The Case for Change

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 GP Practice PRELIMINARY Scarborough’s catchment area catchment Hospital

Catchment for Scarborough Hospital1 Electoral wards in Scarborough catchment, by local authority East Riding of Yorkshire ▪ Bridlington Central and Old Town ▪ Bridlington North ▪ Bridlington South ▪ Driffield and Rural Ryedale ▪ Cropton ▪ Kirkbymoorside ▪ Pickering East ▪ Pickering West ▪ Rillington ▪ Sherburn ▪ Thornton Dale ▪ Wolds Scarborough ▪ Castle ▪ Cayton ▪ Central ▪ Derwent Valley ▪ Eastfield ▪ Esk Valley ▪ Falsgrave Park ▪ Filey ▪ Fylingdales ▪ Hertford ▪ Lindhead ▪ Mayfield ▪ Newby ▪ North Bay ▪ Northstead ▪ Ramshill ▪ Scalby, Hackness and Staintondale ▪ Seamer ▪ Stepney ▪ Streonshalh ▪ Weaponness ▪ Whitby West Cliff ▪ Woodlands 10 km 1 Catchment defined by electoral wards where more than 40% of non-elective inpatients were treated at Scarborough Hospital. All GP surgeries in the catchment also met these criteria - no GP surgeries outside of catchment meet this criteria Source: HES 2016/17 8 THE LOCAL POPULATION AND THEIR HEALTH NEEDS Population projection of catchment area

Population projection by age, area in scope1, ‘000s 2018-25 CAGR, %

+0.2% p.a. Scarborough All England 178 181 2.2% 2.4 90+ 2 3 70-89 34 39 2.0% 2.3

0.1% 0.7 50-69 53 54

-1.0% -0.2 20-49 53 49

<20 35 36 0.1% 0.6

2018 2025 1 Catchment are defined as the following wards: Stepney; Central; Weaponness; Eastfield; Woodlands; North Bay; Newby; Filey; Falsgrave; Northstead; Cayton; Scalby; Hackness and Staintondale; Lindhead; Hertford; Castle, Derwent Valley; Ramshill; Bridlington South; Bridlington North; Seamer; Bridlington Central and Old Town; Thornton Dale; Sherburn; Fylingdales; Pickering East; Streonshalh; Whitby West Cliff; Pickering West; Rillington; Mayfield; Wolds; Cropton; Driffield and Rural; Kirkbymoorside; Esk Valley accessed online in September 2018 [http://www.localhealth.org.uk] Source: ONS 2016-based Sub National Population Projections 9 THE LOCAL POPULATION AND THEIR HEALTH NEEDS Non-resident visitors to Scarborough PRELIMINARY

Top 10 destinations in UK, 2015-20171 Other Business Visiting Friends and Relatives Holidays Annual number of nights spent per year (millions of nights) xx Total nights spent in local authority by tourists (millions of nights)

20.1 7.1 6.6 6.3 5.6 5.2 5.2 5.2 5.0 4.6

1% 3%

17%

79% 1% 2% 8% 2% 13% 11% 3% 13% 4% 1% 13% 1% 2% 5% 11% 2% 4% 30% 13% 10% 3% 27% 25% 11% 78% 85% 81% 84% 39% 43% 87% 54% 81% 29% 20% Cornwall Highland Isle Of Edinburgh, South East Lindsey Manchester Birmingham Scarborough Pembrokeshire Anglesey City Of Lakeland

1 Number of nights spent is annual average from 2015, 2016 and 2017 SOURCE: GB Tourism Survey 2015,2016 and 2017; data present by local authority 10 THE LOCAL POPULATION AND THEIR HEALTH NEEDS Birth rate PRELIMINARY

Birth rate per 1,000 Annual % change

Change in Scarborough birthrate Births per 1,000 inhabitants; annual % change in birth rate 8.8 8.3

1.0% ‘17- ‘25 CAGR: (0.9%)

-0.5% -0.6% -0.7% -0.9% -0.9% -1.2%

-1.7% 2018 ‘19 ‘20 ‘21 ‘22 ‘23 ‘24 2025

SOURCE: ONS 2016-based Sub National Population Projections 11 THE LOCAL POPULATION AND THEIR HEALTH NEEDS

xx Sites for new dwellings (No. of potential homes indicated)

New dwellings: Scarborough Scarborough Hospital

Scarborough local authority has set a target of 5,825 new dwellings by 2032

590 Whitby

140 Burniston East Ayton

415 Scarborough 1,200 Middle Deepdale 180 Seamer 254 140 Cayton

200 Filey

140 Humanby

SOURCE: Scarborough Borough Council Housing strategy 2017-2021; Scarborough Borough Local Action Plan July 2017 12 New dwellings: East Riding xx Sites for new dwellings (No. of potential homes indicated) Scarborough Hospital Bridlington Hospital East Riding local authorities plans include 3300 new dwellings for Bridlington by 2029

3,300 Bridlington

SOURCE: https://www.eastriding.gov.uk/environment/planning-and-building- control/new-housing-and-self-build-homes/ 13 THE LOCAL POPULATION AND THEIR HEALTH NEEDS Health summary for Scarborough (1/2) PRELIMINARY Regional average England average Significantly worse than England average Significantly better than England average England England worst best Not significantly different from England average Not compared 25th 75th percentile percentile Local Local Eng Eng Eng Domain Indicator Period count value count value England range best 1. Deprivation score (IMD 2015) 2015 N/A 25.2 21.8 42 5

2. Children in low income families (under 16s) 2014 3,540 20.9 20.1 39.2 6.6

3. Statutory homelessness 2015/16 18 0.4 0.9

4. GCSEs achieved 2015/16 500 48.3 57.8 44.8 78.7

Our communitiesOur 5. Violent crime (violence offences) 2015/16 n/a 10.6 17.2 36.7 4.5

6. Long term unemployment 2016 220 3.515 3.715 13.8 0.4

7. Smoking status at time of delivery 2015/16 171 18.1 10.6 26 1.8

8. Breastfeeding initiation 2014/15 637 N/A 74.3 47.2 92.9

9. Obese children (Year 6) 2015/16 142 14.7 19.8 28.5 9.4

10. Admission episodes for alcohol-specific conditions (under 2013/14 – 21 36.0 37.4 121.3 10.5

people’shealth 18s) 15/16 Children’s youngand 11.Under 18 conceptions 2015 34 20.5 20.8 43.8 5.4

12.Smoking prevalence in adults 2016 n/a 13.8 15.5 25.7 4.9

13.Percentage of physically active adults 2015 n/a 59.4 57 44.8 69.8

Adults’ Adults’ lifestyle health and and health 14.Excess weight in adults 2013-15 n/a 66.7 64.8 76.2 46.5 1 Index of Multiple Deprivation (IMD) 2015; 2 % of children (under 16) in low income families; 3 Eligible homeless people not in priority need, crude rate per 1,000 households; 4 5 A*-C including English and maths, % pupils at end key stage 4 resident in local authority; 5 Recorded violence against the person crimes, crude rate per 1,000 population; 6 Crude rate per 1,000 population aged 16-64; 7 % of women who smoke at time of delivery; 8 % of all mothers who breastfeed their babies in the first 48hrs after delivery; 9 % school children in Year 6 (age 10- 11); 10 Persons under 18 admitted to hospital due to alcohol-specific condition, crude rate per 100,000 population; 11 Under-18 conception per 1,000 females aged 15 to 17 (crude rate); 12 Current smokers (aged 18 and over), Annual Population Survey; 13 % adults (aged 16 and over) achieving at least 150 mins physical activity per week, active people survey; 14 % adults (aged 16 and over) classified as overweight or obese, Active people survey SOURCE: Public Health England 14 THE LOCAL POPULATION AND THEIR HEALTH NEEDS Health summary for Scarborough (2/2) PRELIMINARY Regional average€ England average Significantly worse than England average Significantly better than England average England England worst best Not significantly different from England average Not compared 25th 75th percentile percentile Local Local Eng Eng Eng Domain Indicator Period count value count value England range best 15.Cancer diagnosed at early stage 2015 292.0 51.8 52.4 39.0 63.1 16.Hospital stays for self-harm 2015/16 209.0 216.6 196.5 635.3 55.7 17.Hospital stays for alcohol-reIated harm 2015/16 757.0 667.2 647.0 1,163.0 374.0 18.Recorded diabetes 2014/15 6,276.0 6.4 6.4 9.2 3.3

19.Incidence of TB 2013-15 9.0 2.8 12.0 85.6 0.0

poor health poor Disease and Disease 20.New sexually transmitted infections (STI) 2016+ 284.0 443.4 795.0 3,288.0 223.0 21.Hip fractures in people aged 65 and over 2015/16 175.0 635.1 589.0 820.0 312.0 22.Life expectancy at birth (Male) 2013-15 N/A 78.5 79.5 74.3 83.4 23.Life expectancy at birth (Female) 2013-15 N/A 83.0 83.1 79.4 86.7 24. Infant mortality 2013-15 10.0 3.3 3.9 8.2 0.8 25.Killed and seriously injured on roads 2013-15 145.0 44.8 38.5 103.7 10.4 26.Suicide rate 2013-15 39.0 12.9 10.1 17.4 5.6 27.Smoking related deaths 2013-15 N/A N/A 283.5

causes of death ofcauses 28.Under 75 mortality rate : cardiovascular 2013-15 282.0 80.4 74.6 137.6 43.1 Life Life andexpectancy 29.Under 75 mortality rate : cancer 2013-15 451.0 126.6 138.8 194.8 98.6 30.Excess winter deaths Aug 2012 - 192.0 14.7 19.6 36.0 6.9 Jul 2015

15 Experimental statistics - % of cancers Diagnosed at stage 1 or 2; 16 Directly age sex standardised rate per 100,000 population; 17 Admission involving an alcohol-related primary diagnosis or an alcohol-related external cause (narrow definition), directly age standardised rate per 100,000 population; 18 % people (aged 17 and over) on GP registers with a recorded diagnosis of diabetes; 19 Crude rate per 100,000 population; 20 All new diagnoses (excluding chalmydia under age 25), crude rate per 100,000 population aged 15 to 64; 21 Directly age- sex standardized rate of emergency admissions, per 100,000 population aged 65 and over SOURCE: Public Health England 15 THE LOCAL POPULATION AND THEIR HEALTH NEEDS Life expectancy PRELIMINARY Life expectancy at birth for males1, 2011-15 (lighter colour is Life expectancy at birth in females1, 2011-15 (lighter colour is associated with lower life expectancy) associated with lower life expectancy) Catchment area life expectancy: 78.7 years (England average 79.5) Catchment area life expectancy: 83.1 years (England average 83.1) Highest and lowest wards identified Highest and lowest wards identified Years: 64.0 to 77.4 77.5 to 79.3 79.4 to 80.6 Years: 72.1 to 81.4 81.5 to 83.0 83.1 to 84.3 80.7 to 82.1 82.2 to 91.9 ( N/A 84.4 to 85.9 86.0 to 96.0 N/A Scarborough Hospital Scarborough Hospital

Esk Valley 83.8 years Derwent Valley 87.0 years

Castle 72.5 years Falsgrave 79.4 years

Inequality slope for men Life expectancy for men Inequality slope for women Life expectancy for women

Life expectancy gap for men1: 7.6 years Life expectancy gap for women1: 7.7 years 95 95

90 90

85 85

80 80

75 75 Life expectancy at birth (years) birth at expectancy Life

70 70 Life expectancy at birth (years) birth at expectancy Life 65 65 Most Least Most Least deprived deprived deprived deprived decile of the decile of the decile of the decile of the local local local local authority authority authority authority

1 Refers to Scarborough Local Authority SOURCE: Public Health England 17 THE LOCAL POPULATION AND THEIR HEALTH NEEDS All cause mortality in the Scarborough region compared with national expected deaths

Deaths by cause1 Deaths in Scarborough compared to 100 deaths that would be expected from national average 149

125 120 106 106 100 101 100

UK average Scarborough Circulatory Coronary Stroke Respiratory Cancer all cause disease heart disease mortality disease 1 (Scarborough catchment area selected – electoral wards within catchment are Stepney; Central; Weaponness; Eastfield; Woodlands; North Bay; Newby; Filey; Falsgrave; Northstead; Cayton; Scalby; Hackness and Staintondale; Lindhead; Hertford; Castle, Derwent Valley; Ramshill; Bridlington South; Bridlington North; Seamer; Bridlington Central and Old Town; Thornton Dale; Sherburn; Fylingdales; Pickering East; Streonshalh; Whitby West Cliff; Pickering West; Rillington; Mayfield; Wolds; Cropton; Driffield and Rural; Kirkbymoorside; Esk Valley accessed online in September 2018 [http://www.localhealth.org.uk] 18 Inequalities in early deaths over time Local least deprived Local average England average Local most deprived Local inequality Age-standardised rate per 100,000 population

Early deaths from all causes: men Early deaths from all causes: women 1,500 1,500 IMD 2010 IMD 2015 IMD 2010 IMD 2015

1,250 1,250

1,000 1,000

750 750

500 500

250 250

0 0 2002 04 06 08 10 12 2014 2002 04 06 08 10 12 2014 Years Years

Data points refer to local population quintiles e.g., local least deprived quintile and local most deprived quintile

