Table of Contents...on Acute Kidney Injury (AKI) and renal replacement therapy. Supporting the...
Transcript of Table of Contents...on Acute Kidney Injury (AKI) and renal replacement therapy. Supporting the...
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Annual report 2015-6
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1. Introduction 2
2. CardiovascularNetwork 3
3. CancerNetwork 8
6. Maternity&Children’sNetwork 12
7. MentalHealth,DementiaandNeurologicalConditionsNetwork 14
5. RehabilitationProgramme 18
4. PaediatricGeneralSurgeryandUrologyNetwork 20
8. ClinicalSenate 22
9. Finance 25
Table of Contents
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WelcometothethirdannualreportoftheSouthWestClinicalNetworksandSenate.AsMedicalDirectorforNHSEnglandSouth–SouthWest,Iwouldliketothanktheteamandourclinicalleadsforalltheirhardworkandleadershipthroughouttheyear.FollowingaprolongedreviewoftheroleoftheClinicalNetworks,wenowareclearthatthenetworkswillberefocusedfor2016/17ontheNHSEnglandpriorityareasofmentalhealth,dementia,cancer,diabetesandmaternity.
Thisreportgivesabriefsummaryofworkundertakenduring2015/16andshowcasessomespecificexamplesforeachareasuchasthefootcarereview,cardiacandstrokemapping,reducingstillbirthandspecificworkonrehabilitationanddementia.
OnNovember272015theClinicalNetworkheldtheirannualconferencewithkeynotespeakersincludingPatOakleyandleadersfromNHSEnglandgivingexamplesofhowtheworkoftheClinicalNetworkwasdirectlysupportingtheNHSFiveYearForwardView.
Duringtheyear,wehavewelcomedanewSenateChair,DrPhilYates,andhisdeputy,ProfessorDavidHalpintoleadtheworkoftheSenate.FormentalhealthwewelcomedDrLaurenceMynors-Wallis,fromDorsetwhoishelpingshapetheworkonmentalhealthintheSouthWest.
IwouldliketothankDrHelenThomas,ourCancerclinicallead,whoafterthreeyearshasstooddowntofocusonhernationalworkwithNHS111andwearecurrentlyrecruitingnewclinicalleadstoleadourworkaroundimplementingtheCancerAlliancesfortheSouthWest.
WealsohavetwonewDementiaClinicalLeads,DrPeterBagshawandDrColmOwens,andwouldliketothankDrNickCartmellwholedtheworkondementiaintheSouthWestfrom2013whostooddowninsummer2015.
IwouldliketothankallourpartnersfortheirenthusiasticparticipationintheNetworkandlookforwardtoworkingwiththemandtheteamaswemoveforwardwiththenewmodelsofcommissioningandtransformationplans.
DrCarolineGamlinChair
1. Introduction
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TheCardiovascularNetworkcontinuestoworkwithourpartnerstoenablesignificantandbeneficialtransformation;severalmajorpiecesofworkweresuccessfullycompletedin2015.
OnekeyprojectwasanoptionappraisaltoreconfigureemergencyheartattackandstrokeservicesfortheSouthWestofEngland.TheNetworkworkedwithacademiccolleaguesintheSouthWestPeninsulaCLAHRC1andreportedtoprovidersandcommissionersthroughtheCardiacandStrokeWorkingGroups.TherewasalsoconsultationwithpublicandpatientrepresentativesthroughtheSouthWestClinicalSenateCitizens’AssemblyandtheHealth&WellbeingBoards.Youcandownloadthefullreporthere.
Renalhasfeaturedhighlyonthisyear’sprogrammewiththeNetworkfocusingonAcuteKidneyInjury(AKI)andrenalreplacementtherapy.Supportingthenationalinitiativethe‘ThinkKidneys’campaign,theNetworkheldtworegionalAcuteKidneyInjuryeducationalworkshopsforGPs,aidedbyeducationalpacksincludinga‘TenTopTips’guidanceleafletforprimarycare.OurAcuteKidneyInjurycasestudyprovidesmoredetailedinformation.
Aprojecttoimprovethepatientexperienceandclinicaloutcomesforthosereceivingrenalreplacementtherapyalsolaunchedin2015,withtheaimtoincreasetheuptakeofdialysishometherapiesasanalternativetocentre-baseddialysisandtoreducevariationacrosstheSouthWest.AHomeTherapiesconferencewasheldinMarch.Bothpatientsandprofessionalsattendedandexperienceswereshared.TheworkprogrammewillnowincludereviewingcurrentresourceswithinthefiveSouthWestrenalcentresandmodelopportunitiesforserviceredesign.
FollowingtheDiabeticFootCarePeerReviewscompletedbytheNetworklastyear,theprojectentereditsnextphasesupportingthedeliveryofthekeyrecommendations.TheNetworkhostedtwolearningeventsinJuly2015andFebruary2016,whichwerebothwellattendedbyrepresentativesfromClinicalCommissioningGroups(CCGs)andprovidersacrosstheSouthWesttoshareexamplesofbestpractice.OtherdevelopmentsincludedresourcepackagesondiabetesfootcareeducationforpracticenursesandaguidetoundertakeRootCauseAnalysisandSignificantEventAuditforamputations
Bi-annualreportsfromcommissionersregularlyprovidevaluableinformationtomonitortheprogressandimprovementsinlowerlimbamputationratesintheSouthWest.Sincethereviews:
•Twoareashavecommencedpracticestaffeducationprogrammes;
•Sixhaveenhancedtheircommunitypodiatryteams;
•Fourhaveappointedanin-patientpodiatrist;
2. Cardiovascular Network
1CollaborationforLeadershipinAppliedHealthResearchandCare
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•Fivehavestartedtorotatecommunitypodiatristsintothemulti-disciplinaryteam;
•Tenhavestrengthenedthemulti-disciplinaryteam;
•RootcauseanalysesarecommencinginfourCCGareas.
Supportingareductioninthenumberoflowerlimbamputationsinhigh-riskdiabeticpatientswillremainaprioritynationallyandfortheNetwork.
Aswemoveinto2016andinlinewiththeFiveYearForwardView,NHSPlanningGuidanceandtheSustainabilityandTransformationPlans(STPs)theNetworkwillsupporttheSTPprocessbyworkingwithorganisationstoimplementtheNHSEnglandnationalprioritiesfor2016/17.Diabetesisoneofthe10topnationalpriorities.TheNetworkdiabetesworkprogrammeasmandatedbyNHSEnglandwillfocuson:
•WorkingwithareastosupportreadinesstoimplementtheNHSDiabetesPreventionProgramme;
•IncreasingGPparticipationintheNationalDiabetesAudit;
•ImprovingachievementinthethreeNICE-recommendedtreatmenttargets;HbA1c,cholesterolandbloodpressure;
•Increaseby10%newlydiagnosedpeoplewithdiabeteswhoattendastructurededucationcourse;
•preventionofcomplicationswithinitialfocusonfootcare.
