Annex 1: The Case for Change Scarborough ASR | 21 January 2019 Introduction to the Scarborough Case for Change fact pack Context and purpose ▪ In line with the overall vision of the Humber Coast and Vale Health and Care Partnership, York Teaching Hospital NHS Foundation Trust sets out a clear ambition to have high quality, safe and sustainable hospital services across the whole of its geographical patch ▪ York Teaching Hospital NHS Foundation Trust, Scarborough and Ryedale CCG and East Riding CCG, working under the auspices of the Humber, Coast and Vale Health and Care Partnership, have agreed to undertake an independent review of the configuration of Scarborough acute services ▪ Through the review we will seek to understand the clinical, operational and financial drivers that support a case for change, moving from tactical, piecemeal improvements or service developments towards a clinically and financially sustainable model fit for the future ▪ The process will involve a detailed appraisal of existing services, prioritisation of key sustainability issues, evidence-based evaluation of options and recommendations for future service delivery ▪ This document seeks to draw together the data which supports the case for change to ensure a safe and sustainable integrated local and health system that meets local people’s needs in the long term What is included? What is not included? The document is focusing on the case for change for services for the Scarborough population, ▪ Data supporting a case for change drawing on: across the entire Trust or STP area – ▪ Data on population and population health the focus is on the sustainability of ▪ Primary and community care service data services for the wider Scarborough ▪ Hospital clinical and operational service data population only ▪ Information captured through patient and public insight and feedback ▪ Detailed recommendations for service transformation – these will be Wherever possible it has used the most recent data from publicly available sources (e.g. NHS developed as part of the review Digital) or from local sources where available but this is not consistently of the exact same time process with input from clinicians, period commissioners, patients and other Comparisons are made against England national average / quartiles / deciles and against peer stakeholders group CCGs / local populations with similar characteristics (e.g. other hospitals designated ▪ Evidence base and case for best small / remote), or neighboring Trusts with similar population flows practice Note that the data in document is preliminary and may be added to or revised as the review ▪ Any patient identifiable data or non- progresses anonymised information 2 CASE FOR CHANGE Summary case for change ▪ Life expectancy is in Scarborough is below the national average for men, driven by high rates of stroke and coronary heart disease ▪ The local population (within the catchment) is growing by 0.2% per year but ageing, with the number of people over 70 projected to The local population is grow over the next seven years ageing and has changing ▪ This will result in a higher prevalence of people with long term conditions (LTCs) and frailty health needs… ▪ Scarborough has a large and seasonal non-resident population - there are 5 million nights a year spent in the Scarborough region by tourists ▪ The underlying population is projected to grow by 2.2% by 2030, in the same period demographic-related activity growth in non-elective care is projected to increase by 10.4% ▪ Care for people with LTCs and frailty needs to be provided in a different way & in a different place than in the past … requiring a different ▪ It will need a more pro-active approach, delivered by multi-disciplinary teams working together, with easier access to diagnostics and sort of care to that specialist opinion and more consistent quality of care historically provided… ▪ It will also require greater use of technology, e.g. virtual outpatient clinics or remote monitoring ▪ Currently over 50% of NHS funds available for the local population are spent in the acute sector … which will result in ▪ The clinical evidence base suggests that a greater focus on prevention of ill health and on caring for people with LTCs and frailty in the decreased in-hospital community can significantly reduce the need for acute hospital care resulting in better health status and greater independence activity… ▪ Examples from elsewhere suggest that new models of out of hospital care could reduce the amount of acute activity by ~3.5% per year ▪ Scarborough hospital is recognised as a remote site, 42 miles away from the nearest hospital, challenging collaborative working ▪ Acute hospital services in Scarborough have relatively low volumes and acuity, and relatively high