Dorset CCG Clinical Services Review

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1 Dorset CCG Clinical Services Review PUBLIC INFORMATION EVENT FEBRUARY 2015

2 Why are we doing a Clinical Services Review in Dorset? NHS Dorset Clinical Commissioning Group (CCG) wants to ensure that everybody in Dorset has access to healthcare that is: SAFE HIGH QUALITY SUSTAINABLE 2

3 How is the review being delivered? Four stage review process Review Analyse Design Formal public consultation CCG Decision Making Implementation October 2014 Spring 2015 Summer 2015 Autumn 2015 Autumn We are currently in Stage 1 and we are discussing potential designs for new ways of delivering care to meet changing needs. No decisions have yet been made and won t be until the autumn. 3

4 Stage 1: Review, analyse and design stage (Oct 2014 Spring 2015) What are people s needs? How are services currently provided? What services can best meet people s needs, and what is the best way of delivering them? What are the potential options we have for organising the delivery of services? (eg what range of services could we have and where could they be located?) What are the potential organisational arrangements to deliver the services? Develop future options & a preconsultation business case to assist the CCG in its decisionmaking about what options to consult on Engage stakeholders 4

5 Who is involved in the review? Dorset s clinicians Public, patients and carers GPs and primary care teams NHS staff: Dorset CCG, acute hospitals, community health services and ambulance service Other stakeholders across Dorset including local authorities, NHS England, Health & Wellbeing Boards, MPs, councillors, voluntary organisations 5

6 Stage 1: Completed activity Gathering data and evidence to explain why there is a need to change Dorset s health services Identifying what good care and treatment looks like (based on national and international evidence, and patient feedback and insight) Core principles and themes informing the way we could deliver care Key enablers in delivering the emerging models of care 6

7 The need to change in Dorset 1 Growing elderly population with changing health needs Dorset CCG Clinical Services Review Case for change supporting materials Variable quality of out of hospital care with patients reporting difficulty accessing care Variable quality of hospital based care, particularly for some more specialist services Difficulty staffing services, particularly some specialist services requiring consultants on site 24x7 Growing financial challenge with a projected deficit of around 200 million each year by 2020/21 8 th December 7

8 Clinicians have set out what good health care for Dorset looks like in key service areas a snapshot of some of the content Encourage patient self-management Rapid review by specialist One team working for the patient 24/7 services More people supported at home Multi-disciplinary teams 8

9 Summary of core principles and themes clinicians have said should inform the way we deliver care Greater focus on prevention and early targeting More clinical management of patients in the community Collaborative working across primary, secondary and social care More and better use of multi-disciplinary teams 24/7 services where required Meeting national quality guidance on specialist services More effective senior level assessment and signposting to services ensuring patients are seen by the right person in the right place at the right time. 9

10 Key enablers clinicians have highlighted for effectively delivering care Integrated information systems Effective contracts, regulation and tariffs (pricing) to align incentives across the NHS system Transparent systems to monitor and support clinical teams in the delivery of care Better structures for segmenting and delivering the population s need for health services based on their risk factors (risk stratification) Patient education and information sharing 10

11 Stage 1 of the review: Current and ongoing activity Summary of emerging models for delivering out of acute hospital care Developing potential options for out of acute hospital models of care across Dorset Summary of emerging models for delivering acute hospital care Developing potential options for acute hospital based services across Dorset 11

12 Out of acute hospital care for Dorset 12

13 Summary of emerging models for out of acute hospital care long term conditions and frail elderly Increased focus on prevention of ill health, including mental health Different potential models (such as single site community facility, hub and spoke, network etc.) in recognition that one size does not fit all Better integration of intermediate care teams with other parts of the health system across Dorset Alignment across providers, to provide continuity and a seamless service that meets the holistic health and social needs of patients and their carers Segmentation of patients based on need / dependency / risk to enable care to be more tailored and holistic. 13

14 Summary of emerging models for out of acute hospital care maternity and children s services Move to multi-disciplinary teams for antenatal care and children s care (GPs, midwives, health visitors, social care teams) making better use of children s centres, schools and community centres/hubs, with a focus on mental health and the most vulnerable women and children Single maternity clinical network /service for Dorset with clinicians and midwives providing women with a single point of access for labour and out of hours questions High quality, consistent post natal care, integrated with primary care, health visitor and healthy child programmes Single urgent paediatric network/service for children across Dorset with a dedicated 111 number and integrated multi-disciplinary teams working in the community and in hospitals, including a specialist children s GP or paediatrican. 14

15 Summary of emerging models for out of acute hospital care planned and specialist More resource focussed on prevention and self-care Community/local assessment centres to include outpatients, diagnostics, rehabilitation and planned care in the community with use of multi-disciplinary teams enabling a holistic physical and mental healthcare approach with improved links and working between different providers of care Third sector / social care / mental and physical health base co-located at community centres Use of community settings for low risk surgical (including general anaesthetic) and medical interventional procedures 15

