Lawrence Goldberg CSSEC Chair

 This model may assist decisions about the level of assurance required by NHS England for particular service change proposals.

A) The Four Tests for Service Change (Government Mandate to the NHS): 1. strong public and patient engagement; 2. consistency with current and prospective need for patient choice; 3. support for proposals from clinical commissioners 4. a clear clinical evidence base B) NHS Assurance toolkit:  There is a clear articulation of patient and quality benefits  The clinical case fits with national best practice

 Requested by the sponsoring organisation  Terms of reference agreed with the clinical senate: Scope Timelines Methodology  ‘Clinical Review Team’ appointed (responsibility of the Clinical Senate Council) Neutral Chair Professionals with relevant experience/understanding of the issues Citizen representation

 Agreed format  Avoid detailed clinical recommendations or advice on how change would be implemented  Draft checked for accuracy with sponsoring organisation  Sent to Clinical Senate Council: Review (ToR have been met, advice sense-checked, unintended consequences, sustainability) Modification if required Approval Council submits to sponsoring organisation

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 CCG plans must include details on: How you will you be ready to determine the footprint of your urgent and emergency care network during 2014/15, …informed by a detailed understanding for your area of:  patient flows  the number and location of emergency and urgent care facilities  the services they provide  the most pressing needs for your population  How you will be ready in 2015/16 to begin the process of designation for all facilities within your network.

 Two or more Clinical Commissioning Groups  One or more Major Emergency Centres  One or more Emergency Centres  Two or more Urgent Care Centres  At least one Health and Wellbeing Board  At least one 111 provider  At least one GP out of hours provider  At least one ambulance service  At least one community healthcare provider  At least one mental health trust  At least one local authority  Ensure full integration of mental and physical health services

 Receive all patients  Include an Emergency Department and inpatient beds  Open 24/7, 365 days a year  24 hour access to blood products  24 hour access to radiology (including CT and pathology)  24 hour access to specialist support through the network  Transfer and retrieval protocols 12

 An Emergency Centre plus extended ED and inpatient facilities, including at least two of: Major trauma management including neurosciences, plastic surgery, burns Primary percutaneous angiography for myocardial infarction; Stroke thrombolysis Emergency vascular surgery Specialist paediatric facilities Critical care Interventional radiology 13

However …..

 " Most of western Europe has hospitals which are able to serve their local communities, without everything having to be centralised,"  The NHS needs to abandon a fixation with "mass centralisation" and instead invest in community services to care for the elderly;  For more than a decade the NHS had fallen victim to a "steady push towards centralisation" resulting in fewer hospitals, largely as a result of the way the European Working Time Directive had been interpreted by the European Court of Justice.  "deep seated structural problems" will require parts of the NHS to "completely reinvent what we mean by a hospital".  “We already have a fairly centralised hospital system and it may well be that, if we get really creative about what it would take to sustain local hospitals, it may not always be a question of merging or closing in the way that some have seemed to think.”  He believes DGHs, in large towns or cities rather than small towns and villages, can be more sustainable than many in the service have been willing to accept.  “I’m saying two things at once here. Yes there will inevitably and rightly be more change in how hospital services are provided.”  “But, we should take a very careful look at what is driving that to ensure there is actually a strong basis for thinking it will either improve quality or efficiency, and I’m not sure that’s always been the case.”  On that basis those pressing for change could expect strong support if they have good evidence and information to back their proposals, but anticipate problems if they do not.

 Highly sensitive  Shifting sands  CCGs in charge of the agenda  Need to await their formal request for adv ice 1.Draft Surrey CCG Collaborative Project Initiation Document: Implementation of the emergency and urgent care review: implications for acute hospital provision in Surrey’. Role for CSSEC and SCNs in providing advice on clinical specifications for ECs and MECs 2.? Sussex 3.? Kent and Medway

SCN links and resources CSSEC Council Commissioners PPERG People Bank Public, patients and carers SCN MCYP SCN MCYP SCN Cancer SCN MHDNC SCN CVD SCN CVD CSSEC Assembly SCN links and resources

Commissioners Council (includes PPE) Council (includes PPE) Assembly PPERG People Bank Clinical Senate Working Groups Functional Support Health economics Data sourcing and analysis Comms Facilitation External Input Other clinical senates Other clinical expertise Public, patients and carers CLINICAL SENATE Independent Review Panels

 Strategic Clinical Networks clinical directors and clinical leads  Regional reps of specialised services CRGs  Royal Colleges regional reps  Wide range of nursing roles/organisations  Alllied health professionals: all professions  Adult and Children’s Social Care  Education and Training  Local Professional Networks  Individuals with Specific Expertise/Knowledge/experience  Patient and Public Engagement/Third Sector via people bank

 Impact of acquisition of Heatherwood and Wexham Park by Frimley Park FT  Under development  Outline business case from TV CCGs reviewed by TV SCNs (not able to review)  Due to discuss at a Thames Valley clinical senate assembly meeting 17 th July (Oxford)

To follow