AnothermajorpriorityfortheNetworkwillbetosupporttheimplementationoftheUrgent&Emergencyreviewandtheseven-dayservicefourpriorityclinicalstandards:
•Timetofirstconsultantreview(standard2);
•Accesstodiagnostics(standard5);
•Accesstoconsultant-directedinterventions(standard6);
•Ongoingreview(standard8).
Theemphasiswillbeontransformingcareforstroke,vascularsurgeryandcardiaccare,particularlyworkingwiththeUrgentandEmergencyCareNetworksandSTPfootprintstodevelopnetworksofcaretosupportimprovementintheseservices.Thiswillbuildontheworkoftheoptionsappraisalforthereconfigurationofemergencyheartattackandstrokeservicescompletedin2015.
TosupporttheseprojectstheNetworkwillcontinuetobringtogethervaluableexpertiseandresources.Ourcommitmenttoimprovetheoutcomesforcardiovascularpatientsacrosstheregionremainsasstrongasever.
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IMPROVING DIABETES FOOT CARE
6%ofthepopulationintheSouthWestlivewithdiabetes.Thisisnearly170,000peopleandthenumbersareincreasingduetoobesityandanageingpopulation.About20%willhaveincreasedriskoffootulcerationbecauseofneuropathy,peripheralarterialdiseaseorboth.
•Upto7%havecurrentorpreviousfootulceration;
•Inanaveragehospitalpopulationof300,000intheSouthWestRegiontherewillbe18,000diabeticpatients,ofwhom3,600areathighriskofulceration.
In2014/15,theSouthWestCardiovascularClinicalNetwork,supportedbyNHSEngland,commissionedaformalpeerreviewprogrammeofdiabeticfootcareservicesacrossall14AcuteTrustsand11CCGswithintheSouthWest.Thereviewaimedtounderstandthevariationinpractice,establishcompliancewithNICEguidance,findandsharegoodpracticeandmakerecommendationsforimprovement.Reductioninthenumberoflowerlimbamputationsindiabeticpatientshasremainedanationalandnetworkpriority.Thefollowingweretwoareasoffocus:
RootCauseAnalysis:
Evidencefromthefootcarereviewsdemonstratedthattoimproveoutcomesforpatientsandpreventamputations,weshouldexaminecurrentprocessesacrossthewholepathwayto:
•Understandreasonsleadingtoamputations;
•Actuponlessonslearnt;
•Identifyopportunitiestodevelopservices.
Asaresult,theNetworkdevelopedaDiabetesFootCareResourcePack,whichincludesinformationonperformingaRootCauseAnalysis(RCA)andSignificantEventAudit.Theresourceincludesreferencetoolstohelphealthcareprofessionalsinimplementingthesetools.IntroducingaSouthWestapproachwillensurethatallcareprovidersreviewandassesspathwaysofcareconsistently,enablingbenchmarkingandthesharingofbestpractice.
•Theresourcepackisnowavailabletodownload;
•DiabetesUKarenowproducingaRCAguidebasedonthisresourcepack.
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ProfessionalEducation
EvidencefromthefootcarereviewsalsohighlightedthatdeliveryandaccesstoeducationalprogrammesvariesgreatlyacrosstheAcuteTrustsandCCGsintheSouthWest.
Tosupportthis,theNetworkhasdevelopedaDiabetesFootCareEducationResourcePack,whichincludesinformationoncurrentprogrammesavailabletoclinicalstaffmemberswhocareforadiabeticpatient.TheresourcepackisprincipallyfornursingstaffinPrimaryCare,althoughitincludesothertrainingresourceswhichmaybebeneficialtoTrusts.
DevelopingaSouthWestresourcewillensurethatallcareproviderswillbeabletoaccesstrainingthatisrelevant,worksandenablesconsistentbestpractice.
Inthelongerterm,thischangeinpracticewillresultinthepreventionofdiabeticfootcareissues,reductioninamputationsandtimelyreferralsintoSecondaryCareforbothminorandmajoramputationswhenrequired.
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ACUTE KIDNEY INJURY – RESOURCES FOR PRIMARY CARE
AcuteKidneyInjury(AKI)causesharmandsufferingforpeopleandcanbepreventedinmanyinstances.Aroundtwo-thirdsofAKIoccursinthecommunityandsoGPsandpracticenurses,especiallythosecaringforpeoplemostatrisk(theelderlyandthoselivingwithlong-termconditions),haveamajorroleinpreventionandearlydetection,andtreatment.
AcuteKidneyInjuryWarningStageTestResultsaregeneratedwhenasignificantchangeincreatinineconcentrationismeasured.FromApril2016thesewillstarttoarriveintogeneralpracticeonexistingITsystems.GPsandpracticenursesrequestingserumcreatininebloodtestswillbealertediftherearesignificantchangesfortheindividualpatient.
ThischangeistheresultofNHSEngland’sSafetyAlert2014anddetectionalgorithm,whichwasimplementedinmostpathologylaboratoriesinthecountry.ThinkKidneys(theNHSnationalprogrammetoimprovethecareofpeopleatriskof,orwith,AKI)hasproducedasetofresourcesforPrimaryCaretohelpinformaboutAKI,thenewtestresultandwhattodo.
TheSouthWestCardiovascularClinicalNetworkhassupportedthenationalinitiativebyrunningeducationworkshops,theseworkshopswereheldinboththeNorthandSouthoftheregion.NationalexpertsprovidedinvaluableAKIinformationforGP’sandprimarycareleadsandwereonhandtoanswerquestions.GuidancehasalsobeencirculatedthroughGPbulletins.
TheNetworkisalsosupportingthedevelopmentofanationalsuiteoftrainingtoolsforuseincarehomesandcommunityhospitals.ATenTopTipsleafletguidetohelpprimarycarewiththeprevention,identificationandmanagementofpatientsatgreatestriskofAKIisnowavailabletodownload.
YoucangetfurtherinformationandnationalguidanceontheThinkKidneyswebsite.
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ThishasbeenabusyyearfortheSouthWestCancerNetwork.InJune2015NICEpublishedrevisedguidanceforGPsfortherecognitionandreferralofsuspectedcancer.Thiswasfollowedshortlybyanewnationalstrategyforcancer,with96recommendationsforthenextfiveyears.
EarlyDiagnosis
FollowingthepublicationofthenewNICEGuidanceoncancerreferral,theNetworkconsultedwidelywithPrimaryandSecondaryCareclinicians.WeproducedadviceforCCGsonhowtoimplementtheGuidanceandrevisedreferralproformaswerecreated.
