Transcript NHS Surrey Downs CCG

Dr Jill Evans
Dr Simon Williams
17 May 2013
1
Today the Governing Body is asked…
…whether it wishes to go out to consultation
on the basis of the pre-consultation business
case
The final decision on consultation will be taken
by CCGs with consideration of the consultation
document and Equality Impact Assessment
2
Why do local services need to change?
• Healthcare is constantly changing, yet health services have stayed
the same
• The safety and clinical quality of services depends on the day, time
of day or night, and the hospital.
• If someone needs emergency care, it’s important the most senior,
experienced and specialist staff are on hand 24/7
• Concentrating teams of highly trained staff at fewer hospitals
makes services safer and better
• We also want to provide more services in the community
3
We want to deliver better care
We are failing to meet Royal College guidelines and London Quality
Standards.
• The most senior, experienced and specialist doctors and nurses
should be available at weekends as well as during the week
• Maternity units should have the most senior, experienced and
specialist staff available on labour wards 24 hours a day, during
the week and at weekends
• We can provide better quality care by carrying out routine
operations in separate dedicated facilities.
We could save lives by doing things differently
4
Why can’t services stay the same?
• We have considered keeping services at every site and trying to
deliver the recommended improvements across all five sites.
• There are not enough qualified, senior people in training. If these
trainees did exist, we could not afford the extra staff
• We would not be able to meet the standards of care and safety
that we want for our patients.
• We would overspend our budget to the point where our services
would reach crisis point
• We would not be able to invest as much money in services
outside hospital
5
Why do we need to centralise services?
• Advances in technology and treatments mean an increasing need
for specialist staff and equipment.
• It’s difficult for every hospital to have every type of specialist staff,
and even if they did, there would not be enough patients at each
hospital to treat to maintain their skills.
• Patients are already benefiting from centralised services for the
treatment of heart attacks, stroke, cancer and major trauma with
designated centres for each of these. Survival rates are now much
higher as a result.
6
Is this about saving money?
• We spend public money so value for money is important to us
but this isn’t what’s driving this programme.
• For us, this is an opportunity to raise standards of care for our
patients.
• Funding has not been cut but we do need to make our money
go further and respond to our population’s changing needs
• People with long-term conditions can be treated in the
community and in their own homes.
We believe creating specialist centres of
excellence will improve care
7
Where are we now?
• Surrey Downs clinicians joined the programme following
the halting of the proposed merger between Epsom Hospital
and Ashford and St Peter’s.
• The review has been clinically led by over 100 doctors,
nurses, midwives and other clinicians from Surrey Downs
and south west London who formed clinical working groups.
• Clinical working groups have made a series of
recommendations about how care should be provided,
based on best practice and the latest clinical evidence.
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The clinical recommendations
 Services remain at all five hospitals
 More and better services outside hospital
 Three expanded emergency departments
 Three expanded maternity units led by consultant obstetricians
with co-located midwifery led units
 A separate, stand-alone, midwife-led birthing unit for women
with low risk pregnancies if public support and viable
 A network of children’s services with St George’s Hospital at its
centre. This would include inpatient beds, children’s A&E and
children’s short stay units at the three hospitals with emergency
services.
 A planned care centre for all inpatient surgery, except the most
complex, on a separate site from emergency care
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What changes are being proposed?
• One major acute teaching hospital, at St George’s, providing
stroke, heart attack and major trauma services. It would also
have a A&E, obstetric-led maternity unit, specialist children’s
inpatient unit and a children’s ward
• Two major acute hospitals, at Kingston and either Croydon
or St Helier, providing emergency and urgent care and
obstetric-led maternity services with an attached midwife-led
unit. These hospitals would also have children’s inpatient
wards.
• One local hospital with a planned care centre, urgent care
centre, diagnostics, outpatients and day surgery at either
Epsom or St Helier
• One local hospital with an urgent care centre, diagnostics,
outpatients and day surgery at either St Helier, Epsom or
Croydon
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How were the options developed?