16 Summary of emerging models for out of acute hospital care urgent and emergency Development of services to facilitate easier access to diagnostics and urgent care 7 days a week, including better use of community facilities with support from multi-disciplinary teams, including mental health professionals Movement towards 7 day services in primary care will require scale / different ways of working (e.g., network of GPs) which could also lead to other benefits such as having consultant visits or acting as Minor Injury Units Potential to separate planned and urgent primary care 16

17 Example of out of acute hospital models of care 17

18 An example of potential settings of care for activity in the future views of planned and specialist CWG % of current activity by setting Outpatients Intervention under general anaesthesia Intervention under local anaesthesia Rehabilitation Requires co-location with intense support services 5-10% 20% of which the most complex should be on a hyper-acute site 10% 8-15% Could be done in a stand-alone elective centre 20% 70% 10% 0-2% Could be done in a community setting 70-75% 10% 80% 85-90% Source: Planned and specialist care working group, 21 st January,

19 Acute hospital care for Dorset 19

20 Summary of emerging model for acute hospital care long term conditions and frail elderly Good links between specialists and local GPs and other clinical teams, with specialist skills shared across the system, ready access to specialist opinion and with some specialists based in the community offering hospital in-reach Holistic care for patients with integrated care for people with multiple conditions and including attention to psychological needs Focus on making in-hours care as good as possible and providing continuity out-of-hours. 20

21 Summary of emerging model for acute hospital care maternity and children s services Networked model of maternity care across Dorset with one or two facilities able to provide 24x7 consultant presence on labour ward Development of midwife led units alongside all obstetric units Single triage labour telephone line/single telephone line 24x7 consultant presence in any inpatient children s unit and be able to support an appropriately staffed children s high dependency unit; children s surgery and children s emergency care on one site Same-day rapid access children s clinics to reduce admissions to hospital, with rapid access to consultant advice Neonatal care and mental health services aligned with obstetric care 21

22 Summary of emerging model for acute hospital care planned and specialist One Dorset system for pathology, radiology, and picture archiving and communications system (PACS) Services designed and delivered to meet the needs of patients with physical and mental health problems One or two dedicated elective centres for high volume, low/medium-risk planned surgery and procedures Lower volume specialities may choose to locate in one site only One Dorset centre for complex low volume, high risk, planned procedures, appropriate to each speciality and patient risk 22

23 Summary of emerging model for acute hospital care urgent and emergency Single centre to provide 24x7 consultant delivered emergency care and hyper-acute (very specialist) services Provision of emergency services at one or more other sites in Dorset Networked model for urgent and emergency care with consultants working across multiple sites, recognising that mental health needs to be included in any service re-design Hub and spoke model so patients that have required urgent and emergency care can be quickly repatriated back closer to home Supported by community hospitals with bed base for hour assessment and urgent care. 23

24 Indicative interdependencies between acute hospital services: these services need to be able to work closely together Full service 24x7 consultant delivered A&E High risk obstetrics Emergency surgery Critical care More complex specialist elective surgery Interventional radiology 24

25 Different types of hospital based service models Green hospital services Yellow hospital services Purple hospital services Hospital with an A&E/ urgent/emergency/minor Injury Unit department with consultant presence Able to admit patients for acute assessment and treatment Level 3 critical care High risk obstetrics 24x7 Inpatient paediatrics 24x7 Consultant delivered hyperacute & specialist services 24x7 Complex low volume elective care Outpatient services Full range of diagnostic support including interventional radiology 24x7 Hospital with an A&E/ urgent/emergency/minor Injury Unit department with consultant presence Able to admit patients for acute assessment and treatment Critical care Consultant delivered service for some/most of the day but not necessarily 24x7 Outpatient services Full range of diagnostic support Maternity & Paediatrics Clinical Workng Group: Could include obstetric unit need to consider a range of models with appropriate consultant cover alongside midwifery (and SCBU/neo natal support) Could include paediatric services might be paediatric assessment unit or inpatient paediatrics Will need anaesthetic cover Elective paediatrics should be colocated with emergency services 25 Hospital with an urgent/emergency/minor Injury Unit department Able to admit patients for acute assessment and treatment Outpatient services Diagnostic support Maternity & Paediatrics Clinical Working Group: Potential to provide assessment for children possibly 16 hour unit Will need mental health services Consider midwife led unit Potential to be a community hub for midwife, health visitors, GP, paediatric teams, secondary acute and community and mental health etc PLUS Elective paediatric Mental services health services should be colocated with Routine emergency Elective Services services Primary care, community care services, social care services

26 Dorset s existing acute hospital provision Delivering three variations of the yellow hospital based service model No hospitals in Dorset currently have 24/7 consultant delivered on site services across the range of key specialties where national quality standards identify this as important for best outcomes. 26

27 Process for narrowing down long list of potential acute hospital based service options for Dorset MODELS OF CARE Approx. number of site specific options Consideration of high level questions LONG LIST of potential options ~60-70 High level assessment using evaluation criteria MEDIUM LIST of potential options ~20-30 Full assessment using evaluation criteria SHORT LIST of potential options ~6 Final selection of potential options for PUBLIC CONSULTATION 27?