TheNetworkwassuccessfulinabidtoCancerResearchUK(CRUK)toappointateamofHealthProfessionalEngagementfacilitatorstosupportworkinpartnershipwithCommissioners,GPCancerLeads,PublicHealthandotherlocalbodiestosupportPrimaryCareintheprevention,andearlydiagnosisofcancer.TheteamofsixstartedworkinSeptember2015andhaveprovidedawiderangeofsupport.ThisincludesGPeducationeventsinBristol,TorbayandPlymouthaswellaspracticevisitsandtailoredsupport.MacmillanalsosupportedaGPeducationeventinExeter.
AswellaslocalityeducationeventstheNetworkputontwotrainingdaysforGPs,providedbyleadingGPtrainersfromRed Whale.TwohundredpeopleattendedarevisedcoursethatincludedcomprehensivecoverageoftheimpactforprimarycareofthenewNICEGuidelines.
TheColorectalDiagnosisprojectconcluded.ThisdemonstratedthatsupportingpatientsgoingstraightfromGPtocolonoscopyisnotonlypossiblebutsafeandmorecost-effective.Providersdemonstratedavarietyofwaystomakesurethatbothbowelpreparationandthecolonoscopyweredeliveredsafelywithouttheneedforaprioroutpatientappointment.
InMay,theNetworkranaDermatologyevent.Thislookedatthechallengesfordermatologyservices,includingtheriseinskincancerandthenewguidanceofitstreatment.TherewereexamplesofinnovativecollaborationsbetweenPrimaryandSecondaryCaretobettermanagedemandbymakingbetteruseoftherangeofskillsavailable.
CancerTreatmentServices
2016/17wasachallengingyearforcancerwaitingtimes,especiallytheheadlinestandardoftreatmentwithin62daysofanurgentreferralfromaGP.AtthestartoftheyeartheperformanceintheSouthWestwas82.8%againstastandardof85%,byMarch2016thishadimprovedto85.6%.Thiswaswhilstseeing6%morecases,andtreating8%morewithinthestandard.
3. Cancer Network
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TheNetworkagreedarevisedCancerAccessPolicytoclarifyresponsibilitiesandensureconsistencyofapproachacrosstheSouthWest.TheNetworkalsoagreedthemanagementofpatientsreferredtoanotherproviderfortreatment.Thisincludedpathwaysforeachtypeofcancer,specifyingthediagnostictestsneeded,andwhen,toenablepatientstobetreatedwithin62days.ThiswillbeinvaluableastheNetworknowimplementsnewnationalguidelinesontheallocationofbreachesofthisstandard.TheNetworkhasalsosharedgoodpracticeonimprovingpathwaystomakethemfaster,suchasintroducingMRIfirstinprostatediagnosis.
Thecancersite-specificgroupshavecontinuedtomeet,providinginvaluablesupporttoclinicianstosharegoodpracticeandagreesharedstandards.Minutesandannualreportscanbefoundonourwebsite.TheSouthWestChemotherapy,RadiotherapyandChildren&YoungPeople’sGroupsalsometcoveringtheagreementofchemotherapyprotocols,thedevelopmentofadvancedradiotherapytechniquesandsupportingyoungpeoplelivingwithorbeyondcancer.
LivingWithandBeyondCancer
ThemembersoftheNetworkhavecontinuedtorollouttheelementsoftherecoverypackageforpatientsLivingwithandBeyondCancer,whichincludesholisticneedsassessment,careplansandhealth&wellbeingsupport.Thishasalsoallowedtherevisionoffollow-upcareaftertreatment,withmorepatientsnowbeingsupportedtomanagetheirowncareratherthanreceivingroutineconsultantfollow-upappointments.TheNetworkheldtwoeventsinNovembertoagreehowtocommissionforLivingwithandBeyondCancertomakesurethattheseservicesareavailabletoallpatientsandaresustainable.Thiswascapturedinadvicegiventocommissioners.
CommissioningAdvice
InadditiontoadviceonLivingwithandBeyondCancer,theNetworkprovidedadviceoncommissioningsufficientcapacityforcancerservices;theimplementationofthenewNICEGuidance,directaccessdiagnosticsandprovidedinformationaheadofthepublicationoftheCCGImprovementandAssessmentframework.
CancerAlliances
OneofthepriorityrecommendationsoftheNationalCancerStrategyisthedevelopmentofCancerAlliances.Thesewillbedevelopedin2016/17andwilltakeforwardtheworkoftheCancerClinicalNetwork.
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LIVING WITH AND BEYOND CANCER
TheLiving with and Beyond Cancer ProgrammegrewoutoftheNationalCancerSurvivorshipInitiativeledbyMacmillanCancerSupport.ThisinitiativedescribedaRecoveryPackageincludingfourelements
•Holisticneedsassessmentandcareplans;
•Endoftreatmentsummaries;
•Health&well-beingclinics;
•GPCancercarereview.
Thisapproachprovidesbettertailoredsupporttopeoplelivingwithorbeyondcancerandallowsteamstointroducerisk-stratifiedpathwaysofcare.Thissupportsmanypeople,whereappropriate,toself-manage.Morespecificfollow-upcanbeagreedforthosewhoneedongoingclinicalsupportfortheirdisease,treatmentsorsideeffects.Thisissupportedbysystematicapproachestodiagnosticmonitoringthatdoesnotrelyupontheroutineschedulingofoutpatientappointments.
MacmillanCancerSupportisthekeypartnerfortheSouthWestCancerNetworkinimplementingtheelementsoftheLivingWithandBeyondCancerprogramme.Belowaresomehighlightsoftheirworkthisyear.