1 Data from 2010-12 onwards have been revised to use IMD 2015 to define local deprivation quintiles (fifths), all prior time points use IMD 2010. In doing this, areas are grouped into deprivation quintiles using the Index of Multiple Deprivation which most closely aligns with time period of the data. This provides a more accurate way of discriminating changes between similarly deprived areas over time SOURCE: Public Health England 19 Inequalities in early deaths from specific conditions over time

Local average England average

Age-standardised rate per 100,000 population Early deaths from heart disease and stroke1 Early deaths from cancer1 250 250

200 200

150 150

100 100

50 50

0 0 2002 04 06 08 10 12 2014 2002 04 06 08 10 12 2014

Years Years

1 Data points are the midpoints of three year averages of annual rates, for example 2005 represents the period 2004 to 2006 SOURCE: Public Health England 20 THE LOCAL POPULATION AND THEIR HEALTH NEEDS Income deprivation

Income deprivation1 (darker colours are associated with higher levels of deprivation) Percentage of population who live in areas at each level of Catchment area deprivation: 16.3% (England average 14.6%) deprivation Highest and lowest wards identified Percent

Years: 0.8 to 6.5 6.6 to 9.5 9.6 to 14.5 Most deprived quintile Least deprived quintile 14.6 to 20.1 20.2 to 51.4 N/A

Scalby Scarborough Hospital % Residents 5.2% 100 90 80 70 Eastfield 32.9% 60 50 40 30 20 10 0 England Scarborough2

1 Scarborough catchment area selected – electoral wards within catchment are Stepney; Central; Weaponness; Eastfield; Woodlands; North Bay; Newby; Filey; Falsgrave; Northstead; Cayton; Scalby; Hackness and Staintondale; Lindhead; Hertford; Castle, Derwent Valley; Ramshill; Bridlington South; Bridlington North; Seamer; Bridlington Central and Old Town; Thornton Dale; Sherburn; Fylingdales; Pickering East; Streonshalh; Whitby West Cliff; Pickering West; Rillington; Mayfield; Wolds; Cropton; Driffield and Rural; Kirkbymoorside; Esk Valley accessed online in September 2018 [http://www.localhealth.org.uk] 2 Scarborough Local Authority SOURCE: Public Health England 21 THE LOCAL POPULATION AND THEIR HEALTH NEEDS Prevalence of chronic diseases in the two local Scarborough & Ryedale CCG East Riding of Yorkshire CCGs compared with national average England Average Prevalence of diseases – Scarborough & Ryedale CCG, East Riding of Yorkshire CCG and England average, Percentage of population1, 2016/17 0 5 10 15 20 Hypertension Depression (18+) Diabetes mellitus (17+) Asthma Chronic kidney disease (18+) Coronary heart disease Cancer Chronic obstructive pulmonary disease Stroke and transient ischaemic attack Atrial fibrillation Mental health Epilepsy (18+) Dementia Heart failure Rheumatoid arthritis (16+) Peripheral arterial disease Learning disabilities Palliative care Osteoporosis (50+)

1 Percentage of age-specific group for Diabetes (ages 17), Depression (18+), Learning Disabilities (ages 18+) Source: QOF 2016/17 - Prevalence, achievements and exceptions at CCG level 22 COMMUNITY SERVICES Vehicle ownership in Scarborough compared with national average

Households with access to 1 or more cars or vans (2015) Scarborough England Percentage of households by dwelling type 93 94 87 81 77 74 71 65

All Urban Rural Isolated dwelling

SOURCE: ONS 2015; DVLA 23 THE LOCAL POPULATION AND THEIR HEALTH NEEDS Obesity rates Percentage of population 16+ years who are obese (darker colour is associated with higher proportion of obese adults), Catchment % of adults who are obese: 26% (England average 24%) Highest and lowest wards identified

% 5.9 to 21.4 (1,641) 21.5 to 24.0 (1,715) 24.1 to 25.6 (1,306)

25.7 to 27.6 (1,414) 27.7 to 34.8 (1,369) Scarborough Hospital

Streonshalh 30.1%

Ramshill 20.4%

Prevalence projected to in- x% CAGR, based on historical growth over 5 2016/17 crease by more than 7% p.a. years (from 2012/13-2016/17) 2021/22 Prevalence of disease and projection based on historical trends Percent, 2016/17 – 2021/22

1.5% 1.0% 0.1% 8.9% 6.4% 5.2% 1.8% 3.9% 22.1% 7.3% 2.4% 2.2% 18.1 16.8

7.9 8.3

4.9 4.8 5.1 3.7 3.3 3.0 2.7 2.3 2.5 2.7 1.5 1.8 1.7 1.3 0.6 0.9 1.0 1.1 0.9 1.0

Hypertension Asthma CHD Cancer Atrial COPD Stoke/TIA Heart Palliative Dementia Peripheral Mental Fibrillation failure Care Arterial Health Disease

Source: QOF 2016/17—Prevalence, achievements and exceptions at CCG level 25 THE LOCAL POPULATION AND THEIR HEALTH NEEDS Predicted change in prevalence in chronic disease in East Riding of Yorkshire CCG

1.5% 0.0% -0.2% 7.6% 3.1% 1.5% 12.9% -6.9% 2.1% -0.1% 2.6% 10.1%

18.7 17.3

6.5 6.5 5.4 4.8 4.7 3.7 2.7 2.4 2.2 2.4 1.8 1.5 1.0 1.1 0.9 1.0 0.7 0.7 0.7 0.8 0.3 0.5

Hypertension Asthma CHD Cancer COPD Stoke/TIA Dementia Atrial Heart Peripheral Mental Palliative Fibrillation failure Arterial Health Care Disease

Source: QOF 2016/17—Prevalence, achievements and exceptions at CCG level 26 Contents

▪ The local population and their health needs ▪ Primary care ▪ Community services ▪ Ambulance services ▪ Acute services ▪ Scarborough Hospital

27 PRIMARY CARE Primary care – summary of data

Area of focus Source Key findings Primary care ▪ CQC ▪ All local GP practices are rated ‘Good’ by CQC performance ▪ NHS Digital ▪ One local surgery is a significant outlier in QOF performance ▪ GP Workforce Census ▪ GP provision per 10,000 weighted population varies between Health and Social Care 0.7 and 8.4 FTEs Primary care Information Centre ▪ There is an average of 4.1 total nurse FTEs in Primary care per provision 2015-16 10,000 weighted population ▪ HES 2016/17 data ▪ Emergency hospital admissions are lower than national average; elective admissions are above national average ▪ Public Health England ▪ The catchment standardised admission rate for myocardial infarction is 124.7 (indexed to a national average of 100 admission) Variation in ▪ The catchment standardised admission rate for COPD is 76.3 admissions (indexed to a national average of 100 admission) across the population ▪ HES 2016/17 data ▪ The majority of elective orthopaedic referrals from GP practices in the catchment are to Scarborough or Bridlington ▪ A similar pattern is seen in referrals for GI diseases ▪ HES 2016/17 data ▪ Scarborough & Ryedale CCG has 2,422 beds days per 1,000 Elderly care population over 65 years

28 PRIMARY CARE CQC ratings of local GP practices

Outstanding: Service is Good: Service is performing well Requires improvement: Service isn’t Inadequate: Service is performing No rating: Service has performing exceptionally well and meeting expectations performing as well as it should be badly; enforcement action has been not been rated taken against it CQC Categories GP Practice Overall Safe Effective Caring Responsive Well-led Scarborough Medical Group Filey Surgery Practice 3, Medical Centre Bridlington Brook Square Surgery Manor House Surgery Bridlington Falsgrave Surgery Eastfield Medical Centre Whitby Group Practice Practice 2, Medical Centre Bridlington Peasholm Surgery1 Field House Surgery, Bridlington Prospect Road Surgery West Ayton Surgery Practice 1, Medical Centre Bridlington Belgrave Surgery Pickering Medical Practice Hackness Road Surgery Castle Health Centre The Wolds View Primary Care Centre Medical Centre, Driffield Dewent Medical centre Kirkbymoorside Sleights and Sandsend Medical Practice

1 CQC ratings were completed prior to recent change in ownership SOURCE: Care Quality Commission website 29 PRIMARY CARE QOF performance of local GP practices

Overall QOF Performance of catchment GP surgeries

Scarborough Medical Group 100% Filey Surgery 100% Practice 3, Medical Centre, Bridlington 100% Brook Square Surgery 99% Manor House Surgery, Bridlington 100% Falsgrave Surgery 100% Eastfield Medical Centre 94% Whitby Group Practice 100% Practice Two 100% Peasholm Surgery 97% Field House Surgery, Bridlington 64% Prospect Road Surgery 98% The Park Surgery 99% West Ayton Surgery 96% Practice One 100% Belgrave Surgery 100% Pickering Medical Practice 100% Derwent Practice 99% Hackness Road Surgery 95% Castle Health Centre 98% The Medical Centre, Driffield 100% The Wolds View Primary Care Centre 90% Hunmanby Surgery 100% Sherburn Surgery 99% Kirkbymoorside Surgery 100% Sleights And Sandsend Medical Practice 100%

Ø 97

Source: NHS Digital 2018 30 PRIMARY CARE Current GP provision of practices in the Scarborough catchment

Number Number of FTE List size - weighted population (WP)1 Number of FTE of Head Count GPs per 10,000 % GPs GP practice 2016, ‘000s GPs2 GPs WP over 55 HC GP >55 Whitby Group Practice 16 13.5 19 8.4 32% 6 The Park Surgery 16 0.9 1 0.6 0% 0 Scarborough Medical Group 14 7.8 10 5.5 20% 2 Practice 3, Medical Centre, Bridlington 13 4.8 6 3.8 50% 3 Brook Square Surgery 12 6.1 9 5.0 22% 2 Falsgrave Surgery 12 3.5 6 3.1 33% 2 Manor House Surgery, Bridlington 11 5.8 7 5.1 29% 2 Filey Surgery 11 4.1 6 3.9 0% 0 Pickering Medical Practice 11 7.5 9 7.1 11% 1 The Medical Centre, Driffield 10 5.7 6 5.6 33% 2 Field House Surgery, Bridlington3 10 0.7 1 0.7 0% 0 Practice Two, Medical Centre, Bridlington 9 2.4 3 2.7 0% 0 Peasholm Surgery 9 2.8 4 3.2 0% 0 Eastfield Medical Centre 8 5.7 7 6.9 29% 2 West Ayton Surgery 8 ND ND ND ND ND Prospect Road Surgery 8 4.0 4 5.1 50% 2 Practice One, Medical Centre, Bridlington 7 1.8 2 2.5 0% 0 Sleights and Sandsend Medical Practice 6 3.9 7 6.7 14% 1 Kirkbymoorside Surgery 6 3.8 4 6.7 25% 1 Belgrave Surgery 5 2.5 4 4.6 25% 1 Sherburn Surgery 5 2.5 4 5.1 25% 1 Hunmanby Surgery 5 1.0 1 2.2 100% 1 Hackness Road Surgery 4 2.4 4 6.6 25% 1 The Wolds View Primary Care Centre 3 ND ND ND ND ND Castle Health Centre 2 1.0 1 4.1 0% 0 Total 219 94.2 125.0 8.0 23% 30

National median for total FTE GPs per 10,000 WP is 5.0

1 Weighted population - adjusts for variation in age, deprivation and overall health sector needs; 2 All figures exclude locums; 3 Field House Surgery is run by Humber Teaching NHS Trust. Service is provided by predominantly locum GPs Source: GP Workforce Census Health and Social Care Information Centre 2015-16 31 PRIMARY CARE Non-GP primary care staffing in the Scarborough catchment

Total nurse List size - weighted population (WP)1 Total nurse Practice nurse Admin staff FTE per GP practice 2016, ‘000s FTE2 FTE FTE 10,000 WP Whitby Group Practice 16 6.9 6.2 19.6 4.3 The Park Surgery 16 0.8 0.8 3.9 0.5 Scarborough Medical Group 14 3.0 2.5 13.5 2.1 Practice 3, Medical Centre, Bridlington 13 4.6 2.8 12.6 3.6 Brook Square Surgery 12 5.9 5.9 ND 4.9 Falsgrave Surgery 12 4.6 2.9 16.2 4.0 Manor House Surgery, Bridlington 11 3.7 2.8 11.1 3.3 Filey Surgery 11 4.5 3.0 12.9 4.2 Pickering Medical Practice 11 6.8 5.1 13.4 6.5 The Medical Centre, Driffield 10 5.6 2.6 23.5 5.5 Field House Surgery, Bridlington 10 4.2 1.2 11.2 4.3 Practice Two 9 2.4 1.8 11.6 2.7 Peasholm Surgery 9 4.3 2.6 14.3 4.9 Eastfield Medical Centre 8 1.7 1.1 12.1 2.1 West Ayton Surgery 8 ND ND ND ND Prospect Road Surgery 8 4.4 2.5 10.2 5.6 Practice One 7 3.1 2.1 7.1 4.4 Sleights And Sandsend Medical Practice 6 3.2 2.1 ND 5.5 Kirkbymoorside Surgery 6 1.5 1.5 4.1 2.7 Belgrave Surgery 5 2.7 1.6 9.5 4.9 Sherburn Surgery 5 3.7 3.1 8.2 7.6 Hunmanby Surgery 5 1.5 1.0 ND 3.2 Hackness Road Surgery 4 1.8 1.0 6.6 4.9 The Wolds View Primary Care Centre 3 8.0 2.6 8.3 30.6 Castle Health Centre 2 ND ND 7.2 ND Total 219 88.9 58.8 237.2 4.1

