Transcript Document

Northern Lincolnshire
Healthy Lives Healthy Futures Programme
Equalities Focus Group Presentation
May 2014
What is Healthy Lives, Healthy Futures?
Healthy Lives, Healthy Futures is a review of all health and care
services in the North and North East Lincolnshire. The review
aims to make sure the services available to people in our area
will be safe and of high quality for years to come.
The case for change
The current health system is
not sustainable
• Quality is not always where it should be
• There are significant cost constraints
• Demand from our population is rising
The health system will need
to change across providers
• Work needs to be done to understand how services can
be delivered differently
There are many other areas
in the same situation as
Northern Lincolnshire
• The case for change parallels the
national case for change and ‘Call
to Action’
The Shared Vision – A Shift to the Left…
Self care &
independent
living
Home
care
Community
based
care
Local
services
Centralised care
Comprehensive Healthcare providers should provide a comprehensive service, from supporting prevention
and self-care, through community provision, to specialist and tertiary care.
Integrated
Higher quality
Affordable
Providers of these services should take an integrated approach, so that local people have
access to a seamless service
The result will be higher-quality care, with more lives saved and more people returned to full
health
A further result will be a service that is affordable in the years to come
Our Key Messages
Engagement Feedback Summary
Key survey feedback
Based on 308 responses
Engagement Feedback Summary
Key themes from open ended responses
“Sometimes
follow up
appointments
could be dealt
with by GP and
only referred
back to if
preferred”
“[Travel distance] is also important, particularly that
relatives are able to visit where people have long term or
life threatening conditions or in general to aid recovery.
This is more difficult if people are having to travel longer
distances”
“As well as attracting staff to
the area need to develop
'grow own' community/ young
people to be able to work
locally. This means working
with schools/ education
establishments to ensure
children/young people are
supported with the right
education input to work in
some of the careers needed
longer term”
“Continuity is
essential if you want
people to trust
services, particularly
for the elderly”
“Appointments
should be made to
allow consultants to
see patients on the
specified time. It is
common to run 1.5
to 2 hours late and
more”
How are we acting on the engagement feedback?
Here are some responses to public feedback/demand we are making the following changes /
enhancements to the programme
Introduced an additional
element to the commissioner
vision to separate out self-care
from the home care work.
More initiatives being added
and implemented in that area
Set up an integrated transportation group
to work on transportation solutions
7 day working pilot about to commence in
North East Lincolnshire – to extend
community and GP care provision
Plans in place to involve a much wider group
of clinicians to understand the impact on
services of any proposed changes
Technological solutions being
planned to support home and
community based care
provision
Equalities Focus Group Recommendations
3 areas considered by the programme board:
– Hyper-acute Stroke Services
– ENT Inpatient Surgery
– Children’s Surgery
Review of the options appraisals has resulted in
recommendations for each; either:
– Consultation (Stroke, ENT)
– Further options development (Children’s surgery)
We are asking you to review the options for each service and decide whether there
are any negative impacts on any equality groups?
4 Options considered: Stroke
Reviewed the options appraisal for the following options, and scored
against the evaluation criteria:
1. De-centralise the service
2. Remain at SGH
3. Move to DPOW
4. Move off patch to nearest specialist centre
Quality
Access
Affordability
Deliverability
Total
Option 1
52
60
14
24
150
Option 2
164
41
46
80
331
Option 3
146
41
14
32
233
Option 4
101
19
11
32
163
Rationale for scoring
Returning the service to operate on both sites goes against national recommendations for
more centralised specialist services for hyper-acute care. Also it was deemed that this
would not address the serious quality issues that had been raised by the Keogh team and
the local service reviews, which would result in a poor peer review, and have a detrimental
impact on mortality and morbidity for local stroke patients.
It is demonstrated through the temporary location of the service on the SGH site that the
quality of care is improved by centralisation onto one site, and the introduction of a 24/7
hyper-acute stroke service. It was recognised that the service could be delivered on either
site, however SGH scored highest from a quality perspective due to the fact that the service
is established with a fully trained staff, and the required infrastructure is already in place.
