1. Clinical Senates & Networks The Big Picture

2. The Three R’s Rationing Revalidation Reconfiguration

3. NIMROD Not Including My Relatives Or Dependents

4. 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 clinicians Have helped develop our programme of activity

5. We can network Examples: Bill Cunliffe –Planned Care Liz Kendrick- End of Life Care

6. Having the Choice to Die at Home Fast Focus Session End of Life Clinical Innovation Team Design Document for Discussion

7. Most people would prefer to die at home. Most die in hospital GP Palliative care registers Liverpool care pathway Care homes and advanced care planning “would you be surprised?” 24/7 community support Early engagement with 111 initiatives

8. 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?

9. Our reasoning was flawed ! Enhanced Recovery ERP planning clinic Preadmission CHO load Gut friendly anaesthetic Eat,drink and move day 1

10. 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 years69.9 years67.8 years66.1 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 days6.5 days4 days Readmission9.5%15%19%16% ACPGBI 2009 Laparoscopy Enhanced Recovery Prog. 2008 3.5 colorectal surgeons 12 months 129 patients Courtesy Mr Mark Katory, colorectal surgeon

11. ‘The Clinical Network’ Should we integrate clinical networks? What IS a network? What would the governance look like?

12. not all problems will respond to NHS Improvement

13. Clinical Senates How many? How do they interface with networks, CCGs,HWBs, LA’s and F Ts

14. In the land of the blind, The one eyed man is king Clinical Senates & Networks The Big Picture