This involved a carefully structured, five-stage process:
1. Development of non-financial criteria and options
Clinicians and patient representatives were brought together to decide how each
factor should be weighted at three events. When Epsom Hospital was included, a
large-scale event was organised at Epsom racecourse to revisit the weightings
2. Financial ‘hurdle’ to rule out options that would not work financially
Financial assessment of all available options was carried out by a specialist team of
financial experts and agreed by the directors of finance
3. Non-financial assessment
Remaining options were assessed by an expert NHS panel, who worked with data
relevant to the assessment of each of the options against the non-financial criteria
4. Financial assessment
Remaining options were assessed financially by our specialist team of financial
experts and accountants and agreed by the directors of finance
5. Recommendation by the Better Services, Better Value Programme Board
Our Clinical Strategy Group and Programme Board looked at the outcomes and held
further discussions about the best way to shape services in the future
The three options
The preferred option
Rank
Preferred
Croydon
Major acute
hospital
Epsom
Local hospital
with elective
centre
Kingston
Major acute
hospital
St George's
Major acute
teaching
hospital
St Helier
Local hospital
Configuration of the preferred option
• St George’s is a major acute teaching hospital
• Kingston and Croydon are major acute hospital
• Epsom is a local hospital with a planned care centre
• St Helier is a local hospital
Rationale
• This option scored highest on the overall financial and non-financial appraisal
• This configuration where the local hospital with elective centre would be located
on the Epsom site plays to the strengths of Epsom’s existing estate and capability
by locating the elective centre there, and has a relatively low capital cost which is
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reflected in the high financial appraisal score
The alternative option
Rank
Alternative
Croydon
Major acute
hospital
Epsom
Local hospital
Kingston
Major acute
hospital
St George's
Major acute
teaching
hospital
St Helier
Local hospital
with elective
centre
Configuration of the alternative option
• St George’s is a major acute teaching hospital
• Kingston and Croydon are major acute hospitals
• St Helier is a local hospital with a planned care centre
• Epsom is a local hospital
Rationale
• This option scored lower than the preferred option and slightly higher than the least
preferred option in the overall financial and non-financial appraisal.
• Scores lower in the financial appraisal than the preferred option, as it would require a
significant additional in-area capital investment of approximately £100m which reflects
the costs of building a new elective centre at St Helier.
• However, this option faces considerably fewer delivery challenges than the least
preferred option and is therefore the next preferred option
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The least preferred option
Rank
Least
preferred
Croydon
Local hospital
Epsom
Local hospital
with elective
centre
Kingston
Major acute
hospital
St George's
Major acute
teaching
hospital
St Helier
Major acute
hospital
Configuration of the least preferred option
• St George’s is a major acute teaching hospital
• Kingston and St Helier are major acute hospitals
• Epsom is a local hospital with a planned care centre
• Croydon is a local hospital
Rationale
• This option scored lower than the preferred option and slightly higher than the
alternative option in the overall financial and non-financial appraisal
• However this option is least preferable because it has a high level of associated
delivery risks. This is primarily due to proposed changes to emergency and
maternity services in Croydon, which would result in considerable activity flows
to King’s College Hospital and the issues associated with managing this
• This option has the highest estimated capital costs for non BSBV trusts
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Development of a stand-alone midwife led unit
• Local doctors and midwives believe that a stand-alone midwife-led
unit at one of the two local hospitals would be a clinically safe
option
• This unit could support at least 1000 women to give birth per year,
depending on where it is located
• It would be for women who are suitable for a home birth and who
are at low risk of having complications during childbirth.
• It may be potentially expensive to run if not enough women were
to give birth there. First we need to work out if there is sufficient
demand to make this viable
• We want to continue explore how local people feel about the
development of a stand-alone midwife-led unit
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What could still be provided at Epsom?
