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

www.swsenate.nhs.uk @southwestsenate