 111 team.
JC explained that should a patient develop a cough, high temperature and/or shortness
of breath they will be treated by the GP though carers should also contact the 111
team to arrange a PCR test.
reiterated that GPs can provide a clinical assessment on a patient though it is not
within their remit to make any legal decision on self-isolation following a negative
result.
JC advised that following a negative result if the GP still suspected Covid they would
advise the 111 team to be contacted again.
SA stated that he would raise the issue of providing self-isolation advice to homes in
the Bronze and Silver Command meetings.
JS asked if a further issue could be raised also in the above meetings with the
Microbiology team in order to obtain advice as to when the patient should be tested
again should a negative Covid result be received, though the illness is still suggestive of
Covid by the GP. SA agreed to raise the issue.
JC stated that, in his opinion, the Infection Prevention and Control policy is very
hospital based.
JC left the meeting at 5.42 pm.
There being no further business the meeting closed at 5.45 pm.
SA
SA
26/21
Next meeting: Wednesday 27 October 2021 at 4.30 pm on MS Teams.
Apologies received from
Post meeting note; the next meeting is scheduled for Thursday 28 October
2021 at 4.30 pm on MS Teams.
Author(s)
Tammy Hewitt, Head of Strategic Partnerships
Version Number
1.3 FINAL DRAFT
Document effective from
July 2022
Next review due
June 2023
Intended audience
Manx Care and Commissioned Providers
Superseded documents
Not applicable
Stakeholders consulted
prior to ratification
Oliver Radford, Director of Operations
Sree Andole, Medical Director
Maria Bell, Pharmaceutical Advisor
Clinical Advisory Group (CAG)
Ratified by
Executive Management Committee
Date:
Previous reviews
Not Applicable
Changes made during
latest review
Not Applicable
Pathway 1
Urgent Need
Pathway 2
Clinical Priority
Pathway 3
Individual Characteristics
The patient is suffering
from a disease or
condition from which the
likelihood of death or
serious irreversible harm
is probable unless the
course of the disease or
condition is interrupted
by the immediate
introduction of a NICE TA
treatment
OR
The patient’s day to day
life is severely impacted
and impaired resulting in
repeated presentations
for emergency treatment
and/or prolonged
admissions into hospital
as a result of their disease
OR
The patient has previously
received a NICE TA drug
whilst living outside the
Isle of Man and
suspending treatment
would result in a
significant deterioration in
their condition
OR
The patient’s mental
health is being severely
affected.
The condition has an
extreme impact on
quality of life and the
patient is felt to have
particularly severe
disease.
There is strong evidence
that the individual patient
is likely to gain significantly
greater benefit from access
to the NICE TA treatment
than might be expected for
other patients in the cohort
with the disease or
condition, such as studies
demonstrating greater
benefit in those with
specific disease markers or
genetic characteristics.
Author(s)
Tammy Hewitt, Head of Strategic Partnerships
Version Number
1.2 FINAL DRAFT
Document effective from
July 2022
Next review due
June 2023
Intended audience
Manx Care
Superseded documents
Not Applicable
Stakeholders consulted
prior to ratification
Oliver Radford, Director of Operations
Sree Andole, Medical Director
Maria Bell, Pharmaceutical Advisor
Clinical Advisory Committee (CAG)
Ratified by
Executive Management Committee
Date:
Previous reviews
Not Applicable
Changes made during
latest review
Not Applicable
Item
Subject
Action by:
No.
56/23
Apologies for Absence
•
• Dr Sadha Punniyakodi
•
• Dr B Krishnan
•
•
57/23
Review notes/Matters arising from previous meeting
Meeting notes approved
CAG Notes
July23.docx
58/23
Review of Action Log
Action log reviewed and updated
CAG Action Log
02Oct23.pdf
59/23
IT and operational performance data analytics
Due to absence item rolled forward
Verbal
60/23
Role, remit and responsibilities of the Clinical Service Lead – for update &
discussion
Due to absence item rolled forward
Verbal
61/23
Joint care arrangements – for update & discussion
Due to absence item rolled forward
Verbal
62/23
Medical Gas Policy
Updated policy presented by for information.
SOP information removed to provide policy based document, bringing
together medical gas cylinders and pipes.
Ratified by the non-clinical quality group and is due to go to EMC for final sign
off. Medical Gas group now operational should there be any questions.
