Linking clinical expertise and commissioning strategy

2014/15 in review

We are delighted to publish this annual review of the work delivered by the London Strategic Clinical Networks and Clinical Senate for 2014/15.

In a challenging year characterised by resource savings required for a sustainable health system in the future, the SCNs and Senate have proven their ability to do more with less, through collaborative working with all elements within and beyond the health and care system.

Key to our success has been the engagement and expertise by our ambitious and committed stakeholders across the system.

This document presents specific examples of this partnership working across London and the resulting improvements to patient pathways and experience through engaging service users and leaders in the clinical and commissioning communities.

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Creating a system of valueLinking clinical expertise with effective commissioning SCNs provide the opportunity to deliver effective change from a strategic perspective to services across the capital. This creates an increase in quality, a reduction in unnecessary variation and further reach of innovation across services.

Through greater collaboration between providers across different levels of the system, SCNs offer the ability to create best value in health and care with long lasting improvement in outcomes.

SCNs help to develop these for use across all settings of care (community, primary, secondary, ter-tiary care) in the capital through an infrastructure of engaged experts. By linking evidence based clinical decisions with local commissioning needs, Londoners can be assured of a health and care system that will be high value for future sustainability.

Foreword

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Multifaceted improvements 4Planning for the future 5Finances 6Governance 7Mental Health Clinical Network 8Dementia Clinical Network 10Neurosciences Clinical Network 12Cardiovascular | Cardiac and Vascular Clinical Network 14Cardiovascular | Stroke Clinical Network 16Cardiovascular | Diabetes Clinical Network 18Cardiovascular | Renal Clinical Network 20Maternity Clinical Network 22Children and Young People Clinical Network 24Involving patients / Co-producing services 26

Table of contents

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Multifaceted improvements

T he London Strategic Clinical Networks and Clinical Senate translate national priorities into local ambitions, within the NHS England vision where “everyone has greater control of their health and their wellbeing, supported to live longer, healthier lives by high quality health and care services that are compassionate, inclusive and constantly-improving.”

The Strategic Clinical Networks and Clinical Senate align with the three Academic Health Science Networks in the capital to create a comprehensive approach to achieving excellent clinical outcomes, alliances of clinical leadership and innovation without boundaries.

Whilst 2013/14 was a year of organisational establishment and creation of the clinical leadership needed to provide the right strategic views across London, 2014/15 was a year of outputs that will make exciting impact to quality outcomes and experience for patients in the capital.

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Planning for the future

Smith Review

In October, NHS England initiated a national

review of the work of NHS quality and leadership improvement organisations aimed at refocusing their work on helping organisations introduce new models of care, aligned with plans set out in the Five Year Forward View.

Within the Smith Review, SCNs and Senates will be further reviewed and evaluated, along with AHSNs and other elements of the ‘improvement architecture’ in the NHS to ensure clarity of roles, elimination of duplication and rapid acceleration of care improvements. (NHS IQ, NHS Leadership Academy)

The SCNs and Senate welcome the review, as it will provide increased understanding across the system as to how to maximise the alignment and accountability within these organisations. It will ensure that all of the

organisations have a clear and simple purpose, and they work together to achieve maximum results for the greatest value for money.

Whilst the review has posed challenges, the strength and benefits provided by the SCNs and Senate have been reiterated through initial discussions released by the review.

The Smith Review will continue in 2015/16, and findings will be published thereafter.

Business planning

Priorities of the SCNs and Senates for

the future are available within the business plans as found on each of the respective SCN and Senate websites. These priorities take into account: » National priorities and

the vision of the clinical directors

» Implementing the vision depicted in the Five Year Forward View

» Local needs as determined by the SCN directors and clinical leadership groups

» Increased collaboration with the three London Academic Health Science Networks

» Healthy London Partnership programme, developed in response to the Better Health for London initiative, a collaboration between the Mayor’s Office, the NHS in London, local authorities and social care.

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FinancesThe SCNs and Senate are hosted by NHS England.