National median for total nurse FTE per 10,000 WP is 2.3

1 Weighted population - adjusts for variation in age, deprivation and overall health sector needs; 2 Total Nurse Headcount - includes practitioners authorised to practice within England (practice nurses, specialist nurses, and advanced nurse practitioners) All figures exclude locums Source: GP Workforce Census Health and Social Care Information Centre 2015-16 32 PRIMARY CARE Elective orthopaedic referrals from GP practices in the Scarborough catchment Number of elective orthopaedic admissions per 10,000 weighted list size

Referral rate by GP practices in the Scarborough catchment

Scarborough Bridlington York Castle Hill Hull James Cook Other

Hunmanby Surgery 226 West Ayton Surgery 195 Castle Health Centre 148 Hackness Road Surgery 145 Scarborough Medical Group 143 Filey Surgery 143 Scarborough & Brook Square Surgery 132 Ryedale CCG Falsgrave Surgery 122 Peasholm Surgery 114 Eastfield Medical Centre 111 Prospect Road Surgery 106 Sherburn Surgery 104 Derwent Practice 101 Belgrave Surgery 74

Wolds View 220 Manor House Surgery 169 The Medical Centre, Driffield 166 East Riding of Practice 3, Bridlington 163 Yorkshire CCG The Park Surgery 139 Practice One 139 Practice Two 115 Field House 110

Source: HES 2016/17 APC M13 c/o NHS Digital 33 PRIMARY CARE Elective referrals for Gastrointestinal disease by GP practices in the Scarborough catchment Number of elective GI admissions1 per 10,000 weighted list size Referral rate by GP practices in the Scarborough catchment

Scarborough Bridlington York Castle Hill Hull James Cook Other

Hackness Road Surgery 513 Eastfield Medical Centre 475 Filey Surgery 472 Falsgrave Surgery 448 Derwent Practice 442 Hunmanby Surgery 439 Scarborough & Belgrave Surgery 438 Ryedale CCG Sherburn Surgery 429 West Ayton Surgery 426 Scarborough Medical Group 393 Brook Square Surgery 347 Castle Health Centre 342 Peasholm Surgery 331 Prospect Road Surgery 265

The Wolds View 581 Manor House 445 Practice Two 422 East Riding of Practice 3 417 Yorkshire CCG The Park Surgery 326 Practice One 319 Field House 246 The Medical Centre, Driffield 239

1 Includes general surgery, hepatobiliary surgery, upper GI surgery and colorectal surgery

Source: HES 2016/17 APC M13 c/o NHS Digital 34 PRIMARY CARE Emergency hospital admissions

Hospital admissions, all causes Standardised admissions rate in catchment relative to national average indexed to 100

104 100 89

National average Scarborough Scarborough catchment catchment emergency elective admissions admissions

Source: PHE local health tool, accessed online in August 2018 [http://www.localhealth.org.uk] 35 PRIMARY CARE Emergency admissions for myocardial infarction

Emergency admissions for myocardial infarction (darker areas associated with more attendances), Catchment standardised admissions rate 124.7 (England average 100) SAR: 21.9 to 72.4 72.5 to 86.1 86.2 to 99.9 Highest and lowest ward identified 100.0 to 119.7 119.8 to 358.0 Scarborough Hospital

Cropton 71.4

Woodlands 150.7

Source: PHE local health tool, (Scarborough catchment area selected – electoral wards within catchment are Stepney; Central; Weaponness; Eastfield; Woodlands; North Bay; Newby; Filey; Falsgrave; Northstead; Cayton; Scalby; Hackness and Staintondale; Lindhead; Hertford; Castle, Derwent Valley; Ramshill; Bridlington South; Bridlington North; Seamer; Bridlington Central and Old Town; Thornton Dale; Sherburn; Fylingdales; Pickering East; Streonshalh; Whitby West Cliff; Pickering West; Rillington; Mayfield; Wolds; Cropton; Driffield and Rural; Kirkbymoorside; Esk Valley accessed online in September 2018 [http://www.localhealth.org.uk] 36 PRIMARY CARE Emergency admissions for COPD

A&E attendances for COPD (darker areas associated with more attendances), Catchment standardised admissions rate 76.3 SAR: 9.7 to 49.6 49.7 to 69.4 69.5 to 99.9 (England average 100), Highest and lowest ward identified 100.0 to 142.1 142.2 to 586.1 Scarborough Hospital

Kirkbymoorside 32.3

Bridlington South 150.2

CCG quartiles National mean % Difference from top and bottom quartiles Activity by GP practice per 1,000 weighted population

A&E Non-Elective Elective IP & ELDC OP

565 1,149 1,844 1,506

Scarborough & Ryedale CCG

732 1,018

455 1,389 497 854 1,337

356

-54% -19% -57% -8%

Source: HES A&E, IP 2016/17; HES OP 2015/16; Weighted population 2015/16 NHS England 38 PRIMARY CARE Variation in A&E attendance, emergency admission, outpatient referral, and elective care by GP practice in East Riding of Yorkshire CCG

CCG quartiles National mean % Difference from top and bottom quartiles Activity by GP practice per 1,000 weighted population A&E Non-Elective Elective IP & ELDC OP

1,337

466 102 186 1,297

97 356 East Riding of Yorkshire CCG

161 274 87 1,161

133

-41% -15% -13% -11%

Source: HES A&E, IP 2016/17; HES OP 2015/16; Weighted population 2015/16 NHS England 39 PRIMARY CARE Bed days per 1,000 population over 65 years compared to England CCGs and an international organisation

Hospital bed days per 1,000 over 65 population, 2016/17 ▪ Primary care organisation in USA only serving Worst national people aged 65 or above, most of whom have LTCs 3,820 CCG ▪ Each GP has a list of 450 patients, with patients each having at least monthly 20 minute Scarborough & appointments 2,422 Ryedale CCG ▪ ‘Care Team’ supporting each GP able to manage their administration, basic clinical tasks (e.g., basic East Riding history) and patient care coordination 1,803 of York CCG ▪ Operate in dedicated elderly care neighbourhood centres, which include free transport, X-Ray and on-site specialists Top performer 1,725 in peer group1 ▪ Senior medical director performance manages GPs against small metric list, including hospital utilisation and patient satisfaction 1,234 ▪ Twice weekly meetings involving all GPs to discuss -49% all hospital admissions ▪ Organisation payment based on total cost of care Best national CCG 839 full risk capitation to primary care

1 Peer group defined as the 10 CCGs most similar to Scarborough and Ryedale by NHS Right Care (Hastings and Rother, Great Yarmouth and Waveney, West Norfolk, South Kent Coast, Isle of Wight, Lincolnshire East, Hereford, Airedale, Wharfedale and Craven, Lincolnshire West and Harrogate and Rural District). Top performer is South Kent Coast SOURCE: HES 2016/17 APC M13, c/o NHS Digital; Chen Med 40 Contents

▪ The local population and their health needs ▪ Primary care ▪ Community services ▪ Ambulance services ▪ Acute services ▪ Scarborough Hospital

41 COMMUNITY SERVICES Community services – summary of data

Area of focus Source Key findings ▪ NHS Providers ▪ There are approximately 1,600 beds in care homes in Scarborough Transfer of care

▪ NHS England ▪ There were 3.2 DTOC days per thousand in North Yorkshire Transfer of care ▪ Social care was responsible for 26.7% of DTOCs ▪ 20% of DTOC days resulted from patients awaiting packages of care in their own home ▪ DVLA ▪ 65% of urban households in Scarborough have access to Ability to travel a car to healthcare services

42 Care home beds in Scarborough

Beds available in care homes No. of beds in the Scarborough area

1,147

526

Nursing Residential Homes Homes

SOURCE: CQC Website, accessed September 2018; NHS providers website overview 43 COMMUNITY SERVICES Delayed transfers of care in North Yorkshire compared other authorities in the region

Authorities in Yorkshire & DTOC days for which social care Humber region DTOC days per 1000 population, June 2018 responsible1 (%)

Leeds 3.9 25.5 York UA 3.9 51.2 Sheffield 3.6 51.2 North Yorkshire2 3.1 26.7 Wakefield 2.9 3.5 Kirklees 2.4 39.6 East Riding Of Yorkshire UA 2.3 41.9 Kingston Upon Hull UA 1.9 44.0 Rotherham 1.7 55.9 North East Lincolnshire UA 1.7 5.9 North Lincolnshire UA 1.6 30.4 Calderdale 1.3 77.8 Doncaster 0.9 42.3 Barnsley 0.6 11.9 Bradford 0.5 20.5 England 2.4 37.4

Regional average 2.2 Regional average 35.3

1 Social care provision wholly or partially responsible for delay 2 Scarborough is located in North Yorkshire authority SOURCE: NHS England 44 COMMUNITY SERVICES Delayed transfers of care in North Yorkshire

DTOC days by reason for delay, North Yorkshire authority1, June 2018, Percent 100% = 1,885 DTOC days Awaiting care package in own home 20

Awaiting further non-acute NHS care 16

Patient or family choice 15

Awaiting nursing home placement 13

Awaiting completion of assessment 11

Awaiting residential home placement 10

Housing (patients not covered by Care Act) 7

Awaiting public funding 4

Awaiting community equipment and adaptations 4

Disputes 0

Other 0

1 Scarborough is located in North Yorkshire authority Source: NHS England 45 Contents

▪ The local population and their health needs ▪ Primary care ▪ Community services ▪ Ambulance services ▪ Acute services ▪ Scarborough Hospital

46 AMBULANCE SERVICES Ambulance services – summary of data

Area of focus Source Key findings ▪ Yorkshire ▪ Median Category 1 response time was 7 mins 38 secs, Ambulance Services above the 7 min standard 999 services Integrated ▪ Call volume was 8,000 greater than contracted Performance Report

▪ Yorkshire ▪ 85% of calls were answered within 60 secs Ambulance Services 9.3% of calls results in onwards referral to 999 services 111 services ▪ Integrated Performance Report

▪ Yorkshire ▪ 30% of around 18,000 ambulance conveyances last year to Ambulance service Scarborough Hospital were from Scarborough town Ambulance ▪ York Hospital accounts for 42% of the 471 transfers last conveyances year to Scarborough Hospital from other providers and transfers ▪ York Hospital receives 51% of the 1,567 transfers last year from Scarborough Hospital to other providers

▪ EMBRACE ▪ There were 33 neonatal transfers from Scarborough last Transfers year, 12% which were to York hospital

47 AMBULANCE SERVICES 999 service performance

Overview of current quality and performance against targets for 999 services Standard/ Performance Contracted Metric (June 2018) volume Commentary Category 1 response time Performance has failed to reach 7min 38 sec 7 min target most months

999 call volume Consistently above contracted 80,442 calls 72,397 calls number of calls and growing

Responses at scene 58,434 57,318 Generally in line with contracted responses responses performance

Conveyance rate Conveyance rate has remained 75.5% N/A static

SOURCE: Yorkshire Ambulance Services Integrated Performance Report June 2018 48 AMBULANCE SERVICES 111 service performance

Performance against target for June 2018 Standard/ Performance Contracted Metric (June 2018) volume Commentary Calls answered in 60 Performance has not reached seconds 85.0% ≥95% target in more than 12 months

Call transferred to a Consistently improving clinical advisor 42.3% 50%

Combined clinical contact Performance has declined in last (warm transfers plus call 35.8% ≥65% 12 months backs in 10) Referrals to 999 services Consistently achieves target 9.3% ≤10%

SOURCE: Yorkshire Ambulance Services Integrated Performance Report June 2018 49 Volume of ambulance conveyances to Scarborough Hospital by pickup location

Pick-up location of ambulance conveyances to Scarborough hospital, 2017 Number of transfers (‘000s) 5.5

4.4

3.6

0.9 0.9 0.8 0.7 0.5

0.3 0.2 0.2

Norton Flamborough Scarborough Bridlington Driffield Whitby Filey Eastfield Pickering Hunmanby Other

1 Includes all locations accounting for fewer than 1% (187) of all conveyances to Scarborough Hospital SOURCE: Yorkshire Ambulance Service 50 Volume of ambulance transfers from Scarborough Hospital to other hospitals

Destination of ambulance transfers from Scarborough Hospital to other facilities, 2017 Number of transfers

797

222 192 131 91 46

31 22 19 16

Hull Middlesborough

Other York District Hospital District York Hill Hospital, Castle recorded Not Infirmary Hull Royal Cook, James General Leeds Hospital Hospice Catherine’s St Scarborough Pinderfields Hospital, Wakefield Hospital Bridlington

1 Includes all locations accounting for fewer than 10 transfers from Scarborough Hospital SOURCE: Yorkshire Ambulance Service 51 Volume of ambulance transfers to Scarborough Hospital from other hospitals

Origin of ambulance transfers to Scarborough hospital, 2017 Number of ambulance transfers

199

143

37 32 31

16 13

Hospital

York District York Bridlington Hospital Hospital Whitby Other recorded Not Hospital Malton Hull Royal Infirmary

