West Midlands Strategic Clinical Network and Senate. West Midlands Clinical Senate

West Midlands Strategic Clinical Network and Senate West Midlands Clinical Senate Minutes of the Senate Council Meeting from Wednesday 17 th September 2014, 13.00 until 16.30 held at the Hilton Hotel in Bromsgrove, Birmingham Members Present: Name Job Title Organisation Dr David Hegarty (DH) Senate Chair West Midlands Strategic Clinical Network / Ms Fay Bailliee Director of Nursing Birmingham, Solihull and Black Country Area Team, NHS England Mr Simon Brake Assistant Director Coventry City Council Communities and Health Dr Bernie Coope Lead Consultant Psychiatrist Worcestershire Health & Care NHS Trust / Associate Medical Director Ms Sarah Dugan Chief Executive Worcestershire Health and Care NHS Trust Dr Neil Gittoes Consultant Endocrinologist / University Hospitals Birmingham Associate Medical Director Dr Bill Gowans Senate Vice Chair Vice Chair Shropshire Clinical Commissioning Group Prof David Luesley Professor of Gynaecological Oncology Pan-Birmingham Gynaecological Cancer Centre Mr Mark Pulford Patient Representative n/a Ms Mary Ross Clinical Director of Therapy Heart of England NHS Trust Services Dr Russell Smith Deputy Postgraduate Dean Health Education West Midlands Mr Peter Thompson Consultant Obstetrician Birmingham Women s Hospital Mr Brendan Young Patient Representative n/a In Attendance: Name Job Title Organisation Mr Andrew Constable Organisational Development People Opportunities (AnC) Consultant Ms Julie Davies (JD) PA to Associate Director West Midlands Strategic Clinical Network / Miss Karen Edwards (KE) PA to Clinical Senate West Midlands Strategic Clinical Network / Mrs Angela Knight Jackson (AKJ) Clinical Senate Manager West Midlands Strategic Clinical Network / Ms Marilyn McKoy Quality Improvement Lead West Midlands Strategic Clinical Network / Ms Anna Morton (AM) Associate Director West Midlands Strategic Clinical Network / Prof Matthew Cooke Deputy Medical Director Heart of England NHS Foundation Trust (MC) (Strategy & Transformation) Dr Mark Newbold (MN) Chief Executive Heart of England NHS Foundation Trust Ms Ruth Paulin (RP) Programme Lead Surgery Heart of England NHS Foundation Trust 1

Mr Richard Steyn (RS) Reconfiguration Associate Medical Director for Surgery Heart of England NHS Foundation Trust Apologies: Name Job Title Organisation Helen Carter Consultant in Public Health Public Health England Trevor Cole Consultant in Clinical and Birmingham Women's NHS FT Cancer Genetics Eddie Crouch General Dental Practitioner n/a Guy Daly Dean of Faculty - Health and Coventry University Life Sciences Nick Harding Chair Sandwell and West Birmingham Clinical Commissioning Group Anthony Kelly GP / Chair and Clinical Lead South Worcestershire Clinical Commissioning Group Michael Kuo Otolaryngologist Birmingham Children s Hospital John Omany Medical Director Arden, Hereford and Worcester Area Team, NHS England Gavin Russell Medical Director University Hospital of North Staffordshire NHS Trust Tarsem Sidhu Patient Representative n/a Dave Thompson Deputy Chief Constable West Midlands Police 1 Welcome, Introduction and Apologies The meeting commenced at 13.00. DH thanked all for attending this Clinical Senate Council meeting. Apologies these are noted above. 2 Declaration of Interests None declared. 3 Minutes and Actions of the Meeting held on the 9 th July 2014 DH informed all the minutes and actions from the previous Clinical Senate Council meeting have been circulated and the opportunity to pass comment was provided. No amendments were received. DH and AKJ to sign as approved post meeting. Action notes to be carried on to the next Clinical Senate Council meeting which is scheduled for November 2014: Email signature for all members: disclaimer and content is currently being explored by Russell Booth, the Communications Officer within the SCN and Senate. Shropshire and Telford Future Fit Clinical Review: SB is Chair and PT is Vice Chair Arthroplasty: A meeting is scheduled in November to discuss next steps 2

JULY 2014 CLINICAL SENATE COUNCIL MINUTES TO BE SIGNED BY DH/AKJ. JULY 2014 CLINICAL SENATE COUNCIL ACTIONS TO BE CARRIED ON TO THE CLINICAL SENATE COUNCIL MEETING IN NOVEMBER 2014. 4 Core Business (a) NHS England Update: Simon Stevens DH informed all the NHS England update was distributed for information only. DH said the stable environment of the NHS is ever changing, within this the Area Team structures which form part of the West Midlands are to change and a review of the SCN s and Senates is taking place; this will available later in the calendar year. DH s view is the Clinical Senate has significant pieces of work to do and will remain focused on the business. FB informed all the 15% cost savings which NHS England must ensure it undertakes means there will be a 10% in actual savings and 5% will be reinvested into funding specialised commissioning. DH clarified the term co-commissioning. This is a new role which the CCG;s will be leading on from the 1 st April 2015. DH informed all one piece of work which the Senate is working on is around Primary Care. Dr Kiran Patel, Medical Director for Birmingham, Solihull and the Black Country requested feedback from the CCG s for their views; responses were varied. As part of the ever changing structure, DH informed all that AM will be departing from the West Midlands SCN and Senate as Associate Director in October 2014. DH thanked AM for her work over the past 12 months in driving the SCN and Senate forward. DH will discuss with Kiran Patel the next steps forward. (b) NHS England Update: The Role of Clinical Senates in Providing Clinical Advice for Service Change AKJ informed all at the previous Clinical Senate Council meeting, the documents regarding the role of Clinical Senates in providing clinical advice for service change were discussed in detail and in August 2014, these were adapted and finalised nationally for use. DH said there had been a couple of reiterations, however, asked all members to accept these. DH asked AKJ to update the Terms of Reference to reflect the contents. AKJ TO UPDATE THE CLINICAL SENATE COUNCIL TERMS OF REFERENCE TO BE REFLECTED AS PER THE NATIONAL ROLE OF THE CLINICAL SENATE. (c) Birmingham, Solihull and Black Country Stroke Service Reconfiguration Independent Clinical Review 3

DH informed all as part of the review, DH appointed BG as Chair of this panel and DH had had no input into this due to his role within Dudley CCG. BG said this review was very complex due to a large population, a large number of clinicians, the number of providers and commissioning organisations and subsequent ASU s and HASU s within the geographical area. The main criteria of the review was noted around the volume of patients who would be affected and the travel time of which it would take for patients to access such services. The terms of reference were very narrow and so the question was asked; would the volume of patients and travel time support the clinical model. BG informed all the panel could assure this work due to this criteria. It was noted the NHS England guidance is a little generic and the narrow terms of reference made it difficult to decide on what could be assured in the very first instance. This is because the clinicians who formed part of the expert panel for the review wished to consider the whole pathway and asked they meet with all the providers. BG said due to timescales this was not possible. BG asked the commissioning organisation NH for further evidence in relation to the whole pathway. The recommendations from the review are noted to not be within the scope of the review but do form part of the final report (see pages 20-21) so a wider picture is provided. BG hoped the Clinical Senate had striked a balance as all the information provided by the commissioning organisation was pertinent in the review. He added the report was sent to the commissioning organisation asking for factual accuracy, and in response to this correspondence was received by the Clinical Senate by NH asking for further comments to be included in the final report. BG informed all correspondence was returned to NH stating this would be tabled at this meeting for further discussion. DH thanked BG and informed all he shall thank all panel members with a formal letter. DH added the final report highlighted a number of recommendations, the terms of reference and asked all members whether the correspondence from the commissioning organisation should be a key part of the report or be an addendum being the content of it sat outside of the report in a retrospective area. NG wished clarification about whether the Clinical Senate should be responsible for signing off this review, understanding the wider implications. DH replied to NG saying this assurance sits in two parts, the Commissioners and NHS England; with the Clinical Senate being one section of the wider NHS England process. SD asked if the Clinical Senate could be clearer with the scope, terms of reference and panel members for the future reviews undertaken. BG said there had been difficulty with ensuring all panel members views were heard. NG said he had concerns around commercial sensitivity and asked BG how this was identified. BG informed NG that a legal company were involved and the providers were not invited to discuss the review due to this sensitivity. NG suggested the members of future independent clinical review panels be made aware of this sensitivity as it was mentioned, this will likely be the case in future reviews. 4

PT asked BG whether the Clinical Senate would feedback to the National Clinical Advisory Team on the process which was undertaken for this review. BG said he had spoken with Dr Chris Clough, who was previously the Chair of NCAT about his concerns of which Dr Clough said he generally dealt with a couple of people (maximum of 3) for each review which was undertaken by NCAT whereas the review undertaken by the Clinical Senate had had at least 14 clinicians involved in the process. PT said, should the Clinical Senate be adopting this. DH replied, saying no, as the Clinical Senate needs to fulfil guidance and to ensure a robust process is in place. CC has been retained in post for advice for 6 months. Lessons Learned Terms of reference for future reviews to be more robust. Explicit detailed and body of evidence from the commissioning organisation to be provided to the Clinical Senate and how this is then put together needs to be undertaken in a consistent manner for distribution. Due to the content in the commissioning organisations correspondence, this provided information showing the Clinical Senate had hit some delicate points a balance and an examination of the context in full has to be taken into consideration but within this, panel members did not wish to be restricted in their professional views. BY asked if the commissioning organisation accepted the restricted view of the clinicians involved. BG said yes. BY also hopes the commissioning organisation learns from this. Commissioning organisations wish quick, prompt deadlines however it was noted the Clinical Senate cannot be driven into undertaking reviews without adequate timescales being provided. DL suggested the independent clinical review panel team should review the terms of reference for each given review after first sight of these and this could be incorporated on the agenda for the first day of each new review panel when they convene. DH asked all if they were happy to approve the final report (version 10) all agreed. AKJ to make the final adjustments in respect of adding the addendums to this report including the correspondence to NH from BG asking for proof of factual accuracy, correspondence from NH to BG with comments and the correspondence from DH to NH stating comments will be discussed further at this meeting. AKJ TO MAKE FINAL ADJUSTMENTS TO THE REPORT AND PRODUCE ADDENDUM AND FORWARD TO COMMISSIONING ORGANISATION ONCE COMPLETE. (d) Future of Acute Hospitals in Worcestershire Second Stage Independent Clinical Review The following members declared a conflict of interest in respect of the above discussion: NG, SD, BY, PT. DH updated all on this review stating: Dr Martin Lee sent in the original request for the Clinical Senate to undertake this review, a teleconference was then arranged between AM, AKJ and the commissioning organisation. There was much conversation by email and a number of phone calls were then directed to DH, of which the Clinical Senate had been asked to pursue the convening of a panel 5

sooner than what was possible in terms of both turnaround and deadlines. An email was then received at a later stage regarding a concern over the clinical model where a number of clinicians had said this had not been fully agreed. A meeting was then scheduled for DH and a number of individuals throughout Worcestershire; this was then cancelled as no agenda was identified. DH then met with Jo Newton, Chair of the Programme Board and agreed the Clinical Senate would undertake this review once the final clinical model had been decided. Vicky Millward was then contacted by a journalist for information on how the Clinical Senate was progressing with this review this was dealt with by the internal communications team within NHS England. There was query regarding the ownership of the letter which Dr Martin Lee sent on behalf of the Arden, Hereford and Worcester Area Team for NHS England this was requested by the Director of Operations and was confirmed to be the case. HC has been appointed as Chair for this review and DH assured all that impartially by HC will occur on the understanding there has been much activity and conversations by many colleagues throughout the geographical area regarding this review. NG asked if the terms of reference will be encompass the wider services and consequent implications which form outside of the geography of Worcestershire. DH replied to NG saying the terms of reference will be looking at the clinical model and the Clinical Senate will assure depending on the linked interdependencies. PT asked whether the Clinical Senate are being asked an open question. SB replied to PT saying no, the Clinical Senate is being asked if the model is safe and if it could be carried out. BG said in terms of the Stroke Service Reconfiguration panel review that it was consistent, coherent and hopes this will be similar for all future reviews. AKJ asked DH whether there will be support for HC as Chair. SD asked if there was guidance on how to convene panels. DH replied to SD stating there is little guidance but the Clinical Senates on a national level support each other in a reciprocal fashion. (e) Surgical Reconfiguration at Heart of England NHS Trust DH introduced a number of colleagues to the meeting from the Heart of England NHS Trust. DH informed all that Professor Matthew Cooke approached DH regarding a request to the Clinical Senate for the surgical reconfiguration proposals at the above trust. This is for stage 2 assurance regarding a final clinical model. Amendment 28.10.14: Following this conversation, HEFT colleagues were then invited to this Clinical Senate Council meeting to present the clinical case for change. It was noted normally commissioning organisations send in requests to the Clinical Senate and infrequently provider organisations. Ruth Paulin from HEFT did a presentation (see attachment 1 for information) to members on this request. KE to send this presentation out to all post meeting. KE TO SEND OUT RUTH PAULIN S PRESENTATION TO ALL BY EMAIL ELECTRONICALLY AFTER THIS CLINICAL SENATE COUNCIL MEETING. 6

