FREQUENTLY ASKED QUESTIONS
THE CLINICAL SERVICES REVIEW
What is the Clinical Services Review?
The review is a programme of work led by Dorset Clinical Commissioning Group to analyse the future health needs of the people of Dorset and plan how best to meet them. Dorset Clinical Commissioning Group is the organisation, led by local GPs, responsible for securing the NHS health services needed in Dorset. We will consult the public about the findings and then, subject to consultation with the public, implement any changes necessary to improve healthcare for people in Dorset.
Who is running the review?
NHS Dorset Clinical Commissioning Group (CCG), as the organisation responsible for commissioning (planning and securing) healthcare in Dorset, is planning, managing and leading the review. However, it is vital that all organisations with an interest in ensuring high quality healthcare in Dorset are involved in the review and we are working closely with GPs, local NHS service providers, the county, district and borough councils and Healthwatch.
Why are you carrying out this review?
The need for change document sets out why the NHS in the county needs to change if it is to ensure that everybody has access to care, which is both high quality and affordable for the future.
Here are some of the main reasons why we need to change:
- We have a growing elderly population with changing health needs who are placing greater and new demands on services.
- We have variable quality in out of acute hospital care and patients reporting difficulty accessing care.
- We have variable quality in acute hospital based care, particularly for more specialist services.
- We have shortages of healthcare staff, including specialist consultants, which means it is difficult to ensure we have enough staff available, especially where 24/7 care is needed.
- We have a growing financial challenge with a projected gap between costs and available funding of around £200m by 2020/21.
Why take on such a big project?
We realise that the needs of the 750,000 people living in Dorset are changing, and that we have an ageing population living with more long term conditions and there are many more frail older people with complex co-morbidities (ie more than one health condition).
The evidence we have gathered shows variation in the quality of services across Dorset and there are financial challenges as costs and rising demand exceed our available funding for healthcare in the county.
We realise that we will need to organise ourselves and work differently if we are to continue to provide safe, high quality care in an affordable and sustainable way in the future. Our ambition is to ensure we get maximum health gain for the local population from the money we have – we need to ensure our resources are in the right place to achieve this. This means we need to look at all, and not just parts of the system.
Are NHS foundation trusts bound by the review outcomes or can they make their own decisions about whether or not to participate in these changes?
NHS foundation trusts are fully part of the NHS, subject to NHS systems of inspection, governance and provision of service. This includes the need to operate core services as proposed by local commissioners. They treat NHS patients according to NHS principles and NHS standards but are controlled and run locally, not nationally.
On the 1 April 2013 all NHS foundation trusts received a licence to operate as such. The licence applies to all NHS foundation trusts. It sets out a range of conditions that providers must meet so that they play their part in continually improving the effectiveness and efficiency of NHS health care services to meet the needs of patients and taxpayers, today and in the future. This licence puts an express obligation on all foundation trusts to support commissioners to protect essential health care services for patients.
What are the timescales for implementation?
The review was launched in October 2014 and is in four stages:
- Review, analysis and design – 2014- 2016:
- A thorough review of current services and the evidence base for best practice.
- The proposals will then be subject to a robust NHS assurance process and a Gateway review undertaken by independent reviewer.
- Public consultation on the options – Late 2016:
- We will be widely consulting with patients, carers, the public and clinicians before any decisions are made.
- The feedback will be gathered and analysed by an independent organisation and compiled into a report for the Governing Body. The report will be published and made available to the public.
- NHS Dorset CCG decision making – 2017
- NHS Dorset CCG, as the statutory decision-making body, will use all of the information and feedback on the proposals to decide what the future of healthcare in Dorset will look like and what services to commission.
- Implementation – 2017 onwards:
- Planning starts for phased implementation and delivery of any agreed changes.
- There will not be any overnight changes to services (unless for safety reasons) and this phase is likely to take some months to plan and put in place.
- It is possible that some implementation may start earlier as there could be changes that do not affect how services are delivered.
HOW WILL DECISIONS BE MADE?
How can you reassure local people that their feedback really matters and that their comments can effect a change in these proposals?
As we have been clear about since the launch of the Clinical Services Review, our proposals will be subject to a full and thorough public consultation. The views we gather during the consultation will help us shape the final decisions which won’t be made until into 2017.
Who is making the decisions about these proposed changes?
The statutory responsibility for any final decisions about what proposed changes are to be implemented, will be made by NHS Dorset CCG’s Governing Body. The Governing Body comprises local GPs who represent each of Dorset’s 13 health locality areas. This ensures our decisions are clinically led.
Throughout the review, a wide range of Dorset’s clinicians, staff, voluntary groups, patients, carers, and members of the public have been working together to develop these proposed changes. Any decisions will be informed by the evidence gathered during the design stage of the review and the outcomes of the formal public consultation. No decisions have yet been made and won’t be until after the public consultation has been completed and the findings reported and considered by NHS Dorset CCG’s Governing Body alongside all the evidence and information which has been collated.
Who will oversee the decisions and review made by NHS Dorset CCG’s Governing Body?
The role of a Joint Health Overview and Scrutiny Committee is to review and scrutinise any matter relating to the planning, provision and operation of health services in its area of this scale. We have kept the three local authority Health Overview and Scrutiny Committees informed about the review and throughout they have made helpful observations and recommendations. In accordance with their statutory duties, at the end of the public consultation we will present their joint scrutiny committee with the outcomes of the review and any recommended service changes, along with the outcomes of the public consultation.
The Wessex Clinical Senate (a body of leading expert clinicians from across Wessex) has also been engaged throughout the process. Wessex Clinical Senate brings together multi professional clinical leaders with other public sector and patient leaders. The members work collaboratively and will advise, and where necessary challenge, all parts of the healthcare system to drive improvement.
While the decision making authority remaining within the CCG as the relevant statutory organisation, any recommendations made by the strategic clinical network and clinical senate will be endorsed, unless there is clear evidence for an alternative course of action.
Who has been involved in developing the proposals?
Throughout the review, a wide range of Dorset’s clinicians, staff, voluntary groups, patients, carers, and members of the public have been working together to develop these proposed changes. At every stage, the outcome of the clinicians discussions was shared with GPs, special reference groups, such as a finance reference group and, crucially, with patients, carers and the public in a specially formed Patient and Public Engagement Group, and in a series of public events across Dorset. Their views were then fed back into the next round of clinician discussions.
How are you working with the rest of the health system in Dorset?
We are working with all our NHS and local authority partners in Dorset, and partners in the voluntary sector, as we undertake this review.
This is a review of the whole health system, rather than a look at individual services. We know that the way services work together and ensuring that this ‘interconnectivity’ of services is effective and efficient is critical to the day-to-day functioning of our health service, and ultimately to the quality of the patient experience. Depending on their condition, patients might receive NHS services through a number of different providers, including primary, community, mental health, social care and acute services. People tell us they want this journey to be seamless so that it is co-ordinated and trouble free.
How are you involving staff from Dorset’s NHS?
We are working closely with provider organisations, such as our local hospitals, and other partners in care, such as the Local Authority, throughout this review. Our partners are engaged through:
- The meetings and governance structure we have put in place to underpin the programme – we have established working groups to gain the specialist input of a range of clinicians and health service leaders.
- 1-1 meetings and conversations with system leaders, such as Chief Executives of the local hospitals and other service providers.
