BEH Clinical Strategy newsletter october 2013

High Quality and Safer Healthcare in Barnet, Enfield and Haringey barnet Safer, better local healthcare Enfield gets green light haringey Barnet, Enfield and Haringey Clinical Commissioning Groups gave the approval to make the planned changes agreed under the Barnet, Enfield andH aringey Clinical Strategy as soon as possible, from 15 November 2013 at their joint governing body meetings held in common on 25 September 2013.

The most significant change to health health needs and developments in The decision to move forward services in North for many healthcare, local clinicians agreed that with the timing of these changes years, the strategy is an integral step changes need to be made to acute is founded on robust, clinically-led to providing residents across the three services at three – Barnet, decision making. Earlier this month boroughs and neighbouring areas Chase Farm and North Middlesex there was assurance from the boards with the highest quality of care. University hospitals. of directors of both Barnet and Chase Farm Hospitals NHS Trust and North With over 300 years of clinical Under these changes, A&E services Middlesex University NHS experience in the room, there was and labour wards will be moved from Trust that all three hospitals would be almost unanimous agreement (one Chase Farm Hospital, with expanded ready to implement the changes from abstention) on the clinical readiness facilities and staffing at Barnet November, with facilities and staff in for the implementation of the Hospital and NMUH. New facilities place. NHS England also maintains planned changes to services at Chase at Chase Farm include an urgent oversight of the readiness of the Farm, Barnet and the North Middlesex care centre for non life-threatening programme to make the changes. University (NMUH) hospitals. conditions, and assessment centres for children and older people. In response to changing local See page 2

Chase Farm remains open only small percentage of people affected by changes Over 94% of patient journeys for care at Barnet, Chase Farm or the North Middlesex University (NMUH) hospitals will not be affected by these planned changes. The vast majority of patients who currently use Chase Farm Hospital In this issue... will continue to use the same services at Chase Farm. These services include Safer, better local healthcare gets green light 1 urgent care, outpatient, inpatient beds for rehabilitation, planned surgery and Chase Farm Hospital remains open 1 Changes to A&E and urgent care 3 diagnostics such as x rays and blood tests, all of which will continue to be Improved care for older residents 4 provided onsite at Chase Farm Hospital. Care for children 4 Chase Farm Hospital will become the centre for elective surgery (planned Planned changes to maternity and neonatal 5 operations) and we expect there to be fewer cancelled operations because Urgent care saves lives 6 there will be no emergency surgical cases to treat at the hospital. A new GPs invited to find out more about women’s services 7 Come and find out more about the BEH plans 8 document – The New Chase Farm, is available online from www.bcf.nhs.uk Contacts 9

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High Quality and Safer Healthcare in Barnet, Enfield and Haringey

Chase Farm remains open - only small percentage of people affected by changes Continued from page 1 Since 2007, local residents, campaigners Liz Wise, Chief Officer for Enfield CCG and Senior Responsible and clinicians have been engaged on Officer for the BEH Clinical Strategy said: the best way to deliver the high quality “The Barnet, Enfield and Haringey Clinical Strategy is critical health services they need. This clinical to the long term quality of healthcare services across our three boroughs. The decision to move forward now will be a strategy was developed by senior significant benefit to the health of our local residents. clinical staff to improve the health of “Changes under the strategy mean more senior emergency local people, by delivering better, safer doctors in A&E, better maternity care in modern labour care and improving services for patients. wards and improved children’s inpatient services. We have It has been endorsed by an independent always said changes will only be implemented when we have panel of expert clinicians and approved assurances that safe, high quality services can be provided for the local population. These assurances have been met, and I by the Secretary of State for Health. am pleased the decision has been made to press ahead.”

Over 450 new doctors, nurses, midwives and clinical specialists are being recruited at the North Mid alone to deliver the planned changes. See inside for more information about the changes confirmed by the decision.

