Senates - the interface with SCNs and AHSNs

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

Senates - the interface with SCNs and AHSNs

Nigel AchesonMedical DirectorNHS England (South)

SCNs and Clinical Senates

4 in the South

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


• Cardiovascular (cardiac/stroke/diabetes)

• Maternity/children and young people

• Mental health/dementia/neurological conditions

• Cancer

• [ Respiratory]


SCN 2014/15 priorities

Themes:

• Early diagnosis

• Parity of esteem

• Optimisation of pathways

• Reducing avoidable admissions

• Reducing variation


AHSNs

5 in the South:

• South West Peninsula

• West of England

• Wessex

• Oxford

• Kent, Surrey and Sussex


AHSN licence agreement focus upon:

• Wealth creation

• Spread and adoption of innovation

• Building upon a culture of collaboration

between stakeholders


AHSN 2014/15 priorities • Clinical workplans include:

• Pharmacy

• Mental health

• Long term conditions

• Enhanced recovery

• Urgent care

• Informatics/telehealth

• Patient safety collaboratives


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


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


Some “big” issues

• Smoking/Hypertension/Obesity/Diabetes

• Parity of esteem

• Primary care transformation

• Variation in quality

• Urgent care

• End of life care


Some issues to address…

• Dogma

• You can’t close my…..


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”


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)


• 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


• 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


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


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


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


Senates will undertake functions 1 and 2

Independent clinical assurance of

reconfiguration

Early advice


• 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


• 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


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


A proportionate approach

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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


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


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

Senates - the interface with SCNs and AHSNs

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