Regional Service Reviews

Governance and region-wide service reviews

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This chapter makes a number of key strategic statements about the implementation of Healthy Ambitions and the ways in which we will approach, and make decisions about, the small number of issues (identified by clinicians) as needing to be determined at the regional level. These statements are in addition to the key principles which govern our approach to implementation and which are set out in the previous chapter.

We are committed to ensuring a sustainable future for each of our existing tertiary centres. Working in partnership with clinicians and local organisations we will work progressively to define clear quality standards and service models for the small number of services being reviewed at regional level e.g. vascular services.

These standards will be based on the best available clinical evidence and will be wholly directed at securing the best possible outcomes for patients across Y&H.

Services will only be commissioned from providers able to meet these quality standards.

Whilst these sorts of providers are likely to be specialist and therefore few in number, we will not be specifying the numbers of units who can deliver these key services such as hyper acute stroke care and major trauma.

The conduct of these regional reviews will be clear and transparent – following the arrangements set out in the governance chapter. It will be clear how anyone with an interest can feed into these reviews.

The Strategic Commissioning Board – made up of the SHA CE and PCT CEs (with senior clinical and local authority input) will oversee these reviews and keep track of the delivery of Healthy Ambitions across Y&H.

This group will also consider the cumulative impact of any reviews or proposed changes with a view to ensuring the sustainability of key services across the region.

Our regular updates about the delivery of Healthy Ambitions will outline the work of the Strategic Commissioning Board and its recommendations.

Specialised Commissioning

SCG and Healthy Ambitions

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Specialised commissioning in Y&H is the responsibility of the Specialised Commissioning Group (SCG). The SCG undertakes the following functions in relation to specialised services:

  • Planning of services to meet the needs of the population
  • Service reviews
  • Managing the introduction of new services, drugs and technologie
  • Designating service providers
  • Developing commissioning policy
  • Negotiating, agreeing and monitoring contracts for specialised services with the relevant providers.

The Specialised Commissioning Group (SCG) has been identified as the lead for a number of workstreams in delivering Health Ambitions including:

  • Commissioning additional morbid obesity surgery services
  • A review of Tier 4 child and adolescent ntal health services
  • Reviewing a range of services involving high volume or complex treatments including:
    • Upper gastro-intestinal surgery services
    • Interventional radiology
    • Vascular services

The reviews will be progressed working closely with all clinical and non-clinical stakeholders. The initiation, conduct and outcome of these reviews will be reported to the Strategic Commissioning Board (as described in the chapter on governance) for the cumulative impact to be considered and next steps agreed. They will also be reported to the SCG Board.

Where the outcome of the review work may lead to the possible reconfiguration of services the Strategic Commissioning Board and SCG Board will be involved at all the key decision making points to ensure full commissioner and provider engagement and ownership of the proposed way forward.

What are Specialised Services?

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Specialised services are those services provided in relatively few specialist centres to catchment populations of more than one million population. These services are not provided by every hospital and tend to be found in larger hospitals based in big towns and cities.

There is a national list of specialised services. The list and the definition of each service are currently being updated.

It is estimated that specialised services account for about 10% of total PCT expenditure on hospital services.

The wider work of the SCG will also be reported to the Strategic Commissiong Board to make sure that there is an overview of service developments and an understanding of the impact across the region.

How does the SCG work?

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The SCG is established as a joint sub-committee of each of the 14 PCT Boards.

The accountability and responsibilities are clearly set out in an Establishment Agreement which has been formally adopted by all the PCT Boards.

The SCG Board meets on a monthly basis. Each PCT is a member of the SCG through their Chief Executive or a named deputy. Each member has a mandate to: commit resources; decide commissioning policy; and agree action plans. Decisions taken by the SCG are binding on all 14 PCTs. The minutes of the SCG meetings go to the public session of PCT board meetings. Key aspects of the SCG accountability arrangements include the production of an annual work programme and the publication of an annual report.

The work of the SCG is delivered by a multi-disciplinary specialised commissioning team, including finance, information, public health and commissioning staff.

The SCG arrangements are hosted by NHS Barnsley and the Chair of the SCG is the Chief Executive of NHS Barnsley.

Links with clinical networks

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There is an important relationship between specialised commissioning and a range of formal clinical networks – in particular: the cancer networks; the cardiac networks; the renal networks; and the children’s networks. Key aspects of the commissioning process are delivered via the relevant clinical networks. The role and function of the clinical networks enables: strong clinical engagement; the development and delivery of co-ordinated patient care pathways across all health care settings; the development of services to meet the required standards, consistently across the network area; and a collaborative approach to achieving reductions in health inequalities. Most of the networks also have regular and systematic ways of securing patient and public engagement.

Meeting service standards

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SCGs have been established to “drive up the quality of specialised services and prevent wasteful or even unsafe duplication of services” (NHS in England: the Operating Framework for 2008-09). One of the ways in which the SCG will discharge this duty is to designate specialised services in their SCG area.

Designation is a formal process of checking that specialised services providers: meet quality and other standards; deliver services which are safe and effective; deliver the best possible outcomes for patients and achieve good ‘value for money’ for commissioners.

Some highly specialised services will be designated at national level. The majority will be designated by individual SCGs applying a common set of standards agreed at a national level to ensure a consistent approach. Again updates on these issues will also be made to the Strategic Commissioning Board.