In 2014/15, £833k was allocated for running costs and £3.6m for programme costs.

This funding has been incorporated into the wider Medical Directorate for the London region. Funding covers both pay and non pay costs, such as events, meetings, conferences, training and leadership development.

An estimated £XX in underspend may be attributed to delayed recruitment in staff posts.

1 There are established, productive strategic clinical

networks in London in the mandated areas: » Cardiovascular (cardiac,

vascular, stroke, renal, diabetes)

» Mental health, dementia, neuroscience

» Children and young people, maternity

2 There are additional networks in London which address local

areas of complex challenges in the capital:

» End of life care » Respiratory » Tuberculosis

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3 Operational delivery networks provide coordination of patient

pathways between providers to ensure access to specialist resources:

» Burns » Major trauma » Neonatal intensive care » Adult critical care

The Strategic Clinical Networks are hosted within NHS England. Strategic Clinical Networks (SCNs) are non

statutory bodies. However, they are able and charged with adopting whole system approaches to healthcare

design, working with both commissioners to reduce service variations as well as with providers across complex

pathways of care.

Each SCN is led by a clinical director, strategic clinical leadership group (SCLG) and members of the SCN project

team (network lead and project managers).

Networks provide the opportunity to focus on identified health issues from a broad strategic perspective. They help

commissioners reduce unwarranted variation in services and encourage innovation to deliver effective change to

services where required across the capital.

Through greater collaboration between providers across different levels of the system, SCNs offer the ability

to develop best value care pathways with long lasting improvements in quality. SCNs will help to develop these

for use across all settings of care (community, primary, secondary, tertiary care).

SCNs constantly provide the infrastructure to create this change. The SCNs can ensure that evidence based clinical

decisions link with local commissioning intentions.

Governance

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Mental health

One million Londoners in any one time experience a mental health problem. If you have a serious mental illness in London, you are likely to

die 17 years earlier than the rest of the population. In London, 90 per cent of people with a mental health disorder are cared for entirely within the primary care sector. Depression doubles the risk of developing coronary heart disease, and 25 per cent of all people with long term physical conditions have depression and die earlier.

The London Mental Health SCN produced several commissioning guidance documents aimed at reuniting mind and body, working to improve care and supporting whole people. Two examples:

»» A commissioner’s guide to primary care mental health details ten lessons derived from international, national and regional case studies, covering community based care, proactive wellbeing, accessible services and coordinated mental healthcare. The case studies were compiled into a directory to help readers make positive changes in primary care mental health. It was downloaded more than 10,300 times in the first few months (3,000 in the first month), from as far away as Australia, America and the UAE.

»» Commissioning recommendations for psychological support, developed in conjunction with the London Diabetes SCN, demonstrates the link between physical and mental health. The report has been shaped through surveys of London provision and discussions with both professionals and people with lived experience. It provides recommendations for commissioners when providing emotional and psychological support on the diabetes care pathway and will be the basis for future work in long term conditions. It was downloaded more than 7,500 times in the first few months (1,500 in the first week), and was highlighted in NHS Networks, the King’s Fund and HSJ.

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Mental health

London has a greater burden of mental ill health and the highest rate of compulsory psychiatric admissions in England. Mental ill health is

estimated to cost the capital nearly £2.5 billion in health and social costs each year and £5.5 billion in lost working hours. Matthew Patrick, Clinical Director for the London Mental Health Strategic Clinical Network (SCN) and Chief Executive of South London and Maudsley NHS Foundation Trust had a bylined article in the Guardian describing the SCN’s role in improving mental health crisis care and parity of esteem through its organisational network links, recommendations for commissioning and involvement as one of 22 linked organisations working together to deliver crisis care through the London Crisis Care Concordat. Using a whole systems approach to care (including social care, housing, employment support), the commissioning standards provide recommendations for commissioning mental health crisis services in the capital. Pilots in South London and Maudsley such as 24-hour clinical support for police answering mental health related calls is proof of this vital collaboration between the NHS and the Met police, working together to deliver excellent crisis care and save lives of Londoners. The Concordat and the work of the Mental Health SCN was recognised by Dr Geraldine Strathdee, NHS England National Clinical Director for Mental Health, on Twitter as she tweeted, ‘Great progress London’.

