1. Specialised Services Specifications Compliance Programme For Senate BNSSSG Area Team November 2013

2. 1. Validation process 120 National Specifications were published in July Trust self-assessment process Outcomes: Compliant – Derogate until compliant - Exit Checked by team and SCN’s, Triangulated with quality feedback (QSG etc.) CCGs asked to support engagement and validation, 2

3. 2a. Emerging findings - Providers 3 Independent & Mental Health providers mainly compliant There is a need for stronger definition and specification of shared care arrangements – need to focus on the spokes Anxieties over the cumulative effect on DGHs of services being centralised

4. Children's services key across the SW Cardiac, numbers of cases and 24/7 coverage Emergency Vascular Cancer, common theme multiple providers within one pathway - who is responsible? Spinal surgery Severe Asthma emerging as a theme Many where there seem to be a lot of providers – is this desirable? A more complete briefing is attached 4 2b. Emerging findings - Services

5. 5 4c. Emerging findings - CCGs Children's services - all Cancer services - all Neurorehabilition - all Cluster of Cardiac provision concerns for BGSW area DC&IoS, Cancer services being a theme Less issues for BNSSSG area as closer proximity to largest specialist providers, but service may move between UHB and NBT &common themes will apply Numbers of cases / population bases being a theme that could effect local provision

6. Provider impact, will this tip the balance? The role of hub and spoke to retain centre quality care locally – commissioned through the hub. Impact on population basis, such as Cornwall and Isles of Scilly and Wiltshire. Logistics of derogation, how to make it meaningful Strategic consideration for a number of services required, may not be short term resolutions – need clinical leadership How we demonstrate to the populations this is about improving the quality of services provided to them 6 6. Considerations & Implications for today

7. 7. Conclusion and next steps 7 So There will need to be changes and decisions regarding how to manage the elements presented here Hence the question to the Senate