Clinical Senates

Continuously improving the quality of care we give patients and improving the outcomes of their treatment is the core purpose of the new NHS commissioning system. Clinical Commissioning Groups (CCGs) and the NHS Commissioning Board (NHS CB) will use the interactions they have with providers (such as hospitals) and the clinical expertise offered by new organisations in the system to drive these improvements.

The NHS Future Forum found that there was universal support for multi-professional clinical leadership in the NHS and recommended the creation of multi-specialty Clinical Senates to provide strategic, independent advice and leadership support to the commissioning and provision of healthcare designed to best meet the needs of patients.

Following contributions from the clinical community through the NHS Future Forum, and other interactions with stakeholders, the NHS CB has decided that Clinical Senates should be created across the country. The need for Clinical Senates was re- emphasised in the 2012-13 NHS Operating Framework.

Clinical Senates will bring together a range of professionals to take an overview of health and healthcare for local populations and provide a source of strategic, independent advice and leadership on how services should be designed to provide the best overall care and outcomes for patients. Clinical Senates will draw on a variety of health and wider care perspectives, including those of professionals who sometimes go unheard. To support the better integration of services, they will include public health specialists and adult and children’s social care experts.

For details of activities for the Wessex Clinical Senate can be found at

The purpose of Clinical Senates in the new health system

The new commissioning system is designed to give clinicians the best opportunities to plan and pay for the most appropriate and effective health services for their local populations. This local focus, supported by an NHS structure that has clinicians at every level, aims to improve the health outcomes

that matter most to patients. Clinical Senates will be established across the country from April 2013 to play a unique role in the commissioning system by providing strategic clinical advice and leadership across a broad geographical area to CCGs, HWBs and the NHS CB.

Clinical Senates will not be focused on a particular condition. Instead they will take a broader, strategic view on the totality of healthcare within a particular geographical area, for example providing a strategic overview of major service change. They will be non-statutory advisory bodies with no executive authority or legal obligations and therefore they will need to work collaboratively with commissioning organisations.

The core group - the Senate Council

In order to maximise flexibility and utility, Clinical Senates should be composed of a core ‘steering’ group of members who will form the Senate Council. This group should receive objective data and information, and also views and opinions from a broad range of experts and others invited to give evidence to the Senate as the need arises (the ‘Assembly’ of the Clinical Senate). The core members should have wisdom and judgement, and be led by a Chair who is an experienced and credible clinician and who will be retained by the NHS CB on a part time or sessional basis.

Alongside the Chair, the Council should comprise standing members from:

  • CCGs
  • multi-professional clinicians from community, primary, secondary and tertiary care organisations
  • the NHS CB local area teams; with input from the appropriate regional team as necessary
  • public health
  • social care
  • public and patient groups
  • network clinical directors
  • a senior manager from the corresponding network support team.

Local geography and other organisations

The new system is designed to improve local accountability in delivering high quality NHS care. The NHS CB has divided England into 12 areas, broadly based around major patient flows into specialist or tertiary centres. The footprint of each area maps onto CCG and local authority boundaries. There will be one Clinical Senate for each geographical area.

The 12 geographical areas are illustrated on the map below:

Each area will contain a number of different bodies alongside Clinical Senates, including clinical networks and Academic Health Science Networks. The work of these bodies will support and encourage the improvement of local health services.

There are a number of important features that distinguish Clinical Senates from other bodies in the new health system: they cover a larger geographical area than many other bodies

  • they will not focus on a specific condition and will take a broader, more strategic view on the totality of healthcare than clinical networks (of all types)
  • they have a more clinical focus than Health and Wellbeing Boards or Health Overview and Scrutiny Committees.

The Senate Assembly

The Assembly of the Clinical Senate will provide access to a broad range of experts, invited through the Chair as required. These should encompass a wide range of clinical professions, the ‘birth to death’ spectrum of NHS care, and the five domains of the NHS Outcomes Framework. We do not specify a minimum or maximum number of members as this will inevitably vary. The Clinical Senate Assembly could potentially be very large but this will be left to local determination.

Whilst it is important that there should be broad representation of provider and commissioner organisations within a Clinical Senate, members should attempt to decouple their institutional obligations from their advisory role. Members may also be members of professional bodies, trade unions, the third sector or other NHS Bodies such as PHE or HEE. Objectivity and lack of bias will be essential to the credibility of Clinical Senates. Members’ conflicts of interest should be declared in a transparent way.

The process of appointment for all members must be fair and transparent. It will be overseen by the NHS CB Regional Medical and Nursing Directors and led by the nominated Area Team Medical Directors. Once they themselves have been appointed, the Chairs of Clinical Senates should be involved in the appointments process.

Further information is available from the guidance notes published by the NHS Commissioning Board

Membership of Clinical Senates

The composition of individual Clinical Senate membership will be for local determination within the principles set out in this document. The effectiveness, credibility and collaborative ability of the members of a Clinical Senate will be key to its success. CCGs, the local area teams of the NHS CB and the providers of NHS services within the geographical area will be key stakeholders of the Clinical Senate.

Membership should be multi-professional and span a variety of different provider and commissioning organisations. However, membership is not intended to be representative. Members should possess appropriate experience, be held in high regard in their respective fields, and have proven evidence of strategic abilities. The guiding principle must be to engage patients and the public in all the Clinical

Senate’s work. The NHS CB is developing a universal approach to ensure that public and patient involvement is meaningful and effective.