DH thanked Ruth Paulin and asked all if there were questions. BG wished clarification about whether this request to the Clinical Senate was for the Clinical Senate to undertake a review or whether this was for early advice only. DH asked whether this request was for an NHS England second stage review or an internal change within a care pathway. Mark Newbold answered stating this work had begun before the establishment of the Clinical Senate consequently there was a query regarding HEFT s position in being able to move this forward with the Clinical Senate s advice. SB asked whether MONITOR had been involved as yet and if they had a view on this. HEFT colleagues said no response had yet been received from MONITOR but it had been included in the provider organisations 5 year plan. BG said within NHS England guidance, it states a service change could fall within the remit of a Clinical Senate request and consequently a review could be imminent. BG asked HEFT colleagues to clarify what the interdependencies were for this request as this could suggest whether the Clinical Senate needs to undertake a review. The HEFT colleagues were unable at this stage to provide a clear answer. NG directed one point to the HEFT colleagues; this being the interdependencies of surgical assessments in other services external to HEFT but within the wider geographical area of the West Midlands and the subsequent risks. RS said he was disappointed the area of workforce and training is limited as an issue. He added this is an opportunity of which the provider could have the potential to be a centre of excellence however if the organisation does not aspire to be one then how could they do this; especially in the area of trauma and orthopaedics. The HEFT colleagues explained this is being explored more closely. Amendment 28.10.14: PT said he felt that this was a topic that the Clinical Senate should be taking this forward as a possible reconfiguration of services, but thought that if the Trust wished to follow their legal advice that this is not a reconfiguration, but a pathway change then the Clinical Senate would be unable to do a formal review. Ruth Paulin asked DH if there was more guidance. BG suggested the HEFT colleagues review their timeline and decision tree as there are a mixture of timescales for both service change, reviews and gateways. DH confirmed to the HEFT colleagues in their attendance at this meeting and in presenting their request to members. DH asked HEFT colleagues to formally write to the Clinical Senate asking the Clinical Senate to undertake a review and then the Clinical Senate will convene a panel, produce terms of reference, take a view/opinion and assure this on behalf of NHS England. DH informed the HEFT colleagues consultation generally begins after the Clinical Senate has had its involvement however he noted this request is a retrospective fit. The HEFT colleagues asked if the provider organisation needs to send in a formal request or whether this needs to come from the commissioning organisation. DH said, normally the Senate 7

undertakes a review on behalf of commissioners and / or NHS England and not generally providers, however the Clinical Senate could do this although the commissioning organisation needs to be aware of this occurring. BG expressed his concern about whether the Clinical Senate should be undertaking this as it has come directly from a provider. DH said it is the decision of HEFT on whether they wish to send in a formal request. It was noted NHS England is in a changing environment and in April 2015, further changes may occur. DH said the Clinical Senate would submit to the provider organisation formal correspondence summarising this conversation. The HEFT colleagues departed this meeting. SD said it felt as if the different colleagues from HEFT had mixed views on both the request and conversation that had just finished. DH said a teleconference had been undertaken previously to this meeting; it included Ruth Paulin and Matthew Cooke only. FB highlighted her concern about whether this request is for a reconfiguration service review or that of something different. DH requested debate on this matter. BY expressed a concern and believed this request to be a pathway change. NG said he believed if there is any concern or queries regarding this request assurance must be undertaken to satisfy the Clinical Senates uncertainty. BG endorsed this. MR said surely if this is a review which goes out to public consultation then surely the Clinical Senate must undertake this review due to scrutiny to which the provider and the Clinical Senate would be under. FB informed all the provider organisation had visited the Birmingham, Solihull and Black Country Area Team within NHS England for advice some time ago but no further action had continued. DH said although not a unanimous view had been agreed by all members to accept this onto the Clinical Senate s work programme, the majority agreed. 5 Team Building (a) Clinical Senate Council Development DH requested this document provided by AnC of People Opportunities to be distributed by email asking Clinical Senate Council members for their views. The 3 areas for all to consider are noted below for information. 1. Chairing complex review meetings The role of the Chair Preparing for meetings Effective chairing behaviours Sharing experience in the group about what works and doesn t work 8

