South West Clinical Senate

• Thursday 10th April 2014

• @SouthWestSenate

• #assembly

• Wifi : thistle-no password

Welcome • Housekeeping

• Purpose of today:

• Bring together Senate Assembly for the first time & consolidate its role

• Bring together Citizens’ Assembly

• Raise awareness

• Engage with our commissioners and providers

• Identify future topics for the Senate Council

• Provide experience of the Senate Council function

@swsenate#assembly

10.00 1WelcomeThe South West Clinical Senate to date

Dr Shelagh McCormick, Deputy Clinical Chair, South West Senate

10.15 2 Clinical Senates and the interface with SCNs and AHSNs Mr Nigel Acheson, Medical Director, NHS South

10.30 3 Challenges facing the South West Ian Biggs, Area Team Director, NHS England

10.45  4 Questions ? Then 30 minute coffee break  Panel

11.30 5 Public Health impact and Outcomes in the South WestDr Shona Arora, Public Health Consultant, Public Health England

11.45 6Question Generating Workshops – Where can the Senate make an impact?(breakout rooms)

Groups

12.30   Lunch  

13.30  7 “Wise decision making and argumentative logic”Plenary Session (Barristers Ian Fenny & Julie MacKenzie)

14.00 8

 ‘Mini’ Senate SessionBreakout rooms – range of questions; Frailty Urgent Care Paediatric Surgery Primary Care End of Life 

Clinical Chairs

15.45 9 Summary & Close Shelagh McCormick

Agenda

South West Clinical Senate

“Clinical senates will help make the best decisions about healthcare for the populations they represent by providing advice and leadership at a strategic level” (NHS England: The Way Forward - Clinical Senates)

Clinical Senates Map

5

North East, north Cumbria, and the Hambleton & Richmondshire districts of North Yorks

Greater Manchester,

Lancashire and south Cumbria

Cheshire & Mersey

West Midlands

East Midlands

South West

Thames Valley

East of England

Wessex

Yorkshire & The Humber

South East Coast

London

South West Clinical Senate

South West Footprint

Work

Bristol to Preston 189 miles 3hrs

33mins

Penzance to Bristol 190 miles

3hrs 37mins

• 11 CCGs

• 3 Local Area Teams

• 13 Healthwatch Organisations

• Over 30 providers

• 3 large tertiary providers, two in Bristol

and one in Plymouth

• 2 Mental Health providers with Medium

secure services

Senate Management Team

• Senate Manager: Ellie Devine 3 days/week

• Senate Chair: Dr Vaughan Lewis, Paediatrician, RD+E 1 day/week

• Shared admin support with SCN

• Associate Director of SCN and Senate: Sunita Berry

• Medical Director, BNSSSG Area Team, NHS England: Dr Caroline Gamlin

The South West Clinical Senate

Senate Council (Meets 4-6 times a year, 43

members)

Senate Assembly (Meets Annually, 160+ members)

Citizen’s Assembly

(Meets 4 times a year, 26 members )

Senate Management Team

Healthwatch x13

Health & Social care

ProfessionalsCommissioner

Questions (CCGs, Specialised

Services, Area Teams, HWBs, LAs, PHE, Senate Council)

Question

Advice

CRGS HEE SCNS AHSN PHE Providers Patients

Evidence Gathering

Role of Senate Assembly Members • 26 Senate Council members are drawn from Senate Assembly

• Both the Senate & Citizens’ Assembly are the wider conscience of the Council

• Be a repository of expertise and advice across the South West

• Provide comment on topics going to the Senate Council and suggest evidence

• Present evidence to the Senate Council at deliberative meetings if requested

• Act as ambassadors of the Senate & share Senate advice

• Field questions into the Senate Council

• Take part in expert review teams for clinical assurance of service change

• Meet 1-2 times a year as a group

Role of Citizens’ Assembly Members • 4 Senate Council members are drawn from Citizens’ Assembly

• Senate & Citizens’ Assembly are the wider conscience of the Council

• Use local Healthwatch organisations to link into patients and public across South West

• Comment on topics going to the Senate Council and suggest evidence

• Present evidence to the Senate Council at deliberative meetings

• Act as ambassadors of the Senate & share Senate advice

• Field questions into the Senate Council

• Meet 4 times a year as a group

Our Offer

“Working across the South West to develop expert advice for your regional commissioning questions”

• Free resource providing decisive advice to commissioners in one day

• No other part of the healthcare system has access to equal breadth and expertise from healthcare professionals across the South West

• Strengthens the contribution of the patient voice in commissioning decisions

• Provides a growing repository of advice that is openly accessible

Accountability

• Way Forward – Clinical Senates (July 2012 & Nov 2013)

• The Senate is a non-statutory entity with no executive authority or legal obligations.

