Stroke Services Review Appendix Wii Deliverability Panel 4 th September Maidstone Site Options (B & C)
Contents • Executive Summary • Introduction to MTW and its Stroke Services • Timescales for Delivery (plans) • Overview of workstream activities: – Estates and Equipment – Workforce – Operational Readiness – Comms and Engagement • Performance, Patient Flow and Bed Availability • Confidence in Delivery • Risks and Interdependencies
Executive Summary
Executive Summary • MTW is fully supportive of improving Stroke services in Kent and regards its strong Stroke teams as pivotal in this process • The Trust has a clear track record and recognised approach for successfully delivering sizeable service reconfigurations and accompanying capital projects • MTW can confidently deliver the following relatively low risk solutions: – Option B by Oct 19 with £6.253m (Refurb and Office Build) – Option C by Jun 19 with £2.166m (Refurb) • The current substantive workforce will largely cover safe staffing levels in Options C, D & E • Option B will require a larger expansion of nursing staff as well as medical staff. However, the Trust is confident it can reach safe staffing levels to coincide with the refurbed ward being available. The Maidstone site easier to recruit to
Executive Summary • Work around Acute Medicine, Ambulatory and Frailty pathways and Discharge processes are seeing real progress at the Maidstone site. This work has released sufficient beds for both options whilst maintaining escalation capacity • Further improvements are anticipated in these areas, minimising still further the risk to the site of hosting a large HASU/ASU • Maidstone hospital is a medically focused hospital, skilled at managing medically sick patients and able to accommodate an increase in higher acuity patients. Its trauma unit’s and is staffed similarly Medical take is equivalent in size to the • With vacant, serviceable accommodation the site could treat additional Stroke patients faster should services elsewhere become unsustainable during the transition period
Introduction
MTW providing care for Kent and Sussex • Sustainable, integrated modern services at two well-established district hospitals in West Kent • High levels of sub-specialisation • Third largest Oncology Centre in the country, serving 1.8 million people in Kent, Medway & East Sussex • Largest specialised eye unit in the South-East of England, serving one million people • Stable platform to improve patient care across Kent & East Sussex with a track record of delivering quality, safety and efficiency
MTW’s big commitment to care Catchment and T urnover for Kent Acute T rusts: Medway: Population 405,000 Maidstone Budget £270m Dartford: Population 340,000 Budget £250m TWH MTW: Population of 560,000 rising to 1m for eye care and 1.8m for cancer care Budget £450m East Kent: Population 695,000 Budget £560m Key: Red dots show A&Es Grey dots are sites without a front door
MTW’s Support for Stroke Review • Trust is fully supportive of case for change • Started looking to consolidate West Kent’s Stroke Services in 2014 • Have made significant improvement in its delivery of Stroke Services in recent years • Can build upon these achievements by consolidating the two strong Stroke teams at MTW • Strong basis on which to help improve Stroke Services across Kent and Medway • Clinical, Operational, Estates and HR colleagues at the Trust are fully engaged in the Stroke Review process and are focused on maximising its benefits
Stroke - Local Trust results in the National Audit of Performance Latest published quarterly SSNAP performance results Dec- Mar 2018
Timescales for Delivery Implementation Plans
Implementation Plan Key Activities – Option B Mar ‘ 20 Sept ‘1 8 Dec‘ 18 Jun ‘19 Sep‘19 De c‘ 19 Mar’19 Go Live Preferred Option Decision Estates & Equipment Ward ready end Oct De-escalation end Apr (2018 Mar) Gym Re- Planning New Office Build, Ward Refurb and Resus location Workforce Initial Recruitment Formal Confirm Staff Structures and Engage Drive & Identify Consultation Bank Provision agencies Transfers (1:1s) with Staff (TBC) Ongoing Recruitment Efforts Operational Readiness Detailed Operational Clinical Readiness incl. Staff Service Checks & implementation Policies & Support Services (internal and Familiari Benefits Tracking plans Procedures external) sation Corporate Readiness (incl Facilities & Finance) and System Site Amendments Readiness Comms and Engagement Staff Planning Ongoing drop in Transition Updates (internal R eadiness Sessions sessions/ 1:1s & externa) Comms System Planning Sessions with key external System Implementation with key external stakeholders (incl patients) stakeholders (inc. patients)