Mental health problems form a large and growing proportion of primary care presentations, and one in three GP appointments involves significant mental health issues. Bringing together mental health leaders from London CCGs, the Mental Health SCN partnered with UCLPartners Academic Health Science Network to create a knowledge based leadership programme.

In response to the success of the London Mental Health CCG Network, a national programme has been developed based on the programme model. An article in HSJ outlined the development of the programme and benefit of the CCG leadership group in London. Phase 2 of the programme has launched, tailored to build on the benefit of group working, experience and peer-to-peer learning. Master classes have been held to upskill commissioners on informatics and CAMHS.

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Dementia

In 2012, the Prime Minister issued the Dementia Challenge, which expected two-thirds of people with dementia to receive a diagnosis by

March 2015. In 2007, it was estimated that 64,600 Londoners had dementia. By 2011, that number had risen to 79,876 – yet only 50.2 per cent of people had a confirmed diagnosis.

Since the establishment of the London Dementia Strategic Clinical Network, diagnosis rates in the capital have increased 10.85 per cent in one year (from 55.62 to 65.79 per cent, March 2014/15).The national ambition is 67 per cent.

Half of London CCGs (14 of 32) are over the ambition rates, which has led to London having the best diagnosis rates in the country. The Dementia ambassador, Dr Dan Harwood, and the SCN visited all 32 CCGs to provide clinical advice and support.

The Dementia SCN developed a range of tools to support CCGs and GPs, including the creation of dementia checklist for commissioners, which was cited as a “useful toolkit… which helped me to plan and implement a transformation programme,” according to one London commissioner.

The SCN work has been featured on BBC’s Inside Out London, as well as the Journal of Dementia Care.

Since our work began, diagnosis rates in the capital have increased by 10.85 per cent.

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Dementia

People fear dementia more than any other disease. In those aged over 55 year, 39 per cent fear getting Alzheimer’s most, compared to 25 per cent

who fear getting cancer. Prime Minister David Cameron, his Cabinet and more than 40 MPs were trained to be ‘dementia friends’ last week by Professor Eileen Sills, the London Dementia Strategic Clinical Network (SCN) Clinical Director (above). Eileen’s training included a screening of Barbara’s Story, our dementia training film that demonstrates the huge effect that small changes to attitude, behaviours and actions can have on a person living with dementia.

Eileen said: “We want all Londoners to become more aware of the condition to make our community a better place for people with dementia. We’ve seen it’s the small things that make the biggest difference – the smiles, the eye contact, the time. By raising this kind of understanding we can improve the lives of people living with dementia as they go shopping, play sport, go to museums, the cinema or theatre, and visit friends and family without fear.”

To help them spread the word in their constituencies, MPs were given the full set of Barbara’s Story DVDs, a ‘little book of friendship’ with ideas and tips on helping people living with dementia, and a badge to publicly show their support..

The dementia checklist developed by the London Dementia SCN provides guidance for commissioning integrated services which will provide excellent care to people with dementia in both specialist and non-specialist (mainstream) care settings. It has been downloaded hundreds of times since launch.

In recognition of Dementia Awareness Week (18–24 May 2015) the Dementia SCN published a series of daily podcasts in conjunction with our Academic Health Science Network (AHSN) partners, Health Innovation Network (HIN) and UCLPartners, in which a panel of experts explored key dementia care issues. The themes and topics in each podcast were further explored via live daily twitter chats using #LdnDementiaWk. Dementia experts took part to debate issues and answer questions. More than 1,500 people registered and listened to the podcasts, and the hashtag reached nearly 50,000 accounts with more than 146,000 impressions.

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Neurosciences

There are 252,000 people in London living with a neurological condition (excluding migraine, stroke and dementia – which constitute an additional

1.9 million).

