1. A clinically led programme: 5 hospitals 5 Clinical Commissioning Groups 2 PCT Clusters Aim: Improve health services and ensure they have a long term future in face of considerable challenges Ensure services keep up with opportunities for improvement Provide high quality healthcare and best outcomes for patients What is Healthier Together? 1 NHS Corby CCG NHS Nene CCG NHS Bedford CCG NHS Luton CCG NHS Milton Keynes CCG

2. Five hospital sites remain Provide as much care as possible close to home - increasing the opportunity to have tests, treatments and appointments carried out in local or community settings Combine expertise across our five hospitals where we know this will improved quality and/or patient outcomes Properly coordinate services - especially for the frail, elderly and those with long term conditions Deliver high quality, sustainable services - making sure our money stretches to meet the challenges Ensure local doctors, nurses and the other healthcare professionals are at the centre of our health improvement plans Healthier Together - Vision 2

3. The case for change Demands on health – are increasing with a rising population, more older people and more people with complex health needs Public funding is under pressure with 20% efficiency savings by 2014/15 Care can be better – evidence shows outcomes can be improved with different ways of working – e.g. specialist teams doing specialist procedures Shortages of skilled staff – e.g. shortages of consultants in some areas means we cannot optimise care models If we work differently we can meet these challenges – sensibly reconfiguring some of the key resources to improve patient care and outcomes 3

4. Progress to date (1) Six clinical working groups (CWGs) – cancer services - urgent/emergency care – planned care- maternity services – long term conditions- children’s services Draft reports outlining potential models submitted to: – Clinical Senate (chairs of CWGs and representatives from community and ambulance services) – Programme Board (CEOs of hospitals, Clinical Commissioning Groups and Primary Care Trust Clusters) Professor John Wallwork appointed as independent Chair of Clinical Implementation Group (medical directors); group has reviewed draft models 4

5. Progress to date (patient/public) Direct contact with over 9,000 people to raise awareness of the case for change and obtain their views on current services Evaluation criteria developed with public and clinicians: – Quality and Safety – Affordability – Deliverability – Sustainability – Equity of Access – Travel Access Key themes emerging from engagement – A wish to see improvements around weekends, 24/7 – The importance of caring, qualified staff – Access to expertise and the best possible treatment – Support for centres of expertise, but people do have concerns about travel 5

6. Clinical Working Groups – Emerging conclusions 6 Maternity services Planned care Children’s services Majority of services, especially outpatients, delivered locally Consolidating clinical resources and appropriately skilled multi-disciplinary teams to improve patient outcomes Some patients may have to travel to specialist centres in the region for some services where this will improve quality and/or outcomes Normalise low-risk births as much as possible Offer choice through home birth pathways and high quality midwifery-led units on all five acute hospital sites Ensure equitable access to consultant-led services for high risk antenatal care on all five sites Centralise high risk deliveries in three consultant-led obstetric units Majority of care should be community-based Ensure earliest senior assessment of sickest children Key inter-dependency between inpatients and neonatal services and emergency departments Critical and less common paediatric care likely to be provided in fewer centres – workforce and clinical needs support three inpatient units Outpatients, A&E support and short-stay assessment on other sites

7. Clinical Working Groups – Emerging conclusions 7 Long term conditions Cancer services Urgent/ emergency care Proactive improvement in self-help Greater specialist working in the community and developing community hubs for care of more complex patients Co-ordination of whole of health and social care network Consolidation of some elective specialties to improve outcomes Development of some specialist diagnostics Uniform co-ordination of screening services Ensure reconfigured services continue to link with existing cancer networks Consider the development of a South East Midlands network Continue to provide A&E services on all five sites Work with all services to network emergency care in order to deliver the best possible outcomes for patients Working with community partners to improve access more locally to urgent care where appropriate

8. Assessing draft models The Clinical Senate (CWG chairs) reviewed seven different models for the way in which services could be reorganised to meet the healthcare needs of people living in the South East Midlands The models were then assessed by the Clinical Implementation Group (medical directors) against the evaluation criteria The Clinical Implementation Group proposed that two clinical models, with 20 possible location combinations, be subject to more detailed analysis The Programme Board (chief executives, commissioners and partner board representatives) agreed that Models 3 and 6 be taken forward The seven models are described below so you can see the range of models and the two draft models that we particularly want your views on

9. Emerg Surgery Inpatient paeds Obstetrics Trauma Unit Complex & elective surgery Acute medicine ITU and HDU Emerg Surgery Inpatient paeds Obstetrics Trauma Unit Complex & elective surgery Acute medicine ITU and HDU Emerging models – Model 1 (Status Quo) Emerg Surgery Inpatient paeds Obstetrics Trauma Unit Complex & elective surgery A&E Acute medicine Site 1Site 2Site 3Site 4Site 5 ITU and HDU Emerg Surgery Inpatient paeds Obstetrics Trauma Unit Complex & elective surgery Acute medicine ITU and HDU And.. cancer, vascular, interventional radiology, PPCI, HASU, etc. UCC 9 A&E Outpatients Diagnostics Inpatient reablement Outpatients Diagnostics Inpatient reablement Outpatients Diagnostics Inpatient reablement Outpatients Diagnostics Inpatient reablement Outpatients Diagnostics Inpatient reablement