- Attending Board meetings of our provider partner organisations, such as the Health Overview and Scrutiny Committee, Health & Wellbeing Board, the Dorset Senior Leadership Team.
- Responding to invitations to go and present and discuss the Clinical Services Review with key groups.
- Engaging with our GP membership across Dorset.
- Asking and supporting our partner organisations to cascade information and to engage front-line staff.
How is the review taking account of social care services?
Social care services come under the responsibility of local authorities, but can have an impact on health care. Many clinicians across Dorset, as well as patients and their families, have highlighted problems from a lack of integration between health and social care services. For example, delays in finding the right social care lead to delays in discharge from hospital, impact negatively on patients and are an inefficient use of both health and social care resources. We are therefore working closely with our local authority partners, building on existing local initiatives – including those looking at urgent care, information, advice and services for people leaving hospital – and on joint work such as the Better Together programme, which brings relevant organisations together to look at better integration of services and more seamless care for patients.
Have decisions already been made? Is this just an attempt to push services into a preconceived plan?
No decisions have been made and won’t be until after an extensive public consultation. Healthcare delivery is complex. We have some good ideas but no preconceived answer on how to address the challenges we are facing in Dorset. Only after the formal public consultation is complete, the views of people are gathered and reviewed alongside all the clinical evidence, will any decisions be made.
CONSULTATION PROPOSAL OPTIONS
How are the proposed consultation options deliverable from a workforce perspective?
The review is about making sure we use the resources we have available in the best possible way, and organising our workforce in the most efficient and effective way to care for patients. For example by networking some specialist staff across sites and services. We need to work in a more integrated way, improving effectiveness by embracing new ways of working across our healthcare system.
We are working with all the local hospital trusts and GP colleagues to design options for the future and part of the implementation planning will be making sure we have the right staff in the right place at the right time to deliver the best care possible for patients.
We know that the way we organise staff at the moment could be improved upon and that we have highly skilled staff carrying out tasks other more appropriately trained doctors, nurses and administrators could do. We are not always able to fill all staffing vacancies, because large numbers of staff with very specialist skills simply don’t exist. In some areas we have no other option than to employ more expensive agency staff, which isn’t affordable or sustainable long term.
Will these proposals for %22community hubs%22 mean that more clinics can be delivered from Bridport Hospital to save people travelling all the Dorchester?
Yes, the plan is, over the next 5 years to increase the outpatient services through the community hubs such as Bridport Hospital.
What is being proposed for Wareham Hospital and the surgery and how we can effect the outcome of any decisions?
It is too early to say; as we have been clear about since the launch of the Clinical Services Review, our proposals will be subject to a full and thorough public consultation, and no decisions will be made until after this has been completed and local views taken into account.
The proposal for Wareham is to have a community hub without beds, in addition, short term care home beds with enhanced in reach support. We are also proposing to look at the options for sites for the local hub in Wareham, in recognition that the current building of the hospital and the neighbouring GP practice isn’t the best infrastructure for future provision of modern healthcare.
For some specialties and therapies, where there is a high demand, there is potentially the scale to have some outpatients specialities on both the Wareham and Swanage sites.
What risks have been identified in relation to reconfiguration of services and what are the proposed responses?
The evaluation criteria and risks identified regarding the deliverability of each proposal has been published and is available to view in chapter 13 of our Pre Consultation Business Case which you can download from www.dorsetsvision.nhs.uk.
The public consultation for the CSR, that’s currently on-going, and the views gathered will help us shape the final proposals for changing and improving NHS services in Dorset. At this stage a detailed risk profile for each model of care will be developed.
How will you respond to workforce shortages mentioned in the consultation document?
We currently have difficulties staffing some services because there are national and local shortages of some medical staff with key specialist skills and it is difficult to recruit to some posts. This includes GPs, mental health nurses, consultants working in accident and emergency and paramedics. We also face the prospect that quite a lot of our staff are coming up to retirement age in the next few years.
Under our proposals to change and improve NHS services in Dorset, we explain how certain specialist services, including cardiac, stroke, pathology and non-surgical cancer (radiotherapy and chemotherapy), need to be better coordinated across Dorset.
This could be via single clinical networks between the three main hospitals – Poole Hospital, Royal Bournemouth Hospital and Dorset County Hospital. So, for example, there would be one Dorset cardiac service provided across three sites, rather than three separate services across three sites. This would allow us to share staff and resources and provide a more joined-up and consistent service for patients. More information about this can be found in chapter six of the consultation document.
Regarding Primary Care, we recently launched the Doorway to Dorset campaign which is proving a successful tool to attract staff, including GPs, practice nurses and practice managers, to work in Dorset and we’re looking to expand this to include acute hospital staff.
Will Dorchester hospital retain its specialist departments (particularly cardiology)?
Under our preferred proposals for the future of NHS services in Dorset, Dorset County Hospital (DCH) would remain a district general hospital serving the west of the county and would remain largely the same.
However, specialist services (including cardiac services) need to be better coordinated across Dorset with the three main hospitals (Poole Hospital, Royal Bournemouth Hospital and DCH) working more closely together to achieve this. This means that DCH would become part of a Dorset-wide network for certain clinical services along with the hospitals in Bournemouth and Poole. So, for example, there would be one Dorset cardiac service provided across three sites, rather than three separate services across three sites. This would allow us to share staff and resources and provide a more joined-up and consistent service for patients.
Which clinics may branch out to Bridport hospital?
Under our preferred proposals, we’d like to bring more care closer to people’s homes and for Bridport Hospital to be one of 12 community hubs in Dorset. We’re working with clinical staff (doctors, nurses and other health professionals) and managers to develop the range of additional services which could be offered here in the future.
What are the proposed changes to Dorset County Hospital and which services may move to the east of the county?
Under our preferred proposals for the future of NHS services in Dorset, Dorset County Hospital (DCH) would remain a district general hospital serving the west of the county and would remain largely the same as it is now.
It would form part of a Dorset-wide network for clinical services with the hospitals in Bournemouth and Poole – which would allow us to share staff and services. The most seriously ill or injured patients needing specialist care would be transferred to the major emergency hospital in the east of the county (under our preferred proposals this would be the Royal Bournemouth Hospital). This is similar to what would happen now, with the most seriously injured patients going to Southampton or other specialist hospitals.
The most significant change at DCH is the proposal concerning consultant-led maternity and inpatient beds for children. This proposal results from an independent review by the Royal College of Paediatrics and Child Health published in April 2016. It recommended that DCH should open talks with Yeovil District Hospital about providing an integrated service. These talks are continuing to take place but if this option is not possible then DCH must work with teams in the east of the county to provide one service for Dorset.
Will referrals by GPs and consultants for outpatient blood tests be undertaken at Poole Hospital or will people have to go to Royal Bournemouth and Christchurch Hospital?
Under our proposals to change and improve NHS services in Dorset we want to bring care closer to people’s homes and provide more services in community settings, including via ‘community hubs’, reducing the need for patients to travel. By doing this, we’d expect that more outpatient appointments and same-day treatments, including the majority of phlebotomy services, would be provided in a community setting rather than in an acute hospital.
Can I choose which hospital I go to in an emergency?
In an emergency patients travelling to hospital via ambulance will always be taken to the hospital with the most appropriate services and expertise to treat them and this decision will be made the experienced paramedic team.