1 Includes all locations accounting for fewer than 10 transfers to Scarborough Hospital SOURCE: Yorkshire Ambulance Service 52 Obstetric transfers from Scarborough hospital to other units

XX Total number of transfers York Out of region

Other in Yorkshire & Humber

Destination of in utero transfers from Scarborough Destination of neonatal transfers from Hospital, 2015-17 Scarborough Hospital, 2015-17 Number of transfers per calendar year Number of transfers per calendar year

11 23 11 19 34 33

5 10 6

13 3 3 28 28 5 9

4 7 5 9 5 2 1 4 2015 2016 2017 2015 2016 2017

SOURCE: Embrace Yorkshire & Humber Infant & Children's Transport service 53 Contents

▪ The local population and their health needs ▪ Primary care ▪ Community services ▪ Ambulance services ▪ Acute services ▪ Scarborough Hospital

54 ACUTE SERVICES Acute services – summary of data

Area of focus Source Key findings ▪ HES 2016/17 data ▪ Scarborough Hospital admits patients under surgical, Case mix at medical, obstetrics and paediatric specialties Scarborough ▪ There were around 1,400 babies delivered at Scarborough Hospital last year; the national average is around 3,000

▪ Performance and ▪ The highest attendances at A&E at Scarborough occur over information team, the summer York Teaching ▪ The percentage of patients attending A&E in 2017 who Hospitals NHS lived outside the local area was between 13.8% (August) A&E Foundation Trust and 2.9% (January) attendances ▪ HES 2016/17 data ▪ 55% of the ~35,000 ED attendances at Scarborough General in 2016/17 were minors ▪ There were almost 300 attendance per 1,000 weight population from Scarborough & Ryedale CCG last year

▪ HES 2016/17 data ▪ Admissions from Scarborough & Ryedale CCG are growing at 7% per year Inpatient ▪ There were 23.1 ambulatory care sensitive admissions per admissions 1,000 weight population in Scarborough & Ryedale CCG ▪ Over 65s accounted for 73% of all bed days in 2016/17

55 ACUTE SERVICES Scarborough General Hospital by treatment speciality

Inpatient Hospital Admissions per year by treating specialty

Treatment Specialty # of admissions # with a procedure carried out

Urology 3,187 2,905 Colorectal Surgery 2,829 2,829 Ophthalmology 2,670 2,513 Upper Gastrointestinal Surgery 2,460 2,460 Surgical General Surgery 2,223 1,227 Trauma & Orthopaedics 1,230 1,053 Accident & Emergency 799 569 Hepatobiliary & Pancreatic Surgery 415 415 Other 198 181 Respiratory Medicine 4,101 1,420 Cardiology 3,053 1,633 Medical Oncology 2,930 2,838 Gastroenterology 2,121 1,102 Geriatric Medicine 1,913 908 Endocrinology 1,548 797 Medical Clinical Haematology 1,209 1,194 Nephrology 548 359 General Medicine 444 373 Rheumatology 309 303 Diabetic Medicine 205 22 Other 139 113 Obstetrics 3,222 1,295 Obstetrics/gynae Gynaecology 1,379 696 Midwife Episode 784 281 Paediatrics 2,038 163 Paediatrics Well Babies 1,101 78 (0 – 18y.o.) Neonatology 168 6

SOURCE: Performance and Information Team, York Teaching Hospital NHS Foundation Trust 56 ACUTE SERVICES Maternity and paediatric attendances compared with local peers and those serving similar populations Average

Activity level by site across England 16/17, ‘000s

10 James Cook 8 Hereford Hull County 6 York Maternity Scarborough deliveries1 Pilgrim 4 3.2 2 West Cumberland

30 James 15 Cook Hull York Emergency Scarborough pediatric spells2 10 Pilgrim Hereford West Cumberland 5 4.7

1 Excluding sites with <100 births per year. Defined by relevant HRG codes for births 2 Emergency admissions for infants and children under 19 SOURCE: HES 2016/17 57 Consultant-led obstetric units in England and Wales with lowest volumes of births Number of deliveries (’000s)

Activity at small consultant-led obstetric units1, 2015/16

3.2

1.4 1.4 1.2 1.3 1.1 1.0 1.0

0.4

median

National Aberystwyth Furness Bassetlaw Wight of Isle Tyneside South Devon North Scarborough Yeovil

1 Less than 1,500 deliveries reported in National Maternity & Perinatal Audit 2 Includes all obstetric units (consultant-led, alongside midwifery units, and free-standing midwifery units) SOURCE: National Maternity & Perinatal Audit, 2015/16 58 Consultant-led obstetric units in England and Wales with less than 1,500 births

Driving distance3 between Site of low volume low volume obstetric unit consultant-led obstetric Number of births 2015/16 Nearest hospital providing Number of births 2015/16 and nearest equivalent unit1 (‘000s) equivalent service2 (‘000s) hospital (miles)

▪ Dorset County Hospital, Yeovil Hospital 20 1.4 Dorchester 1.7

Scarborough Hospital 1.4 ▪ York Hospital 3.1 42

North Devon Hospital, ▪ Royal Devon and Exeter 46 Barnstaple 1.3 Hospital 3.5

▪ Royal Victoria Infirmary, South Tyneside 1.2 6.2 11 Newcastle

St Mary’s Hospital, Isle 1.1 ▪ N/A N/A N/A of Wight

▪ Chesterfield Royal Bassetlaw Hospital 1.0 2.7 16 Infirmary

Furness Hospital 1.0 ▪ Royal Lancaster Infirmary 1.8 41

▪ Glangwilli General Bronglais Hospital 0.4 2.4 45 Hospital, Camarthen

1 All units with less than 1,500 deliveries reported in National Maternity & Perinatal Audit; 2 Nearest hospital recognised as providing a consultant-led obstetric unit in the NMPA; 3 Shortest driving distance on recognised roads and highways calculated using googlemaps SOURCE: National Maternity & Perinatal Audit, 2015/16; googlemaps accessed October 2018 59 THE LOCAL POPULATION AND THEIR HEALTH NEEDS Deliveries at Scarborough obstetric unit by GP practice Proposed catchment PRELIMINARY

Total deliveries : ≤15 15-45 45-75 75-200 >200 Hospital

Catchment for Scarborough Hospital1 Electoral wards in Scarborough catchment, by local authority Hackness Road Surgery East Riding of Yorkshire Whitby Group Practice ▪ Bridlington Central and Old Town ▪ Bridlington North ▪ Bridlington South Sleights and Sandsend Medical Practice Peasholm Surgery ▪ Driffield and Rural Prospect Road Surgery Ryedale ▪ Cropton Brook Square Surgery ▪ Kirkbymoorside Falsgrave Surgery ▪ Pickering East Belgrave Surgery Castle Health Centre ▪ Pickering West ▪ Rillington ▪ Sherburn Kirkbymoorside Surgery ▪ Thornton Dale Scarborough Medical Group ▪ Wolds Scarborough ▪ Castle Pickering Medical Practice ▪ Cayton West Ayton Surgery Eastfield Medical Centre ▪ Central ▪ Derwent Valley ▪ Eastfield Filey Surgery ▪ Esk Valley ▪ Falsgrave Park ▪ Filey Derwent Practice ▪ Fylingdales The Wolds View Primary Care Centre ▪ Hertford Field House Surgery, Bridlington ▪ Lindhead ▪ Mayfield Manor House Surgery, Bridlington ▪ Newby ▪ North Bay Practice 1, Medical Centre, Bridlington ▪ Northstead Practice 2, Medical Centre, Bridlington ▪ Ramshill ▪ Scalby, Hackness and Staintondale The Medical Centre, Driffield Practice 3, Medical Centre, Bridlington ▪ Seamer ▪ Stepney ▪ Streonshalh ▪ Weaponness ▪ Whitby West Cliff 10 km ▪ Woodlands

1 Catchment defined by electoral wards where more than 40% of non-elective inpatients were treated at Scarborough Hospital Source: Performance and Information team, York Teaching Hospitals NHS Foundation Trust 60 THE LOCAL POPULATION AND THEIR HEALTH NEEDS Paediatric admissions at Scarborough by GP practice Proposed catchment PRELIMINARY

Total admissions : 25-55 55-85 85-115 >115 Hospital

Catchment for Scarborough Hospital1 Electoral wards in Scarborough catchment, by local authority Hackness Road Surgery East Riding of Yorkshire Whitby Group Practice ▪ Bridlington Central and Old Town ▪ Bridlington North ▪ Bridlington South Sleights And Sandsend Medical Practice Peasholm Surgery ▪ Driffield and Rural Prospect Road Surgery Ryedale ▪ Cropton Brook Square Surgery ▪ Kirkbymoorside Falsgrave Surgery ▪ Pickering East Castle Health Centre Belgrave Surgery ▪ Pickering West ▪ Rillington ▪ Sherburn Kirkbymoorside Surgery ▪ Thornton Dale Scarborough Medical Group ▪ Wolds Scarborough ▪ Castle Pickering Medical Practice ▪ Cayton West Ayton & Eastfield Medical Centre ▪ Central Snainton Surgeries ▪ Derwent Valley ▪ Eastfield Filey Surgery ▪ Esk Valley ▪ Falsgrave Park ▪ Filey Derwent Practice ▪ Fylingdales The Wolds View Surgery ▪ Hertford Field House Surgery, Bridlington ▪ Lindhead ▪ Mayfield Manor House Surgery, Bridlington ▪ Newby ▪ North Bay Practice 1, Medical Centre, Bridlington ▪ Northstead Practice 2, Medical Centre, Bridlington ▪ Ramshill ▪ Scalby, Hackness and Staintondale The Medical Centre, Driffield Practice 3, Medical Centre, Bridlington ▪ Seamer ▪ Stepney ▪ Streonshalh ▪ Weaponness ▪ Whitby West Cliff 10 km ▪ Woodlands

1 Catchment defined by electoral wards where more than 40% of non-elective inpatients were treated at Scarborough Hospital. Source: HES 2016/17 61 ACUTE SERVICES 2017 attendances to Scarborough A&E (Type 1 & Type 3) Number of attendances per week

All A&E (type 1 & Type 3) attendances at Scarborough Hospital1, 2017 1,400

1,200 Average weekly attendances 1,000 (1,079)

800

600

400

200

0 Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec

1 Includes admissions to Scarborough A&E and also those streamed/attending urgent care SOURCE:centre on Performance site and Information team, York Teaching Hospitals NHS Foundation Trust 62 THE LOCAL POPULATION AND THEIR HEALTH NEEDS Attendances to Scarborough ED by GP practice Proposed catchment PRELIMINARY

Total Attendances: ≤1000 1000-1500 1500-2000 2000-2500 >2500 Hospital

Catchment for Scarborough Hospital1 Electoral wards in Scarborough catchment, by local authority Hackness Road Surgery East Riding of Yorkshire Whitby Group Practice ▪ Bridlington Central and Old Town ▪ Bridlington North ▪ Bridlington South Sleights And Sandsend Medical Practice Peasholm Surgery ▪ Driffield and Rural Ryedale ▪ Cropton Brook Square Surgery ▪ Kirkbymoorside Falsgrave Surgery ▪ Pickering East Belgrave Surgery Castle Health Centre ▪ Pickering West ▪ Rillington ▪ Sherburn Kirkbymoorside Surgery ▪ Thornton Dale Scarborough Medical Group ▪ Wolds Scarborough ▪ Castle Pickering Medical Practice ▪ Cayton West Ayton & Eastfield Medical Centre ▪ Central Snainton Surgeries ▪ Derwent Valley ▪ Eastfield Filey Surgery ▪ Esk Valley ▪ Falsgrave Park ▪ Filey Derwent Practice ▪ Fylingdales The Wolds View Surgery ▪ Hertford Field House Surgery, Bridlington ▪ Lindhead ▪ Mayfield Manor House Surgery, Bridlington ▪ Newby ▪ North Bay Practice 1, Medical Centre, Bridlington ▪ Northstead Practice 2, Medical Centre, Bridlington ▪ Ramshill ▪ Scalby, Hackness and Staintondale The Medical Centre, Driffield Practice 3, Medical Centre, Bridlington ▪ Seamer ▪ Stepney ▪ Streonshalh ▪ Weaponness ▪ Whitby West Cliff 10 km ▪ Woodlands

1 Catchment defined by electoral wards where more than 40% of non-elective inpatients were treated at Scarborough Hospital. Source: HES 2016/17 63 ACUTE SERVICES Patients attending Scarborough A&E who live outside of local area by month % of all A&E attendances (Apr 2017-Mar 2018)

Percentage of patients attending Scarborough A&E who live outside of local area1

13.8

9.2 9.6 9.2 8.2 7.7 6.8 5.0 4.5 4.6 3.7 2.9

Apr May Jun Jul Aug Sep Oct Nov Dec Jan Feb Mar 2017 2018

1 Local area defined as the following CCGS: East Riding of Yorkshire, Harrogate and rural district CCG, Hambleton Richmondshire and Whitby CCG, Scarborough & Ryedale CCG, Vale of York CCG, Wakefield CCG SOURCE: Performance and Information team, York Teaching Hospitals NHS Foundation Trust 64 ACUTE SERVICES HRG codes can be used to categorise A&E visits into major, normal and minor Typical Category combination Category investigation Typical treatment Typical Typical ▪ CPR investigation treatment 5 ▪ Thrombolysis

