1. Contents 2 ParticipantsIntroductionWhat we know so far Creating the future role of clinical...

2

Contents

Contents Participants Introduction What we know so far Creating the future role of clinical leadership

How would this work in reality? Developing Our Opinion Close

1.Participants2.Introduction – Stephen Singleton3.What we know so far – John Burn4.Creating the future role of clinical leadership

•Team Alpha•Team Bravo•Team Charlie•Team Delta•Team Echo•Team Foxtrot•Team Golf•Team Hotel•Team India•Team Juliet

5.How would this work in reality?•Outcomes, Continuous Improvement and Innovation•Function of Clinical Senates•Service Configuration & Support & Advice•Voice of Clinicians•Divergence of Practice, Assurance and Variations•Model of Networks•Clinical Commissioning Groups•Function of Networks•Health and Wellbeing Boards•Principles of Clinical Leadership

6.Developing our opinion•Outcomes, Continuous Improvement and Innovation•Service Configuration & Support & Advice•Health and Wellbeing Boards•Clinical Commissioning Groups•Model the Relationships•Function of Clinical Senates/Configuration of Senates in the North East•Principles of Clinical Leadership•Model of Networks•Function of Networks

7.Close

3

Participants

Alison McLaughlinAlistair Gascoine

Andrew CantAndrew Kilner Andy Roberts

Andy RobinsonAnnette McAdam Bolescaw Posmyk

Brendan HillBridgid Joughin

Carl ParkerCarol Hardy

Carol HedlandCarole Kaplin

Caroline GraysonCaroline Thurlbeck

Chris BrownClare ScarlettCynthia Atkin

Doraisamy Parthasarathy David BeaumontDavid Bottoms

David EvansDavid Landes David Thorne

Dominic Slowie Edward Kunonga

Elaine O'BrienElizabeth MoodyEmma Champley

Gerry Stansby Gillian JohnsonHenry WatersHilary LloydIan Pattison

Isabel GonzalezJackie Kay

Jane Bowie

Jane LeighJane Mullholland

Jean FreundJeremy Henning

John BurnJohn Costello

John O'Donoghue Jonathan BerryJonathan Smith

Joyce LovellJudith Stone

Judith ThompsonJulie TurnerKamini Shah

Kathryn Dimmick Kyee Han

Laura RobsonLesley DurhamLesley Jeavons

Louise WilsonLynda Dearden

Margaret McQuade Marion UsherMark LambertMartyn Boyd

Maurya Cushlow Martyn Farrer Melanie BrownMichael Milner Michael Norton

Mike GuyMike PrenticeNamita KumarNeil Reveley Nicholas Land

Nick RoperPaul HansonPaul Moffat

Paul StainesPeter Mercer

Richard BarkerRobert WilsonRobin MitchellRoy McLachlan

Ruth Evans Sam Cramond

Sarah Rushbrooke Sharon Haggerty

Simon EatonStephen Cronin

Stephen SingletonStephen Sturgiss

Sue Prout Suresh JosephTony Gibson

Yvonne Evans



4

Introduction – Stephen Singleton

The timing of this is important. Now is exactly the right time to have a conversation about change management. One of the things to reflect upon as we pass to the new system is what are the things that have been successful, and what hasn’t. Consider what can we do to influence the future. This is not a drive-you-hard-until-4 o’clock-and-give-me-the-answer kind of day, but a day to have the conversations we need to have.

I was in a meeting last night, talking about the major trauma network. We are down to only a handful of patients a day who at the moment go through the wrong pathway, get the wrong care, and die. We need to make the right decisions and not confuse leadership with a strong CV.

This is a fundamental point. Clinical is not code for doctors. Clinical means the 55 000 odd people who see patients and directly influence patients through

their care. How this voice and majority voice influences the system. Clinical is how we mobilise these conversations of influence.

How we see things, how we change things and make them better for the whole system. We need to have systems centred around people and patients. We do this by having real vision, and real method to change. It could be by clinical senates, or networks. The method could be anything you like. What we’ve learnt in the North East is that it is about vision, ambition, and culture. This thinking is part of the reason is why the North East does relatively well.

Most of our people believe any of the breakthroughs we have are due to science. For example a new operation or procedure comes along, or medicine. A lot of what networks have been doing already is managing these breakthrough strategies. What is absolutely crystal clear is that if you leave it up to just the science, nothing will happen. You need strategies in place to get breakthroughs. I see the potential of clinical senates and networks to manage these breakthroughs. Can we find a way of developing better breakthrough strategies?