Will the Urgent Care Centre at Poole still deal with Under 16s or will they have to go to Royal Bournemouth Hospital?
Under the proposals within the CSR consultation document, the majority of emergency cases currently treated at Poole Hospital’s A&E department would continue to be treated in Poole at the 24 hour Urgent Care Centre.
More severe and life-threatening cases would be treated at the major emergency hospital in Bournemouth, including loss of consciousness and serious accidents.
The Urgent Care Centre will be able to accept and treat under 16s, depending on the nature of the condition but there may be instances where a transfer to the major emergency hospital is necessary (even with non-life threatening injuries). Specialist 24/7 consultant delivered in-patient paediatric services will be located at the major emergency hospital and will be able to provide support through a network of clinical services across the county.
Why do you propose to make Shaftesbury Hospital a community hub without beds?
We understand that local people feel passionately about the care currently provided at Shaftesbury Hospital and are concerned about the future of health services here.
In respect of providing beds in community settings, our proposals are actually to increase the number of beds available (but to re-distribute these across the county according to need) via community hubs. Detailed analysis has taken place to decide where the community hubs may be and, amongst other issues, our proposals have taken account of NHS recruitment and workforce, the cost of maintaining older buildings and bringing these up to standard, population changes over the next five years and travel times for people to reach community hubs.
Will there be any changes to the air ambulance service?
There are no proposals to change the provision of emergency ambulance or air ambulance services and that these services will continue as normal.
How have you worked out the travel times to each hospital in an emergency?
Detailed Dorset-wide travel times analysis has taken place. You may wish to view appendix I of our Pre Consultation Business Case for more detail about the travel times analysis, which is available to view and download on our website. Please note that the travel analysis also took into account that in parts of Dorset emergency care is also provided outside of the county, including in Yeovil, Exeter and Salisbury, which would continue.
Is there still the risk that surgery could still be delayed despite having a planned site and an emergency site?
One of the major benefits of having a major emergency hospital and a major planned care hospital is that specialist skills are available on one site and can be accessed rapidly. Therefore, there will be no need for such staff to be required to work across sites in an emergency.
What will happen to the St Mary’s maternity site if the main maternity unit is to be based at Bournemouth hospital?
Should the maternity unit move from Poole to Bournemouth, Poole Hospital (the site owners of St Mary’s maternity site) will decide what happens to the site.
Why is there little reference to Salisbury District Hospital in the consultation document? This is a vital service for people living in North Dorset.
We (the NHS Dorset Clinical Commissioning Group) launched the Dorset Clinical Services Review (CSR) to assess the future health needs of people in Dorset and plan how best to meet them. The review is therefore focussing on NHS services in Dorset. We understand that people living close to the Dorset border may use services outside of the county and would like to reassure you that these people would continue to use these services in the future.
Please can you give an approximate indication of the cost to the NHS to run a bed in a community hospital?
The costs of community hospitals beds vary and range from £1,500 to £1,800 a week.
Can you clarify which homes you have in mind to provide end of life/palliative care in the Shaftesbury area?
A number of care homes across Dorset that support people with end of life care, often with support from community services (such as community nurses, specialist palliative care nurses, therapists and GPs).
If the proposals are approved, we’ll progress discussions with local care home providers to develop this care, with ‘in-reach’ support from community services. However, please be assured that no final decisions will be made until after the public consultation and, following this, any changes will take place gradually over a period of approximately five years.
Why would West Hampshire residents be concerned about where the major emergency hospital should be situated in Dorset?
We’ve worked with colleagues and residents in areas close to the Dorset/Hampshire border as there is a significant patient flow from West Hampshire to the Royal Bournemouth Hospital. The people using these services may be affected by the Dorset Clinical Services Review (CSR) so it’s important we hear their views on the proposals too.
Please explain the proposals for maternity services and what ‘midwife led’ care means.
Under our proposals, consultant-led maternity and obstetrics services will be based at the major emergency hospital in the east, these services will also be supported by midwife-led services based in the east (although we’re unable to say exactly where these will be located until the final decisions have been made).
For maternity services in the west of the county, talks are continuing to take place between DCH and Yeovil District Hospital about providing an integrated service to ensure safe and sustainable services for the future. However if this option is not possible, then DCH must integrate with teams in the east of the county to provide one service for Dorset.
Midwife-led maternity services do already exist and are used by women to give birth if they’ve had a healthy pregnancy. For example, Royal Bournemouth Hospital currently has a freestanding midwife-led unit with no consultant cover. If complications during labour do arise, women are transferred from this unit to Poole Hospital.
Explain how beds in care homes are currently used as an alternative to beds in community hospitals and how they may be used in the future under your proposals?
We currently have 347 community beds, of these 61 are commissioned from care homes across the county, including in Lyme Regis, Poole and Bournemouth. These beds provide short-term intensive rehabilitation and reablement care (for example, if people have had an operation or have become frail and this is affecting their mobility and independence). We also commission significantly more than this number from care homes for people at the end of life.
Short-term rehabilitation and reablement beds in care homes are purchased by the NHS. They are ‘block purchased’ for use by the NHS and we can also ‘spot purchase’ when additional capacity is needed. There are also community nurses and therapists who ‘in-reach’ into the care homes and provide additional nursing and therapy support for NHS patients using these services.
Based on research and advice from NHS England, our proposals within the Clinical Services Review (CSR) include an additional 69 short-term care home beds in the east of the county. As indicated above we would look to continue to ‘block purchase’ beds in care homes. However, please be assured that no final decisions will be made until after the public consultation and, following this, any changes will take place gradually over a period of approximately five years. We will continue to work with our local authority partners to ensure that we have the right capacity in the right place to meet current and future needs.
Potential number of beds by each community hospital, the proposed changes by hospital, and the number of short term care home beds.
There are currently 347 community beds across the County, 286 of the 347 are community hospital beds, the others are short term care home beds.
The CSR proposes an additional 69 community beds over 5 years in the east of the county, and a redistribution of where the number of beds are currently located across the County to better reflect current and future local population needs. The additional short term care home beds will be required in a number of areas, particularly in the East of the County, also in Wareham, Shaftesbury and Gillingham to take account of local need and proposals to consolidate community hospital beds on fewer sites.
Until the consultation is concluded, a decision is made on the CSR proposals and the further work on the feasibility studies are completed, the CCG is not able to be definitive on bed numbers by site/location.
It is recognised that careful transition planning will be required to ensure the capacity is available in the right places before changes are made to support care closer to home, in addition to increasing the care and support in peoples own homes.
Provisional work has been undertaken on potential numbers by location, and the changes this may mean by site which is reflected in the table below, and as indicated, this is subject to change.
Summary of sites and potential bed allocation by site:
Wimborne Hospital 48
Swanage Hospital 15
Purple site 96
Mid Cluster Care Homes 28
East Cluster Care Homes 95
Bridport Hospital 25
Blandford Hospital 24
Sherborne Hospital 30
Weymouth Hospital 41
West Cluster Care Homes 14
Summary of potential changes to bed allocation by site:
Future bed requirement 416
Existing bed complement 347
St. Leonards Hospital -22
Alderney Hospital -48
Wimborne Hospital 26
Purple site 96
Wareham Hospital -16
Westhaven Hospital -34
Portland Hospital -16
Weymouth Hospital 41
Mid Cluster Care Homes 19
East Cluster Care Homes 48
Bridport Hospital -19
Sherborne Hospital 0
Blandford Hospital 0
Shaftesbury Hospital -15
West Cluster Care Homes 9
Summary of sites by organisation:
Major emergency site 0
major planned site 96
DHU NHS FT 183
Care home sector 137
How are cancer services going to be provided in Dorset in the future?
