Reviewing the evidence base for ‘multiple site single service’ models of care Ashley Dennison, Chair of East Midlands Clinical Senate Matt Day, Consultant in Healthcare Public Health, Public Health England David Bagguley, ST4 Public Health, University of Sheffield on behalf of the East Midlands Clinical Senate Working Group

An increasing issue for Clinical Senates Whilst they offer a potential solution to the difficult and often conflicting balance between outcomes vs access Currently no agreed, shared definition of ‘multiple site, single service’ models No support currently available to Clinical Senates to assist them when assessing these models https://assets.publishing.service.gov.uk/government/uploads/system/uploads/a ttachment_data/file/570371/childrens_epilepsy_surgery_assessment.pdf TB Delivery Board 4th May

So… Establishment of a clinical expert group chaired by PHE which has defined the key questions for a clinical evidence review on multiple site one service models of care. Undertaken a systematic review in partnership with PHE libraries team to understand the evidence base Planning of national events to consider the experiences of other clinical Senates in this area and to consider these models and where they have worked successfully to improve outcomes. Final report on the clinical evidence, workshop and accompanying framework for senates to utilise when considering these models TB Delivery Board 4th May

Background to Review Review team from Public Health England, East Midlands Clinical Senate and University of Sheffield Systematic Review Protocol published in April 2018 Screening / Study Selection completed in Spring 2018 Presentation to National Clinical Senate meeting in May 2018 Data Extraction and Thematic Analysis completed Summer 2018 TB Delivery Board 4th May

Screening TB Delivery Board 4th May

Study Type + 4 mixed methods studies 3 qualitative studies 4 cohort studies 1 cross sectional study + 4 mixed methods studies 3 qualitative studies 2 retrospective data analyses 1 data audit/analysis 1 expert opinion study 2 case studies/report

Key Questions for the Review What is the optimal definition of a ‘multiple site single service’ model? What is the evidence on patient outcomes and quality of care of ‘multiple site single service’ models? What are the enablers of, and barriers to, the development of ‘multiple site single service’ models? TB Delivery Board 4th May

Optimal Definition of MSSS models Strong central coordination Shared Governance Adopt common policies / treatment pathways Multi-site Single Service All clincial sites maintain services Some aspects of care provided by network Can be enhanced by telemedicine Clinical Network + Feeder hospitals offer diagnostics, some tx Smaller no. of centres offer advanced tx Some central coordination Clinical Network Clinicians visit satellite units from specialist centre Acceptable travel distance? Specialist Outreach Feeder sites assess and refer only Common referral pathway Specialist Centre Increasing centralisation TB Delivery Board 4th May

Evidence on Outcomes and MSSS models Multi-site Single Service Clinical Network + Clinical Network Specialist Outreach Specialist Centre Some evidence that patient satisfaction improves No evidence from included studies that patient outcomes were negatively affected Some improvement in treatment specific measures: TAVI clinical network+ reported 90% of patient discharged directly home 30 day mortality lower within cardiac clinical network model than outside it Some evidence that patients dislike transfer of care mid-treatment TB Delivery Board 4th May

Evidence on Enablers of / Barriers to MSSS models Finance Workforce Estate Organisational Culture Specialism Geography Systems Leadership Access to data & Informatics TB Delivery Board 4th May

Next Steps Working Group to complete quality assessment / critical papers of included studies Complete write up of paper in next 4-6 weeks Aiming for submission of final paper by end of year with Senate Chairs as co-authors Meanwhile, the themes identified will be used to inform qualitative study TB Delivery Board 4th May