1. Clinical Senate South East Coast Council Meeting 2 nd October 2014

2. Chair’s Report Lawrence Goldberg

3. Refine structures to ensure they best fit NHS England’s purpose Achieve 15% savings NHS England’s Organisational Alignment and Capability Programme (OACP): Purpose

4. 1.Get national directorate structure right 2.To better focus and align the work of NHS England on its core priorities Specialist commissioning Design and implementation of new local care models Support for CCG/LA integrated commissioning Payment reform and incentive design Operational research 3.Develop a much more integrated model of operation across regions and areas outside of London OACP: 3 phases

5. Avoid duplication and work more more effectively across all parts of the organisation Under combined review: Clinical Senates Strategic clinical networks Academic Health Science Networks NHS IQ ? other Arms Length Body Review

6. Merging of Surrey and Sussex, and Kent and Medway, Area Teams in to one Amanda Fadero leaving for BSUH NHS Trust Sarah Creamer to interim AT Director Deborah Tomalin to interim Director of Commissioning for SEC Ali Parsons and Jackie Huddleston joint interim SCN/Clinical Senate Associate Directors Vacancy pause for SCNs/Clinical Senates SEC has 40% vacancy factor currently Outcome and of OACP on Clinical Senate/SCNs structure and function awaited SE Coast changes

7. What purpose were SCNs, Clinical Senates, NHS Improving Quality, AHSNs and the Right Care Programme originally designed to fulfill? What functions and benefits are they providing currently? What improvement functions are needed to be sponsored by NHSE in the health system architecture going forward, reflecting NHS England priorities? What should the improvement architecture look like to fulfill these functions? NHS South of England: Review of Improvement Architecture

8. Clinical senate website Week commencing 6 th October Web address to be forwarded once live Proposed name change: South East Coast Clinical Senate (SECCS) replaces Clinical Senate South East Coast (CSSEC) Other issues

9. Clinical Co-dependencies Project Lawrence Goldberg

10. What are the clinically necessary co-locations (i.e. same site) and co-dependencies (which could be provided on a networked basis) for acute hospital-based services? Formal request from the Sussex CCGs Collaborative, to inform strategic planning of future acute hospital services To provide a generic, clinical review of relevant evidence, guidelines, consensus and standards Not site-, county- or region-specific Remit

11. Convene a clinical reference group to synthesise the available evidence Commission literature review BSUH Knowledge and Library Service CRG/summit attendees additions Other sources Produce draft ratings for strength of co-dependency (using agreed grid), and evidence justification Convene a Clinical Senate Summit to widen expert involvement and contribution and revise grid Final write-up Agree and submit report for the commissioners, and publish Project Plan

12. Evidence available Original research National or international guidelines National policy or service specifications Expert consensus not included above (specify) Published relevant standards Cross-cutting themes Relevant workforce issues Ambulance and transport issues Public and patient issues Other factors? Commentary Inputs to evidence collection and synthesis

13. To describe the clinical dependencies of the following: Emergency Medicine (A&E) Acute medical take Acute surgical take Adult critical Care Trauma centres and units Vascular surgery (hub and spoke) Cardiac inpatient services Stroke units (hyper-acute and acute) Renal inpatient hub Consultant-led obstetric services General acute paediatric (medical and surgical) services 11 major acute services defined

14. Workforce issues Diagnostics Mental health services in acute hospitals Paramedic, ambulance and transport issues Patient and Public Involvement Cancer service requirements Community services Pharmacy and medicines management Cross-cutting themes

15. Clinical Reference Group Lawrence GoldbergChair (Clinical Senate SEC) Rob HaighEmergency, Acute and General Medicine Ed PalfreyGeneral and Vascular Surgery; Trauma Mansoor SangeCritical Care (Adult) Adam JacquesCardiovascular SCN (Cardiology, Stroke, Renal) Matthew JollyMaternity (SCN) Ryan WatkinsPaediatrics (SCN) Graham DodgeDiagnostics Priscilla ChandroPPE (Clinical Senate Council) Carolyn MorrisPPE (Clinical Senate Council) Andy CollenAmbulance and transport Nic GoodgerCancer (SCN) Philippa SpicerWorkforce (HE-KSS) Nigel AshurstLiaison mental health (SCN)

16. Steering Group Lawrence GoldbergChair (Clinical Senate SEC) Ali ParsonsClinical Senate Manager Rachael LiebmannClinical Senate Council Deborah TomalinAssociate Director, Clinical Senate and SCNs Increasingly close working with the SCNs

17. Final clinical dependency grid (v10)

18. Pre-summit completed draft grid

19. Refined and final co-dependency PRAG rating PURPLE Service must be co-located (based) in same hospital RED Service should come to patient (patient transfer not appropriate), but could be provided by visiting/in-reach from another site (either physically, or via telemedicine links). 4Within 4 hours 24Within 24 hours Not specified AMBER Ideally on same site but could alternatively be networked via robust emergency and elective referral and transfer protocols GREEN Does not need to be on same site. Appropriate arrangements are in place to obtain specialist opinion or care.

20. 80 attendees, wide range of professional backgrounds CRG presentations Rich and important facilitated working groups p.m. Summit review

21. EventDate Submission of CRG grid ratings and supporting evidence, and cross-cutting theme summaries Monday 6 th October Draft report produced, and resolution (where possible) of discrepant ratings. ? send out for further final check with other stakeholders Monday 6 th – Monday 27 th October Draft report circulated to Clinical Senate Council Week beginning Monday 27 th October Consideration of report by Clinical Senate Council Wednesday 4 th November Submission to Sussex CollaborativeMonday 9 th November CSSEC website publication, and wider distribution Late November (following agreement with Sussex Collaborative) Next steps and timescales

22. How best to get consensus where CRG hasn’t achieved it? Who else should we be consulting? ODN network leads and other relevant regional clinical leads NHS England Urgent and Emergency Care leadership Colleges/Specialist Societies?? Provider trusts?? Publication strategy and handling Other points? Questions for the Council to consider

23. Advance Care Planning Discussion on publication strategy

25. Main document and public facing document Distribution list for discussion: Commissioners Provider organisations ? via MDs/NDs/CEOs GP practices Local authorities Children’s services providers Links to relevant organisations Dying matters ? Public/media launch How/who? ACP publication strategy and considerations