Please note this response should be read in conjunction with the consultation questionnaire

POOLE HOSPITAL NHS FOUNDATION TRUST BOARD OF DIRECTORS RESPONSE TO THE DORSET CLINICAL SERVICES REVIEW CONSULTATION FEBRUARY 2017 Please note this response should be read in conjunction with the consultation questionnaire Section 1 Integrated community services (page 1) 1a To what extent do you agree or disagree that our proposal to provide services closer to people s homes using community teams based at local community hubs will deliver better care? Our response STRONGLY AGREE 1b The draft proposal for NORTH DORSET includes community hubs with beds at Blandford Hospital and at Sherborne Hospital, and a community hub without beds at Shaftesbury, possibly at a different site to the existing hospital. To what extent do you agree with the draft proposal for NORTH DORSET? Comments on NORTH DORSET The successful early implementation of Integrated Community Services (ICS) in Dorset is essential to support the acute hospital changes outlined in the rest of the CSR consultation. Therefore we support the theory, but it is essential that the ICS model is well resources and effectively managed in practice. 1

1c The draft proposal for MID DORSET includes a community hub at Dorset County Hospital with access to community beds in proposed hubs at Wimborne, Bridport, Sherborne and Weymouth Community Hospitals. To what extent do you agree or disagree with the draft proposal for MID DORSET? Comments on MID DORSET Poole Hospital as a DGH already has significant diagnostic, ambulatory and outpatient s infrastructure, capacity and expertise. As a major planned hospital with an associated community hub with beds we would expect to maximise these existing facilities. Therefore whilst we support the development of Wimborne as a community hub with beds, at a time of scare resources, this should be complementary to the community hub developments in Poole Hospital. Finally the successful early implementation of Integrated Community Services (ICS) in Dorset is essential to support the acute hospital changes outlined in the rest of the CSR consultation. Therefore we support the theory, but it is essential that the ICS model is well resources and effectively managed in practice. 1d The draft proposal for WEST DORSET includes a community hub with beds at Bridport Hospital. To what extent do you agree or disagree with the draft proposal for WEST DORSET? Comments on WEST DORSET The successful early implementation of Integrated Community Services (ICS) in Dorset is essential to support the acute hospital changes outlined in the rest of the CSR consultation. Therefore we support the theory, but it is essential that the ICS model is well resources and effectively managed in practice. 2

1e - The draft proposal for WEYMOUTH & PORTLAND includes a community hub with beds at Weymouth Hospital and a community hub without beds at Portland, possibly at a different site to the existing hospital. Westhaven Hospital would not be used as a community hospital hub, but the future of mental health beds at the Linden Unit will be considered as part of a separate review. To what extent do you agree or disagree with the draft proposal for WEYMOUTH & PORTLAND? Comments on WEYMOUTH AND PORTLAND The successful early implementation of Integrated Community Services (ICS) in Dorset is essential to support the acute hospital changes outlined in the rest of the CSR consultation. Therefore we support the theory, but it is essential that the ICS model is well resources and effectively managed in practice. 1f The draft proposal for PURBECK includes a community hub with beds at Swanage Hospital and a community hub without beds at Wareham, possibly at a different site to the existing hospital. To what extent do you agree or disagree with the draft proposal for PURBECK? Comments on PURBECK The successful early implementation of Integrated Community Services (ICS) in Dorset is essential to support the acute hospital changes outlined in the rest of the CSR consultation. Therefore we support the theory, but it is essential that the ICS model is well resources and effectively managed in practice. 1g The draft proposal for EAST DORSET is for a community hub with beds at Wimborne Hospital. St Leonards would close. To what extent do you agree or disagree with the draft proposal for EAST DORSET? Comments on EAST DORSET Poole Hospital currently discharges patients to both Wimborne and St Leonards Hospitals, therefore in finalising and implementing these plans i.e. St Leonards proposed to close, careful consideration will need to be made of balance between capacity and demand. Finally the successful early implementation of Integrated Community Services (ICS) in Dorset is essential to support the acute hospital changes outlined in the rest of the CSR consultation. Therefore we support the theory, but it is essential that the ICS model is well 3 resources and effectively managed in practice.