Medical Gas policy
2023 ManxCare ver d
Operational Policy -
MGPS for Noble's Ho
63/23
Treatment Escalation Plan Standard Operating Policy
Presented by & Dr Duncan Gerry as an update to the group.
In summary the Treatment Escalation Plan is about making decisions for
people both in and out of hospital. It's a step beyond a DNA CPR decision and
it has been a quality improvement project for the best part of a year. Under
the governance format of the Resuscitation Committee multiple people are
involved e.g. palliative care, a specialist, nurses, ambulance crew, GP.
In the next 6 months it is anticipated the DNA CPR form can be replaced with
a treatment escalation form.
They are aware that any policy change involving death and dying can be
misinterpreted so there will be an education and information alongside.
Next step will be to replace all DNA CPR forms with the new combined TEP
form.
Plan is to roll it out gradually throughout the wards starting with ED.
IP advised that the end of life and palliative care pathway falls within CQC
implementation action plan so he would like to be involved. Also questioned
if there had been involvement of Primary Care in the process and it was
confirmed GPs are on board.
VF aware of problems with these policies in the UK and asked if this had been
taken in to account and measures to prevent issues put in place.
DG/ have tried to cover this with education programs, getting people on
board and visibility of the form prior to it being completed. Trying to do this
thoroughly and properly and rolling out area by area.
JN supported what has been discussed so far and also advised that she has
undertaken teaching of F1 & F2 medical students regarding palliative care
and they have been offered shadowing opportunities at Hospice.
Engage with IP to ensure all areas covered
Additional wording to be included to avoid misunderstanding with
assisted dying/euthanasia.
/DG to bring back to CAG in 4 months
DG/
DG/
DG/
64/23
AOB
No further items
65/23
Date of next meeting:
Wednesday, 18 October 2023 @ 1600 hrs
Item
Subject
ACTION
By:
No.
97/22
Apologies for Absence
• Balakrishnan Venkitasamy
• Lakshman Paudyal
•
• Martin Rankin
•
• Ishaku Pam
98/22
Matters arising from previous meeting
Universal Mask wearing was stepped down as a result of the last
meeting on the basis that it is regularly monitored.
advised there are indications of Covid cases increasing in UK.
From data available here the case numbers are very low.
Agreed to continue monitoring and bring back to CAG if anything
needs to be escalated
99/22
Guidance on how to manage patients who cannot have a mRNA
vaccine as a booster – paper submitted by
SA brought the paper to the attention of the group.
For people who cannot have mRNA, Novavax COVID-19 can as per
JCVI guidance be used for primary vaccination.
CAG Submission -
Covid-19 vaccination
100/22
Interpretation of JCVI Guidance re children 5/11yrs - paper submitted
by
strongly against vaccination for 5/11 yrs & 11/18 yrs.
As of 1.8.22, combined totals for the Oxford AstraZeneca and Pfizer /
BioNTech vaccines in the Yellow Card scheme were 418,472 reports
concerning 1,368,814 adverse reactions, with 2,112 fatalities. Contrary
to international data, which suggest higher (approx 2x) ADR rates with
the Pfizer and Moderna vaccines, the Yellow Card numbers are about
1.5:1 Ox/AZ vs Pfizer/BNT.
SA - I understand that we have some reservations in vaccinating this
group but we will continue to adhere to JCVI guidance here in IoM
To go back to vaccination group and verify information provided
CAG submission -
Covid-19 vaccination
SA
101/22
Draft Policy – Testing for COVID in ICU
Policy submitted and presented by
Following a visit by senior ITU staff to Merseyside and Cheshire Critical
Care network group it was established that the other trusts within the
network are continuing to do PCR tests for patients admitted to ICU.
This has resulted in the attached policy which requires CAG to
recommend in order to move forward.
provided case examples as justification for implementing the policy.
advised meeting had taken place as higher rates of flu and
RSV expected this season. A paper/proposal will be put forward for
discussion at the next CAG.
No objections policy agreed
Manx Care COVID
screening for patien
102/22
Alteplase
SA introduction:
This is a drug given for 3 acute emergencies in medicine: stroke/ heart
attack /pulmonary embolism.
There is now a worldwide shortage due to production issues in
Germany.
The latest information is that it may not be any better before March
2023.
Shortage of
antithromlolytic age
There has been a lot of planning in the last few months on how to
manage and a Committee has been formed headed by
(includes cardiologist, stroke physician & respiratory)
provided update:
• National shortage of antithrombolytic agents (ie Alteplase /
Tennecteplase)
• Emergency meeting held last week (notes attached).
