MY Five-year Clinical Services Strategy

Delivering safe, high quality, sustainable healthcare

October 2011

The Mid Yorkshire Hospitals NHS Trust

Purpose of briefing

• Vision for MY future and context• The journey so far• The need for change• Principles and process• Emerging options• Benefits• Three strong hospitals• Achieving our targets• Next steps and timeline• Your views

The Mid Yorkshire Hospitals NHS Trust

Vision: to deliver high quality, integrated healthcare

Several key strands of work:• Strong clinical services: transforming and integrating services,

Clinical Services Strategy and partnerships.• Developing the organisation around shared vision and values and

having a ‘can do’ culture that is focused on quality, safety, efficiency and delivery.

• Achieving FT status: being a strong, viable, fit for purpose organisation that provides high quality patient care in the most efficient and effective way.

• Achieving targets – financial, 95% emergency and 18 weeks

The Mid Yorkshire Hospitals NHS Trust Vision for MY future and context

• 1999/2000 - ‘Grasping the Nettle’ consultation - new hospitals reconfiguring services across Wakefield and Pontefract.

• 2009/10 - consultation created 3 specialist centres in Wakefield - Neo-natal Intensive and High Dependency Care, Inpatient Surgery for Children and Inpatient Orthopaedic Trauma Surgery.

• Some medical patients from Wakefield and Pontefract are now admitted to Dewsbury for their care.

• 2010 National Clinical Advisory Team (NCAT) re-validated our plans as safe but recommended we review services as they had doubts about sustainability of some services in the long-term:

Children’s inpatient medical services Acute surgery Emergency care at Pontefract.

The Mid Yorkshire Hospitals NHS Trust The journey so far

Our journey (con’t)

• March 2011, fully opened our new hospitals and new specialist centres in Wakefield.

• We had planned in some time to consolidate this but the Department of Health brought forward Mid Yorkshire’s requirement to develop the next five year’s strategy.

• We have now started a review of how we organise services - next stage of development and are responding to NCAT recommendations.

The Mid Yorkshire Hospitals NHS Trust

The need for change

National• Policy• Workforce supply• Quality and safety• Increasing sub-

specialisation• Efficiency• Meeting standards and

guidance

Local• NCAT report• Rising demand• Changes in health

needs• Integrating care• Performance• Sustainability

The Mid Yorkshire Hospitals NHS Trust

• Patient safety is the top priority. • Outpatient, diagnostics and day case services will be provided from all three hospitals – Dewsbury, Pontefract and Pinderfields.

• The three specialist centres continue to be provided at Pinderfields.• Focus should be on caring for people at home and in the community, only treating people in hospital where clinically necessary and enabling discharge from hospital sooner.

• Unplanned transfers between the Trust’s sites should be kept to the minimum.

• Patients should be able to use the Trust’s services closest to them.

The Mid Yorkshire Hospitals NHS Trust

Clinical Services Strategy – principles

• Clinically-led by hospital clinicians and GPs.• Robust appraisal and analysis by a Clinical Advisory Group,

using safety, quality, patient experience and sustainability criteria.

• Emerging options developed through discussions with hospital clinicians, local GPs and other key stakeholders.

• Ongoing engagement with key stakeholders, including Overview and Scrutiny Committees.

• Now engaging with staff, public and other stakeholders to discuss options and take needs and views into account.

The Mid Yorkshire Hospitals NHS Trust Clinical Strategy – development process

• Pontefract Emergency Department could change to a minor illness and injury service. It would provide care for around 80% of people who currently use it with the sickest 20% going to Pinderfields for their care

• Consolidate care for sick children who need to stay in hospital for over 24 hours in purpose built facilities at Pinderfields, with easy access to specialist advice. There would be a dedicated assessment service for children at Dewsbury which would cater for  the vast majority of children who stay in hospital for up to 24 hours

• Consolidate planned adult inpatient orthopaedic surgery at Dewsbury with rehabilitation in Pontefract and Dewsbury

• Rehabilitation for patients who need to stay in hospital after a stroke provided at Dewsbury and Pontefract

• Routine eye operations would be provided from Dewsbury and Pontefract and not Pinderfields

• Outpatients and day case surgery on all three hospital sites

The Mid Yorkshire Hospitals NHS Trust

Common features of the emerging options

• Three of the five options consolidate consultant-led maternity care and neonatal care for premature or very poorly babies at Pinderfields, with midwife-led units at Dewsbury and Pontefract

• Three options see specialist care for Acute Haematology and Complex Chemotherapy centralised at Dewsbury

• One option sees higher risk inpatient surgery centralised at Pinderfields to concentrate skills and improve patient outcomes.

• There is also work underway looking at how Spinal Injuries, Neurology and Neuro-rehabilitation (Neurosciences) could be provided in future, with the possibility of some or all of the services moving to other hospitals from Pinderfields. There is also a review of the best way to provide hospital care for people with heart problems (Cardiology care).

The Mid Yorkshire Hospitals NHS Trust In addition

The Mid Yorkshire Hospitals NHS Trust

Minor Injuries Unit and Urgent Care

Centre at Pontefract

Inpatient Paediatrics

at Pinderfields

and Paediatric

Assessment at Dewsbury

Adult InpatientPlanned

Orthopaedic surgery at Dewsbury

PlannedOphthalmology at Dewsbury

and Pontefract.