• You can hold the Clinical Chair to account for failure to follow process but not for the advice the Senate gives.

What have we achieved so far?

Setting up a new non-statutory organisation

• Senate Management Team established– April 2013

• Development of Senate Assembly – 170+ members

• Appointment of Senate Council – 43 members

• Development of Citizens’ Assembly – 26 members

• Launch of new website www.swsenate.org.uk

What have we achieved so far?

Providing Clinical Advice

• First Senate Council Meeting – Specialised Commissioning Principles

• Second Senate Council Meeting – Advice on Model for HIV services

• Operating Principles and Procedures

• Linking in with the National picture for Senates – sharing & pooling knowledge

• First full Assembly 10th April 2014, Exeter – developing workplan

• Third Senate Council Meeting – Acute Emergency Services

Taking on the role of NCAT• NCAT ceased to function as of 1st April

• 12 Senates across England to take on role of National Clinical Advisory Team from September 2014

• 12 Senates working together to develop terms of reference and standard operating principles

• Senate to develop Expert Review Teams to consider Clinical Evidence base for large scale service change as part of assurance process

• Will look to Assembly members to join or nominate colleagues for Expert Review teams

• Senate Council to agree TOR for each review team and sign off final report

• Work across Senate areas if required

Vision

• The Senate serves as the collective conscience of health and social care to develop high quality and sustainable healthcare across the South West.

• The Senate provides outcomes from its deliberations that are highly regarded and valued and are able to be implemented

• Is recognised as valuable to the community and provides leadership in healthcare system transformation and reconfiguration

Next steps

• Clearly articulate role in new NHS and within the South West

• Take on role of clinical advice in service change – Sept 14

• Continue establishing key relationships

• Develop work-plan of questions with commissioners

• Consolidate Citizens’ Assembly

• Develop and ‘build’ Senate Council as expert deliberative body

Summary & Close

• Themes from Mini Senates

• Questions to explore further

• Presentations and Notes to be shared

• Thank you

www.swsenate.org.uk

@swsenate#assembly

Breakout Group Room Changes

• Green – Derby Room (ground floor opposite reception)

• Orange – Chatsworth

• Blue – Devonshire (main room)

• Yellow – Compton B & C (1st Floor)

• Red – Burlington (Ground Floor)

Key Themes from question generating • Need for & impact of centralisation agenda in

South West?

• Models for shifting workforce and meeting workforce needs?

• Is equality of access in rural areas possible?

• How to deliver mental alongside physical health?

• Developing care and effective structures/interfaces in services outside hospitals

Mini Senate Topics• Frailty – developing community services to reduce

hospital admissions

• Urgent Care – designing a new model

• Primary Care – exploring family care networks

• Paediatric Surgery – examining impact of centralisation

• End of Life Care – ensuring equity of access in final weeks of life

Mini Senate Themes• Frailty – on what principles should you develop

the service?

• Urgent Care – what needs to be 24/7?

• Primary Care – what are the possible models for General Practice?

• Paediatric Surgery – what evidence should you use & the pitfalls/beartraps of evidence

• End of Life Care – Developing earlier advanced care plans and equality of access from cancer to chronic respiratory disease

Question GeneratingYellow

What administrative healthcare structure would the Senate advocate upwards? (Current system is helpful/blocks pathways)

Which services in SW need to centralise?

Orange

Can the Senate influence removing the divide between mental and physical health?

Senate to look at models working well nationally & internationally?

• Orange Group

What would a well designed individual care plan look like and how do we deliver this

• How do we empower patients to self manage

• Red Group

• How can interventional radiology/vascular services be provided across rural areas equally

• How should the best possible hospital care be provided for Brain injured patients

• Red group

• How does a hospital that receives <30% of its income from specialised commissioning provide sustainable secondary care

• How do we change the funding of specialised commissioning to remove the perverse disincentives for GPs referral and improve specialist knowledge and expertise in primary and community care

• Blue Group

• How can integrated care improve outcomes for people with complex care needs – medical and social

• When does end of life start

• Green Group

• Can the Senate examine models of care hat encourage cross organisational working

• How can the Senate assure that the Better Care Fund provides improved patient care and that it is not a system to fill gaps (eg pot holes)

• How can the Senate assure equality of access in a fragmented pluriprovider environment. Do we want an free market model where patients are empowered with funds to buy care where they want to

• How can the Senate contribute to keeping people who are dying or close to death out of acute hospitals with decent care and support at or close to home

• How can the Senate respond to the concerns of all relevant groups about the centralisation agenda.

• How can workforce/critical mass of expertise shifts be safely managed