NHS | Presentation to [XXXX Company] | [Type Date]1

Senates - the interface with SCNs and AHSNs

Nigel AchesonMedical DirectorNHS England (South)

2

SCNs and Clinical Senates

4 in the South

• South West• Wessex• Thames Valley• South East Coast

NHS | Presentation to [XXXX Company] | [Type Date]3

• Cardiovascular (cardiac/stroke/diabetes)

• Maternity/children and young people

• Mental health/dementia/neurological conditions

• Cancer

• [ Respiratory]

NHS | Presentation to [XXXX Company] | [Type Date]4

SCN 2014/15 priorities

Themes:

• Early diagnosis

• Parity of esteem

• Optimisation of pathways

• Reducing avoidable admissions

• Reducing variation

NHS | Presentation to [XXXX Company] | [Type Date]5

AHSNs

5 in the South:

• South West Peninsula

• West of England

• Wessex

• Oxford

• Kent, Surrey and Sussex

NHS | Presentation to [XXXX Company] | [Type Date]6

AHSN licence agreement focus upon:

• Wealth creation

• Spread and adoption of innovation

• Building upon a culture of collaboration

between stakeholders

NHS | Presentation to [XXXX Company] | [Type Date]7

AHSN 2014/15 priorities • Clinical workplans include:

• Pharmacy

• Mental health

• Long term conditions

• Enhanced recovery

• Urgent care

• Informatics/telehealth

• Patient safety collaboratives

NHS | Presentation to [XXXX Company] | [Type Date]8

New financial year, new NHS England Chief Executive – Simon Stevens

NHS | Presentation to [XXXX Company] | [Type Date]9

Simon Stevens speech 3rd April 2014

• Out of hospital care

• Personalisation (eg using genomics)

• Reducing variation and assurance of quality

• Early diagnosis, prevention and intervention

• Co-production and self care

NHS | Presentation to [XXXX Company] | [Type Date]10

Some “big” issues

• Smoking/Hypertension/Obesity/Diabetes

• Parity of esteem

• Primary care transformation

• Variation in quality

• Urgent care

• End of life care

NHS | Presentation to [XXXX Company] | [Type Date]11

Some issues to address…

• Dogma

• You can’t close my…..

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New England Journal of Medicine, 2014

• Paper from Ontario, Canada relating to the

surgical safety checklist – little impact on mortality

• Atul Gawande – “government mandate without

serious effort to change the culture and practice of

surgical teams results in limited change”

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Specialised commissioning

• 143 new service specifications and adopted 60

highly specialised service specifications

Only the beginning – equity of access, quality of

services (clinical and cost-effectiveness, patient

experience, patient safety)

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• Need to develop pathways and networks to

ensure both quality and access to specialised

service

• This will require changes in how and where

specialised services are provided

NHS | Presentation to [XXXX Company] | [Type Date]15

• Engaging patients, staff, the wider public and

other stakeholders will be critical if high quality

services are to be developed and improved

• Senates will play important roles in improving the

quality of care through such transformation

NHS | Presentation to [XXXX Company] | [Type Date]16

The Four Key Tests (in 14/15 Mandate)

• Strong public and patient engagement

• Consistency with current and prospective need for patient choice

• A clear clinical evidence base

• Support for proposals from clinical commissioners

NHS | Presentation to [XXXX Company] | [Type Date]17

What guidance has been published?

Sets out a broad framework of

roles and responsibilities for

commissioners in how they

should plan for major service

change, work with providers,

local authorities, patients and

the public

How are proposals assured?

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The aim of clinical assurance through the

Senate is to establish whether the proposed

changes are supported by a clear clinical

evidence base and will improve the quality

of the service provided

NHS | Presentation to [XXXX Company] | [Type Date]20

National Clinical Advisory Team (NCAT) assurance

of service change proposals:• 1 Independent clinical assurance of reconfiguration

• 2 Early advice

• 3 Review and investigation of clinical services (eg re safety)

• 4 Evidence collection

• 5 post-hoc advocacy

NHS | Presentation to [XXXX Company] | [Type Date]21

Senates will undertake functions 1 and 2

Independent clinical assurance of

reconfiguration

Early advice

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• Investigation of issues of clinical safety (function 3) lies

with other bodies

• Evidence collection (function 4) is undertaken by a

range of organisations including NICE, Royal Colleges

and NHS Evidence

NHS | Presentation to [XXXX Company] | [Type Date]23

• The post-hoc advocacy role (function 5) is not a

function for Clinical Senates to undertake in

isolation

• Any communications or advocacy requirements

should be considered by NHS England as part of

its broader assurance process

NHS | Presentation to [XXXX Company] | [Type Date]24

Senate roles

1 Clinical advice to commissioners to help inform

proposals (by ?SCNs or Senate if outwith SCN groups)

• Strategic clinical advice to commissioners on relevant clinical

guidance/best practice

• Advice to support commissioners in developing a case for

change, options appraisal and proposed clinical models

NHS | Presentation to [XXXX Company] | [Type Date]25

A proportionate approach

26

2 Independent clinical advice as part of the NHS

England service change assurance process

• Independent clinical advice by means of a formal report to

be considered as part of the NHS England assurance

process for service change proposals

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Service change assurance exists to give confidence

to patients, staff and the public that proposals are

well thought through, have taken on board their

views and will deliver real benefits

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Next steps

• Development of common products for use by Clinical

Senates (principles for managing reviews, ToR, review report

pro-forma)

• Associate Directors for SCNs and Clinical Senates and

Clinical Senate Managers to examine the potential for

shared working

• Service change proposals are shared regularly with clinical

senates