Stroke Services Review Appendix Wiii Deliverability Panel th 4 September Tunbridge Wells Site Options (D & E)
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 • The estates solution required for Options D & E predominately consists of a new ward but requires the relocation of the education centre outside of the main hospital on a car park area, which will also need to be re-provided • The new 32 bed ward would be available March 2021 at the cost of 16.826m • The current substantive workforce will largely cover safe staffing levels in Options D & E. With the time required for the Estates solution we will have the opportunity to recruit to the ideal establishment. • Work around Acute Medicine, Ambulatory and Frailty pathways and Discharge processes are having a positive effect at the Tunbridge Wells. The improvements are allowing the Trust to cope with a noticeable uplift in demand. • Rolling out the solutions after the Maidstone site, it is possible to see the potential for further gains with time. • These improvements together with the new 32 bed ward at the site should allow: – Access to the HASU beds when required – Ability to maintain patient flow and current hospital performance
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 Turnover for Kent Acute Trusts: 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 Review • Trust is fully supportive of case for change • Started looking to consolidate its 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* – Options D & E Sept ‘18 Mar‘19 Mar’20 Sep‘20 Mar’21 Sep‘21 Sept’19 Preferred Option Decision Go Live Estates & Equipment Ward ready March 2021 New Car Park Education Centre Build & Resus New Ward Detailed implementation plans Operational Policies Service Checks & & Procedures involving key stakeholders Benefits Tracking Feb’21 Mar’21 Sept ‘20 Oct‘20 Dec’20 Jan’21 Nov’20 Workforce Staff Structures and Identify Transfers Formal Consultation (TBC) Engage agencies Bank Provision (1:1s) Ongoing Recruitment Efforts Operational Readiness Clinical Readiness incl. Support Services (internal and external) Staff Familiarisation Corporate Readiness (incl Finance) and System Amendments Facilities & Site Readiness Comms and Engagement Ongoing drop R eadiness Comms Transition Updates (internal & externa) in sessions System Implementation with key external stakeholders (inc. patients)
Overview of Workstream Activities 1. Estates & Equipment (Framework section – Timescales for implementation)
Estate Solution Option D&E 1. Refurbishment of existing stroke ward. 2. Redevelopment of a clinical offices and education centre into new ward (A), design to be similar to previous redevelopment. 3. Provision for 1no. new Resus cubicle. 4. New build for clinical offices/Education centre (B). 5. New car park (C).
Estates Option D&E (Ward) Capital Reqt - £16,826,000 (see appendix for breakdown) Works required; • Relocate education centre • Heavy refurb to develop new 32 bed, based on existing design completed in 2016, incorporating 4 bed bays. 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 will be required for the new building and car park • New car park will be an extension of the existing car park area leased • The building will be built on existing hardstanding, previously discussed with planners during the hospital redevelopment scheme. It will require new utility services from main supplies • PFI partner agreement required for new ward development, who has been approached and informed 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 clinical input
Overview of Workstream Activities 2. Workforce (Framework section - Understanding Capacity)
Tunbridge Well’s Stroke Workforce • Tunbridge Wells Stroke team has worked hard to improve its Stroke services. It is a C rated SSNAP service largely to bed availability. It has managed to achieve B rating in the past. It consistently scores very 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 7.37 1* 2 Occupational Therapist S< Therapist 4.00 0.6* 2.3 Dietitian 0.50 0.2 0.5 Consultants 2.64 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
Delivering the required workforce Qu. Outline your workforce gap and detail the strategy and plans to deliver the required workforce • The main areas of concern are Nursing and Medical • In both Options the Trust will need to employ additional Stroke consultants, although the Trust already employs four Stroke consultants and four Specialist doctors. The Trust also hopes to employ a further consultant shortly • For the TWH options the Trust will not need to move significantly beyond its current non medical substantive staffing levels to open a new service safely and will have time to recruit to full establishment given the duration of the Estates work • The Trust has sufficient unqualified nursing staff to fully staff all of the options from day one Qualified Nursing Requirements Currently in Post Additional WTE Additional WTE Qualified Minimum to Required to maintain open safely Nursing safety Requirement Option B 69 27 42 54 27 Options C-E 52 27 25 36 9
Delivering the required workforce Qu. Outline your workforce gap and detail the strategy and plans to deliver the required workforce Following the steps below and looking at the numbers of stroke staff at other Trusts locally, the Trust is confident it would have sufficient numbers to open the services safely and at establishment by the time the Estates solution is implemented. • Engagement and retention of MTW Stroke workforce (by looking at hrs, travel time and costs, development opportunities etc.) • Understanding the likely scale of TUPE across all clinical groups and extending opportunities and transition support to Stroke employees at other Trusts (in line with Kent wide relocation packages / incentives for Stroke workforce) • Actively participating in recruitment campaigns at Kent & Medway level as well as making Stroke recruitment part of MTW’s ongoing recruitment programme • Early engagement with Bank and Agency staff for supply (if required). The Trust currently uses a number of regular bank staff and frequently uses agency staff to cover roster gaps. It is envisaged that this could continue until the unit is fully staffed
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