1. Welcome…

2. Boleslaw Posmyk

3. Durham, Darlington and Tees The NHS in Darlington, Durham and Tees 150,000 NHS staff 1.2m population 6 hospitals GP practices and community settings, and patients’ homes

4. Durham, Darlington and Tees Better Health – a reminder Jan 2016Better Health Programme PCT led Acute services legacy project 2012/13 Securing Quality in Hospital Services (SeQIHS) 2013/15 Better Health Programme 2015/19

5. Durham, Darlington and Tees Clinical case for change “To do nothing is not an option” Jan 2016Better Health Programme

6. Durham, Darlington and Tees What people said last time… Jan 2016Better Health Programme Clinical Standards Clinical standards should be achieved where possible How patients are treated is as important as meeting standards Access is also a key consideration Resourcing How will resource be put into community services? Recognise staff skills Finance Is this a money saving exercise? How does it deal with financing staff resources?.

7. Durham, Darlington and Tees What people said last time… Jan 2016Better Health Programme Engagement: Needs to be as wide reaching as possible Be honest but don’t raise public expectation Needs to include hard to reach groups Links to voluntary and community sectors Scope Clarity of the Programme objectives How does it fit with other engagement projects Is Mental Health in scope? Timescales need to be defined

8. Durham, Darlington and Tees Since last time… Jan 2016Better Health Programme Our clinicians have continued their work on hospital services – we will share an update tonight We have begun to look at “Not in Hospital” services We have begun work on an engagement plan – details of events in your packs

9. Durham, Darlington and Tees Tonight - Jan 2016Better Health Programme Clinical group progress – Derek Cruikshank “Not in Hospital” – alternatives to hospital care – Neil O’Brien Workshop discussions: −What services could be provided out of hospital −How you can help us and we can help you

10. Derek Cruickshank

11. Durham, Darlington and Tees Healthcare is changing… Patients want better interactions with care providers Demand is increasing and costs are rising We’re getting older Available workforce is diminishing Too many people in hospital for too long Variations in survival and recovery rates Clinical standards are more demanding Patients want better interactions with care providers Demand is increasing and costs are rising We’re getting older Available workforce is diminishing Too many people in hospital for too long Variations in survival and recovery rates Clinical standards are more demanding Jan 2016Better Health Programme

12. Durham, Darlington and TeesBetter Health Programme H Urgent and Emergency Care Acute medicine Acute Surgery Critical care Elective Interventional Radiology Acute Paediatrics, Maternity and Neonatal 100 clinicians are looking at future models for these services which meet clinical standards, networking across our hospitals to ensure safe high quality care and maintain local access. “Not in Hospital” care

13. Durham, Darlington and Tees Clinical Standards 700 standards identified, 1/3 cannot be met without change 700 standards identified, 1/3 cannot be met without change Jan 2016Better Health Programme

14. Durham, Darlington and Tees Clinical standards covers issues like: Availability of consultant staff Staffing levels and availability during the day and at night or weekends Numbers of patients who should be seen and treated by a service to make sure skill levels are maintained Use of best practice and recommended treatments Access to diagnostic tests, where required Timescales for assessment by a senior clinician Jan 2016Better Health Programme

15. Durham, Darlington and TeesJan 2016Better Health Programme Patients aren’t sure where is the right place to go We need the urgent and emergency care system to work together more effectively, for example, sharing information Trauma centres save lives and improve outcomes We also need local services for non life threatening conditions Senior clinicians make better decisions – but some A&Es don’t have emergency consultants on site 24/7 There is also variation in access to support services, like interventional radiology. Urgent and Emergency Care Headlines…

16. Durham, Darlington and TeesJan 2016Better Health Programme Rising numbers of patients are being admitted with increasingly complex conditions Hospitals don’t currently offer consistent clinical cover 24/7, resulting in delays in diagnostics and decision making at weekends It can be difficult for patients and professionals to understand the best place to care for a patient when they need support outside of hospital Acute medicine Headlines…

17. Durham, Darlington and TeesJan 2016Better Health Programme Inconsistent levels of access to diagnostics, interventional radiology and support services such as pharmacy We need to increase access to more specialist surgery for some conditions, eg urology. Better access required to step down care and rehabilitation in the community Acute Surgery Headlines…

18. Durham, Darlington and TeesJan 2016Better Health Programme Specialised environment and skills and we need to make sure these are used effectively Vitally important that patients with a critical care need are care for in the right environment Delays in the system can impact on access to a critical care bed. It can also impact on planned surgery Critical care needs to be considered in the wider context of acute medicine and surgery Critical care Headlines…

19. Durham, Darlington and TeesJan 2016Better Health Programme We want to maintain choice for women. Many women choose medical support, even though midwife led care offers a better experience. Developing networks means patients will receive a consistent standard of care depending on their needs Sufficient numbers of consultants for complex labours (esp at weekends), and midwives for one to one support We need to consider the use and location of midwife led units Maternity Headlines…

20. Durham, Darlington and TeesJan 2016Better Health Programme Improved survival rates and lifestyle factors have resulted in an increase of children living with long term conditions Shortage of doctors in paediatric specialties to provide a safe service 24/7 across all units Potential to increase training and support to GPs Parents are not always clear about the right place to seek advice and care for a poorly child Acute Paediatrics Headlines…

21. Durham, Darlington and TeesJan 2016Better Health Programme Improvements in technology have improved survival rates for pre term babies. The region already operates as a network to ensure the sickest babies get the best care in the right place Strong evidence that extremely pre term and low weight babies do better in specialist hospitals providing neo natal intensive care, further improved in units with higher volumes of activity Independent review says there is a clear case to move to one neonatal intensive care unit across our area Special care baby units would continue to be provided alongside obstetric units Neonatal Headlines…

22. Durham, Darlington and TeesJan 2016Better Health Programme Separation of elective (planned) care from non elective (emergency) care reduces risks of cancellation Centres of excellence in some key areas of surgery have resulted in improvements in outcomes and experience for patients We are also looking at how further improvements in elective care Elective Headlines…

23. Durham, Darlington and Tees Summary Jan 2016Better Health Programme This programme is about how we improve quality of care. We are looking at how we match clinical resource to the needs of our population such as where they live and the time of day that they need to access care. We need to make sure that we have the right services in the right place, and that people understand what services they need and how to access them.

24. Neil O’Brien

25. Durham, Darlington and Tees With Neil – to follow Jan 2016Better Health Programme

26. Workshop

27. Workshop1: Location of Services Jan 2016Better Health Programme What services could be better provided out of hospital? What factors are important to you in determining what services could be provided more locally? What factors should be considered in determining telephone/internet contact with a clinician v attending hospital in person? What services would you be more prepared to travel to access? Are there services where local access is more important than outcomes? What services would you like to be provided at your local GP surgery?

28. Workshop1:2: Engaging with BHP Jan 2016Better Health Programme How can we best engage with people about changes? What information is required to help inform you about the issues? How can you help us: – Case studies – working with voluntary sector? – Innovation in out of hospital care? – Example of use of technology? – Opportunities for us to come and talk to you?

29. Better Health 2016 Timeline January 2016MarchAprilJuneAugustSeptemberNovember Clinical standards refreshLong list of scenariosHurdle criteriaMedium list of scenariosOptions appraisalOptions sign offPublic consultation begins We want to work with stakeholder organisations and public representatives during this process Jan 2016Better Health Programme