1h The draft proposal for the POOLE LOCALITIES includes a community hub with beds at Poole (only if this is the major planned care hospital). Alderney Hospital would not be used as a community hub and proposals for its future would form part of a separate review of dementia services. To what extent do you agree or disagree with the draft proposal for the POOLE LOCALITIES? Our response (tick) STRONGLY AGREE Comments on POOLE LOCALITIES In making this response the CCG need to be aware that the strongly preferred preference for the Board of Directors for Poole Hospital NHS Foundation Trust for Poole to be the Major Emergency Hospital in East Dorset i.e. Option A. That said we have three specific comments on the CCG s preferred option (Option B); (a) Providing community beds to the wider East Dorset conurbation there needs to be a sufficient number of community beds to support the whole of the East Dorset population needs. (b) Avoiding duplication of diagnostic and planned services between Poole and Wimborne Hospitals - A further issue to highlight is Poole Hospital as a DGH already has significant diagnostic, ambulatory and outpatient s infrastructure, capacity and expertise. As a major planned hospital with an associated community hub with beds, we would expect to maximise these existing facilities. Therefore whilst we support the development of Wimborne as a community hub with beds (for Mid Dorset), at a time of scare resources, this should be complementary to the community hub developments in Poole Hospital. (c) Future of Alderney Hospital Assuming Poole Hospital becomes the major planned hospital for East Dorset the proposal is for Alderney to close all of its community beds and that there would be a separate review of dementia services. The Board would like to highlight the importance of coordinating the future development of Mental Health services and physical health community services in East and Mid Dorset and the future role of the Alderney hospital site is key. Broader comments on the proposals for Integrated Community Services The Board of Directors for Poole Hospital NHS Foundation Trust strongly agrees with the vision for integrated community services. Community and primary care services must be effectively established before the planned reduction in acute hospital beds becomes a reality. Community and primary care services must work seamlessly with hospital services in any given locality i.e. vertical integration. This will provide the best patient experience, clinical outcome and financial sustainability for the system. The community and primary care workforce of the future needs to be developed now to support the above. Furthermore key hospital based staff e.g. therapies 4

should either be integrated with or rotated through community and primary care teams to broaden and deepen skills and experience. Significant capital and non recurrent revenue investment will be required in information technology and estate to support working outside of hospitals. If future resources are constrained and difficult decision need to be made around priorities, the system should not duplicate services in the community just because it is in the community. Attention should be given to prioritising future community and primary care capital and revenue investments that have the greatest system wide benefits. As we reiterate throughout our response, the successful early implementation of Integrated Community Services (ICS) in Dorset is essential to support the acute hospital changes outlined in the rest of the CSR consultation. 1i - The draft proposal for the BOURNEMOUTH and CHRISTCHURCH LOCALITIES includes a community hub with short term care home beds at Bournemouth (only if this is the major planned care hospital) and a hub without beds at Christchurch. To what extent do you agree or disagree with the draft proposal for the BOURNEMOUTH and CHRISTCHURCH LOCALITIES? Comments on BOURNEMOUTH AND CHRISTCHURCH LOCALITIES As previously highlighted there needs to be a sufficient number of community beds to support the whole of the East Dorset population needs. 5

