South West Clinical S enate

1. South West Clinical Senate • Thursday 10th April 2014 • @SouthWestSenate • #assembly • Wifi : thistle-no password

2. 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

3. Agenda

4. 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)

5. North East, north Cumbria, and the Hambleton & Richmondshire districts of North Yorks Clinical Senates Map Yorkshire & The Humber Greater Manchester, Lancashire and south Cumbria East Midlands Cheshire & Mersey East of England West Midlands Thames Valley London South West South East Coast Wessex

6. South West Clinical Senate

7. South West Footprint Work • 11 CCGs • 3 Local Area Teams • 13Healthwatch Organisations • Over 30 providers • 3 large tertiary providers, two in Bristol and one in Plymouth • 2 Mental Health providers with Medium secure services • Bristol to Preston 189 miles 3hrs 33mins • Penzance to Bristol 190 miles 3hrs 37mins

8. 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

9. The South West Clinical Senate Senate Council (Meets 4-6 times a year, 43 members) Senate Assembly (Meets Annually, 160+ members) Advice Citizen’s Assembly (Meets 4 times a year, 26 members ) Evidence Gathering Question Health & Social care Professionals Healthwatch x13 Commissioner Questions (CCGs, Specialised Services, Area Teams, HWBs, LAs, PHE, Senate Council) Senate Management Team

10. 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

11. 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

12. 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

13. 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.

14. 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

15. 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

16. 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

17. 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

18. 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

19. Summary & Close • Themes from Mini Senates • Questions to explore further • Presentations and Notes to be shared • Thank you www.swsenate.org.uk @swsenate#assembly

20. 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)

21. 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

22. 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

23. 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

24. Question Generating Yellow 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?

25. 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

26. 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

27. Blue Group • How can integrated care improve outcomes for people with complex care needs – medical and social • When does end of life start

28. 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

29. 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