Northern Lincolnshire Healthy 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 services Centralised care Comprehens ive 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 Home care

Our Key Messages

Engagement Feedback Summary Key survey feedback Based on 308 responses

Engagement Feedback Summary Key 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 Recommendations 3 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: Stroke Reviewed the options appraisal for the following options, and scored against the evaluation criteria: 1.De-centralise the service 2.Remain at SGH 3.Move to DPOW 4.Move off patch to nearest specialist centre Option 1Option 2Option 3Option 4 Quality Access Affordability Deliverability Total

Rationale for scoring Returning 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: ENT Reviewed the options appraisal for the following options, and scored against the evaluation criteria: 1.Do nothing 2.Centralise on DPOW site 3.Centralise on SGH site 4.Move off patch to nearest specialist centre Option 1Option 2Option 3Option 4 Quality Access Affordability Deliverability Total

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. 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’s These options were proposed by NLaG and considered using their business case, and a brief options appraisal paper: 1.Do nothing 2.Rotate consultants locally between sites 3.Rotational training programme with tertiary centre 4.Move off patch to nearest specialist centre Option 1Option 2Option 3Option 4 Quality Access Affordability Deliverability Total

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 SeptOctNovDecJanFebMar Zero- based commissio ners solution Engagement Public consultation Option refinement & assessment Consultation preparation Provider- led solution Stakeholder summit Engagement & communication activities 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 Implementation of safety & quality imperatives, and those elements not requiring consultation Today Zero-based commissioner s solution Provider-led solution

Contact details Telephone: Write to us at: Freepost RTEX-GXUJ-BGTB Healthy Lives, Healthy Futures PO Box 683 HULL HU10 6DT Why not visit our website at Or follow us on Twitter at