Clinical Senates & Networks

The Big Picture

The Three R’s• Rationing

• Revalidation

• Reconfiguration

NIMROD

NotIncludingMy RelativesOrDependents

Clinical engagement is critical to getting more for less

Chairs of the Clinical Innovation Teams and Network Leads meet monthly

Since 2008 over 1000 North East cliniciansHave helped develop ourprogramme of activity

We can network

Examples: Bill Cunliffe –Planned CareLiz Kendrick- End of Life Care

Having the Choice to Die at Home

Fast Focus Session

End of LifeClinical Innovation Team

Design Document for Discussion

Most people would prefer to die at home. Most die in hospital

GP Palliative care registersLiverpool care pathwayCare homes and advanced care planning“would you be surprised?”24/7 community supportEarly engagement with 111

initiatives

Standard care for colon and rectal surgery ……

• Two day bowel prep, in hospital

• Nasogastric tube until passing flatus

• NBM until passing flatus

• Compression stockings, no heparin

Why did we do this?

Our reasoning was flawed !

Enhanced Recovery

ERP planning clinic

Preadmission CHO load

Gut friendly anaesthetic

Eat,drink and move day 1

Elective 1 year Open Resections Laparoscopic

Resections

Pre-ERP(n=21)

Post-ERP(n=20)

Pre-ERP(n=43)

Post-ERP(n=45)

Mean age 73.3 years 69.9 years 67.8 years 66.1 years

Mean post-op stay

12.6 days(4-37)

10.5 days(3-48)

8.0 days(1-45)

4.9 days(1-17)

Median post-op stay 10 days 6.5 days 4 days 4 days

Readmission 9.5% 15% 19% 16%

ACPGBI 2009

Laparoscopy Enhanced Recovery Prog.

2008 3.5 colorectal surgeons 12 months 129 patients

Courtesy Mr Mark Katory, colorectal surgeon

‘The Clinical Network’Should we integrate clinical networks?

What IS a network?What would the governance look like?

not all problems will respond to NHS Improvement

Clinical Senates

How many?How do they interface with networks,

CCGs,HWBs, LA’s and F Ts

In the land of the blind,The one eyed man is king

Clinical Senates & Networks

The Big Picture