The proposed options for acute hospitals 2a To what extent do you agree or disagree with the vision for acute care in Dorset? 2b To what extent do you agree or disagree with the proposal to provide a major emergency hospital and a major planned hospital in the east of the county? 2c To what extent do you agree or disagree with the proposals for Dorset County Hospital to be a planned care and emergency hospital? 2d Which option do you prefer for the delivery of consultant-led maternity care and inpatient paediatric services for the sickest children? Our response (tick) Option B Impact on Maternity services in Dorset Within Poole Hospital, we believe that Dorset needs a single specialist maternity centre, covering the whole of Dorset. As such, it is our view that the service at Dorset County Hospital should network with the service in the east (currently provided from Poole), rather than seek to strengthen links with the maternity service provided at Yeovil. National guidance states that the optimum number for a specialist maternity centre is 7000 births, and if one such centre were to be established in Dorset, this number could be achieved. There are currently around 5000 births taking place at Poole Hospital (just large enough to be sustainable), but far fewer births take place at Dorset County Hospital each year - under 2000 births per annum. If the two services were to come together, working as a networked model, the Dorset service would come near to the optimum number of 7000, with benefits and improved outcomes for all Dorset mothers and babies. Level 2 Neonatal services have recently been centralised in Dorset and are now provided from Poole Hospital for all mothers and babies needing this level of care, from across the whole of Dorset. It is important to note that under Option B, maternity and neonatal teams would be moved to the Bournemouth site, which is less accessible for residents living in the north and the west of Dorset. Looking ahead, under Option B, we are also concerned that there is a risk that maternity services in the east could be disadvantaged. If the maternity unit for those living in east Dorset is established on the Bournemouth site, it is possible that more mothers in the mid- 6

Dorset area will choose to deliver in the west, rather than travel all the way to the far eastern most part of the county. This could therefore result in two smaller, sub-standard units, with both being potentially clinically unsustainable. It is the view of our obstetricians and midwives that the best way to improve services for all mothers, babies and children in Dorset would be for Poole Hospital to become the major emergency hospital in East Dorset, linking with Dorset County Hospital on a networked basis. Whatever approach Dorset County Hospital chooses to pursue, if Option A is adopted (whereby maternity and neonatal services are maintained at Poole Hospital), the option of developing a Dorset-wide service remains open for the future, with no increase in the distance between services in the east and the west. 2e Which option do you prefer for the major emergency hospital and major planned hospital in the east of the county? Our response (tick) OPTION A Overview Within Poole Hospital, we fully recognise that the relentless increase in demand for services, coupled with restricted finances and more stringent quality standards means that the status quo cannot be maintained in Dorset, and things have to change. Representatives of the Trust and its clinicians have been involved in the Dorset Clinical Service Review, and as such, we support the proposals for changing the way in which local community and hospital-based services are organised - recognising that the planning assumptions underpinning this work are extremely challenging, and that a significant amount of the detailed planning work still needs to be done. We look forward to continuing to work with partners in developing and implementing this vision, so as to improve health outcomes and patient experience across Dorset, whilst at the same time ensuring effective use of existing resources. We would particularly like to stress our support for the development of more services in the community, so that patients are able to gain swift access to integrated health and social care services within a community setting. We are committed to working with partners to ensure that patients get the right care, at the right time, in the right place, and we know that a step up in investment in services in the community (including expanding the provision of specialist services outside the hospital setting) is essential, if we are to reduce reliance on hospital care and the need for hospital admission. However, we were very disappointed that the CCG did not select Poole as its preferred site for the Major Emergency Hospital, given our central location in Dorset, our designation as the East Dorset Trauma Unit and lead provider for maternity and paediatric services in the east, and our role as the designated Cancer Centre for Dorset. Much has been made of the fact that the Royal Bournemouth site has more space, and is therefore better placed to accommodate an expansion of services. However, from the joint work carried out together to assess the estate requirement, partners are aware that the Poole site is large enough to accommodate the required new facilities, and could do this by clearing some of the older building stock and creating a new ward tower block. All the benefits of the new model can be provided equally under either option, and whilst the 7