•Anumberofprovidersarenowusinganelectronicholisticneedsassessmentsystem;
•BothUniversityHospitalsBristolandNorthBristolTrustsarenowincentivisedbytheircommissionertohavetreatmentsummariesfor40%ofallpatientsin2016/17;
•Health&Wellbeingclinicscontinuetodevelop,withmoreclinicsavailable,inmoreplaces,coveringmorecancertypes.NorthBristol&UniversityHospitalBristolTrustsruntheseevery6weekswhilstattheRoyalDevon&ExeterTrusthealth&WellbeingclinicsarebeingrunbyFORCE2andareavailabletopatientsfromdiagnosis;
•TheMacmillanHOPE3programmeisnowofferedbytheMacmillanCancerRehab&SupportTeamregularlyinBristol;
•TheMacmillanCancerRehab&SupportTeamhasevolvedtoofferanOccupationalTherapy-ledapproachtosupportingpeopleaffectedbycancerinthecommunityinBristolandreferralshaveincreasedsignificantly.Theserviceevaluations
2FORCEisthecancercharitybasedattheRoyalDevon&ExeterHospital3HOPE-HelpingOvercomeProblemsEffectively
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showverypositiveresults.WorkcontinueswithBristolandSouthGloucesterCCGstosecurealong-termcommissionedservice;
•MacmillansupporthashelpedtodevelopphysicalactivityservicesacrosstheSomerset,Wiltshire,Avon&Gloucestershireregion.InBristoltheEnergiseCancerExerciseProgrammewontheBristol PostTogetherWeAchieveAwardinApril2016;
•TheMacmillanBuddiesservicenowcoversBristol,Bath,NorthSomersetandSouthGloucestershire;
•TheMacmillanPrevention&Re-enablementprojectinpartnershipwithBristolLinkAgehasdevelopeditsservicesforpreventinglonelinessandisolationinolderadultstoincludepeopleaffectedbycancer;
•PrehabilitationservicesareofferedinBristolforkidney,upperGI,lungandgynaecologicalcancers.Thissupportspatientstobefitterfortreatmentandhavebetterrecoveryandoutcomes;
•MacmillanhasaTeenage&YoungAdultWellbeingCo-ordinatorthatcoverstheSouthWest;
•MacmillaninpartnershipwiththeUniversityoftheWestofEnglandhaveestablishedapracticenursecoursetosupportthespreadofknowledgeandskillstosupportpeopleaffectedbycancerintothecommunity;
•RoyalDevon&ExeterTrusthaveintroducedremotemonitoringforprostatepatients.93%saidtheypreferthisfollow-upmodel,whichalsofreesconsultantstoseeotherpatientsmorequickly;
•TheRoyalDevon&ExeterTrusthasintroducedgenericandsite-specific(urology&haematology)Health&WellbeingClinicsonaregularbasis.Thesearenowavailabletopatientsthroughouttheirdiagnosisandtreatment–notjustafterwards.Upto55%ofallnewlydiagnosedcancerpatientsarenowreferredtotheseclinics;
•RoyalDevon&ExeterTrustintroducedanewelectronicpatientrecordsystemstartinginBreastCareServicestoreplacehandwrittennotes.Othercancersiteswillfollow.Thishasimprovedcommunicationwithintheteamandwithpatients,whilstalsoreleasingvaluableadministrationsupportforuseelsewhere;
•Finally,in2015,Macmillanhaveawardedgrantsto1,773patientsintheSouthWesttotalling£626,179.
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4. Maternity & Children’s Network
Saving Babies’ Lives in the South WestThestillbirthrateinEnglandhasbeenfallingsince2004,butat4.6stillbirthsper1000birthsin20144thereisstillmuchworktobedone,withotherhigh-incomecountriessuchasIceland,Poland,CroatiaandEstoniaallhavinglowerratesthantheUK.
172babieswerestillbornin2015acrosstheSouthWest.Thisequatestoroughly14stillbirthspermonth.AlthoughthestillbirthrateintheSouthWestislowerthanthatofthenationalaverage,thereissignificantvariationinratesofstillbirthacrosstheregion.ThisisclearlydemonstratedontheSouthWestMaternityDashboard,whichwasdevelopedbytheNetworkandhasdataonawiderangeofindicatorsfromallfourteenmaternityprovidersintheSouthWestdatingbacktoAugust2014.
Attheendof2015,theDepartmentofHealthannouncedanewambitiontoreducetherateofstillbirths,neonatalandmaternaldeathsinEnglandby50%by2030,witha20%reductionby2020.TheneedtoreducethisratealsowasprominentintheMBRRACE-UK Perinatal Confidential Enquiry Report 2015andtheFebruary2016Better Births: A Five Year Forward View for Maternity Carereport.
NHSEnglanddevelopedSaving Babies’ Lives: A Care Bundle for Reducing Stillbirth,whichcontainsfourelementsthatarerecognisedasbestpracticetopreventstillbirth.AttheSouthWestMaternityandChildren’sClinicalNetwork’sAnnualEventin2015,weagreedtoholdaregionaleventtofocusonthecarebundle.Twoworkshopshavebeenheldin2016,inpartnershipwiththeWestofEnglandandSouthWestAcademicHealthScienceNetworks,toengagematernitystakeholderswiththecarebundleandsupportitsimplementation.SpeakersincludedthosefromthenationalNHSEnglandMaternityTeam,thePerinatalInstituteandtheStillbirthandNeonatalDeathcharity(Sands),aswellascolleaguesfromacrosstheSouthWestandpeoplewhohavelostachildthroughstillbirth.Theseworkshopshavealloweddelegatestogainabetterunderstandingofthecarebundle,networkwithcolleaguesacrosstheregion,discusshowtoovercomebarriersand,mostimportantly,workintheirlocalareastodevelopanactionplantoimplementthecarebundle.
ImplementationoftheSavingBabies’LivescarebundleisbeingfollowedthroughregularsurveysofmaternityprovidersandtheNetworkandstakeholdersareabletoseechangesinoutcomesthroughtheSouthWestMaternityDashboard,whichisupdatedbytheNetworkeachmonth.2016willseetheNetworkfocussingonhowtohelpprovidersandcommissionerstoimplementofthebundlethroughexploringtheuseoflocalCQUINs.
4TheLancet,StillbirthSeries,Stillbirths:recalltoactioninhigh-incomecountries,20165OfficeforNationalStatistics,BirthSummaryTables,EnglandandWales:2014
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Improving Perinatal and Infant Mental Health in the South WestImprovingPerinatalandInfantMentalHealthhasbeenapriorityfortheSouthWestMaternityandChildren’sClinicalNetworksinceitbeganin2013.Akeydevelopmentwithintheperinatalandinfantmentalhealthworkstreamin2015wasthepublicationofthePerinatal and Infant Mental Health Care in the South West: Improving Care Pathways Report inJune2015.ThisprojectwasajointventurebetweentheSouthWestMaternityandChildren’sClinicalNetworkandtheSouthWestMentalHealthClinicalNetwork.ItsobjectivesweretogainagreaterunderstandingoftheprovisionofservicesforperinatalandinfantmentalhealthintheSouthWest,andtodevelopasetofrecommendationsforimprovingserviceprovisionalongthecarepathwayswithintheregion.
Extensivemappingofexistingserviceswasundertaken,aswellasaseriesofstakeholdermeetings.BluebellCare,acharitydedicatedtoprovidingsupportforwomenandtheirfamiliessufferingfromperinataldepression,facilitatedfeedbackfromwomenregardingrecentexperiencesofcarethroughouttheirjourneytorecovery.Alloftheabove,inlinewithnationalguidance,formedthebackboneoftheImprovingCarePathwaysreportandhelpedtodeveloptherecommendationswithinit.
