Clinical control

Clinicians know there’s practically no such thing as a patient with one single condition requiring treatment by one single clinical speciality or team. To provide the best possible outcomes for patients, multi-disciplinary collaboration is a must at all levels of the health service.

It is not surprising then, that the NHS Future Forum found universal support for multi-professional clinical leadership in the new NHS structure. This will become a reality from April 2013, when clinical senates are established in England.
The senates are drawn from a range of health and social care professionals and patient groups. Their mandate is to offer evidence on the needs and wishes of patients across a geographical area, creating collaborative relationships between professionals, their organisations and patients.

These senates will provide a strategic overview and multi-professional clinical leadership: supporting large-scale reconfiguration by identifying the complex clinical issues likely to arise and advising on how to mitigate those challenges. They will also work across the health service to spot areas for improvement and analysis, and will be able to advise when there is local disagreement on clinical strategies and pathways.

There will be 12 clinical senates, each covering a geographic area. A core steering group of clinicians from primary, secondary and tertiary care, along with patients, social care and public health representatives, and members of the NHS Commissioning Board’s (NHS CB) local area teams (LATs), will develop a broader forum of clinicians who are specialists in every aspect of the NHS spectrum from birth to death. They will be available to give expert advice and support for achieving better outcomes for patients.

Each core group will be chaired by an experienced senior clinician with a proven strategic track record. There will be a robust appointment process led by the NHS CB’s regional medical and nursing directors, with essential input from a nominated local clinical commissioning group (CCG) leader.

Each clinical senate will be supported by a clinical network support team, housed in the one of the LAT offices, and funded by the NHS CB. These support teams will also help the strategic clinical networks that share the same geographical areas as the clinical senates by providing project and programme management support, quality assurance, and helping them access appropriate support and expertise for both networks and senates.

The clinical chair and a senior manager from the support team will sit on the senate’s core group, helping to coordinate strategic efforts to improve quality within the local area. The manager will be responsible for running the activities of the senate.

As advisory bodies, clinical senates’ relationships with CCGs, health and wellbeing boards, the NHS CB and Public Health England, will be vital to their success.

Clinical networks, formed around particular illnesses or conditions, will also be important partners for the senates, providing their expertise to support local insights. Close working with health and research networks and health observatories, will also be critical.

Their non-statutory status means they will offer advice when requested by statutory organisations, such as the CCGs and the NHS CB. We expect commissioners and others to listen to clinical senates as they recognise the need for strategic and clinical expertise, not because they need to tick a box. The senates will need to build their influence and credibility through the strength of their membership and track record of useful, timely advice and insight.

Clinical senates should be set up to respond to the needs of their local health economies, so their roles, sizes and activities will vary across the country. The senates should serve the local infrastructure, not the other way around.