As you may be aware, currently there are three main hospitals in Dorset (Dorset County Hospital, Poole Hospital and the Royal Bournemouth Hospital) providing cancer services. However, many of these services are provided differently and, as a result, care can be disjointed for patients, with some services becoming unsustainable as they struggle to meet increasing pressures and demand.
Specialist services (including cancer services) provided in these acute hospitals need to be more coordinated across Dorset and the Dorset Clinical Services Review (CSR) is looking at proposals for future models of care for these services and how they could be better provided. This includes a single Dorset-wide cancer service that will allow the cancer workforce to work more effectively together, across the three sites, to provide more consistent and coordinated care and to share resources
Under our proposals, Dorset County Hospital will remain as a district general hospital (delivering planned and emergency care) serving the west of the county and would continue to provide surgical treatment and chemotherapy with the addition of radiotherapy (from 2018 onwards), making this treatment available closer to home for patients who live in the west of Dorset. However, patients requiring complex radiotherapy may need to travel to the main radiotherapy centre in the east of the county.
In the east of the county the major planned care hospital (our preferred option is Poole Hospital) would provide low risk treatment for cancer patients, including surgery, radiotherapy and chemotherapy. The major emergency hospital (our preferred option is Royal Bournemouth Hospital) would provide care for those admitted via an emergency route and those requiring urgent, critical care (including stem cell transplants and more complicated haematological procedures). Provision for an acute oncology assessment unit and service and high risk cancer surgery would also be available. The main radiotherapy service in the east will continue to be provided at Poole Hospital with an outreach radiotherapy service to Dorchester from 2018.
All the remaining radiotherapy equipment at Poole Hospital will require replacement from now onwards and within the next two to three years and will be replaced at Poole Hospital. Future replacement programmes (after the current one) will be reviewed in line with the outcome following the CSR public consultation and the final decisions.
Working as one service across Dorset will mean that patients have less disjointed care and are able to receive diagnosis and treatment as part of one seamless pathway of care rather than being moved between different services.
You may wish to view our Pre Consultation Business Case via our website (www.csr.dorsetsvision.nhs.uk/downloads) which has more information about cancer services.
How has Dorset CCG engaged with the residents of Portland prior to proposing these changes to community hospitals?
NHS Dorset CCG has a number of ways to engage with people living in and around Dorset including the Dorset wide Health Involvement Network and local Health Networks (including a Weymouth and Portland group) who regularly meet.
During the consultation views and opinions will be sought in a variety of ways including online, via telephone calls and events and on paper through a questionnaire. As we approach the start of the consultation, information on opportunities to get involved will be made widely available to everyone in Dorset.
How are you involving patients and the public?
It is one of our CCG strategic principles that services are designed around people. To date we have involved people in a number of ways including the following:
- 29,000 pieces of feedback themed and used to inform the “Need to Change”.
In November 2014, at the start of the CSR consideration was given to what local people had already been saying. Bournemouth University was commissioned to analyse 29,000 qualitative pieces of feedback collected through 4 Dorset-wide surveys. They reviewed themes around access to services (time and location), integrated working and communication. The outcomes were shared with all working groups and used to inform the need to change.
- 12 Patient (Carer) and Public Engagement Group (PPEG) meetings – providing feedback at all stages of the CSR.
In December 2014 the PPEG was formed. The group comprises about 20 local people with a wealth of life-experience across Dorset’s geography, demography and diversity. It is chaired by a National Patient Leader and meets regularly, providing feedback at all stages of the CSR. Views fed directly into assurance, reference and clinical working groups. Key outputs include:
- Requesting a public facing “Need to change” document (produced Jan 2015).
- Directly informing the development of the CSR Evaluation Criteria (Feb 2015).
- Designing consultation principles for the CSR (March 2015).
- Producing a “Guide to person-centred discussions” – shared widely with clinical working group, clinical delivery groups and community vanguards (December 2015).
- Pan Dorset Engagement Leads Forum set up – representatives from 18 partner organisations.
In December 2014 the pan Dorset Engagement Leads Forum was set up. This forum is attended by engagement leads from health and social care providers, the local authorities, the voluntary sector, public health Dorset, Healthwatch Dorset, NHS England (South) and South West Ambulance and Dorset Fire and Rescue. The forum was set up to share information, intelligence and approach to engagement, to align work, to reduce duplication and act as a professional group for developing, critiquing and enhancing participation across the county. This approach was applied collectively to the CSR.
- Public Meetings hosted across the initial CSR design phase – attended by 525 local people and filmed to reach out to a wider audience, including the working well, seldom heard etc.
During the initial design phase of the CSR the same information that was shared with clinicians and other working groups was shared with the PPEG and through a series of public meetings. A trio of public meetings were held in December 2014, January 2015 and February 2015. One of each trio was filmed to enable the messages to be shared more widely, providing opportunity for information and involvement via the website, Facebook and twitter to a wider audience, including the working well, seldom heard, etc.
- Information and opportunity for involvement provided at 84 forums, meetings and events.
Across the CSR information and opportunity for involvement has also been provided to 1000s of people at numerous forums, meetings, and public shows. These included voluntary sector health and care forums, learning disability groups, equality and diversity forums, Dorset Youth Council, etc.
- 3,900 Health Involvement Network (HIN) and 150 Supporting Stronger Voices members – regularly informed and involved.
Information and opportunities for involvement around the CSR regularly sent to HIN members via the CCG “Feedback” bulletin. 150 CCG patient, carer, lay and public representatives invited to 6 monthly forums with CSR as a standing agenda item.
- Engagement with NHS West Hampshire CCG
CSR presentations given to Involvement Steering Group, New Forest Locality and Patient Public Engagement Group. Information communicated regularly. CSR patient/carer survey in New Forest area – 277 survey responses received and shared with NHS Dorset CCG.
- CSR and Young People
CSR poster co-designed with young people. 2 x CSR young people’s conferences co-designed and co-hosted with with young people in October and November 2015.
- Views collected across the CSR.
Across the CSR comments and questions have been collated for further consideration as appropriate. Recently, the strongest themes were presented in an information walk through at 9 public engagement events around community services.
- Simple animation of the “Need to Change” produced and shared with over 4100 people. 95% understand the need to change.
In response to suggestions from PPEG, the public and Healthwatch Dorset a simple 3 minute animation illustrating a) the need to change b) what is being done about it and c) how people can get involved was produced in October 2015 – to reach out more widely to the working well, the seldom heard, the hard to reach etc. This has been viewed by over 4100 people and those who completed a simple feedback survey 95% said that having watched the animation they understand why local health and care services need to change.
- 9 locality based Integrated Community Services (ICS) public engagement events were hosted in March and April 2016. 339 local people attended providing 2,162 pieces of feedback.