The London Neuroscience SCN carried out an organisational audit to provide a baseline picture of London’s hospital-based neurological services.It encompassed the neuroscience/surgery regional centres, specialist neurological centres (no surgery), and acute general hospitals.

The aim of the audit was to identify a set of standards for London commissioners that describes acute neurological services that are fit for purpose and modern, as well as provide recommendations for improvement programmes.

The organisation of acute secondary care neurological services in London does not promote ownership of patients with neurological problems by neurologists. The audit identified no hospital where patients with a primary neurological diagnosis were systematically admitted under a neurological specialist. This indicated variability in deployment of resources with quality and safety issues.

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Neurosciences

One out of every 10 GP consultations deal with neurological symptoms and 64 per cent of neurological admissions to hospital are on an emergency

basis. From this, a case for change was developed which described why neurological services must evolve for patient management upon entering the health system through emergency and urgent care routes. Using epilepsy as an example, diagnostic errors by non neurologists are common. Nearly half (48 per cent) of those with active epilepsy do not have their condition controlled with anti-epileptic drugs. In fact, 42 per cent of adult and child deaths caused by epilepsy in 2013 could have been prevented. On the other hand, 114,080 people in England were incorrectly diagnosed as having epilepsy at a cost of £221 million per year.

An acute neurology group was established to develop standards, pilot and evaluate hyper acute neurological units. Six London hospitals expressed an interest in developing models for this new acute service. After defining the benefits, functional, population-based models will be developed to define how this care is covered in the capital. This will help to ensure that neurological patients receive rapid specialist care, improving diagnosis accuracy, care and unnecessary costs within the system. Many publications over the last 20 years have identified the key problems in neurological services and made recommendations. A heading in the Guardian in December 2014 “Study exposes ‘scandalous’ state of NHS neurology services” shows we still have a long way to go. This programme of work will attempt to address some of the short falls to meet the acute need, but other parts of the patient pathway will also require attention if we are to get it right for our patients.

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Cardiovascular

Ventricular tachycardia (VT) and complete heart block (CHB) are potentially life-threatening arrhythmias if appropriate specialist

intervention is not available rapidly. Although the number of patients in this pathway is relatively small (approximately 650 per year), quick, appropriate care is essential to optimal outcomes.

A new pathway went live in June 2014 in the capital, which uses the London Ambulance Service (LAS) to triage high-risk arrhythmia patients in the ambulance and take them directly to central units where they can receive quicker care.

Patients with suspected ventricular tachycardia or complete heart block are now triaged to accredited arrhythmia centres, where they receive specialist care 24/7, resulting in quicker treatment and earlier discharge from hospital.

Professor Huon Gray, national and London clinical director for cardiac and vascular, said, “The new high risk arrhythmia pathway in London is the first of its kind in the country. Patients are now diagnosed by ambulance services and immediately taken to a specialist centre, where they receive quicker treatment for arrhythmia emergencies and faster discharge from hospital – safely and efficiently. This will lead to improved outcomes for patients and lower costs from reduced length of stay and fewer LAS journeys for the health system.”

This model is providing better outcomes, increased savings from reduced length of stay and freed up ambulance staff who can assist other emergencies through the elimination of transport to non specialist centres and then transfer to specialist centres.

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Cardiovascular

Creating better care for cardiovascular patients

In September 2014, the London Cardiovascular Strategic Clinical Network (SCN) held an education event for London Ambulance Service (LAS) paramedics on ECG diagnosis and triaging patients with complete heart block (CHB) or ventricular tachycardia (VT). The event, attended by more than 100 paramedics, included information delivered by senior cardiologists from across London. The training event was held in support of the successful June launch of a new pan London patient pathway for people with CHB or VT (left). Developed jointly between patients, clinicians, acute Trusts and the SCN. LAS now triages these patients and transports them directly to designated arrhythmia centres where they receive immediate specialist care..

