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 on Wednesday 9 th September 2015 from 13.00 until 16.00 hours held at the Hilton Hotel in Bromsgrove, Birmingham Present: Name Job Title Organisation Dr David Hegarty (DH) Senate Chair West Midlands Strategic Clinical Network / Senate (NHS England) Dr Aqil Chaudary (AC) Attendance until 15:00 GP & Joint Commissioning Lead/ Board Member Birmingham Cross City Clinical Commissioning Group Dr Eddie Crouch (EC) General Dental Practitioner n/a Mrs Sarah Dugan (SD) Attendance for item 5e and 6 Dr Nick Harding (NH) Attendance until item 6f Mr Michael Kuo (MK) Chief Executive Chair Consultant Paediatric Otolaryngologist - Head and Neck Surgeon Worcestershire Health & Care NHS Trust Sandwell and West Birmingham Clinical Commissioning Group Birmingham Children's Hospital Dr Anthony Kelly (AK) GP South Worcestershire Clinical Commissioning Group Mr Mark Pulford (MP) Patient Representative n/a Dr Russell Smith (RS) Deputy Postgraduate Dean West Midlands Local Education & Training Board Mr Brendan Young (BY) Patient Representative n/a Mr Rob Wilson Interim Associate Director / Network Manager West Midlands Strategic Clinical Networks and Senate In Attendance: Name Job Title Organisation Mrs Angela Knight Jackson (AKJ) Clinical Senate Manager West Midlands Strategic Clinical Network / Senate (NHS England) Miss Karen Edwards (KE) PA to Clinical Senate West Midlands Strategic Clinical Network / Senate (NHS England) Miss Rachel Knowles (RK) Admin Support West Midlands Strategic Clinical Network / Senate (NHS England Unconfirmed minutes version 0.1 Page 1

Apologies: Name Job Title Organisation Mr Simon Brake (SB) Director of Primary Care Coventry City Council Sustainability and Integration Dr Helen Carter (HC) Consultant in Public Health Public Health England West Midlands Centre Mr Andrew Constable Organisation Development People Opportunities Consultant Prof Guy Daly (GD) Dean of Faculty - Health and Life Coventry University Sciences Mrs Sue Doheny (SD) Director of Nursing NHS England West Midlands Dr Neil Gittoes (NG) Associate Medical Director for University Hospital Birmingham Clinical Partnerships Endocrinology Dr Bill Gowans (BG) Vice Chair of the Clinical Senate Vice Chair and Clinical Director of Shropshire Clinical Commissioning Group Transformational Change Prof David Luesley (DL) Professor of Gynaecological Oncology Pan-Birmingham Gynaecological Cancer Centre Mr Paul Maubach (PM) Chief Accountable Officer Dudley Clinical Commissioning Group Ms Marilyn McKoy (MM) Quality Improvement Lead West Midlands Strategic Clinical Network / Senate (NHS England) Mrs Mary Ross (MR) Clinical Director of Therapy Heart of England NHS Foundation Trust Services Dr Gavin Russell (GR) Medical Director University Hospital of North Staffordshire NHS Trust Mrs Jane Teasdale (JT) AHP Divisional Therapy Management University Hospital of North Staffordshire NHS Trust Mr Peter Thompson (PT) Consultant Obstetrician / Medical Director Birmingham Women's NHS Foundation Trust Victoria Tweddle for Sue Doheny (VT) NHS England West Midlands 1 Welcome, Introduction and Apologies The meeting commenced at 13.00. David Hegarty (DH) thanked all for attending the Clinical Senate Council meeting. DH advised that at that time the meeting was not quorate but that there were some members of the Council expected to arrive shortly. Apologies these are noted above. Further Council members arrived and the meeting became quorate. Unconfirmed minutes version 0.1 Page 2

2 Declaration of Interests DH asked the Council to declare any interests pertinent to the meeting. DH acknowledged that Brendan Young (BY) and Anthony Kelly (AK) held previously indicated declarations of interest in relation to item 5(c) Future of Acute Hospital Services in Worcestershire FoAHSW Programme Board and that they would be able to stay for the item but would not comment on that discussion. 3 Minutes and Actions of the Meetings held in March and July 2015 DH informed those present that the minutes and actions from the previous Clinical Senate Council meetings had been circulated in advance. Action Action: CSC 090915 / 3 Previous minutes from March 2015 and July 2015 (extraordinary meeting) to be signed by DH and AKJ. 4 National Update: Organisational Alignment and Capability Programme Rob Wilson (RW) gave an update on the Ed Smith review. Accompanying slides were distributed for further detail. RW advised the review concluded in March 2015 and the report was not released until the 30 th July 2015. RW said that there were 16 recommendations from the report, 12 of which would be adopted in full or in part and the other four needed further work. RW advised that the NHS Leadership Academy would transfer to Health Education England. Talent Management would remain the responsibility of the new NHS Improvement. The new NHS Improvement would be a combined approach between the Trust Development Authority (TDA) and NHS Monitor. Russell Smith (RS) gave a brief update to the Council of the review from the Health Education England and Health Education West Midlands viewpoint. RW advised that there was some detail that remained to be worked through. RW advised that they key information for the Clinical Senate would be the continuance of the links between the Academic Health Science Networks (AHSN s) and the Senates which would remain as separate organisations. RW updated the Council that the intention would be to work more closely together to prevent duplication. RW added that the AHSN s would no longer have a coordination role in improvement activities. RW said that regionally and nationally there was work being done on new operating frameworks for the Networks and the Senates and RW added that he was due to attend a meeting in London on the following day (Thursday the 10 th September 2015) with the Associate Directors of the Networks and RW said that he would endeavour to communicate back to the Council any relevant information from this. RW said that there was ongoing discussion regarding the regional footprints of the Senates and that further clarity would be required. RW informed the Senate Council that he would like to recognise the Senate and Strategic Clinical Network staff for their patience and resilience through this time. RW asked for any further questions. Unconfirmed minutes version 0.1 Page 3

DH advised that his understanding was that the Senate footprint would remain essentially the same and the three regional Senates would remain in place. He said that there would be a greater focus on regional oversight of the three Senates to facilitate consistency, provide coordination around work streams and to share learning. DH asked RW if more information could be provided from the meeting on Thursday 10 th September 2015, National Associate Director s meeting, which RW was due to attend. DH said that more information would be helpful with regard to the on-going status of the Senate Assembly, the recruitment required for the Senate Council, and the awaited information on the Operating Model. RW replied that he would be happy to share information as it was received. RW agreed that clarity of purpose would be useful and added that all twelve Associate Directors plus David Levy would meet on the 10 th September 2015. DH thanked RW for the update. Action Action: CSC 090915 / 4 Reviewing improvement and leadership development capability across health and care in England Ed Smith review slides which Rob Wilson showed to Council members to be distributed to all Council members by email post meeting Action Action: CSC 090915 / 2 Extra-Agenda Item DH advised that he would propose that an email be circulated seeking nominations or volunteers for an additional Vice Chair of the West Midlands Clinical Senate Council, to enable the establishment of a joint Vice Chair role alongside Bill Gowans as existing Vice Chair. 5 Core Business (a) Coventry and Warwick Stroke Pathways Warwickshire North Clinical Commissioning Group (CCG) The Coventry and Warwick team (C&W) arrived and Andrea Green (AG) the Senior Responsible Owner (SRO) for Improving Stroke Services across Coventry and Warwickshire introduced her colleagues as follows: Charles Ashton, (CA), Medical Director, South Warwickshire NHS Foundation Trust & Chair of the Solihull Clinical Reference Group (CRG) for Urgent Care. Sarah Warmington (SW), from Coventry and Warwickshire CCG, Programme Manager. Sarah Mountford (SM), Stroke Coordinator at University Hospitals Coventry and Warwickshire NHS Trust. Jacqueline Barnes (JB), the Clinical Lead for the CRG and Chief Nursing Officer, Coventry and Warwickshire CCG. Unconfirmed minutes version 0.1 Page 4

DH welcomed the team and clarified that the reason for their attendance at the West Midlands Clinical Senate meeting was that they had made a formal request for stage II assurance which was part of the assurance process within NHS England prior to public consultation and implementation of any new model. DH added that as part of the Clinical Senate Terms of Reference (ToR) the team would give a short presentation to the Clinical Senate Council as to what their outline proposal was, to ensure that there were no gaps that would hinder them successfully going through stage II assurance. AG advised that she would present the slides entitled Improving Stroke services across Coventry and Warwickshire AG advised that there was consensus and sign-up to the proposed changes from the main Stakeholder groups. AG gave a brief outline of the group structure and the history of the process up to that time. With reference to the first slide entitled Established our Project to Improve Stroke Outcomes April 2014 NHS Midlands & East Stroke Service Specification AG said that they were working with Clinicians in the Hospitals in order to gain clinical consensus and views. AG added that Professor Tony Rudd (National Clinical Director for Stroke, Professor of Stroke Medicine Kings College, Consultant Stroke Physician, Guy's and St Thomas, London Stroke Clinical Director, Stroke Programme Director Royal College Physicians, London) had visited the sites and met the teams. AG advised that Professor Christine Rolfe (Consultant in Stroke Medicine, Reader and Honorary Senior Research Fellow, Keele University) had provided some external assurance and guidance. AG used the presentation slides to demonstrate the current structure and noted that there was strong stakeholder engagement. AG said that the Clinical Review Group (CRG) had been key in terms of looking at how to make the proposed changes work. AG added that public and Patient engagement had also been a key theme. AG then showed the second slide with a map of the region and she discussed the current provision and patient flow and the infrastructure. AG said that the key challenges would be around the older population, minority populations and with socially and economically deprived areas as per the fourth slide entitled Prevalence suggests AG said that if the aim would be, as per the proposal, to move towards a more centralised model, then transport challenges would be a key focus. AG then gave a summary of the Case for Change, which could be summarised by the headlines on page five of the presentation. AG said that one key aim would be to improve patient flow and ensuring appropriate capacity, as bed flow was currently not correct and that the Trust needed services to be optimally configured. AG said that it would be a staged progression as a stepped change, and that the shortlisted options were those that were demonstrated as per the presentation slides. With regard to the slide named Issues for a clinically viable model as determined by CRG, page 10, AG advised that there was outlined work still to be done with regard to social care aspects as there was inequity of access which required addressing. AG added that with regard to Patient flow to external Trusts such as Worcestershire Acute Hospitals NHS Trust and Heart of England Foundation NHS Trust, the reconfiguration was not planning any changes in this area. Unconfirmed minutes version 0.1 Page 5

AG outlined the shortlisted options and advised that option two would be the preferred option. With regard to the proposed Scenario 2 model, AG advised that this would be the proposed model as a staged approach, with rehabilitation services focused on first and beds to be looked at second. As per the slide titled How will proposals benefit patients and the public, AG said that the key would be around networked services and rotas, to optimise and make the best of the Stroke Specialist Physicians. AG said that the professionals were keen and saw the opportunity for change whilst recognising the benefit to Patients. AG discussed the benefits to the Patients and the Public of the proposals. AG advised that the three Commissioning bodies in the area were fully signed up to the proposals as well as the two Local Authorities. AG moved on to the slide which discussed the four DH tests and said that with regard to public engagement and networks, there had been lots of conversations and it was important to ensure the right service first and in the right time. AG said that the benefit would be improved Patient choice and said that the issue of repatriation had come out of the public discussion. With regard to the slide called Proposed timetable for change, there was a discussion around the timetable for this review. AG advised that the team had received NHS England s dates for that section of the review and added that some Early Supported Discharge (ESD) work had started and that the key would be getting the integrated model and that there was an expectation that from the time of a decision it would then take 12 months to be implemented. AG added that the team were aware of the implications, as per slide Implications for commissioners and providers and she said that there were policies and procedures in development. AG said that an integrated impact assessment had been made. AG then handed over to Charles Ashton (CA) for further discussion. CA discussed the benefits of the proposed model and acknowledged the current limitations of the current workforce and said the aim would be to have a networked service with more opportunities to work on three sites. CA added that patient flows would be important. DH thanked the C&W team and asked the Clinical Senate Council members if there were any questions. Russell Smith (RS) said that this reconfiguration presented a key opportunity for training and asked where the considerations for education and training had featured in the discussions and the project thus far. CA agreed that there was a great opportunity in the central units for training. He said that in terms of general Medicine that this training would be lost, but that this was happening everywhere on a national level and added that the Trust would be working in coordination with the Deanery. RS said that Health Education England and Health Education West Midlands were one of the major Commissioners and stakeholders, but that to his knowledge the Deanery were not yet involved. He said there was a key opportunity to get them involved. RS queried why this Unconfirmed minutes version 0.1 Page 6

information was not in the plan. The C&W team agreed that this was a fair challenge and that it would be detailed in the workforce plans. They asked RS how best to approach this. RS said that it would be crucial to have an education expert in their team, and said that there would be Clinical Tutors in their organisation and that this would be a good place to start. The C&W team agreed that this would be helpful and responded that this could be fed into their business case. Nick Harding (NH) asked regarding changes to measured drive times and whether there was any compromise to the 4 hour window for Thrombolysis. The C&W team responded that there was no plan to change the Thrombolysis status quo and this would be via Coventry, Worcester or HEFT as it was currently. NH asked if modelling and capability information was available around areas such as Speech and Language Therapy (SALT) assessment and a discussion was held around this. The C&W team agreed that this would need to be available. NH also asked if there had been consideration of the political agenda and how this would be managed. There was discussion regarding the future proofing of direct Thrombectomy. NH advised that the two above points would need to be taken into consideration at stage II level and would need to be able to be demonstrated to a review panel. DH asked the C&W team if they had had sight of the related interdependencies with regard to capacity at the neighbouring Acute Trusts and potential changes to population flow. There was discussion regarding this. Brendan Young (BY) queried with regard to the projected increase in patient flow into hyperacute services at Coventry and Rugby, to what extent did the bed configuration meet the Midlands and East Stroke specifications. The team responded that there were 20 beds at Leamington and six beds at Rugby. AG added that they were currently delivering post-acute rehab and CA said that the beds met the specifications at Feldon Ward in Leamington. There followed a general discussion regarding bed specifications, available beds, challenges faced and the team advised that there was strong clinical consensus. BY asked regarding stroke prevention, what measures were in place and were planned, and how far along this was. The C&W team responded that there was a gap in this area, and that they were working with the GP s and network for education to ensure that the prevalence was right and added that they were working with GP s on lifestyle and risk factors, in conjunction with the CCG s. CA said that with regard to capacity there were definitely enough HASU (Hyper-Acute Stroke Unconfirmed minutes version 0.1 Page 7

Unit) and ASU (Acute Stroke Unit) beds proposed as long as the rehabilitation strategy was in place and correct and the team discussed how to build this plan in in partnership with the providers. Aqil Chaudary (AQ) asked for further information around how strong the community footprint was, as he said it would be crucial to ensure this was correct. The C&W team replied that it had become clear to them that the public and patients had ensured a focus on rehabilitation services. They added that the social care element would be required in the review, to be jointly commissioned, and they advised that it was not agreed yet and that discussions were happening with their Social Care colleagues, and in other areas. The C&W team noted that it would be key to ensure combined working to ensure correct patient pathways and that liaison would be important with Social Care colleagues to ensure right place, right time. They added that consistency would be needed across Coventry and Warwickshire and that the evidence around the impact on savings was largest in Social Care. DH said that in summary, there was shown to have been a huge amount of work done and that the key points had been identified. He said that the Clinical Senate would now reflect and DH suggested that this be followed up the following week via telecom between DH and AG outside of the meeting to try and understand what the next steps might be. DH thanked the C&W team and they left the meeting. DH asked the Clinical Senate Council members for further comment. There was general discussion around the information given in the presentation. RS said that with regard to education, it was vital that the C&W team liaised with Health Education England. Michael Kuo (MK) said that there might be a potential challenge with regard to hiring the required workforce as there was a risk of less interest in the roles in the spoke sites which would eventually become de-skilled. BY added that there would be a challenge in terms of the timescales that the team would attempt to work towards. Action Action: CSC 090915 / 5 (a) Coventry and Warwick Stroke Pathway Assurance - phone call to be arranged post meeting between Andrea Green and team and Clinical Senate team to discuss next steps in respect of this assurance request (b) Seven Day Services NHS IQ DH welcomed Helen Sigsworth (HS) a Locality Delivery Facilitator from NHS Improving Quality (NHS IQ) to present on Seven Day Services. DH asked HS to clarify what the purpose and requested outcome was of the presentation to the Unconfirmed minutes version 0.1 Page 8

Senate Council. HS advised that her understanding would be that there had been a request to share the learning, specifically from the early adopter sites over the previous 18 months, with a view to understanding what some of the outcomes had been. HS added that there was a request that the Council consider whether the Senate could provide some clinical leadership at the strategic level in order to bring together more of the whole system approach to Seven Day Services. NH advised that this request for leadership came outside of the remit of the Clinical Senate Council. DH agreed that this would be a concern. DH added that previously the West Midlands Clinical Senate had been approached to organise and host Seven Day Services events, and the response from DH had been that this was not within the remit of the Senate and not within the Terms of Reference either locally, or nationally. DH advised that it would be helpful for the Senate Council to understand some of the learning, as HS had described, and DH also requested some further information into how the work so far would now fit into the new improvement architecture. HS advised that there was awareness that NHS IQ would be dis-established from the 1 st November 2015, and that the programme of work would continue upon the transfer to NHS England. HS added that in terms of operational delivery, there was still information to be confirmed. HS said that just over half the sites worked with on the Seven Day Services project were willing to continue in the project with NHS IQ. HS highlighted the early adopter sites and outlined the baseline clinical standards and work done thus far. HS indicated that it had been shown by the work so far that there was a pressing need to look at how systems could better work together in particular in the arena of workforce planning. HS referred to various case studies in Lancashire, from the Heart of England Trust and Great Yarmouth to demonstrate different ways of working. HS advised that the case study from North East Lincolnshire and Goole was of critical importance, of which further details were provided to the Clinical Senate post-meeting. HS said that this study showed different ways of encouraging rotation of Radiographers and Sonographers in order to extend and maintain skill bases. HS said that with regard to integration, and governance, there was further work required within the entire system but that progress was being made. HS discussed partnerships and networks and added that it was key to understand what was critical in each individual area. HS added that the East Midlands Clinical Senate had been doing some work on seven day services, and that Dr Kiran Patel had been interested in measuring standards and that perhaps there was a piece of work there for the region and perhaps this was something to take further. HS said that with regard to the media, Seven Day Services was often referred to as Seven Day Unconfirmed minutes version 0.1 Page 9

Working, and that it would be key to encourage a move towards the former. HS highlighted that Clinical Leadership was an important success factor, not just in implementation but also in engagement. HS added that further work was required with regard to Patient involvement and consultation. HS also stressed the importance of commissioning with regard to Seven Day Services. DH thanked HS for the presentation and said that more clarity might be required around which directorate of NHS England, NHS IQ were being transferred into. HS responded that it was unclear at that time. DH requested that the presentation slides be circulated post-meeting and the conversation could be picked up again if and when Seven Day Services came into the Senate workstream. HS asked if in the Clinical Senate Council s opinion there was a role at that time for the Clinical Senate to be involved. DH responded that due to limited capacity and resource the Senate were unable to accept that request but that it was useful to have sight of the work with regard to the assurance process into reconfiguration. DH advised that at the present time the Senate focus was to give assurance to reconfiguration. DH thanked HS for attending. Action Action: CSC 090915 / 5 (b) 7 Day Services - Scenario documents and presentation material from Helen Sigsworth to be distributed to all Council members by email post meeting (c) Future of Acute Hospital Services in Worcestershire FoAHSW Programme Board DH welcomed the FoAHSW Programme Board and Kiran Patel (KP) to the meeting. KP began by briefly running through the previous history of the review with regard to the NHS England process. KP advised that it was a clinically driven model. KP outlined the group s progress and explained that a working group had been convened to work towards the generation of consensus of opinion. He said that a great deal of work had been done and that a wide diversity of opinion had been accommodated. DH clarified that the role undertaken by KP was that, as Medical Director for NHS England, KP had been asked in that capacity to take on the Chairing of this group, having not had any previous input to the Programme Board. KP confirmed that he did not sit on the Programme Board. DH asked KP to confirm whether the purpose of the attendance by the Programme Board at the Clinical Senate Council meeting was to have a review as to the current progress made by the working group prior to seeking stage II assurance, or if the working group were asking for stage II assurance at that time. It was confirmed by KP and Lucy Noon (LN) that it was the former. DH replied that this was Unconfirmed minutes version 0.1 Page 10

helpful. The FoAHSW team introduced themselves as follows: Lucy Noon, Director for South Worcestershire CCG and Programme Director of FoAHSW. Dr Carl Ellson, GP from South Worcestershire and Chief Clinical Officer, South Worcestershire CCG Dr Gary Ward, Emergency Medicine Consultant on secondment from University Hospitals Coventry and Warwickshire NHS Trust with County-wide Lead status Dr Andrew Short, Consultant Paediatrician, and Divisional Medical Director for Women s and Children s Services at Worcestershire Acute Hospitals NHS Trust Dr Chris Catchpole, Consultant Microbiologist and Divisional Medical Director for Clinical Support Services at Worcestershire Acute Hospitals NHS Trust Dr Marion Radcliffe, GP in Bromsgrove and Governing Body Member and Urgent Care Lead at NHS Redditch & Bromsgrove CCG Dr Julian Berlet, Consultant Anaesthetist and Divisional Medical Director, Theatre, Ambulatory, Critical Care and Outpatients (TACO) division at Worcestershire Acute Hospitals NHS Trust Dr Gary Ward (GW) thanked the Clinical Senate Council for the invitation to attend. Accompanying slides were available for further detail. He said that it had been an interesting process and the focus had been on designing robust, sustainable county-wide services that reflected the needs of the local population. GW advised that the working group had reviewed the processes in terms of what would be required. GW added, with specific regard to section two of the presentation, which was around Clinical Support Services, the support for the Emergency Department at the Redditch site had been assessed. The working group had been tasked with looking at how services would be reconfigured across the County and also how, if necessary, configure services to support what was required to be done on the Redditch site to obtain elements of services that were safe and sustainable and of high quality. GW noted that an initial discussion had been around the Pillars of Care i.e. the pillars of service which underpinned the Emergency Department (ED). GW stated that he felt the ED service was providing a very good quality service however that this had the potential to become unstable in the future due to changes in other specialty groups. GW added that the challenges around this with regard to the specialty groups were around manpower. GW noted that the working group had seen that removal of specialty services might create a tipping point and cause the ED to become unsustainable. GW said that the working group intention would be to test as a model whether or not the proposed changes would lead to that instability. GW added that the working group had tasked all the Divisional Heads with the query as to what the key changes would be that they would envisage within their services over five to seven years and how they saw that affecting the Redditch site. GW updated the Senate that it was clear within the model overall that what was required was a reconfigured service with a hub based at the Worcester site for complex, high risk work as this would be the best result for Patients in terms of their outcomes. GW said in terms of what needed to happen, that the first principle would be that complex, Ambulance-borne traffic which required detailed in-patient care, in certain of the specialties would need to be moved as a natural flow to the Worcester site as that would be where the Unconfirmed minutes version 0.1 Page 11

facilities would be. GW advised that the presentation gave a brief outline of each of the areas, which comprised: Women s and Children s services Paediatric Assessment Unit (PAU) General Surgery Trauma and Orthopaedics Acute Medicine Critical Care Primary Care Emergency Care Diagnostics DH thanked GW for the presentation. Lucy Noon (LN) noted that the presentation paper had been circulated to key stakeholders with opportunity for comments to be collated and to test the model and demonstrate sign-up. LN advised that this had gone out on the Monday or Tuesday previous to the Clinical Senate Council meeting, and that it was an open-ended process. DH asked if this working group was proposing interim changes to address an intermediate need, whilst the larger scale reconfiguration and cross-county interdependencies were worked up into a new model. The Worcester team responded that this was the formal model, which looked at the interdependencies, and was subject to any required finessing work. DH opened the debate for questions from Council members. Russell Smith (RS) advised that it was positive to see education and training details within the document, but added that there were training and education challenges within the Trust to be resolved and there was a need to ensure improved communication with Health Education England and Health Education West Midlands and to create better engagement. RS discussed the training and education challenges that the Trust might face and highlighted the challenges within the document with regard to the lack of trainee availability nationally. DH advised that in summary, there was some fine-tuning required and that the team appeared to have moved the model forward considerably in a challenging environment. He raised a query with the FoAHSW team with regard to their timescales. LN replied that their timeline would suggest that within 8 weeks, the FoAHSW team would be in a position for the Clinical Senate Panel to reconvene to review the new proposed model in more detail with the hope that NHS England assurance could be done in December 2015. LN added that Public Consultation could then be done in January 2016. DH agreed that the proposed Panel could consist of previous Panel members who had attended the Stage II review. KP said that his view was that 8 weeks was a suitable timeline, for the good of the patients and Unconfirmed minutes version 0.1 Page 12

the staff as there was a need to know the future of services. DH asked if the working group were being asked to consider if the Acute Trust was viable in configuration, and queried if other options were being considered within that Health Economy. KP responded that this was outside of the Senate terms of reference for this review and therefore it was not required for the FoAHSW group assembled to judge on fiscal deliverability. Carl Ellson (CE) added that the model proposed was based on Clinical input. Marion Radcliffe (MR) said that the focus of the group had been to hone the Emergency Care aspect of the model to overcome the concerns of the Senate s stage II review. MR advised that with regard to the aspect of Emergency Care, the view of the CCG was that the proposed model had not overcome the majority of concerns raised by the Senate and that there were developing concerns around this. LN added that with regard to finance, this had been taken forward by the FoAHSW Programme Board, and that there was no answer yet, and that this would be tested by the NHS Assurance Process but that this was outside of the scope of the process undertaken by the working group. DH said that the key theme from the Senate review was that there was a lack of Clinical buy-in and he enquired if an update on this could be provided, adding that he understood what GW had said on this topic but wished for further clarification. Andrew Short (AS) said that within Women s and Children s there was general understanding that services required change. AS said that clarity was needed in terms of what hours cover there would be in Emergency and what Paediatric support would be offered and added that generally there was agreement. He added that the document had been disseminated widely for further comment and said there was concern that there was a risk that events could overtake the Trust without a plan in place. He added that Clinicians from Medicine and Surgery had been involved. Julian Berlet (JB) said that there was a strong feeling within the Trust that the position was developing that there was a desire to continue with a plan in place. He said that there were going to be some small changes to the plan, and it would be subject to modifications, but that Clinicians generally were keen to progress and start to work in a County-wide way. He added that the majority of Consultants were on-side. KP said that there had been a focus on equity of voices heard to ensure awareness. MR advised that after distribution of the proposed model that week, that a letter had been received from the Physicians at the Alex Site (Alexandra Hospital, Redditch), and that they advised they did not support the model. Therefore MR noted it was not possible to say that the position was fully supported at this point. AKJ said that although the concern lay outside the scope of the Terms of Reference, AKJ would advise the team that the Independent Clinical Review Team had mentioned that the Trust would need to consider how the interdependencies, for example with University Hospitals Birmingham, were addressed before the next meeting between themselves and the Clinical Senate team. Unconfirmed minutes version 0.1 Page 13

KP replied that this was outside the Terms of Reference for this review. LN responded that they were working with the CSU and had already had an initial report which looked at journey times and length of journey. LN advised there had certainly been a lot of discussion with regards to looking at capacity and the impact on the other providers and the ambulance service and that the GP s had a strong view on where Patients would choose to go, for example. DH clarified with the sponsoring board that the Clinical Senate recognised that there would be further feedback and modifications and looked forward to receiving this from the FoAHSW team. DH advised that the Clinical Senate Council members recognised the challenges faced by the working group. DH agreed with LN that a follow up telephone call would be required post-meeting. DH thanked the FoAHSW team for their attendance and they left the meeting. DH said to the Clinical Senate Council members that, to pick up on a point earlier from Nick Harding (NH) he agreed that for the next phase of this review, although the Panel would remain the same as its previous incarnation, a Vice Chair would be beneficial. He asked the Council members for their thoughts on this. There was general agreement that a Vice Chair would be required. Michael Kuo (MK) said with regard to the information presented by FoAHSW on Paediatrics he would be concerned about the potential impact on Birmingham Children s Hospital. DH said that there was agreement that the status quo was not an option. Mark Pulford (MP) said that the Provider Trust had a responsibility to maintain Patient safety. MP queried whether if there were an issue with Patient safety, the Acute Trust might act independently of the review process to address that. DH responded that the Acute Trust could enact change independently of the Senate process to ensure Patient safety. There was general discussion regarding the proposed reconfiguration. Action Action: CSC 090915 / 5 (c) Future of Acute Hospital Services in Worcestershire - DH and Lucy Noon to undertake phone call w/c 14th September 2015 (d) Future Fit Programme Review Shropshire, Telford and Wrekin CCG s DH welcomed the Future Fit team to the meeting and thanked them for their attendance. DH confirmed that the purpose of their attendance was for the Future Fit team to present their request for formal stage II assurance on the model and to ascertain if the model was complete and ready to enter stage II assurance. The team representing the Future Fit Programme from Shropshire, Telford and Wrekin CCG s introduced themselves as follows: Unconfirmed minutes version 0.1 Page 14

Dr David Evans, Chief Officer, Telford and Wrekin CCG Dr Caron Morton, Accountable Officer, Shropshire CCG Sarah Bloomfield, Director of Nursing and Quality, The Shrewsbury and Telford Hospital NHS Trust David Frith, Programme Manager for Future Fit, Senior Programme Manager - Strategy Unit, Midlands and Lancashire CSU Dr David Evans (DE) began by introducing the presentation slides, see accompanying presentation for further detail. DE discussed the current configuration of services including an introduction to the geography of the region which included consideration of Patients in Wales. DE said that some consolidation of services had already occurred over the previous few years, particularly around Vascular services, Women s and Children s, Trauma and Emergency Surgery but that there was some duplication of services across the two sites which presented some workforce challenges. DE added that a key message from the public was that the reconfiguration should be clinically driven, and that change was needed to deliver improved outcomes. DE noted that there were significant areas of deprivation in some communities and not only in the urban populations. DE advised that a meeting was being held to decide the preferred option from the shortlist presented, and that this would be on Friday 11 th September 2015. DE said that there was an imperative in terms of timescale and highlighted that the Future Fit team required the process to be concluded by April the 5th, 2016 to avoid Welsh Purdah. Sarah Bloomfield (SB) ran through the figures with regard to the slide entitled Critical Workforce Challenges and discussed the benchmarking undertaken, compared to other West Midlands Trusts. SB added that a key message was the critical fragility of services. SB noted that there was a concern regarding workload and staffing in the Emergency Department, but advised that this was a national problem. SB said that with regard to Critical Care, the Trust had encountered a difficulty in recruiting Intensivists. SB informed the Senate that the staffing challenges were exacerbated by the rural nature of the region. SB noted that it was a time of population change with an increasing number of frail elderly Patients and deprivation in the younger population. SB gave the example of the reconfiguration of Stroke Services as an example of how consolidation of services had led to better outcomes for the Patient population. SB advised that the Case for Change was critical as the current situation was not sustainable and that services needed to be consolidated. SB advised that with the consolidation proposed by the reconfiguration, Seven Day Services would become more achievable and SB ran through the data with respect to this. Dr Caron Morton (CM) discussed the proposed Clinical model. CM said that this was codesigned between the Commissioners and the Patients based on the concepts of increased care at home, empowerment of Patients and increased sustainability of workforce whilst retaining services in the County. CM added that an increased use of new ways of working such as Telemedicine would ensure the model could work. CM discussed the proposed structure of the Urgent and Emergency Care model. CM said that it was a networked model along the lines of the new national guidance that had come out. CM Unconfirmed minutes version 0.1 Page 15

added that the Urgent Care Centres had been piloted across the two CCG s, one in Shrewsbury and one in Telford and they had been running for almost a year. CM noted that the rural Urgent Care work was under way. The proposal would be to have a single Emergency Care Centre and to ensure that what comes into that EC would be purely time critical. CM discussed the concept around complete access to Intermediate Care and Community Care to ensure that Patients could transfer from the Urgent Care Centre straight back into the Community and ensuring the Patient would not default back into an Acute bed. CM said that with regard to Planned Care, there was a focus on more Day Surgery, enhanced recovery and ensuring that In-Patient stays were as short as possible. CM discussed Long-Term Conditions and said the aim would be better utilisation of Community Hospitals and more Ambulatory care for Patients and CM added that pathways were already in place and being rolled out to trial the impact of this. CM said that a summary of what the model was would be as follows: Networked Urgent and Emergency Care Local Planned Care supporting the In-Patient Planned Care Networks so both sides could have an Urgent Care Centre in urban areas One Emergency Care Centre One Diagnostic and Treatment Centre Midwifery-led Unit unchanged with ongoing provision in the rural centres CM said that what was being proposed was consolidation of all Non-Elective activity to one site, having a single Emergency Care site and consolidation of all non-complex Elective procedures onto a single site. CM advised that the actual bed base would not shrink but that there was no growth in the proposed bed numbers instead increased Community provision would be utilised. CM went into further detail regarding the model, information which was also provided on the presentation slides for further reference. CM advised that this would not be verbatim from the Case for Change as any questions regarding the detail could be asked after the presentation. CM updated the Council that the Programme Board had done the initial shortlisting based on the financial options appraisal. CM discussed the financial assessments which were taking place and advised that the affordable options were the proposed models that were cost-neutral and that this did not include the no change option as this would accrue a financial deficit. CM discussed the individual proposed options as per the presentation in more detail. CM added that these would be the options presented to the non-financial review on Friday 11 th September 2015. DH noted that one of the option permutations contained a proposed separation of Women s and Paediatric Services. CM responded that there was concern from some local clinicians that not co-locating the Women s and the Children s with the Emergency Centre posed a potential risk. CM added that the Programme team had gone to the College of Emergency Medicine and the College of Unconfirmed minutes version 0.1 Page 16

