The Clinical Senate’s completed projects are available in this section of the website as published advice and recommendations.
Putting people at the heart of service change - February 2024
Co-production is becoming increasingly relevant and manifest within healthcare; planning, design, implementation, review, evaluation and of course research. The National Institute for Health Research (NIHR) and other major national funders of health and social care research require patient and public involvement (PPI) to be meaningful; non-tokenistic, integrated throughout protocols and involving people with relevant lived experience and diversity. The ethical argument for people to be involved in service change is clear; ‘nothing for us without us’, but PPI and co-production can offer so much more than a means of attaining moral virtue. People with real world experience of health conditions and services, including the family and friends of patients and other carers, form a missing piece of the informational jigsaw required to be able to piece together and complete the picture of what may be the best option for service change in terms of meeting the needs of the end user and other stakeholders. Co-production has been positioned as the gold standard for PPI; requiring equitable power-sharing in decision and other processes related to planning and assessing options for service change. There is no one blueprint for what might work best in a given set of circumstance in enacting co-production. Trial and error has been evidenced as the best way to learn, and no one should be afraid of not getting co-production right every time. We all live and learn. However, much can be learnt from instances where co-production has been carried out. This report provides many valuable and informative cases of co-production in action and what has been achieved as a consequence of enabling people with lived experience to be equitable team members.
The Clinical Co-Dependencies of Acute Hospital Services - January 2024
The first edition of this document was produced in response to a major focus on the future role of acute hospitals. That focus has not diminished over the intervening time period and the acceleration of new and different ways of working driven by the COVID-19 pandemic has prompted a fresh look at what services we provide from acute hospitals, how we provide those services, and how they might be provided differently in the future. Acute hospitals continue to need to better integrate their function with the local community and primary care services, deliver high quality, safe and accessible inpatient care to their populations with a wide range of general and specialist needs, whilst also finding novel and innovative solutions to the growing backlog of elective care. This in itself has also focussed interest on separating and centralising certain aspects of care away from what we traditionally think of as acute care (where a patient receives active, short-term treatment for a condition). There remains uncertainty as to the evidence and need for centralisation, the resultant impact, and the unintended consequences. As we attempt to address these, at the same time it continues to be the case that pre-existing inequalities persist with data showing that between 2019 and 2020, the fall in completed treatment pathways was 35% higher in the most deprived areas of England, compared with the least deprived areas, with a similar picture for cancer referrals.
The Clinical Co-Dependencies of Acute Hospital Services Summary Report - January 2024
This document presents a summary of what to find in the revised South East Clinical Senate report ‘The Clinical Co-Dependencies of Acute Hospital Services’ and should be read in conjunction with that report and the allied report ‘Teaching, Training and Research: Workforce Considerations for Major Service Change’.
Health care systems and their commissioners, in partnership with providers and the public, have to consider the most appropriate configuration of their hospitals so that their clinical services are adequately supported by other specialties, and they are fit for purpose, sustainable, accessible and deliver the highest possible quality of care.
Whilst there are many factors that will need to be considered in hospital configurations, the clinical relationships, and dependencies of hospital-based services on each other is key, whatever their size. Within the updated report we have also included Respiratory Medicine together with the major acute services and the clinical dependencies of these services on hospital-based services were reviewed. The four-level system for describing the strength of the dependencies was then revised accordingly: Purple (needing to be based on the same site); Red (visiting or in-reach services sufficient); Amber (patient could transfer to another hospital or site for ongoing care through network arrangements); or Green (loose or no direct relationship).
Teaching, Training and Research: Workforce Considerations for Major Service Change - January 2024
This report is an adjunct to, and complements, our update of The Clinical Co-Dependencies of Acute Hospital Services report.
Service delivery can never be considered in isolation. Education, training, and research are integral to delivery of quality services and by extension to service change and reconfiguration. This report comes at a time when the NHS has undergone profound changes in response to the COVID-19 pandemic and is both recovering and restructuring whilst also responding to significant workforce challenges. We are heavily indebted to those who have contributed to the report’s preparation and review. They have reminded us of the importance of workplace-based learning to diminish the gap between theory and practice, the crucial importance of linking training, education and research to service delivery, and the significant gaps that exist in time, resource, and facilities to support these essential activities. I strongly believe that implementation of recommendations within the report will help address these gaps for the future.
Health inequalities within the southeast region through a service change lens - September 2023
Service reconfiguration is a window of opportunity to drive forward the delivery of fair and equitable care. Both service providers and commissioners have a responsibility to support the triple aim of improving quality of care, reducing health inequalities across communities, and delivering the best value care.
The aim of this report is to provide guidance to help both systems and review panels to ensure tackling health inequalities is a key consideration within service change proposals from the outset and to demonstrate ‘what good looks like’ for us as a Clinical Senate. The background provides an overview of the current issue of health inequalities and the need for action by implementing the Core20PLUS5 approach. Section 4 provides key questions for systems to review in relation to health inequalities when planning service changes, with examples of good practice. Particular consideration has been given to coastal communities within this report as they experience significant health inequalities and there are a large proportion of Integrated Care Boards (ICBs) within the southeast which serve coastal communities. Further information and resources are signposted in the final section of the report.
Review of the Centralisation of Section 136 Health Based Places of Safety (HBPoS) in Kent and Medway - May 2023
The South East Clinical Senate were requested by the NHS England regional reconfiguration assurance team to review proposals aimed at improving the experience and outcomes for patients through creation of a centralised HBPoS service for Kent and Medway. The improvement work addresses workforce, estate and facilities, access to assessment and reduction in the period of detention in a HBPoS.