• Pharmacy have provided a list of total stock available across all
depts/wards/ambulance. Worst estimation is they will run out
by end of year
• Primarily we have to protect stroke (Alteplase) as time critical
(within 4.5 hrs)
• MI’s (Tenecteplase, Alteplase, Streptokinase & Urokinase) have
a window of 12 hours with initial use of Clopidogrel
• PE can have initial treatment of heparin infusion to stabilise
• In order to monitor accurately we will collect all Alteplase and
store in the stroke department, including any part bottles from
Ambulance. Anything left in a bottle can be safely used in
stroke unit.
• Tenecteplase not licensed in UK but there are ongoing studies
and has confirmed ok to go ahead.
• Suggest we upgrade contract with Liverpool to include transfer
for mechanical thrombectomy.
VF confirmed Radiology support for this, hopefully Radiographers will
also be on board.
SA we need system wide response - will keep informed
SA – bring back to CAG
SA/
102/22
AOB
Medicinal Cannabis – update
SA - We want a policy for what we can do for patients that come into
healthcare settings. Pharmacy dept is now leading on response and
sending out questionnaire to all medics for their input to
operationalise the pathway.
Update from on insourcing with Synaptik
• Started in April with Synaptik on IOM (we were second client)
• Phase 1 home surgeons operating with Synaptik ward staff,
theatre staff etc.
• Length of stay reduced from 4.5 to 1.5 days. (Extended hours
physio, higher staffing ratio)
• Feedback from patients is successful.
• Subsequent phases included Synaptik surgeons.
• Start of project waiting list was 600 – currently done 270 (so all
waiting lists for joint replacements now under 1yr.
• Good learning experience for us and Synaptik.
• 40% of waiting list done in 10 weeks and trying to learn from it.
• Multidisciplinary approach needed
• Ophthalmology is similar story doing high volumes of
cataracts.
• Should be further project of general surgery starting
December.
• Model is extremely successful - beds ring fenced in PPU.
• Important to engage with the process and be open minded.
103/22
Date of Next Meeting:
Wednesday, 2nd November 2022 @ 0800 hrs
Item
Subject
Action by:
No.
65/23
Apologies for Absence
• Dr Lakshman Paudyal
• Dr V Balakrishnan
• Dr David Hedley
• Dr Ishaku Pam
•
66/23
Review notes/Matters arising from previous meeting
Meeting notes approved
Notes CAG
02Oct23.docx
67/23
Review of Action Log
Action log reviewed and updated.
18Oct23.CAG
Action Log 2023.pdf
68/23
IT and operational performance data analytics
Presented by
suggested this be a regular item on the CAG agenda in order to
review outcome measures for each service and to have up to date
operational performance measures for sharing. Sree had initially
circulated a slide to be used as template but this was not taken up.
It was agreed to roll forward to next month when Sree will be
back when a definitive set of measures can be agreed and then
used to submit data.
69/23
Role, remit and responsibilities of the Clinical Service Lead – for update
& discussion
Presented by
looking for a definition in writing of a Clinical Lead with remit &
responsibilities. The reason for raising this topic is that with leadership
comes accountability, which needs to be addressed. The Clinical Service
Lead role currently comes with 1 SPA allocation in the Consultant job
plan. He asks for this role to be defined in writing and attach correct
amount of time. In the UK the standard term for this role is 3 years.
MH advised this is an ongoing discussion In Clinical Director meetings.
Currently there is no Manx Care job description. Currently looking at
leadership going forward which will become more obvious and
transparent in coming year.
agreed with what has said and he has noticed these roles are very
different on IOM as Clinical Leads are expected to have a wider range
and cover far more.
MH confirmed the plan is to work on this in order to be very clear with
leadership models. It is work in progress and we should know in the
New Year what the roles will be in leadership.
raised the point that in UK business managers provide support,
whereas this is not the case here. Without managerial input the role is
very difficult.
MH advised this is something she will hand over to Sree upon
his return as it is ongoing work and will require engagement
with medical workforce to establish what the role is.
MH
70/23
Joint care arrangements across primary & secondary care
Presented by
brought this topic to CAG following a trigger in his speciality that
highlighted the lack of formal arrangements in place that is probably
similar across other specialities.