A vascular clinical advisory group was established to explore improvement opportunities and service specification compliance with specialised commissioning. Examples of its outputs include a patient specific protocol for abdominal aortic aneurysm, enordsed by London Ambulance Service and London’s vascular hubs, and a response to NCEPOD’s lower limb amputation report and critical limb ischemia to implement key recommendations.

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Cardiovascular

London’s acute stroke model is a global exemplar, saving 300 lives each year in the capital.

In August, its success was again highlighted in a research article in the British Medical Journal, which showed a significant decline in risk adjusted mortality, with approximately 168 lives saved by 90 days after admission, and a 7 per cent reduction in length of stay in the first 21 months.

Throughout the year, reviews of hyper acute stroke units (HASUs) and acute stroke units (SUs) by the network ensured the ongoing high quality care for patients. These reviews will be handed over to commissioners, providing a front line view of the excellent services they commission.

The London Stroke Acute Commissioning and Tariff Guidance was revised to accurately reflect the current landscape (since the 2010 reorganisation of stroke services), to ensure commissioners maintain the high standards of care in London. Similarly, the HASU and SU quality standards were updated in alignment with the Stroke Sentinel National Audit Programme. Quarterly analysis of SSNAP data at London level by the network uncovers areas for improvement and what commissioners can do to improve these outcomes.

Atrial fibrillation (AF) is the most common cardiac arrhythmia and is a major risk factor for stroke. The annual risk of stroke is five to six times greater in AF patients than people with a normal heart rhythm.

The interdisciplinary stroke prevention of AF group (iSPAF) exists to address this high priority area. With three key subgroups -- primary care education for SPAF, identification and management in GP practices, and improving anticoagulation management, the network can influence commissioning strategy and develop high impact outputs, from providing clinical advice to commissioners on the management of AF with anticoagulants to responding to the NICE AF quality standard consultation for better care at a national level.

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Cardiovascular

Innovation in stroke services

Of equal priority to the network is to improve services to support people once they leave hospital. The acute stroke model is dependent on an increased use of stroke specific community services. The importance of early supported discharge (ESD), stroke specific community rehabilitation, emotional and communication support and vocational rehabilitation in maximising independence and achieving a good quality of life has been endorsed at both a London and a national level.

Examples of outputs by the network in this area include: service specifications (such as for ESD and multi-disciplinary team access to psychological rehabilitation for stroke survivors); a patient guidance document, Going back to work after stroke, and a three-level proposed model of work support interventions for people returning to work following a stroke.

Yet limited community support creates difficulties with the flow of patients through the pathway,which ultimately impacts bed capacity in the HASUs. Unless appropriate community services are commissioned to support patients outside of the hospital environment, the continued performance of this world renowned stroke model is at risk.

Helen Cutting, Senior Project Manager, London Stroke Strategic Clinical Networks, had a opinion piece published on the BMJ website regarding outcomes of the London stroke reconfiguration, “London stroke model: Acute care – not the whole picture”.

Helen noted that whilst great strides have been made in reduced mortality rates following stroke in the capital, four years on from the reconfiguration limited improvement has occurred in the services commissioned to support life after stroke. Following on from this, Helen was approached by the BMJ to submit a letter on the subject for publication in the journal.

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Cardiovascular

There are an estimated 475,000 Londoners diagnosed with diabetes, and a further 200,000 people could be living with diabetes by 2025.

The Diabetes Strategic Clinical Leadership Group, a multidisciplinary group of clinicians, patients and commissioners, detailed priorities to address for London in Understanding diabetes in London.

One priority is to improve the detection of diabetes by using the HbAlc testing as the preferred diagnostic method. With this, more patients will be identified and their disease progression can be managed better, to enable them to live well for longer.

As part of the project to optimise the delivery of, and access to, structured education for type 2 diabetes, the SCN, in conjunction with Health Innovation Network, the Academic Health Science Network, produced a toolkit to address the causes and low uptake of structured education for people with type 2 diabetes and to provide guidance on how to make high quality structured education easily accessible across the UK. The toolkit was accessed more than 5,000 times within the first few months of launch.

