1. Clinical Assurance Structure Guide for Clinicians and Commissioners

2. Transition to a National Specialised Commissioning Team During July 2011 the NHS Management Board confirmed that there would be four SHA clusters established across England. These will form the sub-national arrangements of the NHS Commissioning Board (NHSCB) when it is formally established in April 2013. The NHSCB will deliver specialised commissioning functions through a single operating model and a national leadership team will be formed, with teams based in the four geographic sectors; these teams will undertake the co-ordination of key functions. The previous 10 SCGs have clustered in line with SHA geography with a work programme to merge and work as a single team by the start of Q3 2012/13.

3. The Specialised Commissioning Transition Oversight Group This group is established to: put in place oversight arrangements to allow for clear recommendations to be made to the NHS Commissioning regarding the form and function of ‘specialised service’ commissioning. This group is chaired by Moira Dumma, SHA Lead Midlands & East, and membership includes: Chairs of the cluster SCGs (4) Cluster SHA leads for specialised commissioning (4) National transition team (6) Chair of the Transition Directors Group Chairs of 3 Assurance Groups

4. The Transition Oversight Group Subcommittees Transition Oversight Group Chair: Moira Dumma Clinical Assurance Group Chair: James Palmer Finance Assurance Group Chair: Vanessa Harris PPE Steering Group Chair: Sally Brearly Note: In Phase I of specialised services transition a group was formed called ‘CAG’ – the clinical advisory group. This group had a specific remit about advising the DH on the scope of services that should be directly commissioned. Currently stood down this group will be reformed as part of the Group 3 work (see later)

5. The Clinical Assurance Group Reporting to the Transition Oversight Group, this assurance group is being established as part of the project framework to deliver change in specialised commissioning. The group will seek to provide assurance that the products (see later) of commissioning have clinical support from as broad a range of sectors and services as possible. The Chair is James Palmer, Transition Programme Lead for Quality & Innovation and also currently Medical Director for SW SCG, and a Consultant Neurosurgeon at Plymouth Hospitals NHS Trust. Membership of the group includes a Clinical Lead from each of the cluster SCGs, Public Health Leads from the cluster SCGs, and Five Care Group Chairs formed from the constituent Clinical Reference Group chairs (see later). Monthly meetings will be in person every other month and by web conference the other month.

6. The Products of Specialised Commissioning The products of commissioning include: national service specifications treatment approval policies quality measures innovation portfolios.

7. Programmes of Care Clinical Assurance Group Digestion, renal and hepatobiliary and circulatory system Infection, cancer, immunity and haematology Secure and specialised mental health Traumatic injury, orthopaedics, head and neck and rehabilitation Women and children’s health, congenital and inherited diseases Five Programmes of Care will be formed under the Clinical Assurance Group. A single chair for each Programme of Care will be selected from the Chairs of the constituent service specific clinical reference groups.

8. Clinical Reference Groups Transition Oversight Group Clinical Assurance Group Programmes of Care Clinical Reference Group Working below the Programmes of Care and hence the Clinical Assurance Group will be a number of National Clinical Reference Groups. These will be established for each of the specialised services within the SSNDS portfolio. These groups will have the same terms of reference to identify the scope of the work focussed on securing high quality ‘products’ of commissioning. These groups do not have an operational role in delivery of services but may be asked to provide expert advice to the cluster SCG teams. The chairs have been appointed through national advertisement for this voluntary role.

9. Clinical Assurance Group Mental health – secure and specialised mental health Specialised Services for Eating Disorders Forensic and Secure Mental Health Specialised Mental Health Services for the Deaf Gender Identity Disorder Perinatal Mental Health Tier 4 Child & Adolescent Mental Health Services Women and children’s health, congenital and inherited diseases Infection, cancer, immunity and haematology Traumatic injury, orthopaedics, head and neck and rehabilitation Digestion, renal and hepatobiliary and circulatory system

10. Clinical Assurance Group Mental health – secure and specialised mental health Women and children’s health, congenital and inherited diseases Medical Genetics Paediatric Surgery Paediatric Medicine Paediatric Cancer Services Paediatric Cardiac Services Metabolic disorders Paediatric Intensive Care Neonatal Critical Care Paediatric Neurosciences Complex Gynaecology Specialised Maternity Fetal Medicine Infection, cancer, immunity and haematology Traumatic injury, orthopaedics, head and neck and rehabilitation Digestion, renal and hepatobiliary and circulatory system

11. Clinical Assurance Group Mental health – secure and specialised mental health Women and children’s health, congenital and inherited diseases Infection, cancer, immunity and haematology Radiotherapy PET-CT Specialised Cancer Blood & Marrow Transplantation Haemophilia and other bleeding disorders HIV Infectious Diseases Haemoglobinopathies Specialised Immunology and Allergy Services Traumatic injury, orthopaedics, head and neck and rehabilitation Digestion, renal and hepatobiliary and circulatory system

12. Clinical Assurance Group Mental health – secure and specialised mental health Women and children’s health, congenital and inherited diseases Infection, cancer, immunity and haematology Traumatic injury, orthopaedics, head and neck and rehabilitation Complex Disability Equipment Brain Injury Rehabilitation Adult Neurosurgery Neurosciences Stereotactic Radiosurgery Burn Care Cleft Lip & Palate Specialised Pain Specialised Ear Surgery Specialised Orthopaedic Services Hyperbaric Oxygen Therapy Specialised Ophthalmology Services Spinal Injury Complex Spinal Surgery Major Trauma Digestion, renal and hepatobiliary and circulatory system

13. Clinical Assurance Group Mental health – secure and specialised mental health Women and children’s health, congenital and inherited diseases Infection, cancer, immunity and haematology Traumatic injury, orthopaedics, head and neck and rehabilitation Digestion, renal and hepatobiliary and circulatory system Cystic Fibrosis Hepatobiliary and Pancreas Specialised Medicine Vascular Disease Morbid Obesity Surgery Renal Dialysis Renal Transplant Specialised Colorectal Services Complex Invasive Cardiology Cardiac Surgery Pulmonary Hypertension

14. The Membership Structure of the Clinical Reference Group DRAFT NOT FOR CIRCULATION

15. The Chair of the Clinical Reference Group The chairs of the clinical reference groups have been selected through national advertisement and formal expression of interest. This was to allow as broad a field as possible to become involved with the future of specialised commissioning through its transition. Role Descriptor. A clinical leader in the field of the clinical service from a broad range of professional backgrounds. Experience as a clinical director, network director, medical director, or professional body leader would be desirable. The role is voluntary supported by the host NHS organisation within the professional activity component of the individual’s role. On average bi- monthly meetings of the group are held using web-conferencing supported by a national administration. A biannual summit of all chairs is planned. The role will seek consensus from the group membership on support for the key products of specialised commissioning. The chair reports through one of 5 Programmes of Care leads to the Clinical Assurance Group for specialised services. DRAFT NOT FOR CIRCULATION

16. The Public Health Lead for the Clinical Reference Group The Public Health Lead for each Clinical Reference Group has been nominated by the Specialised Commissioning Public Health Network Role Descriptor. A PH Consultant with a broad experience of the service area who may have been involved in designing service specifications, setting quality standards, defining policies, or undertaking designation. They will provide the group with public health advice and with the commissioning lead act to maintain the group focus on their assurance role. They will maintain communication links to other PH consultants across the PH Network. They will be involved in and where appropriate lead the development of specifications, quality dashboards, and the development of nationally agreed policies. DRAFT NOT FOR CIRCULATION

17. The Commissioning Lead for the Clinical Reference Group The Commissioning Lead for each Clinical Reference Group has been nominated by the Specialised Commissioning Group Senior Management teams. The final selection was by the Chief Operating Officers of the Cluster SCGs. Role Descriptor. A commissioner with a broad experience of the service area who may have been involved in designing service specifications, setting quality standards, or undertaking designation. They will provide the group with commissioning advice and act to maintain the group focus on their assurance role. They will develop communication links to other commissioners in the field in the clusters and within highly specialised services commissioning. They will be involved and where appropriate lead the development of specifications, quality dashboards and will work with the Public Health Consultant on project managing the development of nationally agreed policies. DRAFT NOT FOR CIRCULATION

18. The Sector Clinicians for the Clinical Reference Group Two clinicians for each Clinical Reference Group has been nominated by the Specialised Commissioning Group Senior Management teams. Where there were more than 2 identified the final selection is by the Chair. Role Descriptor. Clinical leaders from a broad range of professions related to the clinical field. They will have already experienced clinical leadership roles such as clinical director, network director, or service lead. They will need to bring a thorough understanding of the clinical field and of any reports, standards, guidance and statutory responsibilities related to the field. They should represent the clinical body across the sector and in doing so should establish communication links across all providers. They will need to declare any conflicts of interest. As the meetings use Web-based conferencing, they will need access to a computer with broadband internet connectivity. This is a voluntary role supported by the individual’s host NHS organisation. DRAFT NOT FOR CIRCULATION

19. The PPE Representatives for the Clinical Reference Group Two PPE representatives for each Clinical Reference Group are nominated by the PPE Steering Group. Where there were more than 2 identified the final selection is by the Chair. Role Descriptor. The nominee will have a thorough understanding of the clinical field from a user’s (patient’s) point of view. This may have been gained as a leader in a support group or organisation. They should represent the patient and public view and in doing so should establish communication links across all patient and public organisations related to the clinical field. They will have had experience of providing advice to NHS organisations. DRAFT NOT FOR CIRCULATION

20. Additional Invited Representatives for the Clinical Reference Group Up to four additional clinical members can be invited to join the Clinical Reference Group by the Chair. These will ensure that there are links to other reference groups or cover sub- specialty areas. There are a further four additional members that can be invited to join the Clinical Reference Group by the Chair of the Clinical Assurance Group. There may be national organisations or other groups that wish to be formally affiliated to the Clinical Reference Group The minimum membership is 13 members The maximum membership is 21 members DRAFT NOT FOR CIRCULATION

21. Clinical Reference Group Meeting Organisation The Clinical Reference Groups will function as virtual groups using email communication and Webex Web Conferencing The use of NHS Mail allows the safe transfer of email communication. All group members will be asked to establish an NHS Mail account. We will develop a calendar of work for the clinical reference groups so the completion of products hits the planning milestones for 2013. DRAFT NOT FOR CIRCULATION

22. WebEx Web Meeting We aim to achieve all the Clinical Reference Groups to learn the benefits of using WebEx web conferencing Please click the following link to see a general overview http://www.webex.co.uk/overview/index.html http://www.webex.co.uk/overview/index.html You join WebEx from your normal internet connected computer. On the first time using Webex a control software needs to be uploaded to your computer – an ActiveX Control. You will need administrator rights to the computer for this. When a meeting is set up you receive an email. Click the joining link and follow instructions. When prompted provide Webex your telephone number, Webex rings you to join the meeting. Test meetings will be run to ensure you can connect. Do not sign up for Webex on their website. DRAFT NOT FOR CIRCULATION

23. Clinical Reference Group Production Teams The work to develop the products will be through the following Production Teams The Specification Production Team will be lead by the CRG Commissioning lead. The clinical membership on this team will be facilitated and approved by the Chair The Policy Production Team will be lead by the CRG Public Health lead and project managed by the CRG Commissioning lead. The clinical membership on this team will be facilitated and approved by the Chair The Quality Measures Production Team will be lead by the CRG Chair or nominated clinician. The process will be project managed by the CRG Commissioning lead DRAFT NOT FOR CIRCULATION

24. Clinical Reference Group First Actions 1.Chairs confirm they accept the role to proceed [JDP] 2.Members nominated confirm they accept the role to proceed [JDP] 3.Vacant membership slots are filled [Chair] 4.Trial runs of Webex for members [JDP-PA] 5.Selection of Programme of Care Leads [JDP with Chairs] 6.Communication across sectors about the structure [Sector Clinicians] 7.Define a long list of specifications for the CRG [Commissioner] 8.Define a long list of polices for the CRG [PH Lead] 9.First meeting of Clinical Assurance Group to approve Clinical Reference Group Terms of Reference 10.Preparation for Spring Specialised Commissioning Summit DRAFT NOT FOR CIRCULATION

25. Specialised Commissioning Summit It is planned to hold a summit every 6 months for the full range of Clinical Reference Groups to meet The first Summit is planned on Monday 26 March and Tuesday 27 March in Bristol. The second day will be reserved for the clinical groups working on the Group 3 services. Attendees invited include: All CRG Chairs All CRG Public Health Leads All CRG Commissioning Leads Sector SCG Chief Operating Officers National Transition Team