South Yorkshire and Bassetlaw Integrated Care System Strategic Outline Case on Hospital Services Presentation to Governing Bodies and Boards 1 August 2018
The final report of the Hospital Services Review was published in May The Hospital Services Review was set up to ensure people across South Yorkshire and Bassetlaw, Mid Yorkshire and North Derbyshire (SYBMYND), continue to receive excellent hospital services now and in the future. • Urgent and Emergency Care It made recommendations focused on 5 services (see purple box) which: • Maternity • Care of the Acutely Ill Child Are facing significant difficulties • with workforce and quality; and • Gastroenterology and Endoscopy have a significant impact on the • service as a whole • Stroke 2
Strategic Outline Hospital Services Case Review An independent The statement by the • Review, chaired by health and care Comments by Boards, Prof. Chris Welsh stakeholders in SYBMYND Governing which Made • Bodies, Local lays out SYBMYND’s recommendations • Authorities, response to the around members of the public; recommendations; and how Trusts can work • assurance together; and lays out the agreement • by NHSE by commissioners and configuration of • trusts as to how services SYBMYND will take forward work in these areas 3
The three main principles of the HSR are also the main principles of the SOC: 1. There will continue to be a hospital in every Place: we are not closing any District General Hospitals; 2. Most patients will receive most of their hospital-based care at their local DGH; 3. We need the staff we have – we do not expect that the work of the Review will lead to any redundancies, although we may need to work differently. 4
The SOC lays out three main workstreams Developing Hosted Networks to support co- operation between trusts and improve 1. Shared conditions for staff. working Support for workforce and innovation through a Health and Care Institute and Innovation Hub Shifting activity from the acute sector to primary and community care, where appropriate 2. Transformation Transforming the workforce, e.g. by changing job roles Exploring options around how services are 3. configured, for maternity, paediatrics and Reconfiguration gastroenterology. 5
The proposal for Hosted Networks is formal collaborations between trusts • Agreed protocols for patient transfers The host • Managing capacity • Agreed clinical could be any across sites – e.g. a protocols of the SYB single point to co- • More direct role in trusts (and ordinate available • Opportunities to supporting the beds across sites potentially work across sites eg delivery of services secondments, Mid Yorks / on another site • More direct role in rotations Chesterfield workforce planning in long to address • Standardised job term) shortages roles for the alternate professions All trusts, All trusts, Some trusts, for all for some for some specialties specialties specialties 6
Transformation is focused on making the best use of our workforce and buildings Delivering care in the right Making the best use of our setting workforce • The 2016 Sustainability and • The HSR recommended that hospitals Transformation Plan identified that should work together to redesign the some patients are receiving care in workforce, for example around hospital which could better be making more consistent use of delivered elsewhere Advanced Nurse Practitioners and Physicians’ Associates • The Clinical Working Groups will look at shifts of activity in their own • The Clinical Working Groups will look specialties, supporting existing work at the options in their own specialties in Places Patient and public input will be sought on any recommendations the CWGs put forward 7
On reconfiguration, we will explore options for maternity, paediatrics and gastroenterology A&E Maternity Acutely ill Stroke Gastroenter- children ology • Maintain 6 • Increase choice: • More care for • Standardised • Explore consultant led home births; all children at approach to consolidating A&Es (plus the hospitals have home / in Early Supported evening and consultant led midwifery led community Discharge, TIA weekend cover paediatric A&E services for low and rehab onto 3 or 4 sites: • Explore focusing at Sheffield risk women services so that all sites 24/7 paediatric Children’s) have formal • Could replace 1 units on fewer • Consultants on access to 24/7 GI or 2 obstetric sites: 1 or 2 Sites which will bleed cover at all units with MLUs. could become have a Hyper times, if But we will Paediatric Acute Stroke necessary on explore other Assessment Unit support another site options to meet Units open services on requirements 14/7. We will those sites for explore options which have interdependen- to meet Acute Stroke cies with interdependen- Unit paediatrics. cies with 8 obstetrics
Responses to the Hospital Services Review Some changes have been made in response to feedback on the HSR. Trusts requested that we make it clearer that the acute work is built on transformation of the workforce and Greater emphasis moving care out of hospital. We have made this a piece of on transformation work in its own right. Reconfiguration work will be based on the transformed workforce. Interdependencies Some concerns were raised about moving to standalone Midwifery Led Units. The SOC says that we will explore between maternity other options around meeting interdependencies between and paediatrics paediatrics and obstetric units. Some concerns were raised about the impact on patients Patients travelling who might move to a non-SYB Trust. The ICS team will out of area look at the quality implications of this and assess against the evaluation criterion on quality at evaluation stage. LAs asked to be more engaged going forward. The Involvement of governance of the ICS is being reviewed, and the hospital Local Authorities services team will engage with LA colleagues. A key theme of transport was raised, which we will explore Public feedback further in a dedicated transport group. The SOC outlines public feedback and how comments have been addressed. Some updated data on activity was provided too late to be Refreshing included in the HSR final report. We have refreshed the modelling to include it; the changes are marginal and do modelling 9 not change the recommendations.
Next steps The shared working and transformation workstreams will require public engagement. Any reconfiguration options will require formal consultation which requires a longer timeframe. These timescales are provisional. Sep – Dec 2018 Jan – May 2019 Jun – Sept 2019 Oct -> Shared working: Development and implementation of the hosted networks, Health & Care Institute, Innovation Hub Transformation: CWGs identify out of hospital shift, workforce changes Reconfiguration: Signoff by Governing develop evaluation Continue modelling, Public Bodies, NHSE criteria, the model work on travel and consult- Gateway 2, finalise and the longlist of transport ation Business Case options Public engagement on all workstrands 10
Thank you 11
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