Improving the management of diabetes care shares approaches, past and present, which aim to improve diabetes care. The toolkit is a timely collection of learning from areas of London that have recently made some radical changes and improvements in the management of care in primary care, highlighting themes that run throughout which were key to making the improvements successful.

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Cardiovascular

In London, patients are younger – 20 years on average and have a higher rate of diabetes.

Up to 80 per cent of diabetes-related amputations in England each year are preventable. Of those people with diabetes who have an amputation about half will survive for two years. The good news: London has the lowest average number of amputations in the country; other regions have nearly double the rate in the capital. Some of this is attributable to the high number of expert vascular centres in London. Essential to ensuring that we maintain these low amputation rates are ongoing service improvements and clinical engagement. The Diabetes Strategic Clinical Network hosted ‘Aspiring to Footcare Excellence’, in conjunction with the London Footcare Network (above), which linked more than 100 healthcare professionals in the capital to discuss how we can improve care and services for people with diabetic foot disease and other foot complications.

Discussions highlighted challenges in commissioning, how to care for those patients with comorbidities (especially kidney disease) and current local and national audits. Attendees worked together to develop a gold-standard service specification and to set priorities for their local sector..

Improving foot care services

The Diabetes SCN published Foot care service for people with diabetes: Guidance for commissioners, details the provision of a foot service for people with diabetes according to best practice guidance. This guide and service specification builds on recommendations in the Cardiovascular disease outcomes strategy, and responds to the challenges and aims of the Five year forward view. In its first month, it was downloaded more than 1,100 times, and shared through various commissioning publications. The All Party Parliamentary Group on Vascular Disease has expressed a specific interest in this guidance and the SCN’s future plans.

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Cardiovascular

Two per cent of the annual NHS budget is spend on renal care (transplants, dialysis, acute kidney injury). By increasing self care and

improving detection in primary care, we can delay or prevent these conditions further upstream. Dialysis is incredibly personal and can potentially take up a person’s entire life. It can take 4-5 hours, three times per week. This means not only the appointment times for dialysis, but includes travel time, potential infections, fistulas. Diet must be constantly monitored. Other complications (such as eye and foot) and outpatient appointments (such as dieticians) must also be considered. There may also be stigmas associated with renal conditions, particularly in certain cultures, where patients may not wish to disclose health information to their families, thereby adding additional pressures.

For all of these reasons, patient involvement is especially critical in this focus area.

There are six service users serving on the Renal Clinical Leadership Group. Their contributions provide first hand insight into what improvements are needed and the priority areas of focus.

Additionally, a London toolkit of best practices was developed, promoting shared decision making and improving end of life care, particularly symptom control.

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Cardiovascular

Half (50 per cent) of London renal patients have diabetes. This can lead to additional complexities with foot and eye care. In London, patients are

younger – 20 years on average and have a higher rate of diabetes.

Members of the Renal Strategic Clinical Leadership Group developed two questionnaires to look at the experience of service users and providers of renal care to find out what works well, what could be improved, what is important, what matters and what can be done to improve care and quality of life.

By looking at the experience and views of the providers as well as service users the SCLG will:»» Identify areas where patient experience is excellent and make sure that good practice is shared»» Identify areas of particular concern for London’s renal patients and focus efforts on improving them»» Identify ways of measuring your experience which are helpful and relevant to service users and providers.

Influencing kidney care tariffs

Monitor held a consultation on proposed 2015/16 kidney care kidney care tariffs over the summer. This caused a huge furore in London, as the proposals meant that there could be up to 18 per cent cuts in funds received for treatments -- well above the 3-5 per cent efficiency savings required elsewhere across the NHS. The SCLG wrote to Monitor objecting strongly to the proposals for a number of reasons which included:»» Lack of evidence or validation»» No expert patients or clinical advice was sought»» Disincentive to move patients to independent therapies, such as home dialysis or peritonealdialysis, as these were especially hard hit

The SCLG lobbied on behalf of the network’s members, believing that these cost reductions would lead to a major decline in the quality of care. In October, Monitor agreed to review the cost reductions and not implement the cuts in the coming year.

