South West Clinical S enate

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 1 WelcomeThe 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 West Dr Shona Arora, Public Health Consultant, Public Health England

11.45 6 Question 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 SenateSenate 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 GeneratingYellowWhat administrative healthcare structure would the Senate advocate upwards? (Current system is helpful/blocks pathways)Which services in SW need to centralise?OrangeCan the Senate influence removing the divide between mental and physical health?Senate to look at models working well nationally & internationally?

• Orange GroupWhat 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