Northern LincolnshireHealthy Lives Healthy Futures Programme

Equalities Focus Group Presentation

May 2014

What is Healthy Lives, Healthy Futures?

Healthy Lives, Healthy Futures is a review of all health and care services in the North and North East Lincolnshire. The review aims to make sure the services available to people in our area will be safe and of high quality for years to come.

The case for change

• Quality is not always where it should be• There are significant cost constraints• Demand from our population is rising

The current health system is not sustainable

• Work needs to be done to understand how services can be delivered differently

The health system will need to change across providers

• The case for change parallels the national case for change and ‘Call to Action’

There are many other areas in the same situation as Northern Lincolnshire

The Shared Vision – A Shift to the Left…

Community based

care

Self care & independent

living Local

servicesCentralised care

Comprehensive

Affordable

Healthcare providers should provide a comprehensive service, from supporting prevention and self-care, through community provision, to specialist and tertiary care.

Providers of these services should take an integrated approach, so that local people have access to a seamless service

The result will be higher-quality care, with more lives saved and more people returned to full health

A further result will be a service that is affordable in the years to come

Integrated

Higher quality

Homecare

Our Key Messages

Engagement Feedback SummaryKey survey feedback

Based on 308 responses

Engagement Feedback SummaryKey themes from open ended responses

“Sometimes follow up appointments could be dealt with by GP and only referred back to if preferred”

“As well as attracting staff to the area need to develop 'grow own' community/ young people to be able to work locally. This means working with schools/ education establishments to ensure children/young people are supported with the right education input to work in some of the careers needed longer term”

“Continuity is essential if you want people to trust services, particularly for the elderly”

“Appointments should be made to allow consultants to see patients on the specified time. It is common to run 1.5 to 2 hours late and more”

“[Travel distance] is also important, particularly that relatives are able to visit where people have long term or life threatening conditions or in general to aid recovery. This is more difficult if people are having to travel longer distances”

How are we acting on the engagement feedback?

Introduced an additional element to the commissioner

vision to separate out self-care from the home care work. More

initiatives being added and implemented in that area

Set up an integrated transportation group to work on transportation solutions

Plans in place to involve a much wider group of clinicians to understand the impact on

services of any proposed changes

7 day working pilot about to commence in North East Lincolnshire – to extend community and GP care provision

Technological solutions being planned to support home and

community based care provision

Here are some responses to public feedback/demand we are making the following changes / enhancements to the programme

Equalities Focus Group Recommendations3 areas considered by the programme board:

– Hyper-acute Stroke Services– ENT Inpatient Surgery– Children’s Surgery

Review of the options appraisals has resulted in recommendations for each; either:

– Consultation (Stroke, ENT)– Further options development (Children’s surgery)

We are asking you to review the options for each service and decide whether there are any negative impacts on any equality groups?

4 Options considered: StrokeReviewed the options appraisal for the following options, and scored against the evaluation criteria:1. De-centralise the service2. Remain at SGH3. Move to DPOW4. Move off patch to nearest specialist centre

Option 1 Option 2 Option 3 Option 4Quality 52 164 146 101Access 60 41 41 19Affordability 14 46 14 11Deliverability 24 80 32 32Total 150 331 233 163

Rationale for scoringReturning the service to operate on both sites goes against national recommendations for more centralised specialist services for hyper-acute care. Also it was deemed that this would not address the serious quality issues that had been raised by the Keogh team and the local service reviews, which would result in a poor peer review, and have a detrimental impact on mortality and morbidity for local stroke patients.

It is demonstrated through the temporary location of the service on the SGH site that the quality of care is improved by centralisation onto one site, and the introduction of a 24/7 hyper-acute stroke service. It was recognised that the service could be delivered on either site, however SGH scored highest from a quality perspective due to the fact that the service is established with a fully trained staff, and the required infrastructure is already in place. DPOW does not have a spare CT scanner, which could present a risk if the current one is not available for any reason, and there is no clinically appropriate space on the DPOW site in close proximity from the A&E department.

Moving the service to Hull (or another tertiary centre) was deemed less attractive to the programme board due to the additional travel time, and the fact that capacity at the specialist centres may not easily be identified.

4 Options considered: ENTReviewed the options appraisal for the following options, and scored against the evaluation criteria:1. Do nothing2. Centralise on DPOW site3. Centralise on SGH site4. Move off patch to nearest specialist centre

Option 1 Option 2 Option 3 Option 4Quality 62 133 133 115Access 76 68 61 44Affordability 40 32 24 16Deliverability 56 64 56 56Total 234 297 274 231

Rationale for scoringClinicians have raised concerns over the volumes for surgery, so the programme board deemed that “do nothing” was not an acceptable option.

Centralisation at DPOW and SGH scored equally from a quality perspective, assuming that the same level of care could be delivered on each site through effective care pathways and processes. DPOW scored slightly higher as there is more available theatre capacity and greater staffing complement, meaning recruitment/retention may be more achievable than SGH. In addition there are outlying clinics in Mablethorpe and Louth that would be impacted negatively by a move to SGH, these patients are unlikely to travel to SGH. With IFR procedures removed, (tonsillectomy, grommets, sleep apneoa), the numbers are still significantly greater at DPOW.

Locating the service at a specialist centre was deemed favourable from a clinical quality perspective, however it would require all patients to travel further, and the receiving trust would need to identify significant capacity which could be costly.

4 Options considered: Children’sThese options were proposed by NLaG and considered using their business case, and a brief options appraisal paper:1. Do nothing2. Rotate consultants locally between sites3. Rotational training programme with tertiary centre4. Move off patch to nearest specialist centre

Option 1 Option 2 Option 3 Option 4Quality 72 45 118 145Access 36 24 36 24Affordability 40 16 16 24Deliverability 48 16 40 72Total 196 101 210 265

Rationale for scoring

Clinicians have raised concerns over the volumes for surgery, so the programme board deemed that “do nothing” was not an acceptable option.

The options were scored by the programme board, however it was queried why a local centralisation option was not included in the paper. It was clearly recognised that there would be safety improvements through centralising with a tertiary provider, however the travel distance and non-elective attendances at local A&E departments may be disadvantaged by not having local expertise on site.

Options 1 and 2 were felt to score too poorly to pursue. The programme board requested more work on the options appraisal for options 3 and 4, to include centralisation at DPOW or SGH as options 5 and 6. It was suggested that a further period of engagement on this could mean that (with this scale of change) there would not need to be a formal consultation in the future. The further engagement would take place alongside the formal consultation from June 2014, and therefore implementation of changes may not be delayed.

Apr

Refine high level themes / service models

for public engagement

Programme Timeline

Sept Oct Nov Dec Jan Feb Mar

Zero-based

commissioners

solution

Engagement Public consultation

Option refinement & assessment

Consultation preparationProvider-led

solution

Stakeholder summit

Engagement&

communicationactivities

Key stakeholder

1-to-1s

May June

Engagement

Jul Aug-Oct

Key stakeholder

1-to-1s

Work to assess/incorporate outputs of consultation

Implementation beginning October 2014

20142013

Implementation of safety & quality imperatives, and those elements not requiring consultation

Today

Zero-based commissioner

s solution

Provider-led solution

Contact detailsTelephone: 0800 9155397Email: hlhf.team@nhs.netWrite to us at:

Freepost RTEX-GXUJ-BGTBHealthy Lives, Healthy FuturesPO Box 683HULLHU10 6DT Why not visit our website at www.healthyliveshealthyfutures.nhs.ukOr follow us on Twitter at www.twitter.com/hlhf_nhs