one-off capital costs of developing the Poole site are greater than developing the Royal Bournemouth Hospital site, this only represents just over 0.1% of the 1.4 billion annual health expenditure for Dorset. In our view, the priority should be to invest in the right location that is, the one that will best serve all the people of Dorset in the longer term. It is important to note that over 90% of the inpatient work carried out at Poole Hospital is emergency activity, so adopting Option B would represent a major change from our current portfolio of services and a significant change for the population of Dorset. It is also important to note that as things stand at present, the proposals for the Major Planned Care site do not include the provision of Level 3 Intensive Care facilities, which we believe would be a retrograde step. Setting services up in this way would significantly reduce the amount of planned surgery that could be carried out on site including cancer surgery - and as such, means that not all the benefits associated with separating planned and emergency care could be realised. The Major Emergency Hospital would still have to carry out a large amount of planned care, and this activity would then be at risk of disruption in the event of any surge in demand. It is our view that this needs to be reviewed as part of the future detailed planning work, so that intensive care services are provided as required, to match the pattern of services that best meets the needs of the Dorset population. In our view, whilst it is recognised that either option can be made to work, Option A is by far the better option, and we would ask the CCG to reconsider its preferred option for the site of the Major Emergency Hospital. By implementing Option A that is, with Poole Hospital designated as the Major Emergency Hospital doing only the things that it needs to do, supported by a thriving Royal Bournemouth Hospital, maximising the amount of planned care that can be delivered - we believe that all the benefits of the proposed new models can be realised, without the risks associated with Option B. This arrangement would result in the following:- it would be much easier for people living in rural areas (such as west and north Dorset) to access emergency care; there will be far less disruption to the Dorset health and care system, as Option A builds on the current configuration of clinical services; we can avoid fragmenting cancer services; we can strengthen and develop maternity services, whilst keeping options open for the future; we would see a better distribution in the east of the Community Hubs with beds, so as to better meet the needs of the population. These issues are explored in more detail below. Access to services In our view, in creating one Major Emergency Hospital for Dorset, the site chosen for this purpose should be the most central of the three hospital sites, the one which is most accessible for the whole population. We do not think that this facility should be sited on the far-eastern most point of the county. The consultation document acknowledges that Poole Hospital is an extremely accessible site. Poole s central location, accessed by three major roads, and supported by excellent public transport links (with the bus station and railway station 8

both only half a mile away), has long been recognised as being hugely convenient by patients, staff and members of the public alike. There are significant advantages in siting the Major Emergency Hospital in Poole whatever form of transport is utilised - particularly for patients living in the rural parts of Dorset, in the west and north of the county. We recognise that the CCG has undertaken a very sophisticated travel times analysis in order to assess the impact on residents across the county, and do not dispute the results of this work. However, in our view, greater attention should be paid to the needs of people living in more remote/rural areas, given that they experience the most significant travel challenges. Given that the Royal Bournemouth Hospital and Poole Hospital are only 8 miles apart, it can be argued that the location of the Major Emergency Hospital makes relatively little difference for residents in the east. However, there is a very significant difference for those coming in from the west and north of the county. It is much easier for these residents to get to Poole than it is to get to Bournemouth, and we believe that the needs of these groups should be given greater priority in the overall assessment. Given our role as the Major Trauma Unit for east Dorset, and our lead for the associated specialities of paediatrics and maternity, the people of Bournemouth, Christchurch and parts of West Hampshire are already well-served by Poole Hospital, and have been for many years. Whilst we recognise that the Royal Bournemouth Hospital site is closer to those localities, we would hope that these residents would acknowledge the greater challenges of those coming from the north and the west, who have a greater distance to travel. As a final point under this section, we should like to reflect on the needs of the people living in west Hampshire. Whilst it is clearly important to take account of the views of these residents, it should also be noted that this group currently has more choice than many other Dorset residents with regards to hospital care. In addition to any facilities that they may wish to access within Dorset, they may also attend Salisbury Hospital, Lymington Hospital and/or the University Hospital Southampton and the routes to these places are quite straightforward. Their position is very different to that of the people living in the more rural parts of Dorset, who face much more complex journeys. In summary, we do not think it right to establish the Major Emergency Hospital for Dorset on the most far-eastern point of the county the nearest site to Southampton, and the furthest from the rural populations of Dorset. Disruption to the Health System Poole Hospital is currently the designated Trauma Unit for east Dorset, and as the Major Accident Centre (using old terminology) has a long history and tradition of providing emergency care for the local population. Being the Trauma Unit, Poole Hospital already provides the vast majority of the services that have been specified for the Major Emergency facility, and all our supporting services have been designed around the provision of emergency care. In our view, the most straightforward means of establishing a Major Emergency Hospital would be to build on what is already working well that is, to designate the Poole Hospital site for this purpose. Option B represents very significant change for the Dorset health community, with a large number of services and staff having to move to a different site. Given that the vast majority of the specialities needed within a Major Emergency Hospital are already situated at Poole, there is less disruption associated with Option A. There are only four services that are not currently provided from this site that is, vascular services, urology services, cardiac intervention treatment and interventional radiology services that would need to transfer from Bournemouth to Poole. As highlighted above, the Poole 9

