1. The BHRUT Clinical Strategy Presentation for stakeholders, patients and the public

2. Contents 2 Background3 Strategic Context4 Clinical Model: Unplanned Care5 Clinical Model: Planned Care6 Clinical Model: Children7 Strategic implementation plan8 Next Steps9 1 2 3 4 7 6 5

3. Background 3 Clinically-led Health for North East London plans (HfNEL) set out by our commissioners in 2010 following major public consultation Objective is to improve quality of care, generate benefits in centralising specialist services and strengthening staffing levels, while enhancing urgent care and out of hospital care where appropriate Secretary of State signed off the plans in October 2011 following review, subject to conditions to ensure they were not implemented until safe to do so Work since then to plan safe implementation, improve performance and to review assumptions to reflect current service needs Development with staff, our commissioners and patient representatives Clinical strategy is the outcome of this work Approved by the Board 6 November 2013 1

4. Strategic Objectives Deliver safe, quality, effective care Ensure BHRUT is financially secure with a viable and sustainable future Aims Address poor performance in the Queen’s Emergency department (ED) Decompress the Queen’s site and promote integrated care Implement HfNEL Base Case Implement Extension to HfNEL BHRUT Clinical Strategy Radically redevelop the Queen’s ED to improve performance and address the forecast additional demand Develop BHRUT’s intermediate care and rehabilitation at KGH Utilise sufficient space at KGH to provide a high quality of patient care across both sites Complete the vision for paediatric services Move all emergency medicine and surgery to Queen’s Hospital Maintain an urgent care centre (UCC) on both sites Move critical care beds from KGH BHRUT to implement new services from the space liberated on the KGH site Maximise the use of KGH for day case, short stay elective and diagnostic activity Maximise the use of the Queen’s site for complex inpatient activity Centralise all breast services into a dedicated unit located on the KGH site 2 Strategic Context 4

5. 5 Move all emergency medicine and surgery to Queen’s Hospital by mid 2015 Maintain and develop 24/7 urgent care centres on both sides as per HfNEL Radically redevelop the Queen’s ED to address the current performance issues and address the forecast additional demand. Key changes are: ►Introduce a Senior Streamer ►Route patients arriving at the ED to the UCC, ED area, four speciality assessment centres and short stay beds as appropriate ►Physically remodel the existing ED to accommodate the four speciality assessment areas, cope with the increased demand and support the proposed clinical model ►Provide dedicated facilities for children, including a paediatric specific entrance 3 Clinical Model: Unplanned Care

6. Maximise use of the Queen’s site for complex inpatient activity Maximise the use of KGH for day case, short stay elective and diagnostic activity Develop provision of BHRUT’s intermediate care and rehabilitation at KGH such as orthogeriatrics, stroke, neurosurgical (rehabilitation – proposed new service), aiming to: Reduce pressure on Queen’s site so we can improve patient experience, cope with winter pressures, and reduce delays for patients Develop further integrated care and community interventions Centralise all breast services into a dedicated unit located on the KGH site with co-localised breast histopathology at KGH Move critical care beds from KGH, supporting the strategy of complex inpatient activity at Queen’s Utilise sufficient space at KGH to provide a high quality of patient care across both sites. This will be the subject of detailed capacity modelling and is subject to assumptions on likely length of stay (LOS) improvement and impact of integrated care initiatives, but initial estimates place this at around 55-60% Implement new services on the space liberated on the KGH site (BHRUT), or provide alternative uses for the space, through a range of identified opportunities. 6 4 Clinical Model: Planned Care

7. 7 5 Complete the vision for paediatric services, as per HfNEL. Specifically: All births now at Queen’s. Relocation will help staff to attend labour ward emergencies and neonatal care, and avoid the need for transfers of sick babies from Queen’s, potentially away from their mothers Special care baby unit (SCBU) to be relocated to Queen’s Clinical Model: Children Maximise the use of the Queen’s site for complex inpatient activity as per HfNEL Move paediatric inpatients to Queen’s Maximise use of KGH for day case, short stay elective and diagnostic activity Paediatric day case and elective and planned diagnostics to KGH Extend the existing successful Hot Line providing direct access to advice and guidance for GPs to paediatric consultants at the KGH and Queen’s site Roll out of Hot Clinics Provide dedicated facilities for children including a paediatric specific entrance, as covered in the unplanned care section of the strategy Develop the Paediatric ED clinical pathways Strategic component Rationale

8. ► A high level strategic implementation plan by clinical directorates has been developed ► Business cases for major capital investments in Emergency department, critical care & SCBU, Queen’s infrastructure ► Further work on bed requirements will be developed and regularly refreshed to match current need ► Key milestones / dependencies are: 1. BHRUT’s intermediate care beds to be established at KGH in spring 2014. This will free up space on the QH site to support reconfiguration 2. Renal dialysis to be moved off the QH site in summer 2014 to allow work on the Queen’s Hospital ED to commence as soon the full business case is approved in August 2014 3. Emergency department redevelopment and critical care bed provision at QH to be completed in autumn 2015, allowing the majority of the day case activity to move to the KGH site, and majority of the inpatient activity to move to the QH site in early 2016 8 Strategic Implementation Plan 6

9. Feedback invited on the clinical strategy and questions/clarifications: email feedback@bhrhospitals.nhs.ukfeedback@bhrhospitals.nhs.uk BHRUT progressing bids for funding for the major capital works required Work underway to finalise the long term financial model (LTFM), which brings together the financial and clinical planning Further work to make the strategy operational, working with clinicians in each of the Trust’s clinical directorates, and planning in their detailed business plans. 9 Next Steps 7