Barnet’s Dr Clare Stephens, a local Barnet GP Dr Helen Pelendrides, GP Chair and Governing Body member, said: of Haringey CCG said: “I am pleased to see the expansion of Barnet Hospital with “The agreement to move forward with new services and a strengthened workforce. This will mean that this strategy is the best decision for Barnet Hospital will be among the first in London to meet the the residents of Haringey. As a GP and new London Quality Standards, ensuring more senior doctor Chair of Haringey CCG, I want to ensure availability and better patient care. As a clinician, I am convinced our residents have access to safe, well change needs to happen and it is safe to proceed now. I and my co-ordinated and high quality services. colleagues at Barnet CCG are now looking forward to working Moving ahead with the strategy is a vital with our colleagues in the hospitals to make sure these changes step in attaining our vision. The new improve local NHS services for our patients.” facilities and staff at North Middlesex University Hospital will ensure an outstanding level of care for Haringey Dr Alpesh Patel, GP Chair of Enfield CCG said residents.” “As a GP in Enfield and Chair for the Enfield Clinical Commissioning Group, offering high quality care for local people David Riddle, Lay Member is my highest priority. This decision is good for our patients and, led by local clinicians, it is a clear demonstration that we now have for Barnet CCG said: the necessary assurances and the time is right for the strategy to “At Barnet CCG our vision is to provide move forward. the right care, at the right time, in the “The assurances we, as local GPs, wanted before moving ahead right place to all residents. This decision to with these changes have been met and we look forward to begin the implementation of the Barnet, working with our partners to improve care for our patients. Enfield and Haringey Clinical Strategy in The changes mean local people will get better maternity and November means that we can continue to A&E services, and better access to primary care while Chase Farm move forward and be able to reassure our Hospital will have expanded planned surgery and improved residents that they will receive safer and urgent care services.” higher quality services.”

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High Quality and Safer Healthcare in Barnet, Enfield and Haringey

Changes to A&E and Urgent Care The new configuration for emergency, urgent and acute care will see emergency services concentrated on Barnet Hospital and North Middlesex University Hospital sites. The transfer of A&E and associated acute inpatient wards from Chase Farm Hospital will happen on 9 December. Concentrating emergency services and specialised Initial modelling proposed a 70:30 NMUH: clinical staff onto a smaller number of sites enables Barnet Hospital split in the shift of emergency the provision of higher quality and safer emergency activity following the decommissioning of the services, meeting the London Quality Standards for Emergency Department at Chase Farm Hospital. adult emergency departments, with appropriate and To accommodate the proposed increase in activity, timely access to senior decision making clinicians and both Trusts have reorganised and expanded their timely access to theatre and diagnostic services. emergency care services and bed provision.

Urgent Care Centres are up and running at all three As of 03:00hrs on 9 December 2013, all emergency hospitals. At Barnet and NMUH, Urgent Care Centres admissions will be diverted from Chase Farm Hospital are integrated with the emergency units. The UCC to either Barnet Hospital or NMUH. The department at Chase Farm Hospital forms a stand-alone service will remain open until 09.00 when the Chase Farm from 9 December 2013. Hospital UCC opens to accommodate any non-blue light emergency attendances. The acute inpatient The Chase Farm site will provide urgent care services wards will discharge patients naturally, but at the for 12 hours a day, 7 days a week and will be GP-led latest by 19 December. with a ‘see and treat’ model, and a full-time clinical streamer enabling appropriate direction of patients Some medically complex patients may need to be through the primary and secondary care systems. It transferred. The ITU and HDU will continue to provide is expected that the UCC at Chase Farm will manage a service until 20 December, when any remaining 40% of the current A&E attendances. patients will be transferred to Barnet Hospital for ongoing treatment. Outside of the UCC’s opening hours, there will continue to be GP out of hours support on site at There will be a significant public communications and Chase Farm. The GP out of hours provider will work advertising programme to ensure local residents are within the UCC facility, with joint staff working aware of changes and Enfield Council is being asked enabling continuity of service which means that to review the signage on the public highways. people will continue to be able to access a doctor 24/7 on the Chase Farm site.

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High Quality and Safer Healthcare in Barnet, Enfield and Haringey

IMPROVED CARE FOR OLDER RESIDENTS The Older Person’s Assessment consultant-led service will enable recommended by the National Unit (OPAU) has been developed older people to have access to rapid Emergency Care Intensive Support at Chase Farm Hospital and is uni-disciplinary and multi-disciplinary Team. now providing a new model of assessment, diagnostics and agreed These three initiatives will reduce integrated high quality care to treatments as part of established unnecessary emergency admissions patients over 65 years of age care pathways, without requirement and decrease inpatient length of stay with the aim of avoiding hospital for inpatient admission. Further to ensure that patients receive rapid admission for older people initiatives are being rolled out by access to treatment within the most with complex health needs. The both Trusts. clinically appropriate setting. OPAU is not a walk in centre but New Rapid Assessment Interface They were established to ensure patients need to be referred in or Discharge (RAID)*, Post Acute that there will be at least a two by their GPs. Care Enablement (PACE)* and month lead-in time to embed new Triage and Rapid Elderly Assessment The new service went live on 16 pathways ahead of the service Teams (TREAT)* are in place and are September and is working as a changes. considered good practice nationally, pilot with local GP surgeries. This *see page 9 Care for children New ways of caring for children coming in for urgent care has started at Chase Farm Hospital. A new Paediatric Assessment Unit (PAU) at Chase Farm Hospital adds to the existing PAU at Barnet Hospital and NMUH. The PAU at Chase Farm Hospital will be co-located with the Urgent Care Centre and will be a consultant-led service for the assessment, treatment and observation of children and young people with minor or moderate acute illness, without the need for in-patient admission. Paediatric care in the new service configuration would meet the Royal College of Paediatrics and Child Health (RCPCH) standards of care as outlined in ‘Facing the Future: a review of Paediatric Services’.