site is large enough to accommodate the new facilities; we would incorporate the additional beds that are needed by building a new ward block at the back of the hospital, overseeing Poole Park, and in doing so, would create a brand new, state of the art Maternity and Paediatric Unit. Pursuing Option A would also involve a less complex decanting plan for the on-going provision of clinical services whilst the building work takes place. From our assessment, the other way round (that is, pursuing Option B) means that nine major services would have to be moved from Poole Hospital to the Royal Bournemouth site, which would result in major disruption to existing health services, would involve a more complex move-in programme and would take many years to settle. It should be recognised that choosing the option that represents the most change will create greater risk during the transition period. Clearly, creating one A&E Department within the east Dorset conurbation will represent a major change whichever site is chosen. However, pursuing Option B and establishing this facility on the Royal Bournemouth Hospital site would represent much greater change, affecting a far larger number of staff and specialist teams. There is now clear evidence that good team-working makes for better patient care and improved outcomes, therefore in planning for the future, we should be seeking to minimise the disruption to teams. The power of the team and the value associated with keeping teams together should not be under-estimated. A positive culture and effective team working takes time to develop and is forged from clinical experience, shared learning and governance. Both Trusts already have good lead arrangements in place for the provision of specialist services, and in seeking to improve outcomes, we should collectively be planning to minimise the disruption to teams. Fragmentation of Cancer services As the designated Dorset Cancer Centre, Poole Hospital has long played an important role in the planning and development of cancer services for the whole of Dorset. As more detailed work has been carried out over the past few months, the full impact of the separation of planned and emergency care on cancer services is better understood. As a result, we are concerned that in pursuing Option B and establishing the Major Emergency Hospital on the Royal Bournemouth Hospital site, cancer services for the people of Dorset will become more fragmented. Poole Hospital currently has all the services and facilities on site to support the delivery of cancer services for the population, including radiotherapy and chemotherapy services, haematology and oncology beds, specialist diagnostic services such as PET scanning, CT scanning and nuclear medicine, along with a Level 3 Intensive Care facility. Whilst other hospitals in Dorset provide cancer surgery and certain parts of the patient pathway, as the Dorset Cancer Centre, Poole is the only hospital to have all these facilities sited together. The non-surgical management of cancer for Dorset is managed and delivered through the Dorset Cancer Centre in Poole, with effective coordination of services across the three acute trusts, and with robust and expanding links to community services. The Dorset Cancer Centre has an excellent reputation, performing well against other parts of the country in terms of outcomes, patient feedback and waiting time metrics. Having a central hub with co-location of diagnostics, chemotherapy, radiotherapy, oncology inpatients and proportion of surgical oncology has huge advantages for the effective and efficient delivery of the service. It optimises opportunities for education, improves recruitment and staff morale across all staff groups and creates the best environment for creating fast efficient patient pathways. The impact of Option B on the provision of cancer services in Dorset risks fragmenting the service, and as such, needs very careful consideration. The oncologists are united in stating that oncology inpatients require rapid access to critical care outreach and on-site ITU. The requirement of oncology patients for ITU now and in the 10