In response to the need to co-design integrated community services with local people a series of 9 public engagement locality based events were held across Dorset in March and early April 2016. This is an important stage in on-going engagement or participation work in Dorset – with a vital local community focus. The focus of each event was to listen and learn from local people, with lived-experience and knowledge of each area, exploring what they felt we need to consider when developing health and care services in their particular area of Dorset. Their views were also sought on emerging models of care. A high-level overview was shared at Clinical Working Group 9. The 2, 162 pieces of feedback have been collated and themed and 9 individual reports and a master report produced. Feedback is being shared to inform emerging models and local people will then be updated.
- Engagement “roadshow” being planned for June 2016.
Local people have asked us to come to where they are and to provide engagement opportunities across a wider geographical area. During June 2016 we will be covering a wide area of Dorset’s geography in a mobile vehicle – providing information and an opportunity for people to provide us with their feedback, views, concerns and questions. As with all previous engagement work – all views will be used to inform emerging models and options that will be taken back out to public consultation.
I have comments I want to make now, how can I comment?
We are always happy to receive questions and comments, but we need to be clear that our formal public consultation as part of the Clinical Services Review has not begun.
In the meantime, for general comments and questions we have a dedicated email address and telephone number. You can email us on email@example.com or call us on 01202 541 946.
You can keep up to date with all of the ways to get involved by joining our Health Involvement Network.
Will I get a chance to give my views before any changes to services are recommended?
Yes. Proposals will go to formal consultation and no changes will be made until this has happened.
What if I have further questions?
If you have any questions that are not answered here, please email firstname.lastname@example.org or call 01202 541946.
Or write to us at:
NHS Dorset Clinical Commissioning Group
You can find out more and keep up to date by signing up to our Health Involvement Network.
Why is there no public meeting in my area?
A number of public drop-in events for the Clinical Services Review will be taking place across Dorset throughout December, January and February to support the 12 week public consultation.
These events will be an opportunity to watch a presentation-style film, ask questions and pick up a consultation document and questionnaire. To view a full list of public drop-in events, please visit our website (www.csr.dorsetsvision.nhs.uk/calendar-of-events).
In addition to these events, we’ll also be holding ‘pop-up’ events throughout the county (these will be smaller events with members of staff handing out consultation documents and encouraging people to complete the questionnaire) in areas of high footfall, including shopping centres and GP surgeries. Dates, times and venues for these events will be publicised widely, including via our partners, the local press and our Twitter and Facebook pages.
How can staff get involved and have their say on the proposals?
The most effective way for people, including staff, to provide their feedback and have their say regarding our proposals to change and improve health services in Dorset is by reading the consultation document and completing the questionnaire. We encourage all staff to get involved and provide their comments as employees and as users of NHS services in Dorset.
Are there any public events taking place for West Hampshire residents?
The details for the public drop-in events in Hampshire, which you can call into between the times given and where you’ll be able to hear about the proposals and ask any questions, are:
|Wednesday 18 January||New Milton Memorial Centre, Whitefield||10am – 7pm|
|Tuesday 7 February||The Ringwood Meeting House, Ringwood||5 – 7.30pm|
|Wednesday 8 February||The Ringwood Meeting House, Ringwood||10am – 4.30pm|
|Wednesday 15 February||Bransgore Parish Council, Bransgore||4 – 7.30pm|
How can people find out more about the consultation and make their comments if they don’t have access to the internet?
We’re reaching out as far and wide as we can to make sure as many people as possible have a chance to consider the proposals and have their say. As well as being able to collect a consultation document from any GP surgery or hospital in Dorset and view the document and questionnaire on our website, people are welcome to request a copy (or copies) of the document and accompanying questionnaire to be posted to them. They can do this by calling 01202 541946 or emailing email@example.com
Do I have to answer all the questions on the consultation questionnaire or can I just answer those about the area I live in?
No you don’t have to answer every question: that’s why the questionnaire is laid out in the way it is. We understand that people might not know much about services in areas outside of where they live. The important thing is to fill in the bits that are relevant to you and return the questionnaire so that your views can be taken into account.
What will happen to any feedback or questionnaires received after the public consultation deadline of Tuesday 28 February 2017?
In order for comments and feedback to be considered within the consultation analysis, all questionnaires and responses should be returned to Opinion Research Services (ORS) via the FREEPOST address below (or submitted online via the questionnaire on our website) by midnight on Tuesday 28 February 2017.
Any responses submitted to ORS after this date will not be included in the analysis and will be destroyed in accordance with ORS’s data protection policy.
Please be assured this deadline has been widely publicised via our website and social media channels and is clearly marked within the consultation document and questionnaire.
Opinion Research Services
PO Box 530
SCOPE OF THE REVIEW
Which services are included in the review?
The review covers all NHS health services in Dorset, that is hospital, community and GP services, except standard dental, optician and pharmacy services. However, the review is looking at services on a large scale, and will not be looking at each individual service and pathway of care (that remains the day-to-day business of the CCG and its work commissioning care for local people). The scope of the review is to design a framework for delivering care across Dorset in hospitals and in primary and community based settings (out of hospital care). The review will look at four main areas of care, looking at options and models of care and describing the best way of delivering these:
- Maternity and family health
- Planned and specialist care (including planned hospital operations and treatments)
- Urgent and emergency care
- Long term conditions and frail elderly.
How are mental health services being incorporated into the review?
A priority for Dorset NHS CCG is to make sure that mental health is treated equally with physical health to achieve ‘parity of esteem’, a nationally expected benchmark. With the agreement of our mental health clinical leads, the decision was made to ensure mental health was not discussed individually or as a separate part of our health system. Instead, mental health discussions have been incorporated into each of the four Clinical Delivery Groups.
Mental health has been discussed at each of the CSR Clinical Working Groups and the Clinical Reference Group (a group of senior clinical leaders who are advising on the CSR). The GP who provides lead advice on mental health and learning disabilities for the CCG, the Medical Director for Dorset Health Care University Foundation Trust and a number of senior consultant psychiatrists have been involved in these working groups and discussions.
NHS Dorset CCG is also carrying out a great deal of work to improve mental health services as part of its ongoing work outside of the review. We have completed a review of Children’s and Adolescent Mental Health Services (CAHMS), and a review of services for children with autistic spectrum disorders and with ADHD. We are also reviewing the perinatal mental health pathway. NHS Dorset CCG is currently leading a review of the mental health acute care pathway for people in Dorset and this is running in alongside the CSR. The proposals will be consulted on separately. Further reviews are scheduled for more specialist areas within mental health such as the dementia pathway and rehabilitation and recovery. Many services are jointly commissioned and reviews need to be undertaken with our partners who jointly fund these services. Co-production of options with our service users and carers will be a key part of these reviews.
Work to improve the delivery of acute mental health care includes:
- Improving access to CAMHS and developing more appropriate service delivery
- Improving the focus on recovery for people with serious mental illness
- Developing a partnership approach to crisis care in line with the Crisis Care Concordat
- Delivering safe, effective, sustainable and high quality mental health acute care to the residents of Dorset ensuring services reflect need and that the interventions are in line with NICE guidance.
NHS Dorset CCG is investing around an additional £3 million during 2015/16 into mental health services.
All of this work is aligned to the clinical services review and will continue to feed into it as detailed work on care pathways and individual services is developed.
Is this all about hospitals and pressures on A&E. What about other services?
