Governing Body Special Meeting 20 September 2017
Purpose and introduction Dr Forbes Watson Chair NHS Dorset Clinical Commissioning Group
Clinical Services Review Phil Richardson Director of Design and Transformation NHS Dorset Clinical Commissioning Group
The Need for Change Doing nothing is not an option due to: difficulty staffing services, particularly some services requiring consultant support 24x7 growing elderly population with changing health needs variable quality of out of hospital care with patients reporting difficulty accessing care variable quality of hospital based care, particularly for some more specialist services growing financial challenge with a projected deficit of around 158m by 2020/21
Steps to consultation Design Launch October 2014 Need for Change January 2015 Clinical Working Groups November 2014 (13 to date) Public Engagement Throughout Public Consultation Governing Body (preferred options) May and July 2016 Consultation 1 December 2016 28 February 2017 Deliberations Governing Body (workshops) June September 2017 Consultation feedback Additional work
Evaluation criteria
Assurance March 2015 to July 2016 Wessex Clinical Senate March 2015 to November 2016 Stage 1 & Stage 2 NHS England Assurance May and July 2016 CCG Governing Body August to October 2016 National Investment Committee July 2015 to August 2017 Joint Health Scrutiny Committee/LA Assurance May 2016 to September 2017 the Consultation Institute
Public consultation Extensive pre-consultation engagement Comprehensive public consultation 1 December 2016 to 28 Feb 2017 c 20,000 responses in total Wide reach across demography, geography and diversity using a range of methodologies Followed legal requirements and national guidance, including our duty to involve best practice accreditation from the Consultation Institute
Additional work Four main areas of additional work Transport Emergency transport Non-emergency transport Clinical risk Equality Impact Assessment (EIA) Health and wellbeing
Integrated Community Services Dr Karen Kirkham Assistant Clinical Chair NHS Dorset Clinical Commissioning Group
Model of care (ICS) Increase the number of people supported at home or in the community Increase the range of services in the community and reduce the need to travel Health and social care staff working in teams Seven-day services and available longer during the day Improved use of community hospitals as community hubs by consolidation of some and increased use of others
Integrated Community Services proposals Enable/improve integrated community services by creating 12 community hubs 7 with beds and 5 without beds
Consultation response headlines Little disagreement with the proposal to provide care closer to people s homes in principle across all methodologies except the open questionnaire There were, however, many questions and significant doubts that they could be achieved in practice (resourcing, affordability and overcoming current disjoint between different services) For the proposed locations, some areas were more controversial than others. Negative opinion was strongest where it proposed that beds or hospitals are closed
Integrated Community Services recommendations Enable/improve integrated community services by creating 12 community hubs 9 with beds and 3 without beds
Patient benefits Reduced travel Better access Services closer to where people live Less reliance on acute hospitals More services, better joined up Right place, right time, right person
Chief Executive: views on implementation Ron Shields Dorset HealthCare NHS Foundation Trust
Integrated Community Services Governing Body Questions
Integrated Community Services recommendations Conrad Lakeman Secretary and General Counsel NHS Dorset Clinical Commissioning Group
ICS 1 The Governing Body is requested to approve the recommendation: to commission more services closer to people s homes delivered through integrated community teams and local community hubs to deliver better care
ICS 2 The Governing Body is requested to approve the recommendation: to commission a community hub with beds at Sherborne Hospital
ICS 3 The Governing Body is requested to approve the recommendation: to commission a community hub with beds at Blandford Hospital
ICS 4 The Governing Body is requested to approve the recommendation: to maintain a community hub with beds in Shaftesbury Hospital whilst working with the local community until a sustainable model for future services based on the health and care needs of this locality is established, possibly at a different site to the existing hospital
ICS 5 The Governing Body is requested to approve the recommendation: to commission a community hub without beds at Dorset County Hospital
ICS 6 The Governing Body is requested to approve the recommendation: to commission a community hub with beds at Bridport Hospital
ICS 7 The Governing Body is requested to approve the recommendation: to commission a community hub with beds at Weymouth Community Hospital