future is similar to that of clinical haematology patients, with many of the treatments being identical. The few cancer centres around the country that were previously located at a site independent of an acute hospital with ITU support have all in the last decade moved to be with acute trusts, co-located with ITU support. To move services in the opposite direction as part of the reconfiguration of emergency services in Dorset would be a retrograde step. The oncologists in Dorset believe that separating the oncology inpatients from radiotherapy services would have a massively negative impact on the service. Not only do these inpatients frequently require emergency radiotherapy, the clinical staff critical to supporting the management of the inpatients also need to work closely with the radiographers and physicists within radiotherapy. In this way, they can best manage the patients on treatment and effectively plan complex radiotherapy treatments. Staff recruitment is likely to remain a real challenge for the cancer centre for the foreseeable future and it is difficult to see how the separation of these services could be managed without a substantial increase in staff numbers, across a number of different staff groups. It is also important to note that the Dorset Cancer Centre is one of the smaller cancer centres in the country and fragmenting it by separating the inpatients from radiotherapy would be expensive and detrimental to the quality of care that can be delivered. Nearly 5 years ago, a detailed review of these services was carried out, and it was agreed that the preferred model would be to merge the Poole and Bournemouth haematology services, and co-locate these with oncology on the Poole site. Oncology inpatients were moved to a single site (Poole) at that time, in order to ensure the on-going provision of a safe inpatient / on call service across the two sites. In our view, better outcomes and greater efficiency within cancer services can only be achieved by adopting Option A. By developing the Cancer Centre in Poole and completing the centralisation of haematology services on the Poole site (supported by appropriate ITU services), savings can be made and the quality of cancer services in Dorset further improved. Co-location of haematology with oncology in-patients provides clear advantages in avoiding the duplication of specialist staff, training and pharmacy services. This is also the only model whereby true 3-tier, 24/7 on-call cover could be organised for both haematology and oncology patients. Whilst it has been suggested that in time, radiotherapy services could be moved to the Royal Bournemouth Hospital site (should this become the Major Emergency Centre), the impact of this change on the Dorset population has not been assessed and the costs of such a move have not been taken into account. The radiotherapy department serves the whole of Dorset, with around 36,000 attendances per year, so moving services to the eastern side of the county would have a significant impact on a large number of people. At the same time, the cost of relocating this very expensive equipment has not been included in the capital assessment for Option B; clearly, if radiotherapy services have to be re-sited, then the costs of Option B are significantly higher (estimated at around 20 million). In summary, Option A represents a much better option for cancer services as opposed to Option B. If Option B were to be adopted, appropriate critical care facilities must be made available to avoid fragmenting services, and to enable the on-going provision of complex elective cancer surgery on site. Impact on Maternity services in Dorset Within Poole Hospital, we believe that Dorset needs a single specialist maternity centre, covering the whole of Dorset. As such, it is our view that the service at Dorset County Hospital should network with the service in the east (currently provided from Poole), rather than seek to strengthen links with the maternity service provided at Yeovil. 11