To paraphrase Einstein: ‘If the world was going to end in an hour, I would spend 59 minutes trying to work out what the problem was, and 59 seconds working out the solution.’

I am a little like the emperor in gladiator, lying in his tent, dying, and has the idea – ‘I know, ill hand Rome back to the Senate!’

The SHA is dying, so I’ll hand over to John. He’s the general.

To view Stephen’s presentation click here



http://www.theclinicalnetwork.org/gsf.php5?f=12040&fv=12747

5

What we know so far – John Burn

We can network. An example of this is between Bill Cunliff, and Elizabeth Kendrick. Elizabeth is not only is the mother of two sets of twins under the age of 5, but manages to lead a clinical innovation team. The difference here is that leadership is not about a CV but the ability to lead a service.

Bill Cunliffe took a look at practices regarding patients undergoing bowel surgery. He determined that our reasoning was flawed and outdated. By challenging and changing some of our assumptions, the patients mostly get to go home sooner. Not because we are kicking them out, but because they are getting better quicker. It can be done. We can make these breakthroughs if we want and if we are willing to look at ourselves, and challenge ourselves to change.

Some of the questions we need you to address are:• The clinical network – should we integrate clinical networks?• What is a network?• How do you measure this? How do we now if they are failing, or doing their jobs well?

Many of the problems we have in the North East are self-inflicted, and we pick up the pieces. What can we do to get upstream from these health issues and stop the supply to these problems?

Clinical senates. We want the whole clinical community to contribute to the health of the North East. How many of these should we have? How do they interface with networks, CCGs, HWBs, Las and FTs?

Ill go back to the first slide – the big picture. In the land of the blind, the one eyed man is king.

To view John’s presentation click here



http://www.theclinicalnetwork.org/gsf.php5?f=12047&fv=12754

Team Members

Creating the future role of clinical leadership

TEAM ALPHA

Alison McLaughlinAndy RobertsCarol HedlandDavid Bottoms

David EvansDoraisamy Parthasarathy

Michael MilnerMark Lambert

Nick RoperSuresh Joseph

Larger copies of walls AssignmentsAdditional Materials

6



Team Members


TEAM BRAVO

Carol HardyCynthia AtkinDavid LandesIan Pattison

John CostelloJonathan Smith

Judith ThompsonPeter Mercer

Sharon Haggerty

7




Team Members


TEAM CHARLIE

Carl ParkerChris Brown

David BeaumontDominic SlowieHenry Waters

Maurya CushlowPaul Moffat

Stephen CroninSue Faulkner

8




9

Team Members


TEAM DELTA

Bridgid JoughinDavid Landis

Gillian JohnsonJeremy HenningRobin Mitchell

Ruth EvansRobert Wilson

Stephen SingletonYvonne Evans




10

Team Members


TEAM ECHO

Alistair GascoineBrendan Hill

David ThorneJoyce LovellJulie Turner

Laura RobsonLesley DurhamLesley Jeavons

Sarah Rushbrooke




11

Team Members


TEAM FOXTROT

Gerry StandbyJane Mullholland

Jean FruendJohn O'Donoghue

Lynda DeardenMike PrenticeNeil ReveleyPaul StainesTony Gibson




12

Team Members


TEAM GOLF

Andrew CantBoleslaw Posmyk

Clare ScarlettGill Rollings

Jonathan SmithKyee Han

Louise WilsonMarion Usher

Mike Guy




13

Team Members


TEAM HOTEL

Caroline GraysonEmma Champley

Hilary LloydKamini Shah

Margaret McQuadeMartyn Boyd

Namita KumarNicholas LandSam Cramond




Team Members


TEAM INDIA

Carole KaplinCaroline Thurlbeck

Elaine O'BrienJackie Kay

Jonathan BerryMartin Farrer

Richard BarkerRoy McLachlan

Stephen Sturgiss

14




Team Members


TEAM JULIET

Christine BriggsElizabeth MoodyIsabel Gonzalez

Jane LeighJohn Burn

Kathryn DimmickPaul HansonSimon Eaton

15




Team Members

How would this work in reality?