JS advised that if this is specifically regarding Shared Care, then there is
a Shared Care programme, with business cases submitted for each
Shared Care pathway. If this is an undeveloped pathway it will need to
be put in the program via the Care Group leadership.
MH informed that Shared Care arrangement with CAMHS regarding
ADHD & melatonin medications is a pilot with GPs whereby GP’s are
being paid. MH will feed back on the success of the process in a few
months’ time.
clarified that the reason he described it as ‘Joint Care’ is due to the
inpatient situation where medics and surgeons are not working
together. An agreed set of ground rules for inpatient setting would be
helpful.
agrees, this is ongoing and MH currently involved.
MH confirmed here is a distinct lack of collaboration and there
needs to be a collaborative exercise to review SOPs to ensure fit
for purpose and she will take this issue forward in her handover
to Sree (SA).
MH
71/23
Organ Donation Policy for information & comment
presented the policy that she has co-written. The policy has been
ratified at the Organ Donation committee in September and was
presented at the Quality Care Group meeting where they asked for the
policy to be presented at CAG.
Essentially the policy lays out processes on how we function and deliver
organ donation in this hospital and what everybody’s jobs are, with
being Clinical Lead in Organ donation. Main audience to address is ED,
ICU, theatres, pathology and mortuary. However everyone should be
aware and supportive.
The policy has 8 appendices, eg how to contact and bring over the
retrieval team, how to approach families
No issues raised by the group.
Appendix 1 Form Appendix 2 Appendix 3
for the diagnosis of Diagno sing D eath SDona t ion afte r Diag
Appendix 4 Appendix 5 Appendix 6
care-of-potential-lunWITHDRAWAL OF TRDONATION AF TER C
Appendix 7 Appendix 8 CARE
DONATION AFTER DAFTER DONA TION.d
OTD-01 -
IOMOrgan Donation
72/23
Pathology MDS Policy for information & comment
Item to be carried forward to the next meeting.
73/23
Do Not Attempt Cardiopulmonary Resuscitation Policy – for
information & comment
Presented by
Having taken the DNA CPR to OCG Dr Pam suggested bring it to CAG.
explained it is not a new paper, only a review of an existing policy.
There are no changes as there is a group working to implement a
Treatment Escalation Plan (TEC) in the near future. This group is
currently working on a policy that will replace in part this DNA.
(Presented at CAG 02Oct23 by Dr Duncan Gerry & )
MR currently using one from TEP group as part of the limited rollout.
advised it was always intended to be a limited roll out to work
through issues.
confirmed that the intention is for the DNA form to cease once the
TEP form is finalised. The DNA CPR will be incorporated into TEP.
The DNA CPR needed a review to keep it legal and current until TEP is
rolled out.
raised a concern as to whether the wording is strong enough on 2.8
lack capacity. Although advised it is worded more strongly elsewhere
in the policy AD suggests strengthening the wording in that particular
paragraph wording, ie MUST
Questions were asked about the status and rollout of the TEP.
advised that has been produced as a Quality Improvement Project and is
only used in a limited in way. E.g. Dr Gerry team, Ward 6, Ramsey &
Siverdale (MR)
will revisit the wording on sec 2.8 and amend accordingly
2023DNACPRV2.pdf
74/23
AOB
Nothing raised
75/23
Date of next meeting:
Wednesday, 15 November 2023 @ 1600 hrs
Item
Subject
Action by:
No.
76/23
Apologies for Absence
•
• Dr B Krishnan
•
77/23
Review notes/Matters arising from previous meeting
Meeting notes approved
Notes CAG
18Oct23.docx
78/23
Review of Action Log
Action log reviewed and updated
CAG Action Log
2023.xlsx
79/23
IT and operational performance data analytics
to discuss with as AMD for Patient Safety & Governance
80/23
Urgent/non urgent pathways for discussion
Non raised
81/23
Updated TOR for review
TOR agreed (reporting line to Bronze & Silver Commands removed)
Terms of Reference
Clinical Advisory Gro
82/23
Referrals
Not discussed
83/23
Medicines Policy for information/review
MH apologised as she had to make a decision on this policy, otherwise we
would be in a vulnerable position of having no signed off policy in place.
(One of the CQC standards that we kept failing).
Reference to EBNF was removed as the GP’s do not have access to this.
It was agreed to ratify the policy as somewhere to start working - there will
be 6 months to review and have a meaningful consultation exercise by all
Doctors.