Any 5 MAJOR

▪ General anesthetic 3 1-4 4 ▪ Manipulation of limb fracture ▪ External pacing 2 4 ▪ Ultrasound ▪ Primary sutures

3 ▪ MRI ▪ Intramuscular injection 2 1-3 NORMAL ▪ CT ▪ Occupational therapy assessment ▪ Plain X-ray ▪ Wound closure with steristrips 1 3-4 2 ▪ Cross-match ▪ Physio for falls prevention

▪ Bacteriology ▪ Local anesthetic MINOR 1 1-2 ▪ ECG ▪ Remove sutures 1 ▪ Biochemistry ▪ Eye drops None None ▪ Urine dip ▪ Advice/guidance

SOURCE: HES data 65 ACUTE CARE A&E attendances to Scarborough A&E by severity A&E attendances (‘000), 2016/17

All attendances1 Attendances to Type 1 A&E only

VB01Z - Cat 5 Rx 50 50

VB02Z - Cat 3 Ix with Cat 4 Rx 1,152 1,152 Major 20% 34% VB03Z - Cat 3 Ix with Cat 1-3 Rx 1,495 1,491

VB04Z - Cat 2 Ix with Cat 4 Rx 8,235 8,234

VB05Z - Cat 2 Ix with Cat 3 Rx 1,820 1,820

VB06Z - Cat 1 Ix with Cat 3-4 Rx 930 903 Normal 29% 48% VB07Z - Cat 2 Ix with Cat 2 Rx 4,834 4,793

VB08Z - Cat 2 Ix with Cat 1 Rx 8,220 7,790

VB09Z - Cat 1 Ix with Cat 1-2 Rx 8,464 4,359 Minor VB10Z – Emergency dental 1 51% 1 18%

VB11Z - No sig Ix or Rx 19,725 1,300

Total2 54,928 31,895 1 Includes Type 1 (regular ED) and Type 3 (GP led UCC) attendances 2 VB99Z excluded (Dead on arrival- 2 patients both attending Type 1 A&E) SOURCE: Performance & Information Team, York Teaching Hospital NHS Foundation Trust 66 ACUTE SERVICES Attendances at all A&E types for local CCGs compared with peers

CCG performance at, or CCG performance below, England average above England average

A&E attendances at all A&E Types per 1,000 weighted population Scarborough & East Riding of Peer group Peer group top England England top Ryedale CCG Yorkshire CCG average quartile average quartile

527.3 376.4 360.0 Total A&E 325.1 266.4 296.5 attendances

160.8 170.1 158.2 174.8 156.4 Major/ 133.7 normal A&E attendances

392.7 Minor A&E 204.2 172.8 attendances 151.7 107.2 121.9

1 Peer group defined as the 10 CCGs most similar to Scarborough and Ryedale by NHS Right Care (Hastings and Rother, Great Yarmouth and Waveney, West Norfolk, South Kent Coast, Isle of Wight, Lincolnshire East, Hereford, Airedale, Wharfedale and Craven, Lincolnshire West, and Harrogate and Rural District) SOURCE: HES 2016/17 M13 A&E, c/o NHS Digital 67 ACUTE SERVICES Attendances to type 1 A&Es for local CCGs compared with peers

CCG performance at, or CCG performance below, England average above England average

A&E attendances at all A&E Types per 1,000 weighted population Scarborough & East Riding of Peer group Peer group top England England top Ryedale CCG Yorkshire CCG average quartile average quartile

Total A&E 289.7 252.7 237.7 276.6 234.1 attendances 182.0

Major/ 158.0 162.7 normal A&E 132.2 117.2 149.6 144.0 attendances

Minor A&E 157.5 113.3 attendances 64.8 93.3 84.2 83.5

1 Peer group defined as the 10 CCGs most similar to Scarborough and Ryedale by NHS Right Care (Hastings and Rother, Great Yarmouth and Waveney, West Norfolk, South Kent Coast, Isle of Wight, Lincolnshire East, Hereford, Airedale, Wharfedale and Craven, Lincolnshire West and Harrogate and Rural District) SOURCE: HES 2016/17 M13 A&E, C/o NHS Digital 68 ACUTE SERVICES Overall inpatient activity by local CCGs Number of admissions (‘000s)

Inpatient activity by CCG, 2013/14 v- 2016/17

Scarborough & +7% p.a. Ryedale CCG 33 35 38 40

+1% p.a. East Riding of 92 93 92 94 Yorkshire CCG

2013/14 2014/15 2015/16 2016/17

Source: HES Online 2013/14, 2014/15, 2015/16, 2016/17 69 ACUTE SERVICES Ambulatory care sensitive admissions compared with peer group CCGs

CCG performance at, or CCG performance below, England average above England average

Admissions for ambulatory sensitive conditions per 1,000 weighted population Scarborough & East Riding of Peer group Peer group top England England top Ryedale CCG Yorkshire CCG average quartile average quartile

23.1 22.1 21.2 All ambulatory 18.0 20.9 18.5 care sensitive admissions

3.6 3.5 3.5 3.1 3.5 3.1 UTIs

4.9 4.8 4.1 4.0 Influenza/ 3.3 3.4 pneumonia

2.6 2.6 2.4 2.2 2.3 COPD 1.8

1 Peer group defined as the 10 CCGs most similar to Scarborough and Ryedale by NHS Right Care (Hastings and Rother, Great Yarmouth and Waveney, West Norfolk, South Kent Coast, Isle of Wight, Lincolnshire East, Hereford, Airedale, Wharfedale and Craven, Lincolnshire West, and Harrogate and Rural District) SOURCE: HES 2016/17 M13 APC, c/o NHS Digital Excludes regular attenders 70 ACUTE SERVICES Bed days for people over 65 years compared with local peers and hospitals of similar size and remoteness Local peers Peers serving similar populations

Hospital bed days in over 65s as a percentage of all bed days 2016/17, % (total in ‘000s) 65+ <65 100% = Scarborough 73 27 121

York 70 30 228

Hull 58 42 272

James Cook 56 44 307

Hereford 72 28 120

Pilgrim 70 30 134

West Cumberland 69 31 61

England 60 40 38,059

SOURCE: HES 2016/17 APC M13, c/o NHS Digital 71 Contents

▪ The local population and their health needs ▪ Primary care ▪ Community services ▪ Ambulance services ▪ Acute services ▪ Scarborough Hospital – Clinical & operational performance

– Financial performance

– Workforce

72 CLINICAL AND OPERATIONAL PERFORMANCE Clinical & operational performance – summary of data (1/2)

Area of focus Source of data/insight Key findings Overall trust ▪ CQC report for ▪ Scarborough is rated ‘requires improvement' performance Scarborough and peers

▪ ICNARC1 annual quality ▪ Scarborough has a risk adjusted mortality in line with national average report 2016/17

▪ NELA2 3rd annual report ▪ 100% of emergency laparotomy patients were seen by a consultant surgeon and consultant anaesthetist prior to surgery ▪ 6% of patients aged over 70 were assessed by an elderly medicine specialist after surgery

Clinical ▪ TARN3 2017 dataset ▪ There were 2.3% unexpected survivors per 100 patients (adjusted) performance against ▪ National hip fracture ▪ 75% of hip fracture cases met best practice criteria national audit standards ▪ Bowel cancer audit 2017 ▪ The 30-day adjusted readmission rate for bowel cancer patients was 6.2%

▪ MINAP4 2017 report ▪ The average length of stay for NSTEMI patients was 6.0 day ▪ 54.6% of NSTEMI patients had an angiogram prior to discharge

▪ SSNAP5 Audit ▪ 36.5% of stroke patients had a brain scan within 1 hour

▪ NMPA6 2017 ▪ The rate of spontaneous vaginal birth at Scarborough was 63.2% 1 Intensive Care National Audit & Research Centre; 2 National Emergency Laparotomy Audit; 3 Trauma Audit and Research Network; 4 Myocardial Ischaemia National Audit Project; 5 Sentinel Stroke National Audit Programme; 6 National Maternity and Perinatal Audit 73 CLINICAL AND OPERATIONAL PERFORMANCE Clinical & operational performance – summary of data (2/2)

Area of focus Source of data/insight Key findings ▪ Performance and ▪ The monthly average A&E 4 hour wait has varied between 50% and Information team, York 88% at Scarborough over the last 12 months Teaching Hospital NHS ▪ Utilisation of elective theatres has varied between 63% and 88% in the Foundation Trust past 12 months ▪ The number of cases performed overnight in theatres has varied between 6 and 25 from Jul 2017-June 2018 Operational Performance ▪ HES data ▪ 1 in 7 excess bed days at Scarborough General Hospital are due to bacterial diseases, influenza and pneumonia ▪ 67% of all bed days at Scarborough are occupied by stranded NEL patients with length of stay 8 days or longer (majority aged over 65

▪ NHS Friends and Family ▪ 98% of in patients would recommend Scarborough Hospital Test ▪ 83% of A&E attenders would recommend Scarborough Hospital

1 Intensive Care National Audit & Research Centre; 2 National Emergency Laparotomy Audit; 3 Trauma Audit and Research Network; 4 Myocardial Ischaemia National Audit Project; 5 Sentinel Stroke National Audit Programme; 6 National Maternity and Perinatal Audit 74 CLINICAL AND OPERATIONAL PERFORMANCE Scarborough Hospital CQC performance compared with local peers

Outstanding Good Requires improvement Inadequate

Scarborough Hospital York Hospital Hull Royal Infirmary James Cook Hospital Feb 2018 Feb 2018 Feb 2018 Dec 2017

Overview and CQC inspections

Overall requires improvement Overall good Overall requires improvement Overall good

Safe Safe Safe Safe

Effective Effective Effective Effective

Caring Caring Caring Caring

Responsive Responsive Responsive Responsive

Well-led Well-led Well-led Well-led CQC inspections and ratings of specific services Medical care (including older Medical care (including older Outpatients and diagnostic Outpatients and diagnostic people’s care) people’s care) imaging imaging

Urgent and emergency services Urgent and emergency services Maternity and gynecology Maternity and gynecology (A&E) (A&E)

Surgery Surgery Medical care (including older Medical care (including older people’s care) people’s care)

Intensive/critical care Intensive/critical care Urgent and emergency Urgent and emergency services (A&E) services (A&E)

Surgery Surgery

Intensive/critical care Intensive/critical care

Services for children and Services for children and young people young people

End of life care End of life care

SOURCE: CQC website 75 CLINICAL AND OPERATIONAL PERFORMANCE Scarborough Hospital CQC performance compared with peers serving similar populations Outstanding Good Requires improvement Inadequate

Scarborough Hospital West Cumberland Hospital County Hospital, Hereford1 Pilgrim Hospital, Boston Feb 2018 Dec 2016 July 2016 Feb 2018

Overview and CQC inspections

Overall requires improvement Overall good Overall requires improvement Overall good

Safe Safe Safe Safe

Effective Effective Effective Effective

Caring Caring Caring Caring

Responsive Responsive Responsive Responsive

Well-led Well-led Well-led Well-led CQC inspections and ratings of specific services Medical care (including older Outpatients and diagnostic Outpatients and diagnostic Outpatients and diagnostic people’s care) imaging imaging imaging

Urgent and emergency services Maternity and gynecology Maternity and gynecology Maternity and gynecology (A&E)

Medical care (including older Medical care (including older Surgery Medical care (including older people’s care) people’s care) people’s care)

Intensive/critical care Urgent and emergency services Urgent and emergency services Urgent and emergency services (A&E) (A&E) (A&E)

Surgery Surgery Surgery

Intensive/critical care Intensive/critical care Intensive/critical care

Services for children and Services for children and Services for children and young young people young people people

End of life care End of life care End of life care

1 Currently undergoing CQC inspection SOURCE: CQC website 76 CLINICAL AND OPERATIONAL PERFORMANCE Critical care performance at Scarborough compared with local peers

Trust performance Trust performance Trust performance below national average above national average similar to national average Key Results1 from ICNARC2 annual quality report 2016/17 National Scarborough York Hull James Cook3 average 4.7 5.0 Percent of bed days used on critical care survivors 3.7 Bed days of care post 8- more than 8 hours after hour delay, (%) 2.5 2.2 reported time fully ready for discharge

Percent of bed days used on critical care survivors 3.0 Bed days of care post 24- more than 24 hours after 2.4 hour delay, (%) reported time fully ready 1.2 1.2 for discharge 0.7

1.05 1.00 0.97 1.00 Ratio of actual hospital 0.95 mortality rate to expected Risk-adjusted acute mortality rate (based on hospital mortality rate ICNARC risk prediction model)

1 Results are published in graphical form, so numbers used are an estimation based on these graphs 2 Intensive Care National Audit & Research Centre 3 James Cook Hospital Data for General ITU (Generic HDU and Cardiac ICU reported separately)

SOURCE: Intensive Care National Audit & Research Centre Annual Quality Report 2016/17 for adult critical care 77 CLINICAL AND OPERATIONAL PERFORMANCE Critical care performance at Scarborough compared peers serving similar

populations Trust performance Trust performance Trust performance below national average above national average similar to national average Key Results1 from ICNARC2 Annual Quality Report 2016/17 Hereford West National Scarborough County Cumberland Pilgrim average 6.5 6.5 Percent of bed days used 5.0 on critical care survivors Bed days of care post 8- more than 8 hours after hour delay, (%) reported time fully ready 2.5 2.5 for discharge

