Clinical co-dependencies of acute hospital services. Introduction to SE Coast Clinical Senate Summit

Lawrence Goldberg, Clinical Senate Chair

The Clinical Senate, South East Coast

The Clinical Senate

Topic identification and agreement Commissioners Clinical Senate Council Independent strategic clinical advice Clinical Senate Assembly

Remit

What are the clinically necessary co-locations (i.e. same site) and co-dependencies (which could be provided on a networked basis) for acute hospital based services?

• • • Formal request from the Sussex CCGs Collaborative, to inform strategic planning of future acute hospital services To provide a generic, clinical review of relevant evidence, guidelines, consensus and standards Not site-, county- or region-specific

Major acute services under consideration

• • • • • • • • • • • • To describe the clinical dependencies of the following: Emergency Medicine (A&E) Acute medical take Acute surgical take Critical Care Trauma centres and units Vascular surgery Acute cardiology services Stroke units Renal Centres Maternity services Paediatric (medical and surgical) services

Co-dependencies: what are the requirements of these major acute services?

• Care from supporting service must be co located (on same hospital site) • or Care from supporting service ideally on same site but could be provided on a different site via a networked arrangement • or Same site or network arrangement not required

Cross-cutting themes

• • • • • • • • Workforce issues* Diagnostics* Mental health services in acute hospitals* Paramedic, ambulance and transport issues* Patient and Public Involvement* Cancer service requirements* Community services Pharmacy and medicines management

Project Plan

• • Commission literature review BSUH Knowledge and Library Service • Convene a clinical reference group to synthesise the available evidence • Convene a Clinical Senate Summit to widen expert involvement and contribution • Produce report for the commissioners, and wider audience

Clinical Reference Group

Lawrence Goldberg Rob Haigh Ed Palfrey Mansoor Sange Adam Jacques Matthew Jolly Ryan Watkins Graham Dodge Priscilla Chandro Carolyn Morris Andy Collen Nic Goodger Philippa Spicer Nigel Ashurst Chair (Clinical Senate SEC) Emergency, Acute and General Medicine General and Vascular Surgery; Trauma Critical Care (Adult) Cardiovascular SCN (Cardiology, Stroke, Renal) Maternity (SCN) Paediatrics (SCN) Diagnostics PPE (Clinical Senate Council) PPE (Clinical Senate Council) Ambulance and transport Cancer (SCN) Workforce (HE-KSS) Liaison mental health (SCN)

Working with the SE Coast strategic clinical networks

• Cardiovascular Disease: cardiac, stroke, renal and diabetes • Cancer • Maternity , children and young peoples’ services • Mental health, dementia and neurological conditions

Purpose of this Clinical Senate summit

• To involve a wider range of regional knowledge, expertise and perspectives • To review, challenge and supplement the evolving evidence syntheses • To contribute to the clinical senate report

Original co-dependency RAG rating

R Definition Co-location on same site essential.

A G Ideally on same site but could alternatively be networked via robust emergency and elective referral transfer protocols Does not need to be on same site or networked. Appropriate arrangements are in place to obtain specialist opinion or care.

The co-dependencies grid

Refined co-dependency RAG rating

R A G Definition Co-location on same site essential.

i.e. the service must either be based in the same hospital, or be able to deliver appropriate urgent or emergency care (assessment, investigation or treatment) on site without needing to transfer the patient to another hospital.

Ideally on same site but could alternatively be networked via robust emergency and elective referral transfer protocols Does not need to be on same site or networked. Appropriate arrangements are in place to obtain specialist opinion or care.

Framework for evidence synthesis

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

Commentary

Pointers for the day

• Summit is ‘formative’ and developmental • What is the evidence? Is there any?

• Be forward thinking, imaginative but real world: not just describing the status quo, nor nirvhana • Public and patient perspective is essential to ensure appropriate and acceptable models of care • Participants are not representing their employing organisations, colleges or professions • • Avoid jargon wherever possible Wide range of participants’ backgrounds