The Medicines Policy is now on the intranet and MH encourages all Doctors
to review.
Policy to be brought back to the meeting for comments
23-11 Medicines
Policy - V5 All chang
MH/
84/23
AOB
Meeting day/time
It was proposed to alternate the meeting day each month – Tuesday, then
Wednesday.
This was agreed and a new schedule of meetings alternating
Tuesday/Wednesday for 2024 will be sent out.
MECFS & Long Covid Service
had received contact by one of the users and requested input on how to
handle the matter. After discussion it was agreed that the correct route
would be to refer through MCALS so it is dealt with in a systematic way and
it is fully recorded.
85/23
Date of next meeting:
Wednesday, 20 December 2023 @ 1600 hrs
Full Response Text
AGENDA
Clinical Advisory Group (CAG)
Thursday 12 August 2021
4.30 - 5.30 pm
MS Teams
Item No.
Subject
Discussion
Lead
Document(s)
Attached
07/21
Apologies
SA
08/21
CATCH Sites
Verbal presentation by Juan Corkill
JC
09/21
Covid-19 Pathways
SA
10/21
Any Other Business
a) Results Acknowledgement
SA
11/21
Next meeting: Wednesday 18 August 2021 at
4.30 pm on MS Teams.
AGENDA
Clinical Advisory Group (CAG)
Wednesday 23 June 2021
4.30 - 5.30 pm
MS Teams
Item No.
Subject
Discussion
Lead
Document(s)
Attached
01/21
Apologies
SA
02/21
Improving the Quality of Electronic Discharge
Summaries
SA
03/21
Covid 19 Vaccines/Allergies
SK
04/21
Long Covid; the NHS Plan for 2021/22
SA/JS
05/21
Any Other Business
All
06/21
Date of Next Meeting if appropriate
SA
AGENDA
Joint Clinical Advisory Group (Joint CAG)
Wednesday 30th March 2022
4.30 - 5.30 pm
MS Teams
Item
No.
Subject
Discussion
Lead
Document(s)
Attached
15/22
Apologies
SA
16/22
Matters Arising From Last Meeting
SA
17/22
Global Burden of Disease Study on Dementia
Prevalence - implications for population health
Please read link to the paper below.
Estimation of the global prevalence of dementia in
2019 and forecasted prevalence in 2050: an analysis
for the Global Burden of Disease Study 2019 - The
Lancet Public Health
SA
18/22
Capacity Bill - Advance Consent
Department meeting
6 December - Capacit
SA
19/22
Updates on Transformation
SA
20/22
ANP Referrals
SA
21/22
Any Other Business
SA
22/22
Date of next meeting:
Wednesday 27th April 2022 at 4.30 pm
Classification: Official
Publications approval reference: C1312
Long COVID: the NHS
plan for 2021/22
Version 1, June 2021
Classification: Official
2 | Long COVID: the NHS plan for 2021/22
Content
Summary .................................................................................................................. 3
Summary of actions on Long COVID 21/22 .............................................................. 6
1. What we know about Long COVID ....................................................................... 8
2. Expanding Long COVID treatment and rehabilitation services ........................... 12
3. Enhancing general practice services to support patients with Long COVID ....... 20
4. Long COVID in children and young people ......................................................... 23
5. Rehabilitation to manage the most common Long COVID symptoms ................ 25
6. Extending the use of the Long COVID self-management digital tool .................. 27
7. Improving data quality and transparency ............................................................ 29
8. Focus on equity of access, outcomes and experience ....................................... 31
9. Supporting NHS staff with Long COVID ............................................................. 34
Useful information ................................................................................................... 36
Classification: Official
3 | Long COVID: the NHS plan for 2021/22
Summary
• Highly debilitating for many sufferers, Long COVID is an increasingly
widespread, multi-system condition. Regardless of the severity of their
initial illness, it appears that anyone of any age – including children - can
experience Long COVID.
• The term ‘Long COVID’ includes both ongoing symptomatic COVID-19
(5-12 weeks after onset) and Post-COVID-19 Syndrome (12 weeks or
more). It is associated with a wide range of different symptoms impacting
physical, psychological and cognitive health. It can also have an effect on
quality of life and ability to work or attend education.