Percent of bed days used on critical care survivors 4.0 4.0 Bed days of care post 24- more than 24 hours after 3.0 hour delay, (%) reported time fully ready for discharge 1.2 1.2

1.1 1.0 1.0 1.0 Ratio of actual hospital 0.9 mortality rate to expected Risk-adjusted acute mortality rate (based on hospital mortality rate ICNARC risk prediction model)

1 Results are published in graphical form, so numbers used are an estimation based on these graphs 2 Intensive Care National Audit & Research Centre SOURCE: Intensive Care National Audit & Research Centre Annual Quality Report 2016/17 for adult critical care 78 CLINICAL AND OPERATIONAL PERFORMANCE Care of laparotomy patients are Scarborough General England spread Hospital (1/2) 5 4 3 2 1 Scarborough York Hull James Cook Key results from NELA1 report

Top Scar- James Domain Indicator Unit Bottom performer performer borough York Hull Cook

Reviewed by a consultant surgeon within 14 hours of % 76 73 75 54 Admission time admission 0 46 53 63 100

Had a CT scan performed before emergency % 82 83 85 87 laparotomy 0 79 83 88 100 CT scanning Had a CT scan performed and reported by a % 82 78 71 70 consultant radiologist before emergency laparotomy 0 68 73 82 100

Risk documentation 89 70 75 63 Had risk documented preoperatively % 0 50 64 78 100 Cases where interval from decision to operate (or % Operating decision time of booking) to arrival in theatre was appropriate 80 92 85 86 time to documented operative urgency (for cases with 60 78 83 89 100 urgency <18 hours)

Post op length Median postoperative length of stay in patients days 12.0 9.0 11.0 14.0 of stay surviving to hospital discharge 26 12 11 10 7

Return to theatre Returned to theatre following their index laparotomy % 5 14 7 5 40 12 9 6 0

Unplanned critical Unplanned critical care admission from the ward < 7 % 6 1 5 11 care admission days after their index laparotomy 42 6 4 2 0 Reviewed by a consultant surgeon and a consultant % anaesthetist before emergency laparotomy if pre- 98 67 34 64 operative p-possum mortality risk >= 5% 0 43 58 74 100

Reviewed by ONLY a consultant surgeon before % 2 9 25 16 emergency laparotomy if pre-operative p-possum mortality risk >= 5% 100 21 14 4 0 Review by senior clinicians Reviewed by ONLY a consultant anaesthetist before % 0 23 30 15 emergency laparotomy if pre-operative p-possum mortality risk >= 5% 100 24 20 13 0

Not reviewed by a consultant surgeon nor a consultant % anaesthetist before emergency laparotomy if pre- 0 1 11 5 operative p-possum mortality risk >= 5% 32 12 8 1 0

1 National Emergency Laparotomy Audit SOURCE: National Emergency Laparotomy Audit 3rd report 2017 79 CLINICAL AND OPERATIONAL PERFORMANCE Care of laparotomy patients are Scarborough General England spread Hospital (2/2) 5 4 3 2 1 Scarborough York Hull James Cook Key results from NELA1 report

Top Scar- James Domain Indicator Unit Bottom performer performer borough York Hull Cook

Surgery was directly supervised by a consultant % 91 94 61 80 surgeon and a consultant anaesthetist if pre- 0 63 74 88 100 operative p-possum mortality risk >= 5%

Surgery was directly supervised by a consultant % surgeon and a consultant anaesthetist if pre- 89 96 63 84 operative p-possum mortality risk >10% 0 65 76 91 100

Surgery supervision Surgery was directly supervised ONLY by a consultant % by senior clinicians 8 0 25 15 surgeon if pre-operative p-possum mortality risk >= 100 22 15 3 0 5%

Surgery was directly supervised ONLY by a consultant % 0 5 7 4 anaesthetist if pre-operative p-possum mortality risk 57 10 7 1 0 >= 5%

Surgery was not directly supervised by a consultant % surgeon nor a consultant anaesthetist if pre- 2 1 7 1 operative p-possum mortality risk >= 5% 100 5 4 1 0

Post-operative p-possum mortality risk of 5-10% who % 76 57 95 62 were transferred directly to a critical care unit from 15 47 63 81 100 theatre

Post-operative p-possum mortality risk of >=5% who % 85 72 98 78 were transferred directly to a critical care unit from 0 71 79 91 100 theatre Transfer to critical care Post-operative p-possum mortality risk of >10% who % 91 78 100 88 were transferred directly to a critical care unit from 0 79 86 96 100 theatre

Patients over the age of 70 who were assessed by an % 6 29 10 8 elderly medicine specialist after surgery 0 2 11 14 100

1 National Emergency Laparotomy Audit SOURCE: National Emergency Laparotomy Audit 3rd report 2017 80 CLINICAL AND OPERATIONAL PERFORMANCE Attendances and survival of major trauma patients at Scarborough Hospital – comparison with local peers

Key results from TARN1 database, 2017 Scarborough York James Cook2 Hull2 857 817

512 TARN eligible patients3, (No.)

245

2.3

Survival, No. of unexpected 0.3 survivors per 100 patients (adjusted)

-0.5 -0.9 1 Trauma Audit and Research Network; 2 Major Trauma Centre 3 TARN eligibility is defined as patients who have an injury within the recognised TARN list AND one of total LOS >= 3 days including transfers in or out (excluding for rehabilitation) or admitted to Critical Care (irrespective of length of stay) SOURCE: The Trauma Audit and Research Network 2017 dataset 81 CLINICAL AND OPERATIONAL PERFORMANCE Attendances and survival of major trauma patients at Scarborough Hospital – comparison with peers serving similar populations

Key results from TARN1 database, 2017 Scarborough Hereford County West Cumberland Pilgrim 264 245

172 TARN eligible patients2, (No.)

2.3 1.9

1.1 Survival, No. of unexpected survivors per 100 patients (adjusted)

-1.7 1 Trauma Audit and Research Network; 2 TARN eligibility is defined as patients who have an injury within the recognised TARN list AND one of total LOS >= 3 days including transfers in or out (excluding for rehabilitation) or admitted to Critical Care (irrespective of length of stay) SOURCE: The Trauma Audit and Research Network 2017 dataset 82 Trauma patients attending Scarborough Hospital

Destination of all trauma patients attending Scarborough A&E2, FY 2017/18 Number of attendances to Scarborough A&E with any trauma related presenting complaint 4,262

3,284

933 45

Attending A&E Discharged Transferred Admitted out1

1 Transfer out for speicialist input (e.g. neurosurgery or major trauma centre) 2 Includes Type 1 and Type 3 A&E SOURCE: Major Trauma lead, Scarborough Hospital 83 CLINICAL AND OPERATIONAL PERFORMANCE Scarborough Hospital hip fracture performance compared with all national sites

Percentage of cases meeting best practice criteria All hip fracture cases by site, 2017

% Scarborough

95 Pilgrim Hospital, Peers serving similar populations Boston 90 Local peers James Cook 85 Scarborough 80 West Cumberland 75 York 70 65 60 55 50 Hull 45 County Hospital, 40 Hereford 35 30 25 20 15 10 5 0

SOURCE: National Hip Fracture Database, 2017 data (all sites where hip fracture surgery is performed) 84 CLINICAL AND OPERATIONAL PERFORMANCE Bowel cancer treatment outcomes compared with local peers

Trust performance Trust performance Key results from national bowel cancer audit below England average above England average Scarb- James Peer England England top orough York Hull Cook average average quartile

11.5 Bowel cancer adjusted 30-day 9.8 7.8 7.8 8.3 unplanned readmission (%) 6.2 7.4

9.7 Bowel cancer adjusted 90-day mortality 5.1 (%) 3.7 3.7 3.6 3.3 2.3

Underwent major urgent/emergency 16 16 12 13 13 12 surgery (%) 11

86 73 70 70 Bowel cancer LoS > 5 days (%) 63 59 64

SOURCE: National Bowel Cancer Audit 2017 (2015/16 data) 85 CLINICAL AND OPERATIONAL PERFORMANCE Bowel cancer treatment outcomes compared with peers serving similar populations

Trust performance Trust performance Key results from national bowel cancer audit below England average above England average Scarb- Hereford West Peer England England top orough County Cumberland Pilgrim average average quartile

16.6 18.1 Bowel Cancer Adjusted 30-day 15.8 14.2 unplanned readmission (%) 9.8 6.2 7.4

4.3 3.7 Bowel Cancer Adjusted 90-day 3.6 2.4 2.6 mortality (%) 2.3 0

Underwent major urgent/emergency 18 16 11 12 surgery (%) 9 4 1

63 67 68 62 70 64 Bowel Cancer LoS > 5 days (%) 48

SOURCE: National Bowel Cancer Audit 2017 (2015/16 data) 86 CLINICAL AND OPERATIONAL PERFORMANCE Bowel cancer treatment outcomes

Key results from national bowel cancer audit, 2013-17 Scarborough York James Cook Hull 2.8 2.5 2.4

1.8 90-day adjusted mortality, Percent (2013-17)

11.5

7.8 7.8 6.2

30-day unplanned readmission rate, Percent

SOURCE: National Bowel Cancer Audit 2017 website, accessed September 2018 87 Cancer waiting times

2-week wait referrals for cancer, FY 2017/18 Percentage of 2-week wait referrals to Scarborough hospital seen within 14 days National target 88 87 88 88 89 88 83 84 83 93 80 81 74

April May June July August September October November December January February March

SOURCE: Performance and Information team, York Teaching Hospital NHS Trust 88 CLINICAL AND OPERATIONAL PERFORMANCE Treatment of Myocardial infarction patients compared with local peers

Poorest performance Highest performance amongst local peers amongst local peers Key results from MINAP1 annual report

Scarborough York Hull James Cook National average

98.8 97.8 100.0 96.2 82.0 % of NSTEMI patients seen by cardiologist

96.6 % of NSTEMI patients admitted to cardiac 57.1 57.5 unit or ward 23.0 0

96.2 91.4 83.6 % of NSTEMI patients who had angiography 54.6 during admission N/A

97.7 99.6 % of patients who received all secondary 92.0 91.1 prevention medication for which they were eligible 31.8

6.0 5.0 4.0 NSTEMI length of stay (days) 3.0 N/A

6.5 6.0 STEMI length of stay (days) 4.5 2.0 N/A

1 Myocardial Ischaemia National Audit Project SOURCE: MINAP 2015-16 annual report 89 CLINICAL AND OPERATIONAL PERFORMANCE Treatment of Myocardial infarction patients compared with peers serving similar

populations Poorest performance Highest performance amongst peers serving amongst peers serving 1 Key results from MINAP annual report similar populations similar populations

Scarborough Hereford County West Cumberland Pilgrim National average

98.8 98.1 93.1 93.4 96.2

% of NSTEMI patients seen by cardiologist

57.1 60.8 55.5 57.5 % of NSTEMI patients admitted to cardiac unit or ward 30.3

83.6 80.8 74.6 % of NSTEMI patients who had angiography 54.6 during admission 31.9

92.0 90.0 97.1 91.1 % of patients who received all secondary 80.8 prevention medication for which they were eligible

6.0 5.5 6.0 4.5 NSTEMI length of stay (days)

N/.A

7.0 6.0 STEMI length of stay (days) 4.5 4.0

N/A

1 Myocardial Ischaemia National Audit Project SOURCE: MINAP 2015-16 annual report 90 CLINICAL AND OPERATIONAL PERFORMANCE Stroke treatment at Scarborough Hospital compared with local peers

Poorest performance amongst Highest performance amongst local peers local peers Key results from SSNAP1 audit for stroke National Scarborough York Hull James Cook average

51.8 47.4 48.3 53.0 % patients having a brain scan 36.5 within 1 hour

84.1 92.6 93.6 96.1 95.0 % patients having a brain scan within 12 hours

75.8 % patients with direct admission to 65.0 67.6 59.0 stroke unit in 4 hours 22.2

98.4 % patients having formal swallow 88.0 82.7 85.7 89.0 Safety assessment within 72h

55.8 47.5 47.1 51.0 % Speech and language therapy 34.0 target achieved

% patients having joint health and 97.7 98.4 99.0 99.0 94.0 social care plan on discharge

41.2 % patients discharged with stroke 36.3 35.0 specialist Early supported discharge 11.2 team 6.0

1 Sentinel Stroke National Audit Programme SOURCE: SSNAP August- November 2017 91 CLINICAL AND OPERATIONAL PERFORMANCE Stroke treatment at Scarborough Hospital compared with peers serving similar

populations Poorest performance amongst Highest performance amongst peer group peer group Key results from SSNAP1 audit for stroke National Scarborough Hereford County West Cumberland Pilgrim average 53.2 49.1 48.9 53.0 % patients having a brain scan 36.5 within 1 hour

84.1 93.6 97.1 96.5 95.0 % patients having a brain scan within 12 hours

% patients with direct admission to 61.3 62.2 59.0 stroke unit in 4 hours 22.2 31.8

97.1 94.3 95.7 % patients having formal swallow 88.0 89.0 Safety assessment within 72h

65.4 % Speech and language therapy 47.5 47.6 51.0 target achieved 17.9

% patients having joint health and 97.7 93.3 100.0 100.0 94.0 social care plan on discharge

