Confusion is widespread about the role and aim of clinical senates, conference hears

BMJ 2012; 344 doi: (Published 26 April 2012) Cite this as: BMJ 2012;344:e3037
  1. Matthew Limb
  1. 1London

The government has yet to explain clearly what “clinical senates” are for, how they will be funded, and what they will achieve, senior NHS figures told a conference.

Concerns were raised at a Westminster Health Forum seminar that the new bodies being set up in England could create another bureaucratic “talking shop” with little benefit.

David Stout, deputy chief executive of the NHS Confederation, said there had been “remarkable silence” from the Department of Health since clinical senates were first mooted.

The idea emerged in June 2011 from discussions of the NHS Future Forum, without having been mentioned in a government white paper or in the Health and Social Care Bill, he said. The forum was originally set up by the government to conduct a “listening exercise” on grievances about the bill.

“There hasn’t been a lot of clarity since [the idea of clinical senates was first put forward],” Stout told the seminar in London on 24 April.

He said clinical senates could turn out to be beneficial if they supported local commissioning groups to make “tough decisions,” helped to promote innovation and integrated care, and led to more coordination between specialist and local services.

Conversely, he suggested they could end up thwarting service changes by protecting organisational rather than patients’ interests and becoming too narrowly focused on managing the performance of clinical commissioning groups.

Stout said he still did not know how members of clinical senates would be appointed. “The jury is out on what a clinical senate is and whether it’ll be a force for good or bad,” he told the seminar.

Calls for further clarity on clinical senates came from several speakers and members of the audience, who included doctors, health managers, policy advisers, heads of charities, and organisations representing NHS staff.

Phil Gray, chief executive of the Chartered Society of Physiotherapy, said he was “confused” by the distinction between clinical senates and clinical networks.

Lesley Durham, director of the North of England Critical Care Network, said there seemed to be much overlap between the two and asked, “do we need senates?”

Kathy McLean, clinical transitions director at the Department of Health who is leading work on developing clinical senates and clinical networks, sought to provide clarity.

She said clinical senates would have a key role in giving strategic advice to statutory bodies—clinical commissioning groups and local authorities—on major service issues, including hospital and service reconfigurations by “galvanising people’s thinking across a broad area.”

“That will be one of the biggest challenges going forward,” she said. “Senates will try to provide as dispassionate, non-conflicted clinical advice as possible.”

Although their advice would be credible and respected, commissioners would not have to take it, she said, because senates would not have the right to veto commissioning group proposals.

McLean said England would ultimately have some 15 clinical senates, with members drawn from different specialties and professions who have “extensive knowledge of the local health system” and these would aim to encourage innovation and collaboration.

The senates would share administrative support with clinical networks although the latter would be focused on specific conditions, such as cancer, or groups of patients.

McLean said the department had still not been decided which geographical areas clinical senates would cover, or how much funding they would receive.

She said the NHS Commissioning Board would set an “overarching framework” within which clinical commissioning groups would have the “flexibility to build senates.”

“We’ve done a lot of planning but it still feels like there’s an awful lot to do,” she told the seminar.


Cite this as: BMJ 2012;344:e3037