• As an initial response to the challenge of Long COVID, last October
the NHS set out a 5-point plan:
– advice for clinicians and information for patients: NICE published the
case definition in November and clinical guidance on managing the long-
term effects of COVID-19 in December 2020
– providing Post-COVID Assessment Clinics. 89 clinics have now been
established in England to offer specialist physical, cognitive or
psychological assessment. While the second COVID-19 wave impacted
them, early data showed increases to over 1500 referrals a week
– over 1.5 million visits have been made to the patient information section
of the Your COVID Recovery website and over 100 rehabilitation
services have been trained to support patients to use the specialist
online rehabilitation support element
– on research, the NHS worked with the National Institute of Health
Research to support studies to advance understanding of Long COVID
with £50 million having now been committed to research
– finally, we have been much aided by the work of the NHS Long COVID
Taskforce, which includes people with lived experience of Long COVID,
NHS staff and researchers.
Classification: Official
4 | Long COVID: the NHS plan for 2021/22
These foundations provide the basis for a further 10 key next steps,
underpinned by an additional £100 million, to which the NHS now commits in
2021/22:
1.
£70 million to expand Long COVID services to add to the £24 million
already spent on Post-COVID Assessment Clinics. By mid-July 2021, all
local NHS systems will have submitted to regions, fully staffed Long COVID
service plans covering the whole pathway from primary and community to
specialist care. These should cover diagnostics, treatment, rehabilitation,
children’s services and mental health services. To support this NHS England
and NHS Improvement have developed a more detailed Long COVID clinical
pathway, with help from an expert clinician group and people with lived
experience, which was published as part of updated national commissioning
guidance for Post-COVID Assessment Clinics in April 2021.1
2.
£30 million for the rollout of an enhanced service for general practice to
support patients to be managed in primary care, where appropriate, and
enable more consistent referrals to clinics for specialist assessment and
treatment. Funding for the enhanced service will be made available to
general practice to support professional education; support training and
pathway development that will enable clinical management in primary care,
where appropriate; and enable more consistent referrals to clinics for
specialist assessment in line with the recently updated Commissioning
Guidance; and planning to ensure equity of access.
3.
Care coordination. Care coordinators will support the running of Post-COVID
Assessment Clinics. Long COVID can be a complex, multi-system disease.
They will ensure care is joined up and prioritised based on clinical need. We
will publish information about waiting times to ensure transparency.
4.
Establish 15 Post-COVID assessment children and young people’s hubs
across England in order to coordinate care across a range of services.
Building on the services already in place, these specialist hubs around
England will provide assessment services or remote support to other clinicians
and ensure ongoing holistic support.
5.
Develop standard rehabilitation pathway packages to treat the
commonest symptoms of Long COVID. Local NHS systems will include a
rehabilitation pathway programme in their Long COVID service plans due by
Classification: Official
5 | Long COVID: the NHS plan for 2021/22
mid-July 2021. It should be based on the principles included in the RightCare:
Community Rehabilitation Toolkit.
6.
Extend the use of the Your COVID Recovery online rehabilitation
platform. Local NHS systems will include planning to ramp up Your COVID
Recovery supported patient-self management in their Long COVID service
plans due by mid July 2021. The aim is to support those with Long COVID
remotely to manage and monitor their symptoms where appropriate. Improved
functionality will enable Your COVID Recovery online content to be translated
into more than 100 languages. Work will also be undertaken to ensure
improved accessibility through inclusion of easy read options and a printed
manual which replicates online content.
7.
Collect and publish data to support operational performance, and
clinical and research activities. From September 2021 onwards, NHS Long
COVID activity data on referral, assessments and waiting times for post-
COVID assessment clinics and the onward patient journey, including use of
Your COVID Recovery, will be published monthly. A Long COVID registry for
patients attending the Post-COVID Assessment Clinics will be established by
July 2021. This registry will facilitate understanding of the longitudinal patient
journey and support operational, clinical and research activities, through data
linkage across national data collections. Importantly, it will also allow a more
granular understanding of healthcare access for groups who experience
health inequalities.
8.
Focus on equity of access, outcomes and experience. The NHS will use
data tools to track take up by gender, ethnicity and deprivation, against
expected prevalence. We will partner with National Voices, Asthma UK/British
Lung Foundation and other Voluntary, Community and Social Enterprise
Sector (VCSE) organisations to engage with communities more likely to be
impacted by health inequalities. NHS England and NHS Improvement will
appoint six Patient and Public Voice Partners to provide advice on Lived
Experience to the programme. We will carry out a Health Equity Audit to
assess the degree to which we achieve our vision of equitable access,
excellent experience and optimal outcomes for all communities.