10. Emerg Surgery Trauma Unit Acute medicine ITU and HDU Emerg Surgery Trauma Unit Acute medicine ITU and HDU Emerging models – Model 1A Emerg Surgery Inpatient paeds Obstetrics Trauma Unit Networked Complex & elective surgery A&E Acute medicine Site 1Site 2Site 3Site 4Site 5 ITU and HDU Emerg Surgery Inpatient paeds Obstetrics Trauma Unit Acute medicine ITU and HDU And.. cancer, vascular, interventional radiology, PPCI, HASU, etc. UCC 10 A&E Outpatients Diagnostics Inpatient reablement Outpatients Diagnostics Inpatient reablement Outpatients Diagnostics Inpatient reablement Outpatients Diagnostics Inpatient reablement Outpatients Diagnostics Inpatient reablement UCC SSPAU Midwifery-led unit Networked Complex & elective surgery

11. Emerging models – Model 2 Emerg Surgery Inpatient paeds SSPAU Obstetrics Midwifery-led unit Trauma Unit Outpatients Diagnostics Outpatients Diagnostics Outpatients Diagnostics Outpatients Diagnostics Outpatients Diagnostics Inpatient reablement Complex & elective surgery Day case and inpatient elective surgery centre A&E Networked A&E Acute medicine Site 1Site 2Site 3Site 4Site 5 ITU and HDU ITU / HDU And.. cancer, vascular, interventional radiology, PPCI, HASU, etc. UCC 11 Complex & elective surgery

12. Emerging models – Model 3 Emerg Surgery Inpatient paeds SSPAU Obstetrics Midwifery-led unit Trauma Unit Outpatients Diagnostics Outpatients Diagnostics Outpatients Diagnostics Outpatients Diagnostics Inpatient reablement Outpatients Diagnostics Inpatient reablement Complex & elective surgery Day case and inpatient elective surgery centre A&E Networked A&E Acute medicine Site 1Site 2Site 3Site 4Site 5 ITU and HDU ITU / HDU And.. cancer, vascular, interventional radiology, PPCI, HASU, etc. UCC 12

13. Emerging models – Model 4 Emerg Surgery Inpatient paeds SSPAUInpatient paedsSSPAU Obstetrics Midwifery-led unitObstetricsMidwifery-led unit Trauma Unit Outpatients Diagnostics Outpatients Diagnostics Outpatients Diagnostics Outpatients Diagnostics Inpatient reablement Outpatients Diagnostics Inpatient reablement Complex & elective surgery A&E Networked A&E Acute medicine Site 1Site 2Site 3Site 4Site 5 ITU and HDU ITU / HDU And.. cancer, vascular, interventional radiology, PPCI, HASU, etc. UCC 13 Day case and inpatient elective surgery centre

14. SSPAU ITU / HDU Emerging models – Model 5 Emerg Surgery Inpatient paeds Obstetrics Midwifery-led unit Trauma Unit Outpatients Diagnostics Outpatients Diagnostics Outpatients Diagnostics Outpatients Diagnostics Inpatient reablement Outpatients Diagnostics Inpatient reablement Complex & elective surgery A&E Networked A&E Acute medicine Site 1Site 2Site 3Site 4Site 5 ITU and HDU SSPAU ITU / HDU And.. cancer, vascular, interventional radiology, PPCI, HASU, etc. UCC 14 Day case and inpatient elective surgery centre Elective medical and day assessment

15. SSPAU ITU / HDU SSPAU ITU / HDU Networked A&E UCC Networked A&E UCC Emerging models – Model 6 Emerg Surgery Inpatient paeds Obstetrics Trauma Unit Outpatients Diagnostics Outpatients Diagnostics Outpatients Diagnostics Complex & elective surgery A&E Acute medicine Site 1Site 2Site 3Site 4Site 5 ITU and HDU And.. cancer, vascular, interventional radiology, PPCI, HASU, etc. UCC 15 Midwifery-led unit Outpatients Diagnostics Inpatient reablement Day case and inpatient elective surgery centre Midwifery-led unit Outpatients Diagnostics Inpatient reablement Elective medical and day assessment

16. What’s next? Once models have been tested, subsequent location options will be shared/tested A final set of proposals will be developed to go forward to public consultation later this year Decisions will be taken on the consultation proposals, taking into account all the consultation responses Based on the outcome of the consultation we will begin work on implementation from April 2013. We expect this to take 3-5 years to complete 16

17. 17 In Summary Our aim is to improve patient outcomes We want to ensure sustainable services on all five hospital sites No decisions have been made Your views count, let us know what you think