50.3 % patients discharged with stroke 35.0 specialist Early supported discharge 23.2 team 6.0 0

1 Sentinel Stroke National Audit Programme SOURCE: SSNAP August- November 2017 92 CLINICAL AND OPERATIONAL PERFORMANCE Obstetric performance at Scarborough Hospital compared with local peers

Significantly worse than national Significantly better than national Key results from NMPA1 audit for maternity outcomes average average National Scarborough York Hull2 James Cook average 72.5 63.2 56.3 61.8 55.3 % Spontaneous vaginal birth

14.4 13.4 13.0 10.5 12.2 % Instrumental births

25.6 25.2 27.1 25.5 25.9

Proce- % Caesarean births dural

% Vaginal birth after primary 23.7 29.0 28.9 29.0 24.7 caesarean section

26.9 24.4 26.9 19.9 22.7 % Episiotomies

4.2 3.5 2.8 2.8 % 3rd & 4th Degree tears 2.1

3.0 3.0 2.8 % Obstetric hemorrhage of 1500ml 2.2 Safety 1.6 or more

3.3 3.3 2.0 2.5 % Unplanned maternal 1.7 readmission within 42 days

1 National Maternity and Perinatal Audit 2 Results for Hull reported for whole trust - no site specific results available for Hull Royal Infirmary SOURCE: NPMA 2017 93 CLINICAL AND OPERATIONAL PERFORMANCE Obstetric performance at Scarborough Hospital compared with peers serving similar

populations Significantly worse than national Significantly better than national average average Key results from NMPA1 audit for maternity outcomes National Scarborough Hereford County West Cumberland Pilgrim average 63.2 60.1 55.3

% Spontaneous vaginal birth

13.0 10.5 12.6

% Instrumental births 25.6 27.2 25.9

Proce- % Caesarean births dural 23.7 21.1 24.7 % Vaginal birth after primary caesarean section No data published for these sites2 19.9 21.2 22.7

% Episiotomies 4.7 3.5 % 3rd & 4th Degree tears 2.1

2.8 % Obstetric hemorrhage of 1500ml 1.6 Safety or more N/A

4.3 % Unplanned maternal 2.0 2.5 readmission within 42 days

1 National Maternity and Perinatal Audit 2 Data not published by NPMA either due to not being available or not passing NPMA quality checks SOURCE: NPMA 2017 94 CLINICAL AND OPERATIONAL PERFORMANCE Heart failure care at Scarborough General Hospital compared with local peers

Lowest amongst peers Highest amongst peers Key results from Heart failure audit

Scarborough York Hull Royal Infirmary James Cook 343 372 Heart failure admissions 197 (number of patients) 13

84.0 69.2 Received input from a 41.1 consultant cardiologist (%) 12.2

82.2 Inpatient care 38.5 Cardiology inpatient (%) 21.3 1.0

87.5 97.7 97.0 99.4 Received ECHO (%)

83.3 95.6 90.2 Received discharge planning (%) 77.7

Treatment 100.0 & manage- Referral to cardiology follow-up 79.8 54.7 64.6 ment on (%) discharge

22.2 Referral to cardiac 10.5 rehabilitation (%) 3.8 4.4

SOURCE: National Heart Failure Audit 2015/16 95 CLINICAL AND OPERATIONAL PERFORMANCE Heart failure care at Scarborough General Hospital compared with peers serving

similar populations Lowest amongst peers Highest amongst peers Key results from Heart failure audit

Scarborough Hereford Country West Cumberland Pilgrim 249 256 Heart failure admissions (number of patients) 13

69.2 54.6 Received input from a 44.9 consultant cardiologist (%)

52.6 Inpatient 38.5 41.2 care Cardiology inpatient (%)

87.5 99.6 Received ECHO (%) No data published for 48.8 this site

90.5 98.6 Received discharge planning (%) 83.3

Treatment 100.0 & manage- Referral to cardiology follow-up ment on (%) 35.9 41.0 discharge

60.4 Referral to cardiac 22.2 rehabilitation (%) 4.2

SOURCE: National Heart Failure Audit 2015/16 96 CLINICAL AND OPERATIONAL PERFORMANCE 4hr A&E performance at Scarborough over the past 12 months

A&E attendances percentage seen in 4 hours or less, August 2017 - July 2018, Type 1 attendances % of attendances

100 Scarborough York Target 95

45 Aug Sep Oct Nov Dec Jan Feb Mar Apr May Jun Jul 2017 2018

SOURCE: Performance and Information team, York Teaching Hospital NHS Foundation trust 97 CLINICAL AND OPERATIONAL PERFORMANCE Scarborough’s performance on ambulatory emergency care

Adult emergency patients with lengths of stay of 1 day or less, % AEC pathway AEC pathway Scarborough York England average minimum maximum

76 57 71 60 Low risk chest pain 30

66 65 60 Supraventricular 43 tachycardias 30

52 COPD 29 39 30 10

Falls, including 90 syncope or 42 61 59 60 collapse

Congestive cardiac 60 30 failure 16 23 27

Community 27 30 30 19 acquired 10 pneumonia

1 Recommended minimum proportion of patients suitable for ambulatory emergency care Source: HES 2016/17 M13 APC, c/o NHS Digital; AEC Directory of Ambulatory Emergency Care for Adults 98 CLINICAL AND OPERATIONAL PERFORMANCE Day case rates compared with other hospitals in the area

Day cases as proportion of elective activity, % Sites with elective focus and no A&E Hull Royal Castle Hill, James England Scarborough York Bridlington Infirmary Hull Cook Average

91 87 Surgical 76 81 66 68 76 specialties

91 89 80 64 71 Urology 37 n/a

Ophthalmo- 98 96 92 99 97 logy n/a n/a

Colorectal 93 94 98 98 77 82 surgery n/a

98 98 100 97 Upper GI 68 79 surgery n/a

90 91 General 66 78 68 79 surgery n/a

SOURCE: HES 2016/17 M13 APC, c/o NHS Digital 99 CLINICAL AND OPERATIONAL PERFORMANCE 1 in 7 excess bed days at Scarborough Hospital are due to bacterial diseases, influenza and pneumonia Non-elective (NE) excess bed days by primary diagnosis NE excess days per Days (% of all NE excess days) NE spell2

Certain bacterial diseases 976 (8%) 2.2

Influenza & pneumonia 702 (6%) 0.7

Unknown & unspecified causes of morbidity 546 (5%) 60.7

Ischaemic heart diseases 535 (5%) 1.1

Cerebrovascular diseases of care 457 (4%) 4.0

Other infections and disorders of the skin 445 (4%) 1.4

Other forms of heart disease 399 (3%) 0.7

Complications of surgical & medical care NEC1 374 (3%) 1.3

Injuries to the knee & lower leg 370 (3%) 2.3

Injuries to the head 361 (3%) 1.5

All other diagnoses 6,499 (56%) 0.6

1 NEC = not elsewhere classified 2 Calculation includes non-elective spells with 0 excess bed days SOURCE: HES 2016/17 M13 APC, c/o NHS Digital. Excludes regular attenders 100 CLINICAL AND OPERATIONAL PERFORMANCE Case-mix adjusted length of stay at Scarborough Hospital compared with other acute providers in England

Case-mix adjusted non-elective1 average length of stay, for Scarborough Hospital, against all non-specialist acute Trusts in England, 2016/17, Days 5.3

Scarborough – 5.9 days2

Case-mix adjustment separates Trust Median – 5.2 days performance from the complexity of the case-mix -12%

-19% Top quartile – 4.7 days

-24% Top decile – 4.5 days

0 1 2 3 4 5 6 7 8 9 10

1 For acute trusts only 2 Case mix adjusted to Scarborough’s activity mix SOURCE: HES 2016/17 IP 2017/17 APC dataset M13, c/o NHS Digital 101 CLINICAL AND OPERATIONAL PERFORMANCE Utilisation of elective theatres Theatre utilisation Percentage of planned theatre time used at Scarborough Hospital (July 2017 – August 2018) % 90 88

85 82 80 79 76 Average 74 75 73 73 73 73 73 utilisation 75% 70 69

65 63

50 Jul Aug Sep Oct Nov Dec Jan Feb Mar Apr May Jun 2017 2018

SOURCE: Performance and Information Team, York Teaching Hospital NHS Foundation Trust 102 CLINICAL AND OPERATIONAL PERFORMANCE Theatres operational performance

Theatre late start1, July 2017- June 2018 Percentage of theatres starting late % 80 72 70 62 60 53 52 48 50 48 40 40 35 37 38 35 32 30 20 Theatre overrun2, July 2017- June 2018 Percentage of theatre sessions overrunning % 80 70 60 50 40 40 33 27 29 27 30 30 24 24 23 24 18 19 20 Jul 2017 Aug Sep Oct Nov Dec Jan Feb Mar Apr May Jun 2018 1 Starting more than 10 minutes after scheduled time 2 Finishing more than 10 mins after end of session SOURCE: Performance and Information Team, York Teaching Hospital NHS Foundation Trust 103 CLINICAL AND OPERATIONAL PERFORMANCE Operating out of hours

Operating occurring out of hours1 (all cases including emergency and trauma2) Number of cases per month, July 2017 – June 2018

25 23 16 12 13 12 13 10 11 8 6 7

Jul Aug Sep Oct Nov Dec Jan Feb Mar Apr May Jun 2017 2018 Operations sent for after midnight2 Number of cases per month, July 2017 – June 2018

3 3 4 4 4 3 4 4 4 2 1 2 Jul Aug Sep Oct Nov Dec Jan Feb Mar Apr May Jun 2017 2018

1 Includes all cases where operating occurred between 21:00 and 08:00 the next morning 2 No data available for obstetric cases SOURCE: Information and Performance Team Data, York Teaching Hospital NHS Foundation trust 104 CLINICAL AND OPERATIONAL PERFORMANCE Weekend operating

Cases occurring in emergency theatre at the weekend Number of cases per month, July 2017- June 2018

26 21 21 21 21 16 17 14 14 15 12 10

Cases occurring in trauma theatre at the weekend Number of cases per month, July 2017- June 2018 30 22 23 19 20 21 19 19 19 15 12 14

Jul Aug Sep Oct Nov Dec Jan Feb Mar Apr May Jun 2017 2018

1 Includes all cases where operating occurred between 21:00 and 08:00 the next morning 2 No data collected available for obstetric cases SOURCE: Information and Performance Team Data, York Teaching Hospital NHS Foundation trust 105 CLINICAL AND OPERATIONAL PERFORMANCE 65% of bed days at Scarborough hospital are occupied by stranded patients with length of stay 8 days or longer (majority aged over 65)

Patients with LOS of 0-7 days and days 0-7 of patients with LOS >7 days 8-30 days 2016/17 bed days by LOS band and POD1 31+ days Total bed days and % of POD 100%= (in ‘000s) 31 10 3 1 1 = 46,000 bed days 18% 9%

4% 2% 17% 2% 6%

32% 2% 8% 1%

0 Non-elective aged 65+ Other Elective Maternity non-elective Paeds

1 Excluding RA (regular attenders) and Other (not recorded type), Paediatrics patients are defined by age 0 – 18 years old; 2 Figures calculated assuming that all patients in this category currently stay for 31 days, will go down to trust average LOS for NEL patients, and each reduction of a 20 bed unit saves a hospital £2 million SOURCE: HES 2016/17 106 CLINICAL AND OPERATIONAL PERFORMANCE 18 week RTT performance for local CCGs

East Riding of Yorkshire CCG Scarborough & Ryedale CCG National top quartile National average

RTT performance against 18 week target, % 97 96 95 94 93 92 92 91 90 89 88 87 86 85 84 83 82 2013- 2014- 2015- 2016- 2014, 2015, 2016, 2017, Q1 Q2 Q3 Q4 Q1 Q2 Q3 Q4 Q1 Q2 Q3 Q4 Q1 Q2 Q3

SOURCE: HSJ Intelligence 2018 107 CLINICAL AND OPERATIONAL PERFORMANCE Friends and family performance at Scarborough Hospital compared with local peers

Trust performance Trust performance below England average above England average % patients who would recommend the service they received to friends and family who need similar treatment or care James England England top Scarborough York Hull Cook average quartile

99 98 96 97 94 87

Inpatient

97 96 98 83 85 83 A&E

SOURCE: NHS Friends and Family Test - May 2018, NHS England 108 CLINICAL AND OPERATIONAL PERFORMANCE Friends and family performance at Scarborough Hospital compared with peers serving similar populations Trust performance Trust performance below England average above England average % patients who would recommend the service they received to friends and family who need similar treatment or care West County Hospital England England top Scarborough Cumberland Hereford Pilgrim average quartile

98 98 98 95 94 87

Inpatient

96 96 98 83 85 85 A&E

SOURCE: NHS Friends and Family Test - May 2018, NHS England 109 CLINICAL AND OPERATIONAL PERFORMANCE Patient views on relocation of services1 (S&R CCG public meetings; 1/2)

Would you be willing to travel further for a hospital If a service is relocated further away, who should appointment? fund the transport? Number of votes2 Number of votes2