National guidance states that the optimum number for a specialist maternity centre is 7000 births, and if one such centre were to be established in Dorset, this number could be achieved. There are currently around 5000 births taking place at Poole Hospital (just large enough to be sustainable), but far fewer births take place at Dorset County Hospital each year - under 2000 births per annum. If the two services were to come together, working as a networked model, the Dorset service would come near to the optimum number of 7000, with benefits and improved outcomes for all Dorset mothers and babies. Level 2 Neonatal services have recently been centralised in Dorset and are now provided from Poole Hospital for all mothers and babies needing this level of care, from across the whole of Dorset. It is important to note that under Option B, maternity and neonatal teams would be moved to the Bournemouth site, which is less accessible for residents living in the north and the west of Dorset. Looking ahead, under Option B, we are also concerned that there is a risk that maternity services in the east could be disadvantaged. If the maternity unit for those living in east Dorset is established on the Bournemouth site, it is possible that more mothers in the mid- Dorset area will choose to deliver in the west, rather than travel all the way to the far eastern most part of the county. This could therefore result in two smaller, sub-standard units, with both being potentially clinically unsustainable. It is the view of our obstetricians and midwives that the best way to improve services for all mothers, babies and children in Dorset would be for Poole Hospital to become the major emergency hospital in East Dorset, linking with Dorset County Hospital on a networked basis. Whatever approach Dorset County Hospital chooses to pursue, if Option A is adopted (whereby maternity and neonatal services are maintained at Poole Hospital), the option of developing a Dorset-wide service remains open for the future, with no increase in the distance between services in the east and the west. Ensuring sufficient emergency/urgent care provision and developing the Community Hubs Whatever option is chosen, further work is required to ensure that the Major Emergency Hospital is of an appropriate size, and that the needs of the population living in the east can be effectively met by one new, centralised Accident & Emergency Department. In working together as part of the Clinical Services Review, there was a majority view amongst clinicians that a single emergency hospital in East Dorset would be more beneficial for patients, compared to the current arrangement whereby this service is delivered over two sites. Centralising these services is recognised as being particularly beneficial for patients with hyper-critical conditions such as heart attacks, stroke and vascular emergencies. However, as we have continued working collaboratively on these plans for Dorset, concern has since been expressed by some of our clinicians relating to this model, given the increase in demand for emergency services that has been seen in recent years. In taking this work forwards, we must together ensure that this concern is properly addressed. The detailed work that has been carried out recently by our A&E consultants and emergency physicians reinforces the fact that effective alternative services must be established if the number of emergency attendances and admissions on the Major Emergency Hospital site are to remain manageable. The new Urgent Care Centre - that is, a combination of a Minor Injury Unit and a GP Out-of-Hours type facility planned to be established on the Major Planned Care Hospital site must be effective in providing care for patients that would otherwise attend the A&E Department. Similarly, the new Community Hubs will need to provide effective urgent care services, including out of hours support, in order to meet demand. These facilities will be 12

critical to the successful operation of the Major Emergency Hospital. Overall, the model developed as part of the Clinical Services Review assumes that fewer people will need to access hospital care, and for these assumptions to become a reality, demand for emergency care will need to be robustly managed - and this needs to start immediately. Our collective top priority in Dorset must be to develop more robust, integrated services outside the hospital setting. In summary, it is essential that more detailed work is carried out in order to size the A&E Department within the Major Emergency Hospital, taking into account the support that will be provided by the Urgent Care Centre and the new Community Hubs. The expert staff within the Emergency Department of Poole Hospital (including those experienced in dealing with major trauma) expect to play an important part in developing these detailed plans, working in conjunction with colleagues and other partners. As a final point under this section, it is important to reflect on the distribution of community beds under the various options. Under Option B, there would be no Community Hub with Beds in the very east of the county. This would mean that all patients requiring a step-up/step down/rehabilitation bed would have to access this at either Poole Hospital or Wimborne Hospital. This may not be the most appropriate spread of community beds for the eastern side of Dorset, where most of the population resides. Under Option A, community beds would be available at Wimborne, Alderney and the Royal Bournemouth Hospital, which would appear to be a more equal distribution of such an important facility. Maintaining Integrated Paediatric Services Again, as further work has been carried out to assess the potential impact of the proposed changes, it has been very clearly brought to our attention by our paediatric team that maintaining integrated paediatric services is essential. As well as providing an acute paediatric and neonatal service, the paediatricians here at Poole also provide a community and neuro-developmental service, including responsibility for Safeguarding and Looked After Children work for both East and West Dorset. These consultants provide care for children with physical and learning disabilities, vulnerable children in the care system, and all aspects of child safeguarding - including physical and sexual abuse and the investigation of unexpected death in childhood. In all of these areas, close liaison with hospital based colleagues is essential including followup of high risk babies from the Neonatal Unit, joint care and liaison with acute paediatricians for disabled children with complex health needs, access to appropriate medical investigations and 24hour availability for acute admissions via A&E or the Children s Unit when there are concerns about child abuse. Given this situation, it is essential that there continues to be a strong, combined Paediatric Unit, with adequate and appropriate clinical space, whichever option is chosen. A modern, purpose built Children s Unit, designed for and with children, young people and their families should include all services currently provided by Poole Hospital NHS Foundation Trust, including those delivered by the Children s Therapy service, which is an integral part of the neurodevelopmental team. At the present time, the outline plans for re-siting the paediatric unit at Bournemouth under Option B do not include provision for the paediatric community/neurological service. This service currently operates from an 800m2 facility at Poole Hospital, and this would need to be 13