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High Quality and Safer Healthcare in Barnet, Enfield and Haringey

Planned changes to maternity and neonatal The new service configuration for maternity and neonatal care will see new purpose built labour wards and birthing units at Barnet Hospital and North Middlesex University Hospital. Expectant mothers will see more midwife and senior doctor availability. They can choose midwife-led or obstetric-led units at North Middlesex University Hospital and Barnet Hospital.

Antenatal and postnatal clinic still access high quality maternity care November. At NMUH, there is staffing will still be provided on the Chase close to home. to provide 22 cots, from 21 November, Farm site as well as at Barnet GP practices are already making with a phased approach to increasing and North Middlesex University referrals to the new service to 30 cots once the new unit is open. hospitals. configuration for community Detailed protocols and guidelines are in place and align to existing neonatal The changes will enable both midwifery. There is ongoing network arrangements to ensure that Trusts to provide significantly more communication with local women any transfers that are required will consultant-delivered care than to ensure that they are being made continue to be safe and effective. currently, working closer towards the aware of the planned changes and London quality standard for obstetric that patient choice and continuity of Trusts have confirmed that there units to provide 168 hour consultant care is being maintained through the will be sufficient capacity to meet presence every week. In addition, it transition. the needs of expectant mothers and will enable hospitals to provide more GPs with women booked to deliver their babies across Barnet, Enfield & individualised midwifery care through their baby at Chase Farm Hospital Haringey. making it easier for maternity units from November onwards might now The last patient to be discharged (or to sustainably achieve and maintain need to ensure that they transfer transferred) from Chase Farm labour the standard for 1:30 midwife to birth their care from Chase Farm to Barnet ward, midwife-led unit and special ratio. Hospital or NMUH. care baby unit will be by Wednesday Changes to the community midwifery Neighbouring Trusts outside BEH 20 November, with elective caesareans boundaries in Enfield have been have seen an increase in maternity transferring to Barnet Hospital from agreed and communicated to ensure bookings. 15 November and completed by 18 November. The number of patients to that women who may have previously Barnet Hospital neonatal unit will be transfer should be minimal. given birth at Chase Farm Hospital can fully staffed to provide 30 cots from 19

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High Quality and Safer Healthcare in Barnet, Enfield and Haringey

Urgent care saves lives News that at least 40% of the public attending A&E don’t need to be in A&E is reported by all three hospitals. To help the public understand how and when to use A&E, a new campaign has been launched. A&E care is required when a patient’s illness is life- threatening – this could be loss of consciousness, acute confused state and fits that are not stopping, persistent and severe chest pains, breathing difficulties and severe bleeding that cannot be stopped. These patients need to get to an A&E quickly or call 999. The majority of patients attending A&E currently do not have life-threatening conditions but should be treated in an urgent care centre, freeing up emergency care for those who need it most.

Patients who have a stroke or heart attack will continue to be treated at regional specialist centres bypassing local A&Es, a move that took place three years ago and which has seen over 400 lives a year saved in London alone. Those who have had strokes will move back to a new rehabilitation unit at Chase Farm Hospital for local care once stabilised.

Urgent Care Centres are open in all three local hospitals to treat all urgent, non-life threatening cases. Urgent care is for patients who have less serious illnesses such as sprains, suspected fractures, wounds, water infections, tummy pain, headaches, etc.

