Sussex CCGs Collaborative request to CSSEC

1. Sussex CCGs Collaborative request to CSSEC What are the clinically necessary …. a) co-locations (i.e. on the same site) and b) co-dependencies (which could be provided on a networked basis) for hospital-based services?

2. Proposed phases of work • Phase 1 • Undertake a literature review of current recommendations on co-dependencies for the services under consideration (ensuring stroke and it’s co-dependencies are completed fully) • Phase 2 • Clinical Senate to provide a clinical overview and sense-check of this evidence, and produce a report for the Sussex CCGs

3. Questions/task for Council • Agree scope of work • Review, comment then agreement of a project plan • Input potential sources of information • Consider participants for CSSEC Summit

4. Potential scope of review (to be agreed): • Scope 1: Urgent and emergency services in Emergency and Specialist (Major) Emergency Centres • Scope 2: Scope 1 + elective hospital-based surgical, medical, specialist and diagnostic services

5. Scope 1: Urgent and emergency services • General services: • Emergency department (A&E) • Acute medical and surgical (defined range) • Critical care • Urgent paediatrics • Diagnostics • Specialist services • Stroke • STEMI/NSTEMI pathways • Vascular • Major trauma • Cardiac surgery and neurosurgery • Critical clinical support services (e.g. anaesthetics, imaging, interventional radiology, urgent endoscopy, essential pathology services) • Ambulance service and transport issues

6. Scope 2: Scope 1 + elective hospital-based surgical, medical, specialist and diagnostic services • Elective surgery (full range of specialties) • General, orthopaedic, vascular, ENT, urology, oral, max-fax, gynaecology, neurosurgery, plastic • Chronic medical disease hospital services (primarily outpatient and diagnostic): • dermatology, rheumatology, respiratory, gastroenterology, renal, cardiology, neurology, HIV • Maternity • Paediatrics • Cancer services (including chemotherapy, radiotherapy) • Routine pathology and imaging and other diagnostic services

7. Background to future hospital-based care • Centralise care where necessary, localise where possible • Consistent high quality care and outcomes for urgent care (Everyone Counts) • Reconfiguration of hospitals (Keogh Review) • Emergency Centres • Specialist (Major) Emergency Centres • Workforce drivers • Rotas • 24/7 working • Efficient use of resources

8. Care in hospital (Keogh UECR Nov 2013)

9. Emergency Centres(NCD for Urgent Care, May/June 2014) • Receive all patients • Include an Emergency Department and inpatient beds • Open 24/7, 365 days a year • 24 hour access to blood products • 24 hour access to radiology (including CT and pathology) • 24 hour access to specialist support through the network • Transfer and retrieval protocols

10. Major (Specialist)Emergency Centres (NCD for Urgent Care, May 2014) • Extended ED and inpatient facilities, including a grouping of specialist services, current examples of which include: • Major trauma management including neurosciences, plastic surgery, burns • Primary percutaneous angiography for ST-elevation myocardial infarction; • Stroke thrombolysis • Emergency vascular surgery • Specialist paediatric facilities • Level 3 critical care • Interventional radiology

12. Work of other clinical senates in this field • Healthy Liverpool Programme - focus is initially on Trauma / SECs / ECs / Urgent and emergency care but also includes women's services and cancer . • South West – networked approach to non-elective surgery • Wessex – vascular surgery; maternity services • London-wide review

13. London Health Programmes

14. Related SEC work within the SCNs • Surrey – The CVD SCN has commenced the process of identifying critical co dependencies for acute cardiovascular services • Stroke • Cardiology • Vascular • Sussex – CVD SCN is working with the CCG Collaborative on Stroke • Other ?

15. Proposed Project methodology (for discussion) • Agree Terms of Reference • Agree task and finish steering group composition and chair (a small group of 2/3 Council/Assembly members plus support team, working predominantly virtually) • Commission review of the literature (evidence, recommendations, previous reviews) • Triangulate and synthesise evidence • Convene Clinical Senate Summit, drawing from Assembly membership, to review findings and draw conclusions • Produce draft report • CSSEC Council to review, amend and approve • Submit to Sussex CCGs

16. Proposed Project methodologyTimescales • July – mid August - Commission review of the literature (evidence, recommendations, previous reviews) • Mid August – Early September -Triangulate and synthesise evidence • Mid September (week commencing 8.09.14) -Convene Clinical Senate Summit • Week commencing 22.09.14 – Draft Report to Sussex CCG Collaborative

17. Public and Patient Involvement(for discussion) • Attendance and input at the Summit • CSSEC Council membership • Other?

18. Questions/task for Council • Agree scope of work • Review, comment then agreement of a project plan • Input potential sources of information • Consider participants for CSSEC Summit