A multi-disciplinary independent clinical review panel of health and care professionals with a wide range of expertise and experience, including specialist mental healthcare professionals and patient and public partners, was brought together to review the pre-consultation business case (PCBC).
Following this review the Clinical Senate have produced a range of recommendations for how the business case could be potentially improved.
This review was a retrospective review of the final PCBC and unusually the Stage 2 meeting occurred prior to the findings and recommendations of the Clinical Senate panel being shared with the programme team. The Kent and Medway team have therefore requested that this report be read in conjunction with their responses to the points raised following the Stage 2 assurance meeting.
Review of Proposed changes to children's specialist cancer services Principal Treatment Centre serving Brighton and Hove, East Sussex, Kent and Medway, South London and most of Surrey - July 2023
On behalf of the London and South East Clinical Senates we are pleased to share the final joint Senates’ report of the proposed changes to the children’s specialist cancer services Principal Treatment Centre Programme (PTC) serving Brighton and Hove, East Sussex, Kent and Medway, south London and most of Surrey.
We would like to thank our colleagues for their drive and passion to secure these improvements for patients. Significant work has been undertaken to develop these proposals which are grounded in national recommendations and best practice. Our thanks also to members of the review panel including national subject matter clinicians whose time and expertise have been invaluable.
The joint Clinical Senates’ review panel found that the proposals were grounded in evidence and best practice as outlined by Sir Mike Richards’ report on PTCs and subsequent service specifications. They also identified several recommendations as the team move forwards which are detailed in the body of this report.
Embedding healthcare sustainability in major service change - May 2023
The aim of this report is to provide guidance to help both systems and review panels to ensure sustainability is embedded into service change proposals from the outset and to demonstrate ‘what good looks like’ for us as a Clinical Senate. We hope this report provides a useful base to support systems to incorporate sustainability into major service change by providing key questions for systems to ask themselves when considering service reconfiguration and examples of good practice.
SE Region: Patient Support Programmes Regional Principles for ‘value added schemes’ – November 2022
The South East Clinical Senate developed the document Patient Support Programmes: principles for ‘value added schemes’ based on a previous RMOC South West paper.
The document provides:
- A brief overview of Patient Support Programmes and definitions.
- Specifies certain key principles and governance arrangements to be applied.
- Signposting to other key documents that should be considered as part of governance arrangements.
- Benefits and disadvantages of the programmes. Note: the benefits stated are suggested by the pharmaceutical companies.
- A summary of the published strength of evidence for the programmes, including a brief section on cost effectiveness.
- An appendix of the National Homecare Medicines Committee (NHMC) Position Statement: Manufacturer funded PSPs associated with homecare services.
Addendum to the Review of the Pre-Consultation Business Case for West Sussex Stroke Services Transformation - August 2022
The National Stroke Strategy and latterly the South East Coast (SEC) Stroke Services Specification provides the foundation for defining stroke services and outlines what is required to create the most effective stroke services in England. It states that a whole pathway approach to the provision of stroke services is crucial in order to maximise the clinical outcome for patients, their quality of
life and experience of stroke services. More recently, the National Stroke Service Model is driving the formation of Integrated Stroke Delivery Networks (ISDN) with the description of ISDN composition, core functions and service specification.
Integrated Care Systems (ICS) are tasked with reducing unwarranted variation in stroke prevention, treatment and care to meet the 2025
milestone of achieving the best performance in Europe. Across the UK, transformation of stroke services have been taking place and many acute provision reconfigurations have already been implemented to deliver fully compliant Comprehensive Stroke Centres (CSC) and Acute Stroke Centres (ASC) in line with the national stroke model published in May 2021 to reduce deaths and disability. In London, CSC have reduced deaths from stroke by 96 a year, as well as the lives saved by improvements to stroke care nationally, including the
introduction of early supported discharges to ensure patients are discharged in a timely manner with a plan for high quality rehabilitation.
Across the coastal area of West Sussex, there is an aspiration across partners including the former CCG, Sussex Integrated Stroke Delivery Network (ISDN) and provider trusts, to deliver stroke services that offer high quality stroke care by being fully compliant with national standards and achieving the highest levels of performance, therefore delivering improved outcomes for patients. This spans the entire pathway from prevention of strokes to optimising the care for those who have survived a stroke.
A first review of the pre-Consultation Business Case (PCBC) for transformation of West Sussex Stroke services was carried out by the South East Clinical Senate (the Senate) during March 2022. This was undertaken by a stroke services review panel drawn from patients and public, clinical experts and representative multidisciplinary stroke service provider professionals.
The NHS West Sussex commissioning body welcomed the report from the Senate and agreed to address the recommendations in a revised PCBC. Prior to progressing the revised PCBC for transformation of West Sussex stroke services to the next stage of the approvals process NHS West Sussex requested a 2nd review from the Senate.
Review of the pre-Consultation Business Case for Stroke Services for West Sussex CCG - April 2022
Stroke is a preventable and treatable disease; however, it is one of the leading causes of death in the UK and the largest single cause of severe disability. One in eight strokes are fatal within the first 30 days, with one in four strokes fatal within a year. Stroke is a major health problem in the UK, with over 100,000 people having a stroke in the UK every year, with many more experiencing the warning condition of a transient ischaemic attack (TIA).
There is strong evidence that investigations and interventions for stroke, such as brain scanning and thrombolysis, are best delivered as part of a 24/7 networked service that includes comprehensive and acute stroke centres (CSC, ASC) of sufficient size to ensure expertise, time critical treatments, efficiency and a sustainable workforce.