Governing Body Special Meeting 20 September 2017
Purpose and introduction Dr Forbes Watson Chair NHS Dorset Clinical Commissioning Group
Clinical Services Review Phil Richardson Director of Design and Transformation NHS Dorset Clinical Commissioning Group
The Need for Change Doing nothing is not an option due to: • difficulty staffing services, particularly some services requiring consultant support 24x7 • growing elderly population with changing health needs • 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 • growing financial challenge with a projected deficit of around £158m by 2020/21
Steps to consultation Design Public Deliberations Launch Consultation Governing Body October 2014 (workshops) Governing Body June – September Need for Change (preferred options) 2017 January 2015 May and July 2016 Consultation Clinical Working Consultation feedback Groups 1 December 2016 – Additional work November 2014 28 February 2017 (13 to date) Public Engagement Throughout
Evaluation criteria
Assurance March 2015 to July 2016 • Wessex Clinical Senate March 2015 to November 2016 • Stage 1 & Stage 2 NHS England Assurance May and July 2016 • CCG Governing Body August to October 2016 • National Investment Committee July 2015 to August 2017 • Joint Health Scrutiny Committee/LA Assurance May 2016 to September 2017 • the Consultation Institute
Public consultation • Extensive pre-consultation engagement • Comprehensive public consultation 1 December 2016 to 28 Feb 2017 • c 20,000 responses in total • Wide reach across demography, geography and diversity using a range of methodologies • Followed legal requirements and national guidance, including our duty to involve • ‘best practice’ accreditation from the Consultation Institute
Additional work Four main areas of additional work • Transport – Emergency transport – Non-emergency transport • Clinical risk • Equality Impact Assessment (EIA) • Health and wellbeing
Integrated Community Services Dr Karen Kirkham Assistant Clinical Chair NHS Dorset Clinical Commissioning Group
Model of care (ICS) • Increase the number of people supported at home or in the community • Increase the range of services in the community and reduce the need to travel • Health and social care staff working in teams • Seven-day services and available longer during the day • Improved use of community hospitals as community hubs by consolidation of some and increased use of others
Integrated Community Services proposals Enable/improve integrated community services by creating 12 community hubs 7 with beds and 5 without beds
Consultation response headlines • Little disagreement with the proposal to provide care closer to people’s homes in principle across all methodologies except the open questionnaire • There were, however, many questions and significant doubts that they could be achieved in practice (resourcing, affordability and overcoming current disjoint between different services) • For the proposed locations, some areas were more controversial than others. Negative opinion was strongest where it proposed that beds or hospitals are closed
Integrated Community Services recommendations Enable/improve integrated community services by creating 12 community hubs 9 with beds and 3 without beds
Patient benefits • Reduced travel • Better access • Services closer to where people live • Less reliance on acute hospitals • More services, better joined up • Right place, right time, right person
Chief Executive: views on implementation Ron Shields Dorset HealthCare NHS Foundation Trust
Integrated Community Services Governing Body Questions
Integrated Community Services recommendations Conrad Lakeman Secretary and General Counsel NHS Dorset Clinical Commissioning Group
ICS 1 The Governing Body is requested to approve the recommendation: to commission more services closer to people’s homes delivered through integrated community teams and local community hubs to deliver better care
ICS 2 The Governing Body is requested to approve the recommendation: to commission a community hub with beds at Sherborne Hospital
ICS 3 The Governing Body is requested to approve the recommendation: to commission a community hub with beds at Blandford Hospital
ICS 4 The Governing Body is requested to approve the recommendation: to maintain a community hub with beds in Shaftesbury Hospital whilst working with the local community until a sustainable model for future services based on the health and care needs of this locality is established, possibly at a different site to the existing hospital
ICS 5 The Governing Body is requested to approve the recommendation: to commission a community hub without beds at Dorset County Hospital
ICS 6 The Governing Body is requested to approve the recommendation: to commission a community hub with beds at Bridport Hospital
ICS 7 The Governing Body is requested to approve the recommendation: to commission a community hub with beds at Weymouth Community Hospital
ICS 8 The Governing Body is requested to approve the recommendation: to maintain services including beds at Westhaven Hospital until the community hub with beds at Weymouth Hospital is established and staff and services have been appropriately transferred
ICS 9 The Governing Body is requested to approve the recommendation: to commission a community hub without beds on Portland, possibly at a different site to the existing hospital
ICS 10 The Governing Body is requested to approve the recommendation: to commission a community hub with beds at Swanage Hospital
ICS 11 The Governing Body is requested to approve the recommendation: to commission a community hub without beds at Wareham, possibly at a different site to the existing hospital
ICS 12 The Governing Body is requested to approve the recommendation: to commission a community hub with beds at Wimborne Hospital
ICS 13 The Governing Body is requested to approve the recommendation: for St Leonards Hospital to close
ICS 14 The Governing Body is requested to approve the recommendation: to commission a community hub with beds on the Major Planned Hospital site
ICS 15 The Governing Body is requested to approve the recommendation: to maintain services including beds at Alderney Hospital until alternative services have been established and staff have been appropriately transferred. At which point Alderney Hospital’s community beds will close. Mental health and dementia services will remain unchanged pending the outcome of the dementia services review
ICS 16 The Governing Body is requested to approve the recommendation: to commission a community hub without beds at Christchurch Hospital. [This will not affect the palliative care beds]
ICS 17 The Governing Body is requested to approve the recommendation: to commission a community hub with beds on the Major Emergency Hospital site
Acute services and Maternity and Paediatric services Dr Karen Kirkham Assistant Clinical Chair NHS Dorset Clinical Commissioning Group
Models of care (acute) A major emergency A major planned An emergency and hospital with 24/7 care hospital planned hospital consultant cover
Acute hospital proposals
Consultation response headlines • Majority in agreement with the vision of two specialist hospitals • NHS staff had a more favourable view with the proposals in the east and west of the county • Option B was considered more favourable than Option A (quantitative results) • In the focus groups opinion differed between groups and individuals, mainly based on geographical proximity to the proposed emergency hospital, people were pleased that Dorset County Hospital is to remain a district general hospital • Overall there were concerns about travel, congestion, transport and transfers between Poole and Bournemouth and staff retention
Acute hospital recommendations
Patient benefits • more lives saved and better outcomes • less operations cancelled • more services closer to where people live • over £100m investment in state-of-the- art facilities including a new maternity unit • Information will follow the patient • Centre of excellence
Maternity and paediatric options OPTION A OPTION B Consultant-led services at the major emergency hospital A single specialist centre that covers the whole of Dorset, in the east of Dorset. Plus an integrated service across which would need to be based at the major emergency Dorset County Hospital and Yeovil District Hospital. hospital. +
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