Oneoftherecommendationswastosetupaperinatalandinfantmentalhealthworkforcedevelopmentplan.In2015,theSouthWestMaternityandChildren’sClinicalNetworkjoinedforceswithHealthEducationSouthWesttoformanEducationalReferenceGroupwiththeaimofidentifyingprioritiesontheeducationandtrainingofthoseinvolvedinthetreatmentandcareofthosewithperinatalandinfantmentalhealthissues.TheNetworkhasnowreceivedafinancialcontributionfromHealthEducationEnglandSouthWesttosupportthisworkforcedevelopment.TheSouthWestMaternityandChildren’sClinicalNetworkisidentifyingaleadeducationproviderwhowillworkwiththeEducationalReferenceGrouptoshapethistraining,whichwillinturnlinkintoHealthEducationEngland’snationalperinatalandinfantmentalhealthtrainingprogramme.
Capturingtheexperienceofwomenandtheirfamiliestoinformservicedevelopmentwasanotherrecommendationofthereport.In2015,theNetworkdevelopedadigitalPerinatalMentalHealthExperienceSurveysothatwomenandtheirpartners’couldgiveareflectionoftheirexperiences.Afacilitationdayinvolvinghealthcareprofessionalswithaspecificinterestinperinatalandinfantmentalhealthandsecondaryresearchwasheld,buildingonprimaryresearchatalocalchildren’scentre.ThedigitalsurveywaspilotedinKernowCCGduringJanuary2016.TheNetworkisnowlookingtospreadadoptionofthesurveythroughouttheSouthWesttobenchmarkserviceprovisionforperinatalmentalhealthservicesintheregionfromtheperspectiveoftheserviceuser.
TheNetworkwillcontinuetoimplementmorerecommendationsfromtheImprovingCarePathwaysReportin2016.TheNetworkfocusonperinatalandinfantmentalhealthisinlinewithnationalguidancesuchastheFiveYearForwardViewforMentalHealthandtheNHSEnglandBusinessPlan,emphasisingtheimportanceofequityofaccesstospecialistservices.
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5. Mental Health, Dementia and Neurological Conditions Network
WiththepublicationoftheFiveYearForwardViewforMentalHealth,thereisrenewednationalandlocalfocusonmentalhealthanddementia.TheNetworkappointedDrLaurenceMynors-Wallis,anadultpsychiatristasitsClinicalDirectorandweappointednewleadsforDementia–DrPeterBagshaw(GP)andDrColmOwens(adultpsychiatrist).
OverthepastyeartheMentalHealthandDementiaNetworkhasbuiltupontheworkithasdoneintheSouthWest,aswellasenablinglocalimplementationoftherecommendationsoutlinedintheFiveYearForwardViewforMentalHealth,publishedinFebruary2016.
Children and Young Peoples Mental Health and WellbeingTheChildrenandYoungPeoplesMentalHealth(CYPMH)andWellbeingprogrammeofworkiscloselyintertwinedwiththerecommendationslaidoutin‘FutureinMind’andFiveYearForwardViewforMentalHealth.
Aspartofitssupportoffer,theNetworkintheSouthWesttookakeyroleintheassuranceprocessrecommendingthesignofffortheLocalTransformationPlansforChildrenandYoungPeoplesMentalHealthandWellbeing,whichtheClinicalCommissioningGroups(CCGs)co-producedwiththesupportoftheHealthandWellbeingBoardsandlocalauthoritiesinOctober2015.TheLocalTransformationPlansdetailedthelocaljointcommissioningarrangementsbetweenlocalauthoritiesandCCGstodeliveragainsttherecommendationssetoutinthe‘FutureinMind’paperaswellastheFiveYearForwardViewforMentalHealth,withkeytargetsrelatingtoeatingdisorders,self-harmaswellasimprovingaccesstoChildandAdolescentMentalHealthServices(CAMHS).
Tosupportimplementingtheserecommendationsin2016/17theNetworkwill:
•EstablishfourworkinggroupstosupporttheredesignofthemodelsofcareforthewholeCYP/CAMHSpathway,eatingdisordersandself-harm;
•EstablishCYPMHImprovementTeamwithintheSouthWestClinicalNetworkthroughalocal‘spoke’;
•ContinuetosupportimprovementsinlocalcommissioningarrangementwiththerefreshmentandimplementationofthetransformationplansacrosstheSouthWest;
•Supportthedevelopmentofaneffective,skilledlocalCYPMHworkforceacrosstheSouthWestClinicalNetwork;
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•Supportthedatacollectionandoutcomesmonitoringtoshapeandidentifyserviceimprovement.
Crisis and Liaison ServicesImprovedaccessforpatientsincrisisisakeycommitmentofnationalmentalhealthstrategy.InDecember2014,theNetworkranaprocessmappingeventtodescribethecomplexpathwayspatientsandtheircarershavetonegotiatetogetaccesstomentalhealthsupportintheSouthWest.Attendedbyover100membersofhealth,socialcare,policeandvoluntarysectororganisations,theeventishelpingshapetheimprovementprogrammeforthenetwork.TheNetworkisworkingwithpartnerstosupportthedeliveryof7-dayallageliaisonservicesandstrengtheningthecapabilityamongstcrisisteamstoprovidesupport24/7.Largevariationsinpracticeexist.ThegapanalysisconductedbytheNetworkhashelpedidentifyvaryingmodelsofcare,staffinglevelsandskillmix.TheseissuesarenowbeingaddressedbylocalcommunitiesthroughtheCrisisConcordatplans.
In2016/17,theNetworkisworkingtowardsagreeingacommondatasetandstandardsinlinewiththenationalstrategy.Theworkwillbecheckedwithserviceuserswhoarealsoinvolvedinproducingthemodelofcare.
DementiaTheNetworkhasdedicatedclinicalleadershipfromPrimaryandSecondaryCare.ThiswillenabledeliveryofimprovedcaretopatientsintheSouthWest.ThereiscontinuedemphasisonDementiaservicein2016.TheNetworkmeetsquarterlyandisrepresentedontheCCGImprovementandAssessmentFramework.
TheSCNwillcontinueto:
•Reviewthedementiadiagnosismodelanddevelopaprimarycare-ledconsensus;
•Produceaframeworkforpost-diagnosticsupportandsupportitsadoptionbyatleasttwocommissionersintheSouthWest.
WewillworkwithCCGsandoffertargetedsupportwhererequired.TheNetworkwillworkwiththeNHSEnglandassuranceprocesstoensurethattheyoffersupporttoCCGstohelpwithdeliveryofthestandards,butalsoaddresssystemwideissuesastheyarise.
Early Intervention for PsychosisTheNetworkisworkingcloselywiththeOxfordAcademicHealthScienceNetworktosupporttotheEarlyInterventionforPsychosis(EIP)Networkwithdedicatedclinicalleadership.ThiswillhelptoimprovecaretopatientsintheSouthWest.TheemphasisonMentalHealthservicesin2016hasmeanstwonewEIPperformancestandardsfrom1April2016.Thestandardrequiresthat:
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•morethan50%ofpeopleexperiencingfirstepisodepsychosisstartaNICErecommendedpackageofcarewithintwoweeksofreferral.