DPOW does not have a spare CT scanner, which could present a risk if the current one is not
available for any reason, and there is no clinically appropriate space on the DPOW site in
close proximity from the A&E department.
Moving the service to Hull (or another tertiary centre) was deemed less attractive to the
programme board due to the additional travel time, and the fact that capacity at the
specialist centres may not easily be identified.
4 Options considered: ENT
Reviewed the options appraisal for the following options, and scored
against the evaluation criteria:
1. Do nothing
2. Centralise on DPOW site
3. Centralise on SGH site
4. Move off patch to nearest specialist centre
Quality
Access
Affordability
Deliverability
Total
Option 1
62
76
40
56
234
Option 2
133
68
32
64
297
Option 3
133
61
24
56
274
Option 4
115
44
16
56
231
Rationale for scoring
Clinicians have raised concerns over the volumes for surgery, so the programme
board deemed that “do nothing” was not an acceptable option.
Centralisation at DPOW and SGH scored equally from a quality perspective,
assuming that the same level of care could be delivered on each site through
effective care pathways and processes. DPOW scored slightly higher as there is
more available theatre capacity and greater staffing complement, meaning
recruitment/retention may be more achievable than SGH. In addition there are
outlying clinics in Mablethorpe and Louth that would be impacted negatively by a
move to SGH, these patients are unlikely to travel to SGH. With IFR procedures
removed, (tonsillectomy, grommets, sleep apneoa), the numbers are still
significantly greater at DPOW.
Locating the service at a specialist centre was deemed favourable from a clinical
quality perspective, however it would require all patients to travel further, and
the receiving trust would need to identify significant capacity which could be
costly.
4 Options considered: Children’s
These options were proposed by NLaG and considered using their
business case, and a brief options appraisal paper:
1. Do nothing
2. Rotate consultants locally between sites
3. Rotational training programme with tertiary centre
4. Move off patch to nearest specialist centre
Quality
Access
Affordability
Deliverability
Total
Option 1
72
36
40
48
196
Option 2
45
24
16
16
101
Option 3
118
36
16
40
210
Option 4
145
24
24
72
265
Rationale for scoring
Clinicians have raised concerns over the volumes for surgery, so the programme
board deemed that “do nothing” was not an acceptable option.
The options were scored by the programme board, however it was queried why a
local centralisation option was not included in the paper. It was clearly recognised
that there would be safety improvements through centralising with a tertiary
provider, however the travel distance and non-elective attendances at local A&E
departments may be disadvantaged by not having local expertise on site.
Options 1 and 2 were felt to score too poorly to pursue. The programme board
requested more work on the options appraisal for options 3 and 4, to include
centralisation at DPOW or SGH as options 5 and 6. It was suggested that a further
period of engagement on this could mean that (with this scale of change) there
would not need to be a formal consultation in the future. The further engagement
would take place alongside the formal consultation from June 2014, and therefore
implementation of changes may not be delayed.
Programme Timeline
2013
Sept
Today
2014
Oct
Nov
Dec
Jan
Mar
Apr May June Jul
Engagement
Engagement
Zerobased
Zero-based
commissioner
commissio
s solution
ners
solution
ProviderProvider-led
led
solution
solution
Feb
Refine high
level themes /
service models
for public
engagement
Aug-Oct
Public consultation
Option refinement &
assessment
Work to assess/incorporate
outputs of consultation
Consultation preparation
Implementation beginning
October 2014
Implementation of safety & quality imperatives, and those elements not requiring consultation
Key
stakeholder
1-to-1s
Stakeholder
summit
Engagement
&
communication
activities
Key
stakeholder
1-to-1s
Contact details
Telephone: 0800 9155397
Email: [email protected]
Write to us at:
Freepost RTEX-GXUJ-BGTB
Healthy Lives, Healthy Futures
PO Box 683
HULL
HU10 6DT
Why not visit our website at www.healthyliveshealthyfutures.nhs.uk
Or follow us on Twitter at www.twitter.com/hlhf_nhs