Urgent Care Centre – retaining >50% of current A&E work
• Access to a range of therapeutic and diagnostic services including pathology, blood testing and X-ray
• Operating up to 24/7 based on demand
Outpatients
• Retain full range of services and greater range of providers
Community
inpatient
beds
Full suite of
rehabilitation
/ reablement
from NHS
and social
care
Epsom
could also
have
Long-term
conditions
and
support for
older
people
Links to
Community
Assessment
Unit,
virtual
wards and
other
community
hospitals
Day surgery
Enhanced Elective Centre
• Orthopaedic elective cases
• Other surgical elective cases and ITU
Diagnostics
X-ray,
ultrasound,
CT and MRI
scanning
Other
services
• Mental
health
• Community
paediatrics
• Primary care
support
Stand-alone midwife led unit
subject to demand and viability
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What would these changes mean for local people?
For all options
• It is expected that around 80% of the patient attendances would still be
at Epsom Hospital
• Epsom Hospital would become a local hospital that ensured the majority
of people could continue to access urgent care services, diagnostics,
outpatients and day surgery. However it would have an urgent care
centre instead of its current A&E and it would no longer have a full
maternity unit
• Under the preferred option, Epsom Hospital would have a planned care
centre
• The hospital would have an urgent care centre which would continue to
treat patients (including children 0-19 years) with minor injuries or
illnesses, such as broken bones, bites, infections, sprains and wounds.
• Investment in community services, and providing more healthcare closer
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to people’s homes, has already started and this will continue
Investing in Surrey hospitals
• We are committed to raising standards of care for all our patients
and our other Surrey hospitals are working to achieve this.
• Surrey providers have been asked to comment on their ability to
cope with additional activity and their ability to also raise their
standards to meet Royal College guidance.
• Surrey and Sussex Healthcare Trust, Ashford and St Peter’s and
the Royal Surrey County Hospital have confirmed they are all
working towards these standards, recruiting more staff where
necessary
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Expected impact on travel times
For all options
Affected
areas
Travel time
impact
• Between 480,000 and 570,000 residents will have a different
nearest major acute hospital than currently
• This roughly equates to 75,000 – 80,000 A&E attendances per
year going to a different hospital
• The main affected areas are around Epsom, Ewell, Banstead,
Leatherhead, Carshalton, Croydon, Purley, Wallington and
Coulsdon
• Whilst travel times to a nearest major acute will increase for
these areas, all residents in these areas should be able to
reach a major acute hospital within:
• 25 minutes by car
• 100 minutes by public transport (99% of the population
within 60 minutes)
• 20 minutes by blue-light ambulance
• There will be no change in travel times for outpatients,
primary care or day surgery and access to Urgent Care Centres
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will be the same as for A&Es currently
What if we didn’t make any changes?
• We would not be able to meet standards set by clinicians
based on Royal College and London Quality standards.
• All of our hospitals have quality issues at the moment and
some of these would not be addressed
• Local health services would not be financially sustainable
• We would not be able to invest in community services and
improve care for people with long-term conditions
• We would not be able to deliver the needed improvements
in services. The financial position would mean there would
have to be other savings which would affect the services
delivered locally
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How will we involve local people?
• A Consultation Plan has been developed and approved by the
Joint Health Overview and Scrutiny Committee, subject to some
minor comments and amendments
• Detailed individual consultation plans for each area have been
created to help us seek the views of as many people as we can
• The plan includes roadshows and meetings across the local area
and many opportunities for local people to tell us what they
think
• Where possible we are happy to attend your meetings if you
want us to
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What happens next?
• Each of the seven CCGs involved in the review are considering
the options that have been put forward and whether they
would support a move to consultation
• If each CCG agrees to consultation, a date for a 14 week
consultation will be announced
• We want as many people as possible to be aware of the
consultation and to respond
• If the proposals are agreed following public consultation, there
would be no changes to existing services until expansion work
at other hospitals is complete and following further investment
in community services
• Changes would not be implemented immediately – it would
take four to five years to develop the proposed services
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Today the Governing Body is asked…
…whether it wishes to go out to consultation
on the basis of the pre-consultation business
case
The final decision on consultation will be taken
by CCGs with consideration of the consultation
document and Equality Impact Assessment
23