This is absolutely a review of the whole system of NHS healthcare in Dorset. We know that there are many interdependencies between different parts of the system. For example, an elderly person may be medically fit enough to leave hospital, but if the appropriate care to support them and their health and social needs isn’t available, then they cannot be discharged from hospital. This in turn puts pressure on A&E. If somebody cannot see a GP out of hours, they might go to A&E, even though their condition isn’t an emergency. Again this adds to the pressure on A&E. If somebody with a long-term condition gets the support they need in the community, they are less likely to reach a crisis that means they have to go to hospital. Problems like this mean patients don’t get the best care in the best place, and it means we are not using our resources efficiently, which we cannot afford to do.
That is why the Clinical Services Review is looking at all NHS services in Dorset, and at how we can ensure that they do work together to deliver the right care in the right place and make the best use of the available resources.
What about access to hospitals?
Dorset has particular challenges in that it is very rural in the West, with urban areas concentrated in the east. We need to take this into consideration to ensure that we meet our aim that everybody has access to good services. For this reason one of the six criteria we are using to assess the potential options is accessibility and the impact of any potential change on travel times. We are not yet at the stage of deciding on the detail of services but the clinicians leading the review recognise that there needs to be urgent and emergency services provided in both the east and west of Dorset.
What is going to happen to present services whilst the review is taking place?
The CCG’s usual business is to determine the current needs for services and this will continue during the review. There are no proposals as yet on what service change might be necessary. The current stage of the review is about designing possible options for the future pattern of services. This is based on evidence and data that has been gathered into a ‘Case for Change’, and on the knowledge and experience of local clinicians. This evidence, which incorporates patient and public views and experiences, will be taken by GPs and other clinicians and turned into a set of proposals for what services should look like in order to deliver sustainable, affordable and high-quality care for the future. The next stage after that is a full public consultation on the plans. Only after that will any agreed changes be implemented and any changes will be phased in.
Are providers who are geographically outside of Dorset but provide services to Dorset residents going to be included in the Review (eg Salisbury District hospital)?
The aim of the review is to ensure high-quality care for people in Dorset, and inevitably this means a focus on services within the county. However, people already use services outside the county, so we will be looking at out of county services and working closely with health system colleagues in neighbouring areas in our bid to ensure that people benefit from seamless care.
No plans have been drawn up for any service yet; that is the next step in the review. However we are looking at the whole system of health care used by people in Dorset, and that of course includes understanding the services used by Dorset residents outside the county borders. That is why we are working with hospitals such as Yeovil District and Salisbury District. Any decisions on future services in Dorset will be made by clinicians, and will only be implemented after extensive public consultation.
Will the review look at health prevention and health promotion initiatives?
The public health budget, which covers health promotion and prevention initiatives, is now part of local government responsibilities. This is a really important aspect of planning for a healthier future and everyone has their role to play in trying to stay healthy and lead healthier lifestyles to improve our individual and population health in the long-term. If we are to deliver sustainable services we do need to look at ways of keeping people well and out of hospital, whether that is keeping healthy or being supported to manage long-term conditions. So we are looking at where the NHS and local authorities can work together to make improvements where health and care services interact, trying to make services more joined up for local people. Much work in this area is already underway (eg the Better Together work we are doing in Dorset). However, we are at this stage gathering evidence and the work of developing options for models of care for the review has not yet begun.
Can you really carry out such a major programme in the time allotted?
We don’t have the luxury of going slowly. The review needs to be comprehensive and detailed, but we also need to make good progress in planning our strategy for high-quality, affordable health care for the next 10 years or so. Projections show that in five years Dorset will spend about £200m more than it receives on healthcare. There’s too much variation across Dorset – we need to get maximum health gain for all local people with the funding we have, which means looking where we put that resource and how to get the most out of it.
The review is looking at services on a large scale, and will not be looking at each individual service and pathway of care (that remains the day-to-day business of the CCG and its work commissioning care for local people). We can make good progress because we are building on existing programmes of work. We are also building on a substantial programme of public engagement the CCG has conducted over the past 18 months, such as The Big Ask, and other citizen’s panels and focus group insights.
We are minimising risk by having a robust assurance system in place. As the review is being led by clinicians we are confident that patient care and health improvement will remain central to the design work for a new pattern of healthcare delivery in Dorset. The clinicians are basing their discussions on a robust evidence base, as set out in our document The Need to Change. No changes will be implemented until they have been through public consultation.
What evidence is there to suggest the proposals will save lives?
As detailed in the 2013 report Transforming urgent and emergency care services in England written by Sir Bruce Keogh, Medical Director of NHS England, there is very clear evidence that more lives are saved when people are treated at specialist centres with senior specialist staff available on site twenty four hours a day, seven days a week. These centres have specialist staff seeing sufficient volumes of cases to maintain and extend their expertise and skills and also access to the best technology available.
Have the CCG considered the implications of these community hospital proposals for relatives of patients who may well also be elderly and frail, both financially and on their health? Or on the patients themselves who will inevitably have fewer visitors as a result?
When forming these proposals, detailed travel time analysis was undertaken by external experts and based on independent satellite navigation system data from hundreds of thousands of real time journeys. This was used to assess the impact on the population of proposed changes from the current location of services to those contained within the proposals, to maximise access to the widest population.
Under our proposals, 100% of people would be able to reach community bedded sites within 32 minutes by private car and 87 per cent within one hour by public transport.
100% of people would be able to reach a community hospital hub (includes hubs with or without beds) in 23 minutes by private car and 91 per cent within one hour by public transport.
The CCG will be working with partners to look at innovative transport solutions, in recognition of the importance local people have placed on addressing the current transport challenges people have expressed. In July the CCG reflected the views heard at recent public events in a response to the consultation into Dorset’s transport network by Dorset County Council.
How will you recruit new foreign staff, notably from the EU, in light of the current political climate?
If you’re referring to Brexit and the UK’s withdrawal from the EU, it’s not possible for us to predict or say what effect this may have on recruiting staff from the EU. However, we will monitor the situation closely.
Where can I find more details about the acute mental health services review?
The Acute Mental Health Service Review will begin at the end of January. A new website will be up and running by this date but, in the meantime, more information can be found on our website here:
Where can I find your Equality Impact Assessment?
To view our Equality Impact Assessment, please see pages 269 to 276 of our Clinical Services Review Pre Consultation Business Case which is available to download on our website here:
How will residents living in the Dorset/Wiltshire/Hampshire borders be affected by the proposed changes? Has Dorset CCG had consultations with GPs and CCGs outside of Dorset?
People living outside of Dorset who are referred to NHS services in Dorset by their GP (or opt to use services in Dorset), notably at Bournemouth and Poole hospitals, may be affected by the Dorset Clinical Services Review (CSR).
We have been working closely with colleagues in West Hampshire and Wiltshire to ensure that local people are informed about Dorset’s CSR and the proposals.
What is the breakdown of the 30,000 individuals working in the NHS in Dorset?
|NHS||284 (NHS Dorset CCG)
17,902 (4,394 Royal Bournemouth and Christchurch Hospital, 3,461 Dorset County Hospital, 5,553 Dorset Healthcare, 3,820 Poole Hospital and 674 South Western Ambulance Service)
How much is the review costing and where is the money coming from?
The review has been allocated a budget of £2.75 million for design, evaluation and consultation. This is less than 0.3% of the annual budget of the CCG, and is an investment to help Dorset CCG secure a financially and clinically sustainable healthcare system for people in Dorset for the long-term. If we do not undertake this review we will face a potential funding gap from £167 to over £200 million by 2021.
The funds come from an historic one-off budget that cannot be used for on-going operational delivery of front-line services. We are not therefore spending money on this review that would have been spent on patient care.
How can you justify spending so much money during the current economic environment?
If we do nothing at all and carry on running services in the way we do now we will face a gap between the money we need (our costs) and the money we have (our income) from £167 to over £200 million, depending on the level of cost inflation and population demand, by 2021. One of the reasons that we are carrying out the review is because we know that in the current economic climate extra resources for the NHS are limited. At the same time we know that health needs are changing and growing in Dorset because of our changing population. The money we are spending is less than 0.3% of the annual budget and is not money that could be spent on front-line services and direct patient care. It is an investment to ensure we can deliver a thriving and sustainable health service for Dorset into the future.
What is the budget the CCG is setting aside for the public consultation?
The CCG approved £234K non recurrent resource within the 2016/17 opening budget to support consultation. We are legally obliged to carry out the public consultation, it is good practice and we have a duty to our patients, public and staff to ensure that information is accessible to all so that as many people as possible can give an informed response.
How can we be sure the projects will be delivered on budget?
The strategic outline case in terms of the level of Capital Investment required, will be worked through and developed into a full business case by the affected providers. This approach will also be necessary for the community capital changes.
They will then look to secure both the funding for the developments and equally the strategic delivery partner for the project, who will have milestones and expectations and run capital project methodologies.
Recognising as in the previous question that there is a degree of optimism bias, which allows for a degree of flexibility for the project delivery.
What happens if interest rates go up?
The interest rate would be fixed at the point that schemes are approved, so the volatility will only be an issue up to the point that the funding and case is approved.
What happens when inflation increases?
Inflation is included in the Capita case, so whilst it may have a marginal impact, the risk is mitigated.
Which buildings will be sold to make the community estate changes cost neutral?
Dorset Healthcare as the incumbent provider, will continue to use their capital programme, including where possible, disinvestment of estate where appropriate. The sites that are at risk of closure in the Governing Body paper, are within the links below:
Equally in the consultation documentation, link here:
The Clinical Service Review proposals are that Alderney, Westhaven and St Leonards would not be used as community hubs, either with or without beds. The services based there would be moved to other hubs. The three community hospital sites may be used for other purposes.
Proposals for the future of acute mental health inpatient beds at Westhaven hospital (the Linden Unit) will be included in a separate consultation this year. Proposals for the future use of Alderney Hospital will be considered in a review of dementia services taking place over a longer timescale. In addition, it is recommended that we look for alternative sites for the local hubs without beds in Portland, Shaftesbury and Wareham. If better alternative sites are secured, these community hospitals will no longer be required, and will close.
The capital requirements for the proposed community hubs will be phased to match the resources available in each year. Wherever possible, proceeds from disposals will be redirected at the community hubs capital requirements. Capital will not be the major determinate of the locality hubs as some of the existing sites already provide much of the functionality and they are much more about operational ways of working than investment in buildings. Improvements to the physical buildings will be managed within the resources available.
Dorset CCG and Dorset Healthcare are together undertaking detailed feasibility studies for the preferred options described in the Clinical Service review proposals. When completed this will provide more in depth information on the capital requirements to meet the community estate changes. This work was referred to with the Governing Body paper 20 July 2016 (paper 8.1 Page 34 Para 3.11) – Clinical Service Review – Community Site Specific Consultation options.
Where it is appropriate, opportunities for charitable donations to be used will also be considered.
Approximately how much does it cost per week for an acute hospital bed, a community hospital bed and to commission a care home bed?
The average costs per week are:
a. An acute hospital bed = £2,100
b. A community hospital bed = £1,600
c. A care home bed = £800-900
How have clinicians been involved in developing the proposals?
Over 300 local clinicians have been involved in the review process from across Dorset’s health system to date, including GPs, primary care teams, nurses, allied health professionals, medical directors, clinical directors, with consultants from Poole Hospital, The Royal Bournemouth Hospital, Dorset County Hospital, Dorset Healthcare and paramedics from South Western Ambulance Service.
The clinicians in the working groups drew on their clinical knowledge, their experiences of working practices, and UK and international evidence, to define ‘what good looks like’ across the clinical working groups. They looked across four key service areas:
- Urgent and emergency care
- Planned and specialist care
- Maternity and paediatric services
- Services for people with long term conditions and the frail elderly.
Mental health has been embedded in their thinking and considered across all pathways. For each area, they have been looking at every aspect of the care pathway. For example they have described what a good service would look like in maternity care all the way from pre-conception care, education and advice; through antenatal; labour and delivery; and post-natal care. They’ve also focused throughout on maternal mental health and wellbeing.
Once the clinicians had established ‘what good looks like’ for each pathway, they have had extensive discussions on what the delivery model for those would look like. For example a home birth service; a midwife led unit; and a 24 hour 7 day consultant delivered obstetric unit are all different delivery models for different types of maternity care.
Clinicians then looked to see how different models of healthcare, across the four key service areas, might be applied in Dorset.
What questions have the clinicians considered?
The discussions initially gave a huge number of potential options for different ways of delivering care. These options have been reduced by applying six high level questions, which were agreed by the clinicians, and members of our Patient and Public Engagement Group. The six high level questions were:
- Quality of care for all – do any of the potential options fail to support the delivery of high quality care in line with standards for high quality services/best practice?
- Access to care for all –do any of the potential options have an excessive impact on travel times?
- Affordability and value for money – are any of the potential options likely to be highly unaffordable – for example will they require a considerable amount of capital expenditure for minimal positive impact on running costs?
- Workforce – Are any of the options likely to not be deliverable and/or sustainable from a workforce perspective?
- Deliverability – Are any of the potential options not deliverable within a reasonable time frame?
Assessing the long list of potential generic options (i.e. not focused on our current hospital sites) against these high level questions enabled clinicians to narrow down the long list of options. More detailed assessment, using the evaluation criteria, was carried out with clinicians in order to identify a short list of viable potential generic options for delivering services in our acute hospitals.
This process has ensured that the options for the configuration of health services across Dorset proposed for public consultation will meet the needs of people in Dorset by improving healthcare, meeting quality standards and doing so within the available resources.
What are you consulting on?
We want to gather views of local people about the proposed changes to Dorset’s healthcare in order to help inform the final decision making about what changes are implemented.
|Area||To determine public views and levels of support on:|
|The need to change||Why change is required and acceptance that the status quo is neither sustainable or desirable|
|Our vision for healthcare in Dorset||Agreement with the CCG’s overarching vision|
|Transforming our out of acute hospital provision to provide high quality, safe and sustainable care||Changing model of out of acute hospital care focused on bringing more care closer to people’s homes, offering a greater range of services locally (based on a scale model), making best use of estates|
|Transforming our acute hospitals to provide high quality, safe and affordable care||Changing model of acute hospital care with centres of excellence that can offer specialist and day-to-day acute emergency, urgent and planned care. Consulting on site specific options (Option A and B) for new ways to organise care|
|Implementation of the agreed solution||Any specific issues of note or to be aware of during implementation (e.g. public transport routes, sequencing of new and old services)|
How will this review link with existing work such as the ‘Better Together’ programme?
The Better Together and Urgent Care programmes are significant and important pieces of work. They are being overseen by the Better Together Sponsor Board (a board of health and care leaders from across the county) and are focusing on how health and social care services can work in a more joined up way together.
Because the Clinical Services Review is all about looking across the whole of Dorset’s health system, and where it interacts with social care services, there are many synergies with this existing work and it will be built on as part of the CSR work programme. However, the CSR work programme is focused and targeted on designing a pattern of health services across the county that are safe, high quality and affordable not just today but into the long-term.
The review also fits with The NHS England Five Year Forward View. Launched in October, the plan, which was developed in collaboration with the leading NHS organisations, patient groups, clinicians and voluntary groups, is a call for action around demand, efficiency and funding. But it recognises that a one-size-fits-all approach won’t work and that there is a need for local flexibility in responding to the challenges of meeting increased demand, improving quality at a time when there is no additional funding for public services.
Do the proposals now mean there will be less A&E consultant cover in the west of the county?
There are no proposals to stop the provision of 24 hour a day 7 days a week emergency, cardiac and stroke services at Dorset County Hospital (DCH) i.e. in Dorset Clinical Commissioning Group’s options for change these services will continue to be provided by specialist trained doctors and nurses, 24 hours a day, 7 days a week at DCH as now.
However, where very sick patients are assessed as needing to have their care specifically delivered by a senior consultant doctor this level of service will be available at Dorset County Hospital:
- 14 hours a day 7 days a week for emergency surgery;
- 14 hours a day 7 days a week for emergency stroke care;
- 12 hours a day 7 days a week emergency cardiac care.
These hours of consultant led provision are the same or greater than the provision of consultant delivered care for these services as is currently offered at DCH.
Outside of these hours, if very sick patients are assessed as specifically needing consultant delivered care they will be transferred to the proposed Major Emergency Hospital in the east of the county where 24/7 consultant-delivered care will be available. At the moment Dorset’s three acute hospitals do not deliver 24/7 consultant delivered care.
The proposals therefore set out the ambition to offer these higher quality and safer services to local people who are very sick with life threatening conditions at a hospital in Dorset – something that none of the three acute hospitals currently offer on a 24/7 basis.
The new proposals are as recommended in the major national Keogh report into urgent and emergency care services.
How do the proposals affect paediatric services in Dorset?
In Dorset there are two children’s wards with 26 inpatient beds at Poole Hospital and 12-17 inpatient beds at Dorset County Hospital.
There were over 16,000 unplanned admissions at Poole Hospital and Dorset County Hospital in 2013/14 and 40% of these children were admitted for less than 24 hours. Nationally, there has also been a 28% growth in unplanned admissions in the last 10 years, almost entirely for 24 hours or less and often for conditions such as respiratory tract infections and gastroenteritis. This data indicates that these cases are usually not serious and often just need observation. The increase in numbers does not reflect increasing numbers of sick children as the number of childhood deaths has decreased by 17% between 1999 and 2012.
Experts in paediatric medicine and care are indicating that it is therefore not necessary to have large and increasing numbers of inpatient beds for children. Instead of being admitted to hospital the care of children could be delivered in a different and more effective way. We know that parents and carers need ready access to medical advice, and where required to the specialists and technology that means that children’s health can be assessed and diagnosed quickly.
The Royal College of Paediatrics and Child Health in their Facing the Future report outline the standards for acute general paediatric services. The recommendation is for smaller paediatric inpatient units to be replaced by Paediatric Assessment Units (PAUs) to provide observation and care for children with illnesses, injuries, or other conditions that are referred from GPs, community nursing teams, Walk-in Centres.
Facing the Future specifies that smaller units are not viable because the consultants do not see sufficient volumes of cases to maintain their specialist skills. Children’s outcomes are improved if they are seen at larger specialist centres.
In response to the need to change, the proposals outline a bold ambition to build on the good services for children that we have in Dorset to deliver even higher quality, safer and more sustainable service to help sick children across the county. This will see the introduction of a networked approach with paediatric doctors and nurses from across Dorset working closely together to provide community and acute hospital based care.
A significant element of the proposed model for children’s services is about improving the services available closer to people’s home through enhanced GP and primary care services. This would include the introduction of seven day working, which would mean people will have more access to their GPs in the evenings and weekends for medical advice and appropriate care. This is aligned to national plans to deliver improved access to GP services.
Enhanced GP services would be complemented in Dorset by the development of a network of community based ‘hubs’ through which a greater range of services would be provided. This would include services that currently require a visit to an acute hospital including some diagnostics, outpatients and rehabilitation. Consultant paediatricians would deliver appropriate care to patients within the hubs and other dedicated children’s services would also be provided. There would also be an increase in community provision through outreach community nursing teams.
Where children need specialist paediatric assessment or treatment at an acute hospital, the proposals would see the provision of 24/7 consultant delivered care on site at the Major Emergency Hospital in the east of Dorset. This would also include a specialist neo-natal unit for the care of very ill or premature newborn infants.
The details of the proposed future paediatric provision at Dorset County Hospital including inpatients are still being discussed with clinicians to ensure a proposal that will deliver high quality care in a safe and sustainable manner. In identifying the solution the detailed proposal will consider the national guidance, including that from the Royal College of Paediatrics and Child Health and the views of the Wessex Clinical Senate. This work is ongoing and at this time no decisions have yet been made.
To date, the proposals have suggested that the direction of travel in the west of the county would be in line with national guidance towards the provision of a high quality paediatric assessment unit (PAU) as part of a Dorset-wide network. The PAU would provide consultant delivered on site care for 16 hours a day 7 days a week and offer rapid assessment and access to diagnostic tests.
The PAU would work closely in a network arrangement with the paediatric services across the rest of Dorset. This would ensure that community and acute hospital services across the county would make best use of the specialist expertise across the whole county to provide high quality, safe and sustainable care of children’s physical and mental health.
The discussions about the appropriate provision at Dorset County Hospital are ongoing and no decisions been taken regarding a PAU or inpatients.
Children with acute trauma needs including severe head injuries and those requiring major surgery will continue to be transported directly to or transferred to be seen at Southampton General Hospital, as they are now.
Will you be closing community hospitals? And will you be closing community beds?
We recognise the vital role community services play in delivering healthcare, and have a vision for bringing more care out of acute hospitals and closer to people’s homes. Our community hospitals would have a clear role in this and many are well placed to become local health ‘hubs’ where a range of services could be provided for patients, closer to people’s homes and their communities.
However, we know some of our community estate is no longer fit for purpose and would require many millions of pounds to refurbish. Some of it is underutilised i.e. only delivering services for a relatively small number of patients for only a few days and hours in the week. Some of our community hospitals are located away from where the highest numbers of Dorset’s people live. And some might be better used or needed as nursing home rather than hospital facilities. So there is a strong case for looking at our community hospital provision more closely, working out where services and beds are most needed and where they could best be made available for the patients who need them. This will be part of the work of our review and whilst we have a clear future vision for more and better out of acute hospital based care and services we don’t yet have clear answers on what this might mean for buildings in specific locations at this time.