re-provided on the Bournemouth site, in the same way as the rest of the paediatric service. It should be noted that this would further increase the capital costs associated with Option B, which using the same Capita rates as for the wider development, would equate to approximately 6.6m more cost. Maximising the use of the Planned Care Site Whichever option is ultimately adopted, it is the view of the clinicians at Poole that the Major Planned Care facility should be configured to deliver a substantial range of elective surgery. This is essential if we are to maximise the benefits of the model, and avoid cancelling planned operations whenever there is a surge in the demand for emergency care. It is also essential if we are to keep the capital costs associated with this change as low as possible. In order to maximise the use of the Major Planned Care site and deliver most elective care, the Major Planned Care facility will require appropriate critical care support, as stated earlier. This should not be delivered in isolation, but as part of the service provided by a wider critical care team, operating across both sites. This will clearly need more detailed discussion as we take the Clinical Services Review plans forwards, but in the meantime, it is important that we do not leave critical care services as the limiting factor relating to the use of the Major Planned Care site. This may not be in the interest of the wider health economy particularly in respect of cancer services. It is essential that the future design of all clinical support services is based on ensuring the safe and effective delivery of the various clinical specialties across the three hospital sites in Dorset and the community hubs. CONCLUSION In conclusion, the Board of Directors for Poole Hospital NHS Foundation Trust accepts the case for change, and wishes to see the recommendations of the Clinical Services Review implemented across Dorset. It is recognised that benefits can be achieved by introducing new models of care, which involve a much greater focus on prevention, the strengthening of primary and community services, the establishment of more robust networking arrangements between the three acute hospital services in Dorset, and the separation of emergency and planned care services in the east. We recognise that there are advantages and disadvantages associated with both Option A and Option B, and believe that the new models can be made to work, whichever option is ultimately chosen. However, based on feedback from a large number of staff and a wide range of clinicians, the Board of Directors for Poole Hospital NHS Foundation Trust is of the view that the optimum solution would be to pursue Option A and establish the Major Emergency facility on the Poole Hospital site. Most importantly, from the feedback received from our clinical teams, the Board wishes to stress that in the event of Option B being adopted within Dorset, the current plans would need to be modified in order to mitigate the risks/issues that have been identified during the course of this consultation exercise particularly in respect of cancer services. We look forward to continuing our joint work with partners, as we seek to implement these plans together. 14

Section 3 Other comments and suggestions [Blank] Section 4 Impact on equality 4 Are there any positive or negative impacts relating to equalities that you believe we should take into account? If so, are you able to provide any supporting evidence and suggest any ways we could reduce or remove any potential negative impact and increase any positive impact? If so there is a free text box for further comments It is our view that the needs of the more isolated population in Dorset, that is those in rural areas in the north and west of the county, should be given more weighting in considering acute hospital options A and B. Section 5 - Information about You What is your full postcode? BH15 2JB Which organisation do you represent? Poole Hospital NHS Foundation Trust. Centrally based within Dorset at the heart of the East Dorset conurbation, the Trust provides acute general hospital services for the population of Poole, east Dorset and Purbeck as well as several key services for the whole East Dorset population including providing Trauma services, Ear, Nose and Throat (ENT) services, Children s and Maternity services. Poole Hospital also provides several important services for the whole of Dorset including the Dorset Cancer Centre, oral surgery and neurological care. It is the only hospital in Dorset which has the optimum provision of oncology, radiotherapy and haematology on one site. The Trust employs 3,600 staff and has a positive track record of working effectively with partners and commissioners, within Dorset s overall health and social care provision. Within Poole Hospital, a number of events have been held over the past few weeks to brief staff on the proposed changes, listen to feedback, answer questions, and ensure that the information obtained from these events is used to inform the response of the Board. 15