37 20

14 8

Yes No Not sure Patients Local CCG by reducing themselves authority services

1 There will be several engagement events in the future as plans and potential options develop 2 There were 67 attendees across the two meetings (44 at the event in Malton and 23 at the event in Scarborough) SOURCE: Survey of local attendees at town hall meetings (Scarborough and Maldon) regarding the future of the Scarborough & Ryedale CCG, November 2017. 110 CLINICAL AND OPERATIONAL PERFORMANCE Patient views on relocation of services1 (S&R CCG public meetings; 2/2)

Would you support the CCG to move services where the is evidence that it maintains or improves quality and outcomes, but may result in increased travel? What is most important to you? Number of votes2 Number of votes2

40 42

8 7 7 5

Yes No Not sure The quality Access to Shorter of care received services locally waiting times

1 There will be several engagement events in the future as plans and potential options develop 2 There were 148 responses to the online survey (127 members of the public and 25 members of staff); respondees were asked to rank all options in order of preference. SOURCE: Survey of local attendees at town hall meetings (Scarborough and Maldon) regarding the future of the Scarborough & Ryedale CCG, November 2017. 111 CLINICAL AND OPERATIONAL PERFORMANCE Patient views1 on hospital based care (Public engagement survey)

Thinking about hospital based care what is most important to you about the care that you receive? Number of first choice votes2

33 32

5 4 1

Distance to Level of skills, Highest medical Waiting times for Being treated Convenient No answer travel for care training and standards of care appointments/ like an individual times for given experience treatment appointments/ treatment 1 There will be several engagement events in the future as plans and potential options develop 2 There were 148 responses to the online survey (127 members of the public and 25 members of staff); respondees were asked to rank all options in order of preference. SOURCE: Scarborough Acute Services Review Patient and Public Feedback, December 31, 2018 112 Contents

▪ The local population and their health needs ▪ Primary care ▪ Community services ▪ Ambulance services ▪ Acute services ▪ Scarborough Hospital – Clinical & operational performance

– Financial performance

– Workforce

113 FINANCIAL PERFORMANCE Financial performance – summary of data

Area of focus Source of data/insight Key findings ▪ Trust annual report and ▪ The trusts ran an operating deficit before transitional accounts support each financial year 2013/14 to 2016/17 Trust and CCG ▪ York and Scarborough ▪ In a ‘do-nothing’ scenario the Trust is predicted to have a health economy financial deficit of £17 million by 2022/23 strategy

▪ Financial report, YTHFT ▪ 7 of the 10 directorates making the largest loss are based Board of Directors at Scarborough meeting papers 25th July, 2018

▪ York Teaching Hospital ▪ Total service costs, accounting for MFF are 120% of Scarborough NHS Trust analysis, indexed national average Hospital ‘Benchmarking – A&E, women’s services and children’s services costs unavoidable smallness’ are 124%, 120% and 128% of indexed national average assessed costs respectively

▪ Expenditure team, York ▪ Locum/agency spend at Scarborough exceeded £10million Teaching Hospitals NHS in FY 2017/18 Foundation Trust

114 FINANCIAL PERFORMANCE The trust’s financial position 2013/14- 2016/17

End of financial year performance1, 2013/14 - 2016/17 £ million 2013/14 2014/15 2015/16 2016/17

Operating Surplus/ 5.9 7.0 Deficit after 0.8 transitional support1 -7.0 19.7 12.0 12.2 10.9 9.7 Transitional 10.0 support2

Operating deficit before -6.1 transitional -11.4 -12.7 support -17.9

1 Transitional support will not be provided for further financial years 2 Transitional support in 2016/17 made up of £10.0 million transitional support and £9.7 STF SOURCE: Statement of Comprehensive Income from York Teaching Hospitals Foundation Trust Annual Accounts 115 FINANCIAL PERFORMANCE The predicted trust and CCG financial position in ‘Do Nothing’ scenario

NHS Scarborough and Ryedale CCG ‘continue current’ position1 £210 M

£200 M Surplus £16 M £190 M

£180 M

£170 M FY18/19 FY19/20 FY20/21 FY21/22 FY22/23

York Teaching Hospital NHS Foundation Trust ‘continue current’ position £500 M £480 M £460 M Deficit £440 M £17 M £420 M £400 M FY18/19 FY19/20 FY20/21 FY21/22 FY22/23

1 Financial position for East Riding of Yorkshire CCG not available SOURCE: York and Scarborough Health Economy Financial strategy, 2018 116 FINANCIAL PERFORMANCE

Trust directorate profit or loss Directorate based at Scarborough Directorate based at York Cross-site directorate

10 directorates making the largest profit, FY 2017/18 10 directorates making the largest loss, FY2017/18 £ million £million

5.7

2.2

1.1 1.1 0.6 0.6 0.5 0.4 0.3 0.2

-1.0

-2.0 -2.6 -2.9 -3.4 -3.7 -3.9 -4.8 -5.4

-5.8

ED ED

TACC TACC

Urology

medicine medicine

Radiology

Trauma Trauma & Trauma &

&Urology

gynecology

Childhealth

Orthopedics

Obstetrics Obstetrics & Obstetrics &

Orthopaedic

Gynaecology

Lab medicine Lab

Ophthalmology

General surgery surgery General

General & acute General & acute General

Elderly medicine Elderly medicine Elderly

Therapyservices

General surgery surgery General & Communityservices

SOURCE: Financial report, YTHFT Board of Directors Meeting papers 25th July, 2018 117 Costs related to smallness and remoteness

Total service costs1 as percentage of national A&E assessed costs as percentage of national average average (adjusted for MFF2) FY14/15 (adjusted for MFF), FY14/15 % %

120 124 110 111 100 100

National average Peer group2 Scarborough National average Peer group2 Scarborough

Maternity services costs as percentage of national Children’s services costs as percentage of national average (adjusted for MFF), FY14/15 average (adjusted for MFF), FY2014/15 % %

125 120 126 128 100 100

National average Peer group3 Scarborough2 National average Peer group3 Scarborough2

1 Includes costs for Critical Care, Outpatients, Elective IP, Non-elective IP, Daycase and A&E 2 MFF is market forces factor 3 Peer group considered: St Mary's Isle of Wight. West Cumberland, Cumberland Infirmary, North Devon NHS Trust SOURCE: York Teaching Hospital NHS Trust Analysis, Benchmarking unavoidable smallness - Benchmarking and review of costs at Scarborough and Bridlington sites' 2016 118 FINANCIAL PERFORMANCE Locum spend at Scarborough and York

Expenditure on locum or agency staff by group, FY2017/18 % (£ million)

Total locum spend 10.7 9.7 (£million) 2% Other 11% (0.2) Nursing (1.2) 6% (0.5) Medical 33% trainee (3.5) 44% (4.0) Medical 15% staff grade (1.6) 15% (1.4) 2% 39% (0.2) Consultant (4.2) 34% (3.1)

Scarborough1 York

1 Includes locum/agency spend at Bridlington SOURCE: Expenditure team, York Teaching Hospitals NHS Foundation Trust 119 Agency, bank and locum spend Total spend Agency Bank Locum xx £million % (£ million)

Agency, bank and locum spend at Scarborough Hospital 2015/16-2018/19

Total spend= 3.5 3.3 3.5 3.2 2.9 3.1 3.5 3.6 3.5 3.9 3.0 3.7 3.6

7% 4% 6% Average (0.2) 4% 6% (0.2) 4% (0.2) 10% quarterly 4% 7% (0.1) 6% 11% (0.2) (0.1) 21% (0.4) spend 3% (0.1) (0.2) (0.2) (0.4) 16% 16% 23% £3.4 million (0.1) 20% (0.8) 10% (0.6) (0.8) 25% 10% (0.5) 18% 29% 27% (0.3) 22% (0.7) (0.9) (0.3) (0.6) 22% (1.1) (1.0) (0.7) (0.6) 22% (0.7)

78% 84% 79% 73% 78% 73% 73% (2.7) (2.7) (2.8) 74% 70% (2.8) 62% (2.5) 75% (2.6) (2.6) 68% 62% (2.3) (2.4) (2.3) (2.2) (2.0) (2.2)

Q1 Q2 Q3 Q4 Q1 Q2 Q3 Q4 Q1 Q2 Q3 Q4 Q1 2015/16 2016/17 2017/18 2018/19

SOURCE: Finance team, York Teaching Hospital NHS Foundation Trust 120 Contents

▪ The local population and their health needs ▪ Primary care ▪ Community services ▪ Ambulance services ▪ Acute services ▪ Scarborough Hospital – Clinical & operational performance

– Financial performance

– Workforce

121 WORKFORCE Workforce – summary of data PRELIMINARY

Area of focus Source Key findings ▪ Interviews with ▪ Staff have concerns about the impact of workforce shortages Current concerns directorate managers ▪ Staff describe challenges in changing ways of working at both sites and clinical directors with regards to on-call ▪ Summary of GMC ▪ The overall satisfaction of medical trainees at Scarborough is 68% national training survey – Satisfaction ranges from 53% in Obstetrics and Gynaecology to 83% in Paediatrics Training – The percentage who reported gaining adequate experience has ranged from 47.5% in Obstetrics & Gynaecology to 76.7% in General Surgery ▪ York Teaching Hospital ▪ The medical workforce NHS Foundation Trust – There are consultant vacancies in 9 of 11 directorates at Scarborough – There are 19 vacancies (38% of establishment) for non- Recruitment and consultant grade doctors in the general medicine directorate at retention of Scarborough workforce – More than 25% of the consultant workforce are over 55 years old ▪ The nursing workforce – A majority of directorates have filled over 85% of their nursing establishment ▪ NHS National Staff ▪ Staff have concerns about the impact of workforce shortages Staff satisfaction Survey ▪ Staff describe challenges in changing ways of working at both sites with regards to on-call

122 WORKFORCE Quotes from stakeholder interviews about the Scarborough workforce

In the next 3 years there are several The service currently relies on good will and consultants retiring; I don’t know what we that is wearing thin will do then

Something needs to change – the current Scarborough is not somewhere many want to way of working is not sustainable work – in 2 years of advertising for consultant posts my directorate hasn’t had a single applicant

The services are very dependent on one We haven’t decide how to attract people to another, if one service is reduced it will work in Scarborough – we need to decide have an impact on many more what our specific offering is to encourage applicants

Increasingly, we’re struggling to find any We’ve previous applicants reluctant to come locums to cover gaps in all rotas –they’re concerned about finding work for their spouses

SOURCE: Interviews with Clinical Directors, Deputy Clinical Directors and Directorate Management at York and Scarborough Hospital 123 WORKFORCE Quotes from stakeholder interviews about ways of working across Scarborough and York

York and Scarborough would be happy to The travel distances make providing on-call support each other – but neither site has cover to both sites almost impossible the capacity to this

If job plans were changed to enforce cross- Previous innovations have been brought in site working, many would refuse, or look to with minimal consultation – it’s increased our leave resistance to further change

The models of working being tried at Some don’t want to acknowledge we need a Scarborough need people to work as change – they want to carry on as they have generalists; a proportion of consultant only done for years wish to provide specialist services

When we merged we were told we would get support from York – barring a few specialties, this hasn’t happened

SOURCE: Interviews with Clinical Directors, Deputy Clinical Directors and Directorate Management at York and Scarborough Hospital 124 WORKFORCE GMC survey feedback from medical trainees at Scarborough PRELIMINARY

Result is significantly below national average Result is above national average but within confidence interval Result is below national average but within confidence interval Result is significantly above national average Result is in line with national average

GMC survey aggregates feedback from doctors in training to compare training environments across the country Scarborough Deep Dive Overall Clinical Curriculum Overall Clinical Adequate Curriculum Site satisfaction supervision Experience coverage Post Specialty1 satisfaction Supervision experience Coverage

Hull Royal Emergency 76.4 89.8 78.6 75.1 56.3 96.7 54.4 66.7 Infirmary Medicine

James Cook, General Surgery1 Middles- 82.5 93.1 83.2 80.4 74.7 97.3 70.0 brough

Obstetrics 75.09 87.5 74.4 70.7 and Gynaeco- 53.3 82.5 47.5 31.3 York logy

Scarb- 68.3 86.0 69.7 67.5 Paediatrics 82.7 96.7 76.7 orough

National 78.8 65.1 90.2 56.0 Average

1 Most recent data reported by post speciality (due to low numbers of trainees rotating through) - Emergency medicine 2017, General surgery 2015, Obstetrics and gynaecology 2018, Paediatrics 2016 SOURCE: General Medical Council National Training Surveys 2015-2018 125 WORKFORCE

Consultant vacancies at Scarborough Hospital Filled posts Vacant posts % (No. of FTEs)

Current consultant establishment in Scarborough Percentage of vacant and filled FTEs as at end of July 2018

Budgeted 8 3 8 18 6 12 13 6 16 7 4 FTE= 17% 23% (3) 29% (1) 31% 33% (4) (4) (2) 42% 46% (7) 50% (3) (2)

100% 100% 98% (8) (3) (8) 83% 77% (15) 71% (5) 69% 67% (9) (9) (4) 58% 54% (9) 50%%

(4) (2)

Women’s Specialist medicine Orthopaedics Anaesthetics care Critical & medicine Elderly Paediatrics surgery General Urology & Radiology General medicine & Emergency medicine Acute Opthalmology

SOURCE: Human Resources Team, York Teaching Hospitals NHS Foundation Trust; discussion between HR team and directorate managers 126 WORