Northern England Clinical Senate

Senate Advice & Decisions

On this page are the topic decisions and other published documents produced by the Senate for advice and information.

Case Study 1 – Together for a Healthier Future West, North and East Cumbria Review – parts 1, 2 and 3

The Northern England Clinical Senate were requested by Cumbria CCG to provide independent clinical assurance and advice to their Together for A Healthier Future programme.

Phase 1 of this work was to give assurance on the pathways for high risk cardiac cases including high risk cardiac cases including transfer for urgent or emergency percutaneous intervention (PCI), acute stroke, management of acute gastro intestinal bleeds and emergency high risk acute medicine providing external challenge and checks in the system to ensure that proposals that are developed are clinically robust.

For Phase 2 of the work the Northern England Clinical Senate were asked to help the development of a second set of high risk clinical pathways in North Cumbria University Hospitals NHS Trust (NCUHT).  The senate was asked to give assurance on the pathways for acute stroke, transfer of deteriorating patients and paediatrics providing external challenge and checks in the system to ensure that the proposals that are developed are clinically robust.

By phase 3 of the work, the Together for a Healthier Future programme had become part of the West, North and East Cumbria Success Regime. The Success Regime asked for the Northern England Clinical Senate to provide constructive challenge and support to the consultant team in producing a consensus on proposals for medical staffing and supporting arrangements between Cumberland Infirmary, Carlisle (CIC) and West Cumberland Hospital.  The focus of the work was on the acute adult medical pathways and associated services and to review proposals for keeping patients in appropriate settings outside hospital based pathways.

Completed November 2014, July 2015 and January 2016
Phase 1 report can be found here
Phase 2 report can be found here
Phase 3 report can be found here

 

Case Study 2 – Paediatric Model of Care at Northumbria Specialist Emergency Care Hospital

In Summer 2014 the Clinical Senate was asked by Northumberland CCG and North Tyneside CCG to comment on a change to the service model already consulted on for the delivery of paediatric care that can provide rapid assessment, short stay assessment and where observation, investigation and treatment can safely be carried out in a child focussed environment at the new Northumbria Specialist Emergency Care Hospital (NSECH) that was due to open in July 2015.This advice was used by the CCGs as part the NHS England assurance process for service change.

Completed December 2014
A copy of the report can be found here

 

Case Study 3 – Greater Manchester: Healthier Together post-consultation review

The Northern England Clinical Senate led a pan-North of England clinical senate (of which there are four) assessment of the Healthier Together programme proposals for new models of care across Greater Manchester. This clinical review provided independent clinical advice to the CCGs of Greater Manchester’s Committees in Common to support decision making and made recommendations for consideration in implementation.

Completed June 2015
A copy of the Report can be found here

 

Case Study 4 – Durham Dales Paramedic Skill Mix Review

In December 2014, the Northern Clinical Senate received a formal referral from the Durham Dales, Easington and Sedgefield Clinical Commissioning Group to provide an independent clinical assessment of proposed changes to the paramedic staffing of ambulance in the rural Durham Dales. Ambulances covering the Durham Dales were staffed by two paramedics and the CCG were looking for an independent expert view to inform future commissioning decisions on a change proposed by the North East Ambulance Service to a different skill-mix of one paramedic and an Emergency Care Assistant.

 Completed June 2015
A copy of the report can be found here

 

Case Study 5 – Deciding Together: Mental Health Inpatient and Older Peoples Services across Newcastle and Gateshead 

Newcastle-Gateshead CCG had developed a range of clinical scenarios for mental health service configuration as part of their Deciding Together programme. These clinical scenarios formed the basis of a formal statutory 12 week public consultation process and the CCG approached the Northern England Clinical Senate to ask for an independent review of these clinical scenarios to help provide assurance to their programme board and governing body as they progress towards final decision-making.

Completed May 2016 
A copy of the Report can be found here

 

Case Study 6 – Independent Review of Hartlepool Assisted Reproduction Unit

Hartlepool and Stockton-on-Tees CCG sought Northern England Clinical Senate support in undertaking an independent review of the reasons behind the announced closure of the Hartlepool Assisted Reproduction Unit (part of North Tees and Hartlepool NHS Foundation Trust). The Unit was closed at short notice, the local authority had secured a High Court Injunction to force the re-opening of the ARU until a review of potential future options (informed by the findings of the Clinical Senate), and a full public consultation had taken place.

Completed June 2016
A copy of the Report can be found here

 

Case Study 7 – North Tyneside CCG Urgent Care Review

North Tyneside CCG were asked by NHS England to seek additional clinical support from the Northern England Clinical Senate to develop their clinical model for Urgent Care following the formal Stage 2 Assurance Review of the CCGs initial proposals which found that further work needed to be undertaken before any new model could be implemented. The Northern England Clinical Senate identified a panel of clinical experts whose advice and comments helped strengthen the proposals to meet the NHS England assurance requirements.

Completed June 2016
A copy of the report can be found here.

 

Case Study 8 – Review of Services Provided by Liverpool Women’s NHS Foundation Trust

Liverpool Clinical Commissioning Group had produced a Pre-Consultation Business Case (PCBC) setting out the options appraisal process and the resultant short list of reconfiguration options for public consultation following their  review of Services Provided by Liverpool Women’s NHS Foundation Trust.

The rationale for considering how and where services are provided, and in particular the co-dependencies between services, was to ensure the long term viability of the provision of women’s and neonatal services in Liverpool. This service review was focused primarily on assessing whether the ongoing provision of these services is best undertaken at the current LWH Crown Street site or whether another site or multiple sites in Liverpool might be better placed to provide these services in the future.

To avoid conflicts of interest, Liverpool CCG made a referral to the Northern England Clinical Senate to provide independent clinical assurance to inform the decision-making process.

The Northern England Clinical Senate were asked to ascertain (using the clinical evidence base and clinical standards described in the PCBC work to date) whether  the clinical case for change, option appraisal development  and proposals for consultation offer the best clinical options for sustainable, high quality and optimal patient experience for future Liverpool Women’s services.

The main objectives of the Clinical Review were to:

  • Assess the validity of the case for change and the service change proposals.
  • Comment on the clinical appropriateness and sustainability (or not) of all four options in the PCBC.
  • Consider whether the preferred option was aligned with the strategic intent and policy direction of women’s services nationally and also sufficiently takes into account potential changes being planned in women and children’s services in and around Liverpool (given that LWH serves a wider population including Cheshire and Merseyside).
  • Comment on the sustainability and clinical risk of the ‘workarounds’ that were in place at the time (as referenced in the PCBC).

Completed June 2017
A copy of the Report can be found  here

 

Case Study 9 – Hambleton, Richmondshire and Whitby CCG Transforming Mental Health

The Northern England Clinical Senate and the Yorkshire and Humber Clinical Senate were asked to jointly review documentation prepared by Hambleton, Richmondshire and Whitby CCG Transforming Mental Health Programme to support he NHS England service change assurance process ahead of formal public consultation. The desktop review of the documentation focused on four main areas:

  • Is the proposed clinical model clear in the documentation and is it based on the most appropriate evidence base?
  • Have the clinical interdependencies with other services been appropriately considered (and if not what areas may require extra work)?
  • Do the proposals present any potential clinical risks to patients and where they are known, are appropriate mitigations identified?
  • Based on the information provided, are any further details of any aspects of the proposal required in order to be assured that the model is safe and deliverable prior to the beginning of public consultation?

Following the conclusion of the public consultation process, the Clinical Senates reviewed additional documentation submitted by the CCG that addressed issues raised in the initial documentation review.

Completed April 2017 and October 2017
 The initial documentation report can be found here
and the post-consultation follow-up letter found here

 

Case Study 10 – Sunderland and South Tyneside Path to Excellence – Urgent and Emergency Paediatrics

Sunderland CCG and South Tyneside CCG requested an independent clinical review of the safety, efficacy and robustness of two proposed paediatric service configurations which form part of a series of acute change proposals being put forward as part of the Path to Excellence transformation programme across South Tyneside Hospital NHS Foundation Trust and City Hospitals Sunderland NHS Foundation Trust. The review took place post-consultation, but prior to decision-making and implementation of a preferred option, to encompass the review of any further suggested models that may be suggested during public consultation. A view from the senate was requested on the following:

  • The likelihood of the models to deliver safe, high quality services and the best possible clinical outcomes
  • The extent to which they are likely to address current service challenges
  • Due consideration of and alignment with the contemporary clinical evidence base
  • Appropriate consideration of service interdependencies, risk and mitigation

The Clinical Senate review was part of the documentation used by the CCGs in the decision-making meeting-in-common and to support the NHS England service change assurance process.

Completed January 2018
A copy of the report can be found here