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GPs invited to find out more about women’s services

Two open evenings will be held, on 10 and 24 October, from 5pm GPs across Barnet, until 8pm at the meeting area in the board room, Palm Ward, on the Enfield and Haringey second floor at Barnet Hospital. Consultants, managers nurses and midwives will be on hand to answer are invited to an open questions and give advice on the changes so far and those planned for evening at Barnet the future. A tour of the newly opened Willow Ward – with 16 beds for gynaecology and surgery patients – will be available, as well as a Hospital to find out visit to the new colposcopy unit. more about changes Barnet Hospital will provide inpatient and day case surgery. It will also have full maternity services, an early pregnancy assessment unit, to women’s services emergency gynaecology unit, obstetric delivery suite a new birthing and what they mean unit. Please let Karen Bascombe know if you are able to attend: for patients. [email protected]

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High Quality and Safer Healthcare in Barnet, Enfield and Haringey Come and find out more about the BEH plans Members of the public are invited to find out more about service changes across Barnet, Enfield and Haringey. They can come along to local shopping centres where staff will be on hand to answer questions and talk about the improvements to services which are being made.

There will be a chance to see the new BEH video explaining changes and we’ll be testing the public’s knowledge about where they should go if they hurt themselves badly or are unwell or who to turn to for a range of common medical injuries.

We will be at the following venues for seven days and staff will be on hand during the shopping centre opening hours:

The Shopping Centre, near Monday 7 October – Friday 11 October 2013 Phones 4U and WHSmiths 10.00am – 8.00pm

The Co-Op car park, Monday 14 October – Wednesday 16 October 2013 Enfield, EN3 6LZ 9.00am – 6.00pm

The Spires Shopping Centre, High Thursday 17 October – Sunday 20 October Street entrance, Barnet Thursday 9.00am – 5.30pm, Sunday 10.00am – 4.00pm

The Mall () Shopping Monday 21 October 2013 for 7 days Centre, Haringey outside Primark Monday to Saturday 9.00am – 6.00pm Sunday and Bank Holidays 11.00am – 5.00pm

The Palace Gardens Shopping Centre, Monday 28 October 2013 for 7 days Enfield outside Waitrose Monday – Saturday 9.00am – 5.30pm Sunday and Bank Holidays 10.30am – 4.30pm

The Pavilions Shopping Centre, Monday 28 October – Sunday 3 November 2013 Waltham Cross, Herts outside Monday – Tuesday 8.00am – 6.00pm, Sainsbury’s Wednesday – Friday 8.00am – 8.00pm, Saturday 8.00am – 6.00pm, Sunday 10.00am – 4.00pm

See you there!

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High Quality and Safer Healthcare in Barnet, Enfield and Haringey

STOP PRESS Legal challenge threatens patient safety Enfield Council has voted to support the “We believe we have done everything we are commencement of legal proceedings to challenge supposed to have done and are very concerned about the decision made by the three CCGs on 25 the impact on patient safety of any delay. September. “These changes must be made sooner rather than Liz Wise, Chief Officer of Enfield Clinical later to ensure that patients have safe and sustainable Commissioning Group and Senior Responsible Officer services. for the BEH Clinical Strategy, said: “The hospitals have made it clear that they are ready “We believe that there is no merit in this challenge and to make these changes and GPs in all three boroughs are extremely disappointed that Enfield Council has agree that they should happen to maintain services at chosen to take this route. a level that the people of Barnet, Enfield and Haringey deserve.”

Contributions We welcome comments about this newsletter. You can email [email protected]

Please note that the BEH Clinical Strategy programme team has now moved to Holbrook House in Cockfosters. Please note the new email addresses.

BEH Clinical Shauna Sweeney CCG WEBSITES [email protected] Strategy Contacts Kate Woolland www.barnetccg.nhs.uk PROGRAMME DIRECTOR [email protected] Siobhan Harrington Caroline Wright www.enfieldccg.nhs.uk [email protected] [email protected] www.haringeyccg.nhs.uk PROGRAMME MANAGEMENT OFFICE Nell Beecham [email protected] Catherine Ashley [email protected] BEH COMMUNICATIONS LEAD Maggie Lam Stevie Pattison-Dick [email protected] [email protected]

* From page 4 Rapid Assessment Interface or Discharge (RAID) helps ensure patients get help for mental and physical health at the same time – delivering all the care that people need, when they need it Post Acute Care Enablement (PACE) identifies and facilitates the immediate discharge of medically stable inpatients whose needs do not require the intensity of care provided by an acute hospital and can be safely met in the community Triage and Rapid Elderly Assessment Teams (TREAT) thoroughly assesses elderly patients who have come to A&E, identifying those who are well enough to be discharged, and ensuring that support is put in place so that they can receive all of the care they require at home.

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