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Maternity

There are more than 132,000 babies born in London each year. However, evidence showed that variances existed in outcomes and

experience for pregnant women and their babies in the capitalTo ensure equity of high quality maternity care, the London Maternity SCN developed and published a suite of toolkits, which identify areas of good practice for implementation across all maternity units in the capital, ensuring equally good outcomes for all pregnant women and their babies.

The toolkits provide background and rationale for their use, principles, auditable standards and references. Implementation will help to ensure equal access to high quality maternity care throughout London.

Toolkits published include: » Stillbirth » Maternal haemorrhage » Continuity of care » Midwifery led units » Early access to maternity services » Outpatient induction of labour » Fetal fibronectin

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Maternity

A 2013 CQC survey found that London remains the area of England with the worst perceived maternity care.

In response, the Maternity SCN has worked extensively to improve user experience and involvement across London. This work includes running workshops on maternity user experience. These workshops led to a toolkit which outlines the key tasks and steps required for trusts to successfully deliver these workshops. The toolkit has been downloaded hundreds of times since publication.

The user experience workshops have led to personal pledges and action plans being implemented in London trusts. These are practical actions that will improve the care and experience for women and their babies in the capital. implemented in London trusts. These are practical actions that will improve the care and experience for women and their babies in the capital.

A film was created which explores the pregnancy journey from the user perspective, encompassing views of the user and healthcare professional. The film aims to improve healthcare professional practice, promote understanding of the perspectives of others, challenge assumptions, harness empathy and compassion.

London Perinatal Mental HealthThe London Mental Health and Maternity SCNs launch the London Perinatal Mental Health Networks in October 2013. Since then, more than 160 members have joined from a variety of organisations, including representatives from perinatal and parent infant mental health services, midwifery, obstetrics, health visiting, social care, third sector, service users and commissioners.

There are three clinical networks covering London, north east, north west and south, plus the Pan London Network. They promote open communication, knowledge sharing and peer sup-port in terms of service delivery and service development. Several areas in London have plans under way to increase existing resources or develop new services.

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Children and young people

Of the 8+million people living in London, there are more than 2.1 million children aged 0-19 years old. Care and outcomes are variable

for this population across London and commissioning arrangements are fragmented.The Strategic Clinical Network for Children and Young People (CYP) published a report, collating extensive evidence that health services for CYP in London are in need of radical transformation. The report made the case for change to the current provision of health services for children and young people, and the SCN set to work on its plans for improvements, including the development of population based networks for children and young people, standards and more effective arrangements for the commissioning of CYP services.

The CYP SCN case for change served as the framework for mapping how the SCN would improve CYP services. It documented some of the issues facing children’s health services in London, including demographics, variation, commissioning and the development of health services as well as the SCN’s plans to improve these for the entire population of children using London services.

Extensive work was undertaken to collate more than 800 standards relating to acute care such as the Royal College of Surgeons (RCS), National Institute for Health and Care Excellence (NICE), Royal College of Paediatrics and Child Health (RCPCH) into one cohesive document that outlines the minimum standards of care in acute CYP services in London. This is being replicated in other areas, including asthma care, surgical networks and high dependency care.

In further recognition of the complexity of the commissioning of children’s services, a Children’s Commissioning Advisory Group was established and acts in an advisory capacity to develop models of children’s commissioning, in close conjunction with the CYP Strategic Clinical Leadership Group.

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Children and young people

Young Londoners speak out about the NHSIn November the Children and Young People’s (CYP) Strategic Clinical Network held an event to find out what young people think as users of health services. The event was run in conjunction with the Association of Young People’s Health, a charity which advocates for young people on health issues.

A diverse group of young people shared their views with us around how they currently use services and what they would like to see in future.

This included comments such as: “Help us understand where to go to get help and please make it simple.” “Allow me to access services by email - don’t let me waste GP and hospitals’ time.” The young people were very enthusiastic about being involved and requested further contact and engagement with the CYP SCN which is planned for 2015.

