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Exclusive: Clinical senates have only made three recommendations

Only three formal recommendations have been made by clinical senates since their formation, and only two of these have related to clinical matters HSJ has learned.

Twelve of the organisations were set up in April last year under the government’s Health Act reforms, with the intention they would use clinical expertise to advise commissioners on service change.

However, by the end of the year, two had not met at all, three had met only once, and three met twice. Two clinical senates had met three times by the end of 2013.

The senates for London and London and West Midlands met on four occasions.

NHS England’s national lead for clinical senates David Levy said in these two areas there were “senate-like structures” in place before these were introduced meaning “it was possible to move to a formal senate structure more quickly”.

No meetings have been held in public.

Dr Levy said clinical senates were “an important part of the new health landscape”. He added: “However, in much of the country they are new and novel structures and it has taken time to engage the new bodies.”

NHS England said running senates and strategic clinical networks, which they are linked with, cost more than £42.6m in 2013.

Information released to HSJ shows senates have made only three recommendations so far, and one related to administrative issues.

In one of them, West Midlands clinical senate made a recommendation about acute hospitals in Worcestershire in January. It advocated creating a “networked emergency centre” at the Alexandra Hospital and a “major emergency centre” at Worcestershire Royal Hospital.

Wessex Clinical Senate last year reviewed specialised vascular services in Hampshire, recommending the centralisation of surgery in Southampton.

No formal recommendations have been made in London, but the clinical senate is currently reviewing proposals for specialist cancer and cardiovascular services in north and east London and west Essex.

Labour peer and former health minister Lord Hunt said he was “very disappointed” with the lack of progress so far.

He said in Parliamentary debates over the Health Bill, which led to the introduction of senates, “the presumption was they would play a key role in overseeing the configuration of services” and would be a “counterbalance to the introduction of a more marketised [service]”.

Lord Hunt said it was “extraordinary” no clinical senates met in public as “these are public bodies… the people who serve on them are public servants”.

Academy of Medical Royal Colleges chair Terence Stephenson said senates were needed as the “regional geographical tier [between] the national body NHS England and CCGs”, but that “no one’s clear what they’re doing or the added value they provide”. He said: “I’m someone who lives and breathes this stuff and I’m not sure.”

The academy has discussed with NHS England the possibility of it co-ordinating clinical advice nationally for around £1m per year, but this has not yet been agreed.

Readers' comments (13)

  • Clinical Senates are a waste of time , energy and a disgraceful waste of public money . The phrase 'stop flogging a dead horse' comes to mind.

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  • Senates, like so many of the new structures, are embryonic organisations with limited capacity, authority and resources. Apparently they are also supposed to take over from NCAT on major service re configurations. Good luck with that. What a mess we are in.

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  • Judith, can you please tell us :
    1) who is the chair and the members of the London Clinical Senate,
    2)where they meet and
    3)how often.

    Such basic facts were also missing from your 5th March article on the same topic, and I am wondering if senates actually do physically exist, or they are just virtual - a bit like the Bitcoin

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  • Hello Kosta. It's the same person who replies to a lot of your posts on here. Your leads are all listed here
    Good luck.
    They do exist, but only in the sense of portions of people's time. I believe the wonderful expression for this is disseminated leadership.....

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  • Hi Kosta,

    The council members for the London clinical senate are as follows:

    Dr Jane Collins (Chair), Marie Curie Cancer Care
    Caroline Alexander, NHS England (London Region)
    Dr Junaid Bajwa, Greenwich CCG
    Trevor Begg, Patient
    Dr Adrian Bull, Imperial College Health Partners
    Professor Jacqueline Dunkley-Bent, Imperial College Healthcare NHS Trust
    Professor Chris Fowler, Health Education North Central and North East London
    Dr Howard Freeman, Merton CCG
    Dr Mike Gill, Barts Health NHS Trust
    Dr Diana Hamilton-Fairley, Guy’s and St Thomas’ NHS Foundation Trust and Health Education South London
    Professor Chris Harrison, Imperial College Healthcare NHS Trust
    Professor Ann Jacklin, UCL Centre for Medicines Safety & Service Quality and ICL Centre for Infection Prevention & Management
    Dr Jagan John, Barking and Dagenham CCG
    Cathy Kerr, London Borough of Richmond upon Thames
    Wendy Matthews, Barking, Havering and Redbridge University Hospitals NHS Trust
    Andy Mattin, Central and North West London NHS Foundation Trust
    Dr Catherine Millington-Sanders, Richmond CCG
    Dr Andy Mitchell, NHS England (London Region)
    Nicola Kingston, Patient
    Mr Jonathan Ramsay, Imperial College Healthcare NHS Trust
    Dr Mike Robinson, Croydon Council/Croydon CCG
    Bronagh Scott, Whittington Health NHS Trust
    Professor Alan Simpson, School of Health Sciences, City University
    Dr Sylvia Tang, Camden and Islington NHS Foundation Trust

    We gathered this information in research for an earlier story on this subject:

    We don’t have the location for the clinical senate meetings, but as this article states the London clinical senate met on four occasions in 2013.



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  • Another failed experiment...hopefully they will be abolished in the next reorganisation.

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  • The Leeds experience is very different from what has been described. The Leeds Medical Senate has been working together for over two years on how to lead in a system as peers. They have recently established a new Institute for Quality Healthcare in the city, supported by the University of Leeds through the Centre for Innovation in Health Management (CIHM) focusing on improvement in quality care, by enabling clinicians to develop shared expertise in innovation and improvement; and by having a rigorous approach to professional accountability through reviewing variation and decision-making, supported by systematic use of data. This focus will create a culture of continuously providing best quality clinical care at the best value with patients/ service users across Leeds. More about this can be found on our web site

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  • Anon 1.56 What you actually meant was the next reorganisation will probably occur round about the time senates have worked out what their role is.

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  • yet another 'stakeholder' to chip there pennyworth in to prevent sensible restructuring happening.

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  • Insideperspective

    and your definition of "sensible" is? One that you think is right and anybody who disgrees is just "another stakeholder" who wants to "chip their pennyworth in"? Like patients, doctors, nurses, the local authority in fact anybody who has to work in, receive services from or pick up the pieces after your "sensible restructuring"?

    You could try engaging in discussion with people on the basis that your idea is so good that they will be pursuaded and you could listen and adapt your ideas so that they also have a reasonable benefit from what you propose.

    And maybe you have been an insider too long and need to get out a bit more.

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  • The setting up of clinical senates proved how the NHS is being reorganised in a chaotic, reactive manner ; in my area it was given a very low priority by all organisations other than the old SHA because it's remit was confused, poorly thought out and it's authority and lines of accountability were even more vague. The manner that the government/DOH (led by the discredited Dave Nicholson) went about reorganising the NHS is akin to someone randomly taking pieces from several different jigsaws and then trying to put them together in the expectation that they'd fit perfectly and create a clear, understandable new picture. The sooner clinical senates wither away on the vine and consign themselves to history the better.

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  • What has not been mentioned here is that NHS England neglected to provide enough funding for Clinical Senates to operate in any capacity for the second half of the last financial year. Who knows where the reported £40million has gone?

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  • Thank you very much Judith.
    Looking at the list, I wonder if
    1) the London Senate is a true reflection of London NHS with at least 40% of its workforce being from minorities
    2) the commissioners are proportionally represented, and
    3) NHS selection regulations were followed.

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