Implementation Plan Key Activities* – Option C Mar ‘ 20 Sept ‘1 8 Dec‘ 18 Jun ‘19 Sep‘19 De c‘ 19 Mar’19 Go Live Preferred Option Decision Estates & Equipment De-escalation end Apr (2018 Mar) Ward Refurb Workforce Ward ready end Jun Initial Recruitment Formal Confirm Staff Drive & Identify Consultation Structures and Transfers (1:1s) with Staff (TBC) Bank/Agencies Ongoing Recruitment Efforts Operational Readiness Detailed Corporate Readiness (incl Facilities & implementation Finance) and System Site plans Amendments Readiness Operational Clinical Readiness incl. Staff Service Checks & Policies & Support Services (internal and Familiari Benefits Tracking Procedures external) sation Comms and Engagement Staff Planning Ongoing drop in Transition Comms Sessions sessions/ 1:1s (int & ext) System Planning System Implementation (incl patients) key external stakeholders
Overview of Workstream Activities 1. Estates & Equipment (Framework section – Timescales for implementation)
Estate Solution Option B 1. Refurbishment of two co-located existing wards with some internal redesign (A). T o include; a) 38 bed HASU/ASU b) 9 Rehab c) New therapy gym d) Mix of 6 bed bays (existing) 4 bed bays (new) and single rooms (new) 2. Provision for 1no. new A&E majors cubicle. 3. New build for clinical offices (B).
Phase 1 Estates Option B (Ward) Capital reqt – £6,253,000 (see appendix for breakdown) Works required; Phase 1 1. Removal of escalation beds 2. Light Refurb to ward 3. Heavy refurb to convert 2no. Bays to HASU. 4. Design and new staff base 5. Refurb to create TIA clinic Phase 2 • Relocate existing offices/Drs Mess Phase 2 • New Therapy Gym • Refurb offices For thresholds please see appendix
Estate Solution Option C 1. Refurbishment of existing Stroke ward with expansion into a co-located ward (A).
Estates Option C (Ward) Capital Reqt - £2,166,000 (see appendix for breakdown) Works required; • Existing Stroke Ward • Refurb of co-located ward to provide the additional beds For thresholds please see appendix
Timescales for implementation Qu. Is planning permission required and, if so, your assessment of the likely time this will take? Outline of discussions to date with planning departments. • Planning permission is needed for new office build (Option B). Previous similar requests have been processed within the 12 week timeframe Qu. Confirmation of current status of estates plans i.e. architectural drawings and level of clinical engagement. • Estates solutions are progressed as shown and have had full clinical engagement Other points to note: • De-escalation of winter ward is required to enable refurb works to commence. De-escalated March 2018 (Options B & C) • MTW will work with neighbouring Trusts to maintain safe services during the transition phase. Should an earlier transition of patients to a future HASU/ASU at Maidstone be required, this could be accommodated to ensure patient safety due to vacant accommodation • See Appendix for equipment details
Overview of Workstream Activities 2. Workforce (Framework section - Understanding Capacity)
Maidstone’s Stroke Workforce • Maidstone's Stroke team has worked hard to improve its Stroke services. It was an A rated SSN AP service until recently, missing out by only 1 point. It also scores consistently well on Friends and Family assessments. • Highly committed individuals work well in strong multi disciplinary teams including Orthoptists, as recommended by Royal College guidelines • Frequently more than 50% of the Stroke clinical workforces in MNWK are from MTW • Based on staff feedback to date, they are much more likely to move within rather than between Trusts Trust Maidstone & Tunbridge Medway NHS Foundation Dartford & Gravesham NHS Wells NHS Trust Trust Trust Nursing Registered 27.40 11.6 12.75 Nursing Unregistered 33.05 13.12 17.51 Physiotherapist 9.35 1.6* 1.9 Occupational Therapist 7.37 1* 2 S< Therapist 4.00 0.6* 2.3 Dietitian 0.50 0.2 0.5 Consultants 3.00 2.5 1.6 Staff Grades 4.00 1 0 Specialty Registrar 0.00 0.38 0 SHO, F2 & F1 7.00 3 0 *Staff supplied by Medway Community Health
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