9.
Promote good clinical practice through the national learning network on
Long COVID for healthcare professionals including a network for nurses
Classification: Official
6 | Long COVID: the NHS plan for 2021/22
working in community and acute care and for the wider NHS. We have
developed a site on the FutureNHS platform to provide educational materials
and enable information sharing across healthcare organisations and staff.
10. Support our NHS staff suffering from Long COVID by offering a package of
comprehensive support for health and wellbeing including mental health hubs,
rapid referral to services, local occupational health and online wellbeing
resources.
Summary of actions on Long COVID 21/22
Actions
Delivery Date
Owner
1.
Invest a further £70 million to expand Long COVID treatment and rehabilitation
21/22
NHS England
and NHS
Improvement
2.
Invest £30 million in the rollout of an enhanced service for general practice to
support patients in primary care
21/22
3.
Publish information about waiting times of post-COVID assessment services to
ensure transparency
September
2021
4.
Evaluate post-COVID Assessment Clinics to obtain the lessons learned from
set up
Ongoing
5.
Ongoing review of the Long COVID clinical pathway to reflect the latest
research evidence and operational experience
Ongoing
6.
Extend the use of the Your COVID Recovery online rehabilitation platform
August 2021
7.
Use data tools showing take up by gender, ethnicity and deprivation, against
expected prevalence.
July 2021
Partner with National Voices, Asthma UK/British Lung Foundation and other
Voluntary, Community and Social Enterprise Sector organisations to engage
with communities more likely to be impacted by health inequalities.
Summer 2021
Appoint six Patient and Public Voice Partners to provide advice on lived
experience to the programme
May 2021
Carry out a Health Equity Audit to assess the degree to which we achieve our
vision of equitable access, excellent experience and optimal outcomes for all
communities.
Summer 2021
To improve accessibility of information we will ensure ‘easy read’ and printed
versions of Your COVID Recovery materials are accessible, and that
translations in over 100 languages will be available.
August 2021
Promote good clinical practice through the national learning network on Long
COVID for healthcare professionals
Ongoing
Further develop resources on FutureNHS platform to provide educational
materials and enable information sharing across healthcare organisations and
staff
Ongoing
For NHS staff, comprehensive support for health and wellbeing including
mental health hubs, rapid referral to services, local occupational health and
online wellbeing resources will be available.
June 2021
All local NHS systems will have submitted to NHS Regions, fully staffed Long
COVID service plans covering the whole pathway from primary to specialist
care
12 July 2021
Integrated
Care Systems
Local NHS systems will include planning to ramp up Your COVID Recovery
supported patient-self management in their Long COVID service plans
July 2021
Classification: Official
7 | Long COVID: the NHS plan for 2021/22
Long COVID services will nominate care coordinators to manage complex
cases
July 2021
Develop standard rehabilitation pathway packages to treat the commonest
symptoms of Long COVID
July 2021
Establish 15 Post COVID assessment paediatric hubs across England
July 2021
NHS Long COVID activity data on referral, assessments and waiting times for
post-COVID assessment clinics and the onward patient journey including use of
Your COVID Recovery will be published monthly
September
2021
NHS England
and NHS
Improvement
and NHS
Digital
A Long COVID digital code will be added to the psychological therapies
Minimum Data Set.
Summer 2021
A Long COVID registry for patients attending the Post COVID Assessment
Clinic will be established
July 2021
Classification: Official
8 | Long COVID: the NHS plan for 2021/22
What we know about Long COVID
Clinical case definition
Some people can experience ongoing symptoms following COVID-19 well after
their initial infection. People of all ages and backgrounds, irrespective of the
severity of initial infection, can experience Ongoing Symptomatic COVID-19 and
Post COVID-19 Syndrome, also known as ‘Long COVID’.
Long COVID is a multi-system condition with a wide range of debilitating symptoms
spanning fatigue, breathlessness, cough, chest pain, heart palpitations, fever,
headache, muscle pain, gastrointestinal problems and loss of taste and smell.
Many people with Long COVID may experience a range of psychological and
cognitive symptoms such as depression, anxiety, post-traumatic stress disorder
(PTSD) and ‘brain fog’ or other cognitive impairments, in addition to physical
symptoms. This can also have a social impact. Symptoms can fluctuate and change
over time. They are well recognised by p
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