Governing Body Special Meeting 20 September 2017 Purpose and - - PowerPoint PPT Presentation

20 September 2017

Governing Body Special Meeting

Dr Forbes Watson Chair NHS Dorset Clinical Commissioning Group

Purpose and introduction

Phil Richardson Director of Design and Transformation NHS Dorset Clinical Commissioning Group

Clinical Services Review

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

The Need for Change

Steps to consultation

Design

Launch October 2014 Need for Change January 2015 Clinical Working Groups November 2014 (13 to date) Public Engagement Throughout

Public Consultation

Governing Body (preferred options) May and July 2016 Consultation 1 December 2016 – 28 February 2017

Deliberations

Governing Body (workshops) June – September 2017 Consultation feedback Additional work

Evaluation criteria

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

Assurance

• 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

Public consultation

Additional work

Four main areas of additional work

• Transport

– Emergency transport – Non-emergency transport

• Clinical risk
• Equality Impact Assessment (EIA)
• Health and wellbeing

Dr Karen Kirkham Assistant Clinical Chair NHS Dorset Clinical Commissioning Group

Integrated Community Services

• 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

Model of care (ICS)

Integrated Community Services proposals

Enable/improve integrated community services by creating 12 community hubs 7 with beds and 5 without beds

• 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
• thers. Negative opinion was strongest where it proposed that beds or

hospitals are closed

Consultation response headlines

Integrated Community Services recommendations

Enable/improve integrated community services by creating 12 community hubs 9 with beds and 3 without beds

• 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

Patient benefits

Ron Shields Dorset HealthCare NHS Foundation Trust

Chief Executive: views on implementation

Governing Body Questions

Integrated Community Services

Conrad Lakeman Secretary and General Counsel NHS Dorset Clinical Commissioning Group

Integrated Community Services recommendations

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 1

The Governing Body is requested to approve the recommendation: to commission a community hub with beds at Sherborne Hospital

ICS 2

The Governing Body is requested to approve the recommendation: to commission a community hub with beds at Blandford Hospital

ICS 3

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 4

The Governing Body is requested to approve the recommendation: to commission a community hub without beds at Dorset County Hospital

ICS 5

The Governing Body is requested to approve the recommendation: to commission a community hub with beds at Bridport Hospital

ICS 6

The Governing Body is requested to approve the recommendation: to commission a community hub with beds at Weymouth Community Hospital

ICS 7

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 8

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 9

The Governing Body is requested to approve the recommendation: to commission a community hub with beds at Swanage Hospital

ICS 10

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 11

The Governing Body is requested to approve the recommendation: to commission a community hub with beds at Wimborne Hospital

ICS 12

The Governing Body is requested to approve the recommendation: for St Leonards Hospital to close

ICS 13

The Governing Body is requested to approve the recommendation: to commission a community hub with beds on the Major Planned Hospital site

ICS 14

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

• utcome of the dementia services review

ICS 15

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 16

The Governing Body is requested to approve the recommendation: to commission a community hub with beds on the Major Emergency Hospital site

ICS 17

Dr Karen Kirkham Assistant Clinical Chair NHS Dorset Clinical Commissioning Group

Acute services and Maternity and Paediatric services

A major planned care hospital An emergency and planned hospital A major emergency hospital with 24/7 consultant cover

Models of care (acute)

Acute hospital proposals

• 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

Consultation response headlines

Acute hospital recommendations

Patient benefits

• more lives saved and better outcomes
• less operations cancelled
• more services closer to where people

live

• ver £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 in the east of Dorset. Plus an integrated service across Dorset County Hospital and Yeovil District Hospital. A single specialist centre that covers the whole of Dorset, which would need to be based at the major emergency hospital.

+

• This was the most contentious proposal in the consultation and

prior to consultation we did not identify a preferred option

• The majority of respondents supported Option A (quantitative

feedback)

• Based on qualitative feedback, Option A, in many cases, was the

least unpopular, many participants in the focus groups rejected both options

• Two petitions against the closure of Kingfisher Children's Ward

Consultation response headlines

Maternity and paediatric recommendations

OPTION A OPTION B

Consultant-led services at the major emergency hospital in the east of Dorset. Plus an integrated service across Dorset County Hospital and Yeovil District Hospital. A single specialist centre that covers the whole of Dorset, which would need to be based at the major emergency hospital.