ICS 8 The Governing Body is requested to approve the recommendation: to maintain services including beds at Westhaven Hospital until the community hub with beds at Weymouth Hospital is established and staff and services have been appropriately transferred
ICS 9 The Governing Body is requested to approve the recommendation: to commission a community hub without beds on Portland, possibly at a different site to the existing hospital
ICS 10 The Governing Body is requested to approve the recommendation: to commission a community hub with beds at Swanage Hospital
ICS 11 The Governing Body is requested to approve the recommendation: to commission a community hub without beds at Wareham, possibly at a different site to the existing hospital
ICS 12 The Governing Body is requested to approve the recommendation: to commission a community hub with beds at Wimborne Hospital
ICS 13 The Governing Body is requested to approve the recommendation: for St Leonards Hospital to close
ICS 14 The Governing Body is requested to approve the recommendation: to commission a community hub with beds on the Major Planned Hospital site
ICS 15 The Governing Body is requested to approve the recommendation: to maintain services including beds at Alderney Hospital until alternative services have been established and staff have been appropriately transferred. At which point Alderney Hospital s community beds will close. Mental health and dementia services will remain unchanged pending the outcome of the dementia services review
ICS 16 The Governing Body is requested to approve the recommendation: to commission a community hub without beds at Christchurch Hospital. [This will not affect the palliative care beds]
ICS 17 The Governing Body is requested to approve the recommendation: to commission a community hub with beds on the Major Emergency Hospital site
Acute services and Maternity and Paediatric services Dr Karen Kirkham Assistant Clinical Chair NHS Dorset Clinical Commissioning Group
Models of care (acute) A major emergency hospital with 24/7 consultant cover A major planned care hospital An emergency and planned hospital
Acute hospital proposals
Consultation response headlines Majority in agreement with the vision of two specialist hospitals NHS staff had a more favourable view with the proposals in the east and west of the county Option B was considered more favourable than Option A (quantitative results) In the focus groups opinion differed between groups and individuals, mainly based on geographical proximity to the proposed emergency hospital, people were pleased that Dorset County Hospital is to remain a district general hospital Overall there were concerns about travel, congestion, transport and transfers between Poole and Bournemouth and staff retention
Acute hospital recommendations
Patient benefits more lives saved and better outcomes less operations cancelled more services closer to where people live over 100m investment in state-of-theart facilities including a new maternity unit Information will follow the patient Centre of excellence
Maternity and paediatric options OPTION A Consultant-led services at the major emergency hospital in the east of Dorset. Plus an integrated service across Dorset County Hospital and Yeovil District Hospital. OPTION B A single specialist centre that covers the whole of Dorset, which would need to be based at the major emergency hospital. +
Consultation response headlines This was the most contentious proposal in the consultation and prior to consultation we did not identify a preferred option The majority of respondents supported Option A (quantitative feedback) Based on qualitative feedback, Option A, in many cases, was the least unpopular, many participants in the focus groups rejected both options Two petitions against the closure of Kingfisher Children's Ward
Maternity and paediatric recommendations OPTION A Consultant-led services at the major emergency hospital in the east of Dorset. Plus an integrated service across Dorset County Hospital and Yeovil District Hospital. OPTION B A single specialist centre that covers the whole of Dorset, which would need to be based at the major emergency hospital. +
Chief Executive: views on implementation Debbie Fleming, Poole Hospital Patricia Miller, Dorset County Hospital Tony Spotswood, Royal Bournemouth Hospital
Acute services and Maternity and Paediatric services Governing Body Questions
Acute hospital recommendations Conrad Lakeman Secretary and General Counsel NHS Dorset Clinical Commissioning Group
AC 1 The Governing Body is requested to approve the recommendation: to commission distinct roles for Dorset s acute hospitals (a Planned and Emergency Hospital, a Major Planned Hospital and a Major Emergency Hospital), as part of one acute network of services
AC 2 The Governing Body is requested to approve the recommendation: to commission a Major Emergency Hospital at the Bournemouth Hospital site
AC 3 The Governing Body is requested to approve the recommendation: to commission a Major Planned Hospital at the Poole Hospital site
AC 4 The Governing Body is requested to approve the recommendation: to commission a Planned and Emergency Hospital at the Dorset County Hospital site