Handling challenging behaviours during meetings Facilitating productive conversations Responding to requests/demands from others Dealing with conflicting opinions Effective follow-up after the meeting 2. Strategic leadership The nature and characteristics of strategic leadership Differences between strategic leadership and other types of leadership Effective strategic leadership behaviours The role of the strategic leader Connections between strategic leadership, strategic thinking and strategic planning Using a range of leadership styles Working effectively with other strategic leaders Multi-agency and partnership working Challenges of being a strategic leader 3. Leading transformational change Comparing different types of change and the different approaches required What do we mean by transformational change? Insights from complex adaptive systems Sharing experience in the group Using Appreciative Inquiry to create change Leading people through change Leading with Emotional Intelligence Practice using tools to bring about change Implementing change, and making it stick AKJ TO SEND EMAIL TO MEMBERS REQUESTING RESPONSES IN RELATION TO DOCUMENT PROVIDED BY AnC. Responses by Friday 26 th September 2014, if possible. (b) Engendering Positive Relationships with Elected Councillors and MP s: Political Astuteness Catherine Eden introduced herself to all as Director of Cumberlege and Eden and introduced both Dawn Butler and Paul Scriven. Paul Scriven started his working life as a NHS graduate management trainee. He worked at a number of hospitals in the UK and later for a number of private companies. In 2005 he set up his own travel company. He now is managing partner for a consultancy Scriven Consulting, working mainly with public bodies in the UK and South East Asia. In 2000, Paul was elected to Sheffield City Council and became Leader of the Liberal Democrat Group in 2002. He then became Leader of the Council in 2008, following the local elections which saw the Liberal Democrats take control of Sheffield City Council. He served as Leader until 2011 and as a councillor until 2012. At the 2010 general election, he was the Liberal Democrat candidate for the Sheffield Central constituency losing to Labour by 165 votes. In August 2014 Paul was appointed to the House of 9

Lords as a Liberal Democrat life peer. Dawn Butler was Labour MP for Brent from 2005-2010. During this time she served on several Select Committees and chaired the All Party Parliamentary Group on Youth Affairs. She became a Government Assistant Whip and then Parliamentary Under-Secretary of State for Young Citizens and Youth Engagement, becoming the first black woman to hold a ministerial post. Prior to entering Parliament, Dawn worked as a special adviser on employment and social issues to former Mayor of London, Ken Livingstone. She also worked as a trade union officer at the GMB and started her career as a computer programmer and systems analyst. Dawn is the Labour Prospective Parliamentary Candidate for Brent Central in the 2015 general election. There was a discussion around how elected councillors and Members of Parliament were engaged in the West Midlands SCN and Senate activities including how they are consulted and took part in the conversations of the Senate s business such as independent clinical reviews DH departed from the meeting. BG thanked the Cumberlege Eden colleagues for attending and participating and said he found this session very interesting. Once the Cumberlege Eden colleagues had left, BG asked AKJ to place this on the next Clinical Senate Council meeting s agenda to discuss this subject further with all members (internally as a debate). AKJ TO PLACE POLITICAL ASTUTENESS ONTO THE AGENDA FOR THE NEXT CLINICAL SENATE COUNCIL MEETING NOVEMBER 2014 FOR FURTHER DISCUSSION AT BG S REQUEST. 6 Summary AKJ informed all of the dates for future meetings including the Clinical Senate Assembly event. **FUTURE DATES PLEASE NOTE THE VENUE FOR EACH MEETING** Wednesday 19 th November 2014 Hilton Hotel, Bromsgrove Clinical Senate Assembly Event Wednesday 26 th November 2014 Hilton Hotel, Bromsgrove Wednesday 14 th January 2015 Hilton Hotel, Bromsgrove Wednesday 11 th March 2014 Hilton Hotel, Bromsgrove BG closed the meeting at 4.40 pm. 10

Minutes Approved Clinical Senate Chair Signature Date Dr David Hegarty 26.11.14 Clinical Senate Manager Signature Date Mrs Angela Knight Jackson 26.11.14 11