number of patients who could be better treated elsewhere – 51% of attendances at Scarborough A&E (including the UCC) were for minor problems … which is good for the – 65% of all bed days are occupied by stranded non-elective patients local population, but ▪ Services which need to be provided 24x7 are particularly difficult with relatively small numbers of patients will put further – Obstetrics sees ~1,400 deliveries per year, one of the smallest consultant led obstetric units nationally pressure on already – Fewer than 5 emergency surgical cases per month are operated on after midnight fragile, low volume ▪ 24/7 services are more expensive to run in Scarborough: A&E, women’s services and children’s services costs are 124%, 120% and 128% acute hospital services of indexed national average assessed costs respectively ▪ Staffing of services providing 24x7 care is particularly difficult to provide – 46% of posts in Emergency and Acute medicine are not filled with a substantive appointment – 26% of consultant workforce is over 55 – Locum/agency/bank expenditure at Scarborough Hospital was £10.6 million in 2016/17 The Trust therefore ▪ Building on experiences of similar sized hospitals elsewhere, this is likely to involve: needs to change its – New forms of collaboration with neighbouring hospitals, in particular York, while remaining cognizant of travel times between the model of care to two sites continue providing high – More integrated arrangements with local primary and community care services quality sustainable – New workforce models and potentially greater use of technology services – Identifying opportunities to utilise the Bridlington site 3 Contents ▪ The local population and their health needs ▪ Primary care ▪ Community services ▪ Ambulance services ▪ Acute services ▪ Scarborough Hospital 4 THE LOCAL POPULATION AND THEIR HEALTH NEEDS Local population and their health needs – summary of data Area of focus Source Key findings ▪ ACRA1 ▪ Scarborough is one of 8 sites recognised as a remote hospital Location of the hospital ▪ It is 42 miles by road from the closest surrounding acute hospital (York Hospital) ▪ HES 2016/17 data ▪ Scarborough supports a catchment of ~180,000 people in 34 electoral wards; containing 25 GP surgeries ▪ ONS 2016-based Sub ▪ The population across the catchment area is set to increase by The local National Popu-lation ~ 0.2% p.a. by 2025 catchment Projections ▪ GB Tourism Survey ▪ There are 5 million total nights spent in the Scarborough local 2015, 2016 and 2017 authority by tourists each year ▪ Public Health England ▪ The male catchment area life expectancy is 78.7 years ▪ The female catchment area life expectancy is 83.1 years Demographics ▪ Income deprivation in the catchment varies between 5.2% and of the local 32.9% catchment ▪ 26% of the adult population is obese ▪ QOF 2016/17 ▪ The prevalence of chronic disease is expected to grow in Scarborough & Ryedale CCG and East Riding of Yorkshire CCG 1 Advisory Committee on Resource Allocation 5 THE LOCAL POPULATION AND THEIR HEALTH NEEDS Hospitals recognised as remote Peer hospitals based on population size and remoteness1 Not Prop Site Name Remote Remote Remote St Mary's Hospital … 138,393 100.0% North Devon District 15,089 154,763 91.1% Hospital Cumberland Infirmary 45,409 142,037 75.8% Furness General 44,661 68,600 60.6% Cumberland Hospital West Cumberland Infirmary - Carlisle Hospital – Whitehaven Scarborough West Cumberland 80,998 49,894 38.1% Furness General Hospital – Hospital, Hospital Barrow-in-Furness Scarborough Pilgrim Hospital 139,668 51,009 26.80% Pilgrim Hospital – Boston County Hospital, Wye The County Hospital, 145,801 39,771 21.40% Valley - Hereford Wye Valley NHS Trust North Devon District Hospital – Barnstaple Scarborough Hospital 173,952 22,052 11.30% St Mary’s Hospital - Isle of Wight 1 The approach identified hospitals which a) serve a population of under 200,000 people and b) for these hospitals, the proportion of the population they serve for whom the next nearest hospital is more than 60 minutes driving time away SOURCE: Advisory Committee on Resource Allocation 'Unavoidable smallness due to remoteness - identifying remote hospitals' 2015 6 THE LOCAL POPULATION AND THEIR HEALTH NEEDS Scarborough’s distance to other hospitals Scarborough hospital James Cook Hospital, Middlesbrough Acute Hospitals (47 miles) (distance from Scarborough) Stockton Redcar and Cleveland -on-Tees Middlesbrough Scarborough Scarborough Hospital, Scarborough Hambleton Ryedale Harrogate York Hospital, York (42 miles) York East Riding of Yorkshire Leeds Selby Kingston upon Hull, City of Hull Royal Infirmary, Hull (46 miles) Wakefield North Lincolnshire 25 mi SOURCE: Ordnance Survey data 7 THE LOCAL POPULATION AND THEIR HEALTH NEEDS Proposed