Maternity and Paediatrics recommendations Conrad Lakeman Secretary and General Counsel NHS Dorset Clinical Commissioning Group
M&P 1 The Governing Body is requested to approve the recommendation: to commission the delivery of consultant-led maternity and paediatric services from the Major Emergency Hospital
M&P 2 The Governing Body is requested to approve the recommendation: to seek to commission the delivery of consultant-led maternity and paediatric services integrated across Dorset County Hospital and Yeovil District Hospital for the Dorset population. Implications for this recommendation will be considered by Dorset County Hospital and Yeovil District Hospital and any proposed changes to services in either hospital would be subject to further local public consultation by both Dorset and Somerset CCGs as appropriate
Mental Health Acute Care Pathway Kath Florey-Saunders Head of Mental Health and Wellbeing NHS Dorset Clinical Commissioning Group
The Need for Change There are over 7000 people with a serious mental illness in Dorset We need to improve the experience for service users and their carers Current provision/service configuration does meet their needs Inequity of provision Dorset needs a financially viable and sustainable services fit for the future
Steps to consultation View Seeking August- September 2015 Model Options Development November 2015 - end June 2016 Business plan and assurance July 2016-Jan 2017 Consultation February-end March 2017 Deliberations and development of outline business case July 2017- September 2017 Needs Analysis; Benchmarking; Co-production
Assurance April 2016 Wessex Clinical Senate September 2016 to January 2017 Stage 1 and Stage 2 NHS England Assurance October 2016 Strategic Outline Case: Governing Body August 2015 to August 2017 Joint Health Scrutiny Committee/LA Assurance
Model of care (ACP) Retreat Community Front Room Inpatient beds Sturminster Newton North Dorset Three Recovery Beds for the west of the county West Dorset Bridport Forston clinic (+4) Mid Dorset Dorchester Purbeck East Dorset St Anne s (+12)* Bournemouth Four Recovery Beds for the east of the county Swanage 24/7 Connection service *15 inpatient beds from the Linden Unit at Westhaven Hospital (in Weymouth) to move to the east. This means the Linden unit would close. @
Consultation response headlines 16 drop ins 2 informed audience Digital and paper based Weekdays/ evening and weekends 1156 responses 70% supported the increase in beds 63% supported bed moves 77% supported the Retreats 74% supported Dorchester as the west s Retreat area 74% support Community Front Rooms 75% supported 3 Community Front Rooms and 7 Recovery beds 67% supported the proposals overall
ACP recommendations Retreat Community Front Room Shaftesbury Inpatient beds North Dorset Three Recovery Beds for the west of the county West Dorset Bridport Forston clinic (+4) Mid Dorset Dorchester Wareham Purbeck East Dorset St Anne s (+12)* Bournemouth Four Recovery Beds for the east of the county 24/7 Connection service *15 inpatient beds from the Linden Unit at Westhaven Hospital (in Weymouth) to move to the east. This means the Linden unit would close. @
Chief Executive: views on implementation Ron Shields Dorset HealthCare NHS Foundation Trust
Mental Health Acute Care Pathway Governing Body Questions
Mental Health Acute Care Pathway recommendations Conrad Lakeman Secretary and General Counsel NHS Dorset Clinical Commissioning Group
Recommendation 1 The Governing Body is requested to approve the recommendation to: commission increased mental health service provision
Recommendation 2 The Governing Body is requested to approve the recommendation to: commission an additional 16 beds, 4 new beds to be located in Forston Clinic and 12 new beds to be located at St Ann s Hospital
Recommendation 3 The Governing Body is requested to approve the recommendation to: relocate the 15 beds at the Linden Unit to St Ann s Hospital. Services and beds will be maintained at the Linden until the new beds are established at St Ann s Hospital and Forston clinic and staff appropriately transferred, at which point the Linden unit will close
Recommendation 4 The Governing Body is requested to approve the recommendation to: commission a Retreat in Bournemouth
Recommendation 5 The Governing Body is requested to approve the recommendation to: commission a Retreat in Dorchester
Recommendation 6 The Governing Body is requested to approve the recommendation to: commission a Community Front Room in West Dorset
Recommendation 7 The Governing Body is requested to approve the recommendation to: commission a Community Front Room in North Dorset
Recommendation 8 The Governing Body is requested to approve the recommendation to: commission a Community Front Room in Purbeck
Recommendation 9 The Governing Body is requested to approve the recommendation to: re-commission the seven Recovery beds (currently in the west of the county) to three in the west of the county and four in the east of the county
Conclusion and close Dr Forbes Watson Chair NHS Dorset Clinical Commissioning Group