TheNetworkhasbroughttogethertheanalystsfromtheSouthWestprovidingsupporttomakesurethattheEIPtargetisrecordedconsistentlyandtopromotetheNICEcompliantpathway.
Treatmentisdeemedtohavecommencedwhentheperson:
-hashadaninitialassessment,AND
-hasbeenacceptedontothecaseloadofanEIPservicecapableofprovidingafullpackageofNICE-recommendedcare,AND
-hasbeenallocatedtoandengagedwithanEIPcarecoordinator.
In2016/17,theNetworkwill:
•WorkwithprovidersandcommissionerstoconductapeerreviewofEIPserviceprovisiontopromotecompliancewithwaitingtimesstandardsandNICEcompliance;
•SupportproviderstousetheirsystemstoaccuratelyreportthewaitingtimeanddevelopasystemforrealtimeuseoftheEIPmatrixdevelopedbyOxfordAHSNtodriveimprovements;
•WorkwithHealthEducationEnglandsotheycansupporttrainingforEIPacrosstheSouthWest.
TheNetworkwillworkwithNHSEnglandAssuranceteamstoensurethattheyoffersupporttoCCGstohelpwithdeliveryofthestandards,butalsoaddresssystemwideissuesastheyarise.
Improving Access to Psychological TherapiesTheNetworkhasastrongExpertReferenceGroup(ERG),whichmeetsregularlytopromotegoodpracticeinPsychologicalTherapies.TheNetworkappointedaclinicalleadforPsychologicalTherapies,DrUrsulaJamesfromB&NESCCG,wholeadstheworkintheNetworkonreliablerecovery.DrJameshasproduceda‘ReliableRecoveryToolkit’thathasbeensharedviatheRegionalMentalHealthBoardacrosstheSouth.TheERGregularlyreviewsthePsychologicalTherapiesperformanceinformation.TheNetworkhasprovidedclinicalsupporttoCCGsandproviderswithperformancechallenges.AllpartieshavewelcomedthisapproachandtheattendantreportshavebeensharedwithcolleaguesfromtheOperationsandDeliveryTeaminSouthWestandSouthCentral.
TheNetworkhasalsoestablishedstronglinkswiththeNHSIntensiveSupportTeam(IST).Over80peopleattendedthelatestdatafocussedeventrunbytheIST.Theseworkshops,withthosefordevelopingthefinancialframework,helpsupporthealthcommunitiesinimprovingPsychologicalTherapies.
In2016/17,theImprovingAccesstoPsychologicalTherapiesERGis
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planningabroaderimprovementfocusthroughbenchmarking,usingawiderdatasettoincludereliablerecovery,sessionalattendanceandreductioninthenumbersheldbyservicestounlockcapacityissues.Workisalsoproceedingontheskillmix.
Neurological ConditionsTheSouthWestNeurologicalNetworkhasbeeninvolvedinthedevelopmentandpilotprogrammefortheNationalNeurologyImprovementProgramme.AdatasethasbeendevelopedincollaborationwiththeNationalClinicalDirectorforNeurology,theAssociationofBritishNeurologistsandtheNeurologicalAlliancetoimproveaccessandresponsivenessforpatientswithneurologicalproblems60%ofwhompresenttoemergencydepartments.Manyofthepresentationsareforurinarytractinfectionsorchestinfectionsandcanberesolvedwithbetteraccesstoaneurologicalopinionduringtheemergencydepartmentattendance.Thisreducestheneedforadmissions,whichremainhigh.TheNetworkalsocommissionedareportonneurologicalservicesacrosstheSouthWest,outliningthekeyopportunitiesforchange,whichhasbeensharedwithCCGs.
NeurologicalConditionshasbeenremovedfromthelistofnationalprioritiesfortheClinicalNetworksandtheNetworkwillnolongerbeabletoprovidesupportfrom2016onwards.
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A collaborative approach to rehabilitation, reablement, recovery, survivorship and prehab in the South West.
WithintheSouthWest,wehavebeenworkingonimplementingthecollaborativepathwayforrehabilitation,reablement,recovery,survivorshipandprehabthatwasagreedandcirculatedascommissioningadvice.
WehaveestablishedaSouthWestPeninsulaComplexRehabilitationCommissioningForumtodeliverimprovementsincomplexrehabilitationtoitspopulation.Therefore,thisgrouphasfourmainfunctions:
•TobringcommissionersandproviderstogethertocreateasharedvisionandtoundertakeaPeninsula-widedemandandcapacityanalysisofrehabilitationservices;
•TheSouthWestPeninsulaComplexRehabilitationCommissioningForumwillreporttotheNHSEnglandSouthWestSpecialisedCommissioningOversightGroup,whichinturnreportstotheSouthSpecialisedCommissioningOversightGroup.TheForumwillactasthedeliverygroupforthecollaborativecommissioningofcomplexrehabilitation.Thepurposeofcollaborativecommissioningistoreduceinequalitiesandimproveoutcomesforpopulations;
•Tosupportandadviseonimplementingtheprinciplesandpathwaydescribedinthework‘Acollaborativeapproachtorehabilitation,reablement,recoveryandsurvivorshipandprehabintheSouthWest’;
•ToleadtheimplementationofthePlymouthHospitalNHSTrustandLivewellSouthWestneurologicalrehabilitationinvestmentschemestoincreasespecialisedrehabilitationcapacitytorelievepressureonacuteprovision.ThiswillincludethePeninsulaCommunity.
Weareworkingwithcommissioners,providers,patientsandtheircarerstoagreeapathwayofdelivery,whichfocusesonmakingcaretrulypersonfocusedsothatitprovideswhattheywantandnotwhatisavailable.Wehopesuchapathwaywillincreasethethroughputofpatients,reducewasteandfreeupcapacityinthesystem.ButitwillalsosupportthedeliveryofthekeynewdutiesoftheCareActforthelocalauthoritycommissioners.
Patientandthepublichavetoldusthattheywouldlikethefollowing
•Patientfocusedcareplans;
•CareCoordinatorstohelpguidepatientsandtheirfamiliesthroughtherehabilitationprocess;
6. Rehabilitation Programme
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•Lengthofstayinhospitaltobeasshortasissafe;
•Goodcommunitysupport,includingsupportforcarers,thatisalwaysaccessible;
•Afocusonpreventionandself-management.
Allofwhichthisprogrammeaimstodeliver.
“Sometimes you have a meeting that completely changes things. We had one of these recently with our colleagues who commission services on behalf of patients. They were absolutely brilliant and it feels as though we have a rare and precious opportunity to finally make a step change in the way complex rehabilitation services are provided.”
Adam Morris, GP and Medical Director for Livewell South West and Chair of the Commissioning Forum
Where are we now?
Workstream
Name Status Informationavailable
1 Projectmanagement,communicationandengagement
OngoinguntilNov2016
SWCNwebsite
2 Maptherehabilitationservicesavailabletoproducethecurrentstatedocument
Complete SWCNwebsite
3 Auditthedemandforrehabilitationservices
Complete
4 DesignanewmodelofcareforrehabilitationforthePeninsula
Planned
5 SupportandoverseethePlymouthHospitalNHSTrustandLivewellSouthWestneurologicalrehabilitationinvestmentschemes
OngoinguntilNov2016
Reportsavailable
6 SouthClinicalNetworksprojectclose
Nov2016
WewilltakeWorkstream4totherelevantcommissioningandSTPboardmeetingswhenitiscompletetomakesureitisincludedintheirplans.
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TheaimoftheNetworkistogivechildrenwhoneedgeneralpaediatricsurgeryandurologyasafe,highqualitysurgerywiththebestpossiblepatientandfamilyexperience.Careshouldbedeliveredasclosetothepatient’shomeasclinicallypossible,butwhennecessarychildrenshouldbetreatedatthetertiarycentre,whichisUniversityHospitalsBristolTrust.
TheNetworkwill:
StrengthencollaborationbetweenDistrictGeneralHospital’s(DGH’s)andspecialistpaediatriccentres;
•Encouragehighqualitycareasclosetohomeaspossible;
•Ensuretimelysuccessionplanningforsurgeons;
•AudittheworkinboththetertiarycentreandDGH’stoensurehighstandardsofcare;
•Investinappropriatetrainingoffuturesurgeons/anaesthetists/nurses;
•SupportCPDandrevalidation.
YettheaimoftheNetworkisto“setastandardnottocreateamonopoly”-DennisBrowne,afoundingmemberofBritishAssociationofPaediatricSurgeons.
AchievementsService Standards
TheNetworksetouttodevelopasetofservicestandardsbasedonanumberofnationaldocuments.AllmembersagreedtheSouthWestStandards.
Annual meeting
Theannualmeetingshaveanagreededucationalcontentonaparticulartopic.Atthe2016meeting,alltheTrustswillsharetheirindividualactivitydataandcomplexcasereviews.ThesewillbediscussedandthelearningsharedthroughouttheSouthWest.
Audits
TheNetworkaimstoruntwotothreeauditsayearcoveringsurgeryandanaesthetics.Theresultsandlearningaresharedattheannualmeetings.Whereappropriate,topicswillbere-audited.
7. Paediatric General Surgery and Urology Network
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Workforce planning
TheclinicalleadhasworkedwithindividualNHSTrustssupportingtheirsuccessionplanningbyidentifyingtheappropriatelyskilledsurgeonstoworkintheSouthWest.ShehasenabledTruststorecruitthesurgeonstomeettheirTrusts’individualneeds,butalsotheneedsoftheNetwork.
Thishasbeenachievedbyattendinginternaltrustdirectoratemeetings,writingpapers,increasingtheunderstandingofthebenefitsofdeliveringpaediatricsurgeryinthelocalhospitalsandraisingtheawarenessofthesupporttheNetworkoffers.Thishasresultedinrecruitinganumberofpaediatricsurgeons,whichhasinturnreducedthetransfersofchildrentothetertiarycentreandsomorechildrenaresafelytreatedclosertohome.
Continued education
Casesthatcanbeseenlocallyarecontinuallyidentifiedbytheclinicalleadthatrefersthembacktoanappropriatelocalsurgeon.ShewillalsodiscussanysurgicalcomplicationswiththerelevantclinicalteamsintheNetwork.TheNetworkcontinuestoincreasethenumberofchildrenthataresafelytreatedclosetohome.
ThisNetworkcontinuestomeetbutisnolongerwithinthepriorityworkstreamsfortheSouthWestClinicalNetworks.
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2015/16hasbeenaverybusyyearfortheClinicalSenateseeingchangestoitsrole,membershipandmanagement.InSeptember2015,DrPhilYatesbecametheChairoftheClinicalSenatesupportedbyProfessorDavidHalpinasViceChair.DuringthisyeartheSenateCouncilmembershiphasbeenbothreducedandrenewedtoenablefullparticipationwithmoreroundedandcomprehensivedeliberationofeachtopic.
TheClinicalSenatehascontinuedtoreinforceitsroleinprovidingclinicaladvicetocommissioners.DrawingontheexpertiseoftheCouncilmembersandwiderSenateAssemblyaswellasseekingtheCitizen’sVoice,theClinicalSenatehasdeliberatedarangeoftopicsandprovidedclinicalrecommendationstocommissionersonthefollowingissues:
•AssuringandcommendingtotheSouthWestCCGstheapproachtakenbytheSouthEastCoastSenateintheirreportonClinicalCo-DependenciesofAcuteHospitalServices;
•ConsideringthelocalimplicationsoftheemergingconsensusandguidanceforprovisionofUrgentandEmergencyCarefollowinganationalreview,itsrecommendationsandservicespecifications;
•DeliberationaboutthecurrentprovisionofmentalhealthservicesandwhethertheirconfigurationintheSouthWestisappropriate;
•ConsiderationoftheguidanceandinformationthatMDTsshouldconsiderwhenmakingdecisionstoundertakecomplexsurgicalprocedurestoensurethatsurgicalinterventionsareinapatient’sbestinterests.
InMarch2016,theClinicalSenatehelda‘Digital Healthcare Conference’foritsSenateAssemblymembers,clinicians,commissionersandpatientandpublicrepresentativestosupportthedevelopmentofdigitalinnovationacrosstheSouthWest.Theeventreceivedexcellentfeedbackandhighlightsincluded:
•Asocialmediamasterclass;
•AseriesoffourfastpacedTEDtalks;
•Fourinnovativebreakoutsessionsintheafternoonincluding:‘The Big White Wall’;
•DemonstrationofthepioneeringnewEmergencyCareSystem;
•DevelopmentofdigitalroadmapsandaligningtoCCGSTPs;
•TheuseofHealthcareVideos.
8. Clinical Senate
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FascinatinginsightsfromkeynotespeakerDrPhilHammondroundedofftheday.Hespokeabout‘turninghealthcareonitshead’and’achievinghappinessthroughpleasureandpurpose’-ensuringtheeventendedonahighandinspiringnote.
FromSeptember2014the12ClinicalSenatesacrossEnglandtookontheroleformerlydeliveredbytheNationalClinicalAssuranceTeam.ClinicalSenatesaroundthecountryarenowleadingindependentclinicalreviewsoftheclinicalevidencebaseforlarge-scaleservicechangeaspartofthewiderNHSEnglandgatewayassuranceprocess.Inthelatterpartofthisyear,theSouthWestClinicalSenatebegantoreceiverequeststoundertakeindependentclinicalreviewsforcommissionersbothwithinandoutsideoftheNHSEassuranceframework.Todate,thefollowingreviewshavebeenundertaken:
•Clinicalreviewofcommunityrehabilitation,reablementandrecoveryservicesforSouthGloucestershireCCG;
•SouthWestEmergencySurgeryReview–asanoutcomeoftherecommendationsfromapreviousSenateCouncildeliberationabout‘howemergencysurgeryservicesshouldbeconfiguredintheSouthWest’;
•ComplexSpinalSurgeryReferralPathwaysReviewatNorthBristolNHSTrustandPlymouthHospitalsNHSTrust.