Obstetrics and Gynaecology and that the feedback had been that the College and therefore the Programme Board also were awaiting the outcome of a National Maternity Review. DH and CM discussed the potential effects of consolidation of services with regard to the proposed bed situation and the numbers of beds involved. SB added that the proposed plans would ensure more conversions to Day Surgery. MP requested further information for clarification regarding the reference in the report to Orthopaedic services at the Orthopaedic hospital. CM confirmed that for Shropshire, around 87 percent of activity went to the Robert Jones and Agnes Hunt Orthopaedic Hospital NHS Foundation Trust (RJAH) and that the consultant base at Shrewsbury was drawn from this Trust. CM added that in Telford a smaller percentage of Patients went to RJAH but CM clarified that it had been decided there would be no reason to involve RJAH in the modelling activity. CM said that Patients from Shropshire & Telford only accounted for around 50 percent of the take at RJAH and that the rest was comprised of Welsh Patients and Patients from the rest of the country. MP asked if hospitals in Wrexham and Welshpool had been included as part of the consultation. CM responded that there had been communication with those units and that within Wales, especially close to the border, there had been a lot of minor injuries units closing and added that Wrexham struggled with capacity. CM noted that the Trust had seen a significant increase at the Shrewsbury site of diverts from Ambulance Trusts of Patients just on the border. DE advised that the natural flow from Powys was towards Shropshire with only a small proportion going to Wrexham and that there was no indication of change under the mapping done so far for the proposed model. DE confirmed that Powys Health Board were full partners in terms of the Programme Board and that Powys Community Health Council (CHC) sat on the Programme Board. Anthony Kelly (AK) asked whether, besides the process, any other barriers to change had been identified. CM replied that the regional politics presented an on-going challenge but that there was consensus around and support for the clinical model including from Powys Clinicians. DE added that the Programme Board had been clear about what could be best delivered as a clinical model under the circumstances. NH asked CM to clarify further regarding Clinical community engagement levels. CM responded that the Programme had been devised by Clinicians who had been involved in the discussions and the process and that these discussions had been open and transparent. CM added that the difficulty would be with regard to the two CCG boards, and the issue of regional preference on the matter of where the Emergency Centre would sit in either Telford or Shrewsbury. There was general discussion between the Council members and the board representatives on the levels of public and staff engagement. Unconfirmed minutes version 0.1 Page 17

There was further general discussion regarding the proposed separation of Women s and Paediatric Services with more specific reference to the rural nature of the Trust population. RS said that from a Health Education England (HEE) and Health Education West Midlands (HEWM) perspective there were still some queries to be addressed and that there was an offer from HEE to be more involved. The Future Fit team agreed that further communication would be required. DH summarised that the Future Fit team had advised that the results of the shortlist appraisal process would be known on Friday the 11 th September 2015, and that after this the Clinical Senate would need to know that on Friday afternoon there would be one agreed clinical model, and clarified that the Clinical Senate would only review one model. There was general discussion regarding the next steps for the Programme Board with regard to NHS England assurance. DH thanked the Future Fit team for their presentation and the Future Fit team left the meeting. Action Action: CSC 090915 / 5 (d) Future Fit Programme - FFP team to inform the Clinical Senate Office the outcome of their Programme Board meeting on 11.09.15 regarding the final clinical model 6 (f) Stroke Service Report Sandwell and West Birmingham CCG At this stage Nick Harding (NH) advised that he was happy for the Stroke report to be published by the Clinical Senate, and NH then left the meeting. Action Action: CSC 090915 / 6 (f) Sandwell and West Birmingham Stroke Services Report - Nick Harding agreed this report could now be published on the WMSCN and Senate website and be distributed to all Council members and appropriate stakeholders by email post meeting There was general discussion regarding the West Midlands Clinical Senate Terms of Reference with regard to the assurance process before Sarah Dugan (SD) entered the room. 5(e) Heart of England NHS FT Surgical Services -Birmingham Cross City CCG DH welcomed SD, who as Chair of the Independent Clinical Review Panel gave an update on the Heart of England NHS FT Surgical Services Stage II review. SD advised that she would quickly cover the issues so far, as it was still work in progress. SD said that in terms of process, the HEFT review had been underway for quite a long time in terms of discussion with the Senate, that it was postponed at one point because of a leadership change and lack of clarity at HEFT about moving forward. SD said that the Clinical Senate team had pulled together a very impressive, large panel given the timescales and added that the size of the panel was due to the Clinical Senate review being asked to look at five specialties. SD added that Brendan Young who was present at the Senate Unconfirmed minutes version 0.1 Page 18