Clinical Networks and Senates

Kidney care clinical networks emerged around the turn of the century to facilitate integrated care across the kidney patient pathway, spanning the range of different healthcare sectors. The presence of networks in the NHS, indeed in renal medicine and in particular transplantation, was not new as healthcare professionals have always worked together; but in the managed clinical networks that emerged after Sir David Carter's review of acute services in Scotland in 1999 patients, carers, management and commissioners were brought into the professional gatherings. The managed aspect of the role of networks became more prominent and with that the requirement for greater accountability.

Kidney care networks have been described as 'linked groups of healthcare professionals and organisations, from primary, secondary and tertiary care working in a coordinated manner, unconstrained by existing professional and organisational boundaries to ensure equitable provision of high quality effective services'. There has been no single model or master blueprint, each network developed according requirements and challenges, but all are virtual rather than statutory and the best have arisen out of an identified need for service change rather than being imposed for organisational reasons.

In early years of the kidney care networks, the 12 core principles advocated by NHS Scotland formed the basis of the governance and agility to balance clarity of purpose with flexibility of response.

The NHS Futures forum recognised the role of networks and recommended that clinical networks should be strengthened and embedded in the new system. This was accepted by the government and Kathy Mclean, until recently the Medical Director of NHS East Midlands and now Clinical Transitions Director at the Department of Health is leading the work on clinical senates and networks. Commenting on a recent workshop Kathy said, 'I was very pleased with the energy in the room, the support for the role of networks and the desire to make improvements. There were clearly some key themes coming out from the session, including the potential role of networks leading large scale change processes across pathways of care and coordinating complex pathways of care where a lack of a network could lead to harm'. Read the Kings Fund Workshop Report here.

The review will define the role of clinical networks and review their range, function and effectiveness. It will:

• Map the current patterns of networks and assess the current level of resources associated with them;
• Define what is meant by 'network' and the role of potential models in the new system;
• Propose which clinical and professional areas require formal network.

Kidney care networks place an emphasis on partnerships, information and relationships to achieve higher quality care and better outcomes often through more integrated care being delivered by the multi-professional, multi-sector team. This is in contrast to the older 'hub and spokes' model where it was often perceived that the 'hub' (as the title suggests) was where all the action took place, and the 'spokes' were considered relatively minor service providers in support of them.

The lessons from the last decade and the listening exercise have made clear how important clinical advice and leadership are in delivering improvements in health care outcomes. See the letter from Kathy Mclean and the details of how to get involved. http://healthandcare.dh.gov.uk/category/senates/