ItislikelythattheClinicalSenate’sroleinconductingclinicalreviewswillincreaseinthecomingyear,particularlyinlinewithSTPs.Thetermsofreferenceforthefollowingreviewsarebeingformalised:
•SouthDevonandTorbayCommunityHospitalsTransformation;
•NEWDevonSuccessRegime.
Citizens’ AssemblyTheClinicalSenatecontinuestoworkcloselywiththeCitizens’AssemblyandthestrengtheningofthisrelationshipandtheroleoftheCitizens’Assemblyisongoing.WewelcomedKevinDixon,theChairofHealthwatchTorbayandaCitizens’AssemblymemberasthenewChairoftheCitizens’AssemblyinFebruary2016,takingoverfromChristineTeller,ourfirstChair,whowasinstrumentalinsettingupthissuccessfulforum.SimonMathiassupportsKevinasViceChair.KevinhasdiligentlybuiltrelationshipswiththeSouthWestHealthwatchmanagersandengagementwiththeCitizens’Assemblyisincreasing.FournewmembersjoinedtheCitizens’Assemblythisyear.
TheCitizens’AssemblyusesavarietyoftechniquestofeedtheCitizenperspectiveintotheSenateCouncildeliberations.OfparticularnotetheCitizens’Assemblygatheredtheviewsofalmost200mentalhealthserviceusers,usingtheirnetworksintocommunityandpatientgroupsacrosstheSouthWest.TheSenateCouncilusedtheseintheirdeliberationandrecommendationsaboutmentalhealthservicesintheSouthWest.
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TheCitizens’AssemblyhasalsosupportedtheSenateCouncildeliberationofthefollowingareas:
•TheSouthEastCoastClinicalSenatereportonClinicalCo-DependenciesofAcuteHospitalServices;
•Whatisimportanttoapatient,theirfamilyandcarersandwhatwouldtheywanttoknowwhenconfrontingacomplexormajorsurgicalintervention,particularlyattheendoflife?
TheCitizens’AssemblymemberstookpartinadevelopmentdayinJuly2016.ThiswasbeanopportunitytodeveloptheirroleasaCitizenRepresentativeandtogainskillsforenhancingtheirabilitytoinfluencetheworkoftheClinicalSenate.
EMERGENCY GENERAL SURGERY
Asaservice,EmergencyGeneralSurgeryrepresentsthelargestgroupofsurgicaladmissionsinUKhospitalsandaccountsforahighnumberofcomplications,resultinginlongperiodsofcareandahighnumberoffatalities.ItisnationallyrecognisedthatthereismuchvariabilityinoutcomesbetweenTrusts.WhilstservicesbetweenTrustswilldiffer,thereisclearlyanopportunityforoutcomestoimprovethroughsharingwaysofworkingthroughouttheregion.ProcessescanbeimprovedbylearningfromneighbouringTrusts,leadingtoanincreaseinqualityandpatientsafety.
InOctober2014,theClinicalSenatedebatedthefollowingquestion:
‘Based on available evidence and guidance, how should emergency surgical services be configured in the South West, so as to provide comprehensive, high quality emergency care based on national standards that is sustainable for the future?’.
Therecommendationsadvisedthatareviewbeconductedofallcurrentprovidersofemergencysurgerytoassesscompliancewithexistingstandardsontheprovisionofemergencysurgery.
TheClinicalSenatethencommissionedaprojectmanagertoworkwithaleadclinicianandgeneralsurgeonfromtheSenateCounciltoworkwithcliniciansacrosstheSouthWesttodeliverthereview.
FollowingapilotreviewinApril2016thefullreviewofallfourteenSouthWestAcuteTrustsisnowunderway.Thereviewseekstoassesscompliancewith22specificstandards.Aclinicalexpertpanelselectedthestandards,whichwere
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baseduponthreeexistingsources6.Thereviewhasaself-assessmentofcompliancewiththestandardsbyeachproviderandanexternalreviewbyanindependentclinicalreviewteam.Intheself-assessment,hospitalswillprovideevidenceofthestandardstheymeetanddetailanyplansforstandardsthatwerenotbeingmet.Sixweekslater,trustshaveanexternalclinicalreviewtodeterminewhichstandardsarebeingmetduringtheweekandatweekends.Duringthevisitinformationiscollectedfromanumberofsourcesincludingawalk-aroundofrelevantdepartments.Theteamalsoconductfocusgroups,interviewswithclinicalstaffandexamineanumberofpatientnotesfromtypicalEmergencyGeneralSurgeryprocedures.
ThereviewisduetocloseinNovember2016.AswellasprovidingvaluableinformationtoAcuteTrustsontheirEmergencyGeneralSurgeryservices,thefinalreportwillenablecommissionersandTruststounderstandtheirperformancerelativetoneighbouringTrustsintheSouthWest.Thisshouldimproveanuptakeinthestandards;improveperformanceintheSouthWestandprovidetheknowledgetobetterplanfutureservices.
6RCS(2011)StandardsforUnscheduledSurgicalCare,LondonHealthAudit(2012)QualityandSafetyProgramme,NHSEngland(2016)7daystandards.
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SOUTH WEST STRATEGIC CLINICAL NETWORK BUDGET 2015-16
9. Finance
£556,000Runningcosts-tofundmanagerialandadmincosts
Pay TotalPay £491,000
Non-Pay TotalNon-Pay £65,000
GrandTotalRunningCost £556,000
£2,374,050 SWCNShareofNHSprogrammebudget(allocatedonunweightedpopulation)
Pay ClinicalLeadership TotalCDPay £316,600
TotalOtherPay £865,650
TotalAllProgrammePay £1,182,250
NonPay Priorityprogrammes 800000
SenateAllocations 127500
Non-paycosts 218000
TotalProgrammeNonPay £1,145,500
£2,374,050 GrandTotalprogrammecosts £2,327,750
£2,930,050 GrandTotalRunningandProgCosts £2,883,750
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BristolOfficeSouthPlazaBristolBS13NX
TauntonOfficeSouthWestHouseTauntonTA12PX
SaltashOfficePeninsulaHouseSaltashPL126LE
FormoreinformationaboutourworkandtofindouthowyoucanbeinvolvedpleasevisitourwebsitesandfollowusonTwitter
www.swscn.nhs.uk @SWSCN
www.swsenate.nhs.uk @southwestsenate