Annual report 2015-6
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
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