Inpatient Stroke and

Orthopaedic Rehab at

Dewsbury and Pontefract

Inpatient Consultant-

Led Maternity and Neonatal

Unit

Inpatient Acute

Haematology and Complex

Chemo

InpatientAcute

Surgery

1 Pinderfields

2 Dewsbury

3 Pinderfields Midwife-led

Units (MLU) at Dewsbury and

Pontefract

Pinderfields

4 PinderfieldsMLUs at

Dewsbury and Pontefract

Dewsbury

5 PinderfieldsMLUs at

Dewsbury and Pontefract

Dewsbury Pinder-fields

Main emerging options

• Concentrating expertise to improve access to specialist teams

• Quicker recovery, better outcomes• Better meet the needs of emergency and planned

patients:– Shorter waiting times– Reduce number of cancelled operations– Achieving lower rates of infection

• Improving consistency of care and standards• Ability to focus resources on improving services

The Mid Yorkshire Hospitals NHS Trust Benefits

Three strong hospitals

Three hospitals providing local services – each with a clear purpose and role as part of MY integrated care organisation

Pinderfields – major acute hospital

Emergency Department (ED) for Trauma, Surgery and Medicine and full acute Surgical and Medical facilities.

The increasing focus on acute care at Pinderfields would allow greater separation of planned and emergency care, speeding up and improving care and outcomes for both.

The Mid Yorkshire Hospitals NHS Trust

Dewsbury – strong District General Hospital

Non-trauma Emergency Department with Surgery, Medicine and Paediatric Assessment in accordance with status as a DGH. Under all options, Dewsbury takes on a new role as a centre for elective surgery, with Orthopaedics, Ophthalmology and in some variations Colorectal surgery moving to the site. There would be a minimum of a Midwife-led Maternity Unit.

There are also variations for either some or all of Neurosciences (Spinal, Neuro and Neuro Rehab) and Acute Haematology and complex Chemotherapy cancer services to be provided at Dewsbury – potentially creating new Neuroscience and Cancer Centres.

NHS KirkleesNHS Wakefield District

The Mid Yorkshire Hospitals NHS Trust

The Mid Yorkshire Hospitals NHS Trust Three strong hospitals

Pontefract – the elective centre

Under all options, Pontefract provides a Minor Injury Unit and Urgent Care Centre and Midwife-led Maternity Unit – ensuring it continues to provide these critical services to local people.

The new, purpose-built facilities provide an ideal setting for short-stay and day-case planned surgery across a number of specialties. There is also an increased focus on the management of long term conditions and rehabilitation, with all options including Stroke and Orthopaedic Rehabilitation and a variation to provide Neuro Rehabilitation on the site.

This is in line with NCAT’s recommendations.

The Mid Yorkshire Hospitals NHS Trust

Three strong hospitals

• Start of a long process.• Oct/Nov 2011 – fully engaging with staff, local people and key

stakeholders to discuss options and listen to views.• Develop detailed business cases.• As a result - some options may go forward to formal

consultation and some may not. • Feb to early April 2012 – NCAT review to ensure that proposals

offer safe, effective and accessible services for patients.• Late spring/summer - Public consultation. • Autumn 2012 – analysis of consultation. Consideration and

decision at relevant Boards and feedback outcome.

The Mid Yorkshire Hospitals NHS Trust

Next steps and current timeline

• Events for groups who may be affected by possible changes

• Questionnaires• Focus groups• Briefings for councillors, local MPs and voluntary groups• Events for staff• Media briefings• A range of feedback mechanisms including email,

Internet and telephone.

The Mid Yorkshire Hospitals NHS Trust

How we are engaging people

• Call our Patient and Public Engagement Team on 01422 281473 (this is an answerphone service and messages will be responded to within two working days)

• Or email dawn.pearson@calderdale-pct.nhs.uk

The Mid Yorkshire Hospitals NHS Trust

How to give us your views

• There is a national shortage of doctors with the right ED experience. Mid Yorkshire has experienced difficulty in filling gaps for a long time, due to needing to cover 3 EDs.

• From the start of November this will impact further, when Mid Yorkshire will see a large number of posts unfilled.

• Extensive and repeated efforts have been made to recruit with no success so far.• This leaves the Trust no choice but to consider taking urgent and immediate action to

avoid risking patient safety.• After considering all the options, senior clinicians are reluctantly recommending to the

Trust Board that it should agree temporarily to close the Pontefract ED between 10pm and 8am every day.

• The recommendation was based on patient needs across the whole District. Pontefract ED sees the lowest numbers of patients and the vast majority (85%) use it up to 10pm.

• The Trust Board is considering the proposal at its meeting next week and will send out an update following that.

• If the Board agrees the temporary overnight closure, there will be a public information campaign to ensure that local people know what they need to do.

• The overnight closure will be kept under review, but the end point is likely to be the outcome of the public consultation outlined in this briefing.

The Mid Yorkshire Hospitals NHS Trust

Current issue – Pontefract Emergency Department (ED)