28 Evaluation criteria to assess potential options 1 Criteria 1 Quality of care for all Sub-criteria Clinical effectiveness Patient and carer experience Safety Description Improved delivery against clinical and constitutional standards, access to skilled staff and specialist equipment, comparison of current clinical quality of sites Improved patient and carer experience (overall holistic/personalised care, respect and involvement in decisions and consistency) with excellent communication and improved estate Expected impact on excess mortality, serious untoward incidents 2 Access to care for all Distance and time to access services Service operating hours Patient choice Impact on population weighted average travel times (blue light, off-peak car, peak car, public transport) to reflect average impact for emergency and elective treatment and total impact for more isolated and/ or rural populations Ability of model to facilitate 7 day working and improved access to care out of hours No. of sites delivering emergency, obstetrics, elective, outpatients, diagnostics; no. of Trusts with major hospital sites 3 Affordability and value for money Capital cost to the system Transition costs Net present value Meet license conditions Capital requirement to achieve required capacity & quality One off costs (excl. capital & receipts) to implement changes Total value of each potential option incorporating future capital and revenue/cost implications and compared on like-for-like basis Meets regulatory requirements e.g. surpluses generated by each Foundation Trust 4 Workforce Scale of impact Sustainability Loss of Dorset workforce Potential impact on current staff and retraining required Likelihood to be sustainable from a workforce perspective, facilitating 7 day working and taking into account recruitment challenges and change in what work force does i.e. ability to ensure sufficient people with the right skills in the right places? Potential impact on staff attrition due to change 5 6 Deliverability Other (e.g., research and education) Expected time to deliver Co-dependencies with other strategies Disruption to education & research Support current & future education & research delivery Ease of delivering change within 3-5 years Alignment with other strategic changes (e.g. Better Together, national and local NHS strategies) and provides a flexible platform for the future Disruption to Research and Education Support for current and developing research and education delivery e.g. meeting college standards of training individuals and service specifications 28 Note: Health impact assessment will need to be conducted separately and will evaluate impact on deprivation and health inequalities

29 High level questions 1 Quality of care for all Do any of the potential options fail to support the delivery of high quality care in line with standards for high quality services/best practice care pathways, or in line with specific criteria referred to? 2 Access to care for all Do any of the potential options have an excessive impact on travel times? Affordability and value for money Workforce Deliverability Are any of the potential options likely to be highly unaffordable for example will they require a considerable amount of capital expenditure for minimal positive impact on running costs? Are any of the options likely to not be deliverable and/or sustainable from a workforce perspective? Are any of the potential options not deliverable within a reasonable time frame? E.g. within next 5-10 years? 6 Other (e.g., research and education) Are there other factors which would justify removing any potential options at this stage? 29

30 Applying models across Dorset produces many different potential hospital based options? PLUS Mental health services Elective Services Primary care, community care services, social care services 30

31 An initial assessment of acute hospital service options against the high level questions to identify medium list 6 Hospital based service potential option 9 These options have passed the high level questions and are being analysed against the status quo New build green No site specific decisions have been decided. 31

32 Next steps On-going analysis of the medium list of potential hospital-based options On-going discussion and debate to describe the out-of-acute-hospital models of care Assessment of the medium list of potential hospital-based options using the evaluation criteria Conduct analysis to understand the impact of out of acute hospital models of care on acute hospital potential options CCG to make decision on potential options to take to consultation Run public consultation in summer 2015 to get people s views about the potential options CCG to decide what changes to commission in autumn 2015 Implementation of any agreed changes from autumn

33 Overview of engagement 33

34 What local people had already told Information and Communication Consultation Participation Pre Oct 2014 October 2014 Spring 2015 Summer 2015 Autumn Local needs & views Review, analyse and design Public consultation Implementation 34

35 Public engagement update Feb 2015 Public Information Events Feedback database Patient, Carer and Public Engagement Group Equality & Diversity Forum Diverse communities/groups Dorset Learning Disabilities Health Action Group Young People (including young carers) Working well (including NHS Staff) Dorset Connecting Advice in Dorset (CAID) 35

36 Public consultation Summer 2015 Public consultation 36

37 Consultation objectives Representation Access Experience Timing Working together Funding Feedback Local and national view 37

38 Public consultation Summer 2015 Public consultation How would you like to have your say? 38

39 Comfort Break 39

40 Question & Answer Session 40

41 Keep involved Keep informed about the review by joining the Health Involvement Network To join please: Visit: Ring:

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