+

Debbie Fleming, Poole Hospital Patricia Miller, Dorset County Hospital Tony Spotswood, Royal Bournemouth Hospital

Chief Executive: views on implementation

Governing Body Questions

Acute services and Maternity and Paediatric services

Conrad Lakeman Secretary and General Counsel NHS Dorset Clinical Commissioning Group

Acute hospital recommendations

The Governing Body is requested to approve the recommendation: to commission distinct roles for Dorset’s acute hospitals (a Planned and Emergency Hospital, a Major Planned Hospital and a Major Emergency Hospital), as part of one acute network of services

AC 1

The Governing Body is requested to approve the recommendation: to commission a Major Emergency Hospital at the Bournemouth Hospital site

AC 2

The Governing Body is requested to approve the recommendation: to commission a Major Planned Hospital at the Poole Hospital site

AC 3

The Governing Body is requested to approve the recommendation: to commission a Planned and Emergency Hospital at the Dorset County Hospital site

AC 4

Conrad Lakeman Secretary and General Counsel NHS Dorset Clinical Commissioning Group

Maternity and Paediatrics recommendations

The Governing Body is requested to approve the recommendation: to commission the delivery of consultant-led maternity and paediatric services from the Major Emergency Hospital

M&P 1

The Governing Body is requested to approve the recommendation: to seek to commission the delivery of consultant-led maternity and paediatric services integrated across Dorset County Hospital and Yeovil District Hospital for the Dorset

• population. Implications for this recommendation

will be considered by Dorset County Hospital and Yeovil District Hospital and any proposed changes to services in either hospital would be subject to further local public consultation by both Dorset and Somerset CCGs as appropriate

M&P 2

Kath Florey-Saunders Head of Mental Health and Wellbeing NHS Dorset Clinical Commissioning Group

Mental Health Acute Care Pathway

There are over 7000 people with a serious mental illness in Dorset

• We need to improve the experience for service users and their

carers

• Current provision/service configuration does meet their needs
• Inequity of provision
• Dorset needs a financially viable and sustainable services fit for

the future

The Need for Change

Steps to consultation

View Seeking August- September 2015

Model Options Development November 2015 - end June 2016

Business plan and assurance July 2016-Jan 2017

Consultation February-end March 2017 Deliberations and development

• f outline

business case July 2017- September 2017

Needs Analysis; Benchmarking; Co-production

April 2016

• Wessex Clinical Senate

September 2016 to January 2017

• Stage 1 and Stage 2 NHS England Assurance

October 2016

• Strategic Outline Case: Governing Body

August 2015 to August 2017

• Joint Health Scrutiny Committee/LA Assurance

Assurance

Model of care (ACP)

North Dorset West Dorset Mid Dorset Purbeck East Dorset

Swanage Bridport Bournemouth Dorchester St Anne’s (+12)* Forston clinic (+4) Sturminster Newton

Retreat Community Front Room Inpatient beds Three Recovery Beds for the west

• f the

county *15 inpatient beds from the Linden Unit at Westhaven Hospital (in Weymouth) to move to the east. This means the Linden unit would close. Four Recovery Beds for the east

• f the

county

@

24/7 Connection service

• 70% supported the increase in beds
• 63% supported bed moves
• 77% supported the Retreats
• 74% supported Dorchester as the west’s Retreat area
• 74% support Community Front Rooms
• 75% supported 3 Community Front Rooms and 7 Recovery beds
• 67% supported the proposals overall

Consultation response headlines

16 drop ins 2 informed audience Digital and paper based Weekdays/ evening and weekends

1156 responses

ACP recommendations

North Dorset West Dorset Mid Dorset Purbeck East Dorset

Bridport Bournemouth Dorchester St Anne’s (+12)* Forston clinic (+4)

Retreat Community Front Room Inpatient beds Three Recovery Beds for the west

• f the

county *15 inpatient beds from the Linden Unit at Westhaven Hospital (in Weymouth) to move to the east. This means the Linden unit would close. Four Recovery Beds for the east

• f the

county

@

24/7 Connection service

Shaftesbury Wareham

Ron Shields Dorset HealthCare NHS Foundation Trust

Chief Executive: views on implementation

Governing Body Questions

Mental Health Acute Care Pathway

Conrad Lakeman Secretary and General Counsel NHS Dorset Clinical Commissioning Group

Mental Health Acute Care Pathway recommendations

The Governing Body is requested to approve the recommendation to: commission increased mental health service provision

Recommendation 1

The Governing Body is requested to approve the recommendation to: commission an additional 16 beds, 4 new beds to be located in Forston Clinic and 12 new beds to be located at St Ann’s Hospital

Recommendation 2

The Governing Body is requested to approve the recommendation to: relocate the 15 beds at the Linden Unit to St Ann’s Hospital. Services and beds will be maintained at the Linden until the new beds are established at St Ann’s Hospital and Forston clinic and staff appropriately transferred, at which point the Linden unit will close

Recommendation 3

The Governing Body is requested to approve the recommendation to: commission a Retreat in Bournemouth

Recommendation 4

The Governing Body is requested to approve the recommendation to: commission a Retreat in Dorchester

Recommendation 5

The Governing Body is requested to approve the recommendation to: commission a Community Front Room in West Dorset

Recommendation 6

The Governing Body is requested to approve the recommendation to: commission a Community Front Room in North Dorset

Recommendation 7

The Governing Body is requested to approve the recommendation to: commission a Community Front Room in Purbeck

Recommendation 8

The Governing Body is requested to approve the recommendation to: re-commission the seven Recovery beds (currently in the west of the county) to three in the west of the county and four in the east of the county

Recommendation 9

Dr Forbes Watson Chair NHS Dorset Clinical Commissioning Group

Conclusion and close