TEAM ALPHAOutcomes, Continuous Improvement and Innovation

Bridgid JoughinCarole Kaplin

David BeaumontJean Freund

Kyee HanLesley DurhamMark LambertNeil Reveley

16




Team Members


TEAM BRAVOFunction of Clinical Senate

Alistair GascoineAndy Roberts

Jonathan SmithJohn Burn

Lynda DeardenMichael NortonMike PrenticeSuresh Joseph

17




Team Members


TEAM CHARLIEService Configuration & Support & Advice

Carol HardyCaroline Grayson

David LandesDoraisamy Parthasarathy

Julie TurnerTony Gibson

18




19

Team Members


TEAM DELTAVoice of Clinicians

Andrew CantJane Leigh

Jeremy HenningJohn O'Donoghue

Lesley JeavonsMartyn BoydMartyn FarrerYvonne Evans




20

Team Members


TEAM ECHODivergence of Practice, Assurance and Variations

David EvansEmma Champley

Hilary LloydLouise Wilson

Roy McLachlanStephen Singleton




Team Members


TEAM FOXTROTModel of Networks

Alison McLaughlinBrendan Hill

Gillian JohnsonHenry Waters

Isabel GonzalezJudith Thompson

Richard BarkerStephen Sturgiss

21




Team Members


TEAM GOLFClinical Commissioning Groups

Chris BrownDominic SlowieGerry StansbyJohn CostelloJoyce Lovell

Kathryn DimmickNick RoperSue Prout

22




Team Members


TEAM HOTELFunction of Networks

Bolescaw PosmykCynthia AtkinDavid ThorneIan PattisonJackie Kay

Paul StainesSarah Rushbrooke

Stephen Cronin

23




Team Members


TEAM INDIAHealth and Wellbeing Boards

Caroline ThurlbeckClare ScarlettMarion Usher

Melanie BrownMichael Milner

Paul HansonPeter Mercer

Ruth EvansSimon Eaton

24




Team Members


TEAM JULIETPrinciples of Clinical Leadership

David BottomsKamini Shah

Margaret McQuadeMaurya Cushlow

Nicholas LandRobin Mitchell

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Developing our opinion

TEAM ALPHAOutcomes, Continuous Improvement and Innovation

Situation / Issue Role of the Clinical Senate Role of Clinical Networks Role of CCG’s

Network Priorities for example Enhanced recovery (ERP) vs Hyperactive Stroke or gaps in service.

Spot gaps in Network coverage compared to population need and expenditure and consistency of approach

Develop ERP and support implementationStandard setting and monitoring

Specify ERP in commissioning brief

Example of things that could be sorted with a different approach;

• Obesity Prevention 30 SUCS

• Vascular services

Commission + Decommission networks ?(starting and stopping them)Determine number and scope of networks

Supporting QIPP workstreamsA better connection between clinical improvement and potential for saving moneyEvaluation of specialised services (e.g. ICNARC)Showing the benefits of improvementsManaging cover for interventional radiology

Evaluation of services and improvements (Statutory Responsibility)

Walls AssignmentsAdditional Materials

Teamlist



26


TEAM CHARLIEService Configuration & Support & Advice

Service configuration issues• How bodies seek advice• How commissioners ask for advice• Relationship with other bodies – local/national• Statutory services • Politics – local/national• Advice being challenged... How to prepare for this

Why have some issues not been resolved?• Self interest• Perverse initiatives (e.g. status)• Organisational interests (money,

recruitment/retention. NB: sometimes services loses money but reputation and ‘house of cards’ argument and research magnet)

• Public opposition• Assumptions about safety• Self interest about local services• Barmy people

• Therefore Senate has to be very clear about what it can do and what it can’t.

Senate

SoS

OSC

IRP

College etc

Reconfigurations1. Senate won’t, can’t and shouldn’t be a substitute for

competent local work and needs to react clearly when asked to do something ie ‘in scope?’ – yes or no

2. Can arbitrate/honest broker when• Technical advice isn’t definitive• Local solutions vary from national advice• Danger of a purely commercial decision by

provider3. Senate needs to be sufficiently robust * to give

advice that a provider or commissioner can follow without increasing their risk

4. Clear division of labour between senate and IRP and NCAT

5. Clear relationship with OSC power to refer6. *avoids being too susceptible to judicial review7. Role between network and senate is clear:

Network: technical, specialist, evidence etSenate: Arbitration, balanced advice etc (politics)

NB Senates can’t do much about this = provider/CCGs will still have to do consultation/education



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Teamlist


TEAM INDIAHealth and Wellbeing Boards

So...• A health and wellbeing board might seek advice from

a clinical network on matters related to the JSNA and W&W strategy.

• A clinical network night nudge or challenge a health and wellbeing board towards better/best practice

• Sufficiently noisy question from health and wellbeing board might prompt the creation of a new clinical network

• The relationship should/will be dynamic given the cross membership between CCGs and FTs

Nudge challenge

Health and Wellbeing Board

CCG Health Watch

Patients

Clinical Network

Questions help related to HAWES

H&WB Strategy

JSNA



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Teamlist


TEAM GOLFClinical Commissioning Groups

Senate• Clinical advice• Advice of all networks• Role is authorisation = CCG meets behaviour

requirements not direct regulation• Advise communication board• Independent advice and second opinion• 20 people possibly populated from another area –

active/credible and respected• Potential conflict of interested could be influencing

providers in response to questions• ?conflict between Senates dependant on number of

senates – regional and nationally• Local arbitrator on tough decisions

Potential tensions, professional representation/task required

Could be a pool of people multi disciplinary professions.

Questions•How funded?•Top sliced?•CSU to host?



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Teamlist


TEAM ECHOModel the Relationships

“Federation”CCG & HWB

Tasks Clinical Networks

CN CN CNCNCN

Detailed opinion , evidence and argument regarding way forward to Federation

Senate

Unresolved issues

Major changes across providers / areas

Task withquestions

Advise way forward

Regional Outpost

NCB

DH

Regional or Sub Regional?

?Advisory with Authority?

????

Raise issues

?

representatives

Supervises

CCGHWB

CCGHWB Independent

advice re key areas needing attention

Loca

l

Any qualified providers

CP Issue and discussion



30


Teamlist


TEAM BRAVOFunction of Clinical Senates and Configuration of Senates in the NE

Senate

Individual networks

The Clinical NetworkSecretariat/Admin

CCGsProviders

For b

ig

diffi

cult

issue

s

Resource ?

Oversight ?

Performance Mgt ?

RolesAll to have:• Spec terms• Governance and

board structure• ?Advice to providers?• ?Q/A

NHSCB

? Type of Network? Power? Work streams? Funds

£

CCG ProvAudit

performance

Senate

Providers

The Network

Sub



31


Teamlist


TEAM JULIETPrinciples of Clinical Leadership

Organisational workplan to identify:• Passion• Vision• Strategic thinking(no nepotism)

PDP – talent spotting talent grooming

• Development programme• Coaching• Mentoring• Feedback – continuous improvement• Opportunities for leadership – graded facilitated

Inappropriate self selectors – weeded out!(management ≠ leadership, loudest voice ≠ best leader etc)

Important characteristics• Humility • Charisma• Personal insight• Comfort with uncertainty• Comfort with accountability• Ability to articulate and communicate passion and vision• Ability to be the voice in the wilderness• Innovative – creativity/new ideas• Listening

Principles• Honesty/trust• Integrity• Authority – earned/delegated• Time limited tenure•Well and appropriately networked•Measured risk taking

Appr

aisa

l



32


Teamlist

HWBs

SoSNHS Comm

Board


TEAM FOXTROT Model of Networks

Senate will only work if:- Listens to - Owned by- Works on behalf of

CCG/HWB - where accountability rests(NCB & FTs)

Clinical effectives of senate relies on:- Communications- Courtesy- Consideration- Cooperation- Connectivity- Conciliation- Consensus- Courage

ComparisonNICE- Authoritative- Of the system- Power??

Questions- Facing up/down? - Influence

• Advisory but open to public scrutiny• Netag model – multidisciplinary, authoritative,

independent senators leave their ‘bag’ at the door • Empowered to co-opt experts• Agenda setting? accessible but focus

on issues of broad relevance• Broad church• Need skilled secretariat

CCGs

FTs

Private Providers

20

LAs

MPs3rd

Sector

Networks

Senate 12

NHS CB

FTsCCGs

HWBs

The Clinical

Network

FTs

What is the work plan? Proactive or reactive?

AppointedElected- Respected



33


Teamlist


TEAM HOTELFunction of Networks

Function of network• Perform/meet/facilitate National Mandate• Provide advice/not statutory recommendations• Provide single point intelligence - NICE • Provide independence• Provide evidence base• Honest broker role• Maintain integrity• Pathway orientated• Facilitate equity of access• Advise of:

• Saving lives• Saving money• Improving patient experience

• Create/assist in service planning to support commissioning

• Improving quality standards/outcomes• (operational function)

Federated CCG and Senate• Very useful to some Neworks but not all• One size doesn’t fit all (National versus Local funding)

Network issue• Resource availability

Senate

Networks

CCG CCG

NCB

HWB HWB

FT FT FT

LA LA LA

CCG



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Teamlist

35

Close – Richard Barker

The more organised we are the more we can bring about change and effect the way we work. Hopefully this will be a valuable milestone, there was a large consensus gained throughout the day on what we need to do going forward. Thanks everyone for all the hard work



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