Commissioning for childrenIn further recognition of the complexity of the commissioning of children’s services, a Children’s Commissioning Advisory Group was established and acts in an advisory capacity to develop models of children’s commissioning, in close conjunction with the CYP Strategic Clinical Leadership Group.

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Involving patients

Clinical evidence suggests that eating disorders are almost twice as common in adolescent females with type 1 diabetes as their non-

diabetic peers. Approximately 40 percent of 15 to 30 year old women with diabetes regularly omit insulin. Such patients are at an increased risk of hospitalization and diabetes related medical complications. It is felt that there are inequities in the clinical pathway. The cost of complications experienced by those with type 1 or type 2 diabetes is estimated at £7.7 billion. This is expected to dramatically increase in the next 10 years. These issues are frequently unrecognised and individuals can suffer with these problems for many years before the problems surface.

Whilst those in diabetes care have often led the way in delivery of multidisciplinary team approaches, there is a perceived need to bring together mental health care skills and diabetes expertise in the same multidisciplinary team for the benefit of this particular group.

To raise awareness of this issue, three London SCNs – Diabetes, Children and Young People and Mental Health – joined together with lay members and the voluntary sector to host a specialist multi-professional conference aimed at strengthening the psychological skills of those who work with this group. Social media was used as a main channel to generate interest and dialogue for the event. Nearly 31,000 Twitter accounts were reached with 186,000 impressions, demonstrating the need for open conversation and the passion shared for improving care for this group.

An article in the London Evening Standard further highlighted this issue to a wider audience, generating even further social media reach and comments by those affected by this issue and those making a positive impact in their care.

Themes raised at the conference identified a clear need for further work in this area. The Diabetes SCN, in conjunction with Health Education England and King’s College London, to deliver two pilot programmes aimed at empowering healthcare professionals.Above left: Prof Jonathan Valabhji, National Clinical Director for Diabetes and Obesity, NHS England and Rt Hon George Howarth MP, Labour MP for Knowsley,Above right: London Diabetes Clinical Director, Dr Stephen Thomas and hDr Frances Connan, Clinical Director for Vincent Square Eating Disorders Service.

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Co-producing services

People with long term conditions (such as diabetes) often have mental health issues such as anxiety and depression.

To explore the psychological needs and support required for people affected by diabetes and how organisations commissioning diabetes services can build stronger partnerships with mental health teams, the London Mental Health Strategic Clinical Network held a co-production event for service users, commissioners, mental health and diabetes healthcare professionals and the voluntary sector through Diabetes UK. This work was used as a basis for commissioning guidance which aims to bring body and mind back together through practical recommendations and examples of integrated models of care.

Service users were involved throughout the entire process, from the original engagement piece to informing the content of the co-production event, to the development of the guidance for commissioners and providers.

Following the development of standards for the London Mental Health Strategic Clinical Networks’ crisis commissioning guide, an engagement workshop was held to verify that the standards resonated with people with lived experience of mental illness. Mind, the mental health charity, helped to recruit, facilitate and host the event.

The information collated at the workshop helped to shape the commissioning standards and also build on the case studies for lived experience stories. Key statements produced at the workshop formed the table discussions at the Crisis Care Concordat launch.

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About the London Clinical Networks

The London Clinical Networks bring together those who use, provide and commission the service to make improvements in outcomes for complex patient pathways using an integrated, whole system approach.

The Clinical Networks work in partnership with commissioners (including local government), supporting their decision making and strategic planning, by working across the boundaries of commissioner, provider and voluntary organisations as a vehicle for improvement for patients, carers and the public.

In this way, the networks will:

» Reduce unwarranted variation in services » Encourage innovation in how services are provided now and in

the future » Provide clinical advice and leadership to support their decision

making and strategic planning.

London Clinical Networks | NHS England (London Region) londonscn.nhs.uk | england.london-scn@nhs.net

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