Download - Clinical Senates & Networks The Big Picture
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Clinical Senates & Networks
The Big Picture
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The Three R’s• Rationing
• Revalidation
• Reconfiguration
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NIMROD
NotIncludingMy RelativesOrDependents
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Clinical engagement is critical to getting more for less
Chairs of the Clinical Innovation Teams and Network Leads meet monthly
Since 2008 over 1000 North East cliniciansHave helped develop ourprogramme of activity
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We can network
Examples: Bill Cunliffe –Planned CareLiz Kendrick- End of Life Care
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Having the Choice to Die at Home
Fast Focus Session
End of LifeClinical Innovation Team
Design Document for Discussion
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Most people would prefer to die at home. Most die in hospital
GP Palliative care registersLiverpool care pathwayCare homes and advanced care planning“would you be surprised?”24/7 community supportEarly engagement with 111
initiatives
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Standard care for colon and rectal surgery ……
• Two day bowel prep, in hospital
• Nasogastric tube until passing flatus
• NBM until passing flatus
• Compression stockings, no heparin
Why did we do this?
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Our reasoning was flawed !
Enhanced Recovery
ERP planning clinic
Preadmission CHO load
Gut friendly anaesthetic
Eat,drink and move day 1
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Elective 1 year Open Resections Laparoscopic
Resections
Pre-ERP(n=21)
Post-ERP(n=20)
Pre-ERP(n=43)
Post-ERP(n=45)
Mean age 73.3 years 69.9 years 67.8 years 66.1 years
Mean post-op stay
12.6 days(4-37)
10.5 days(3-48)
8.0 days(1-45)
4.9 days(1-17)
Median post-op stay 10 days 6.5 days 4 days 4 days
Readmission 9.5% 15% 19% 16%
ACPGBI 2009
Laparoscopy Enhanced Recovery Prog.
2008 3.5 colorectal surgeons 12 months 129 patients
Courtesy Mr Mark Katory, colorectal surgeon
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‘The Clinical Network’Should we integrate clinical networks?
What IS a network?What would the governance look like?
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not all problems will respond to NHS Improvement
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Clinical Senates
How many?How do they interface with networks,
CCGs,HWBs, LA’s and F Ts
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In the land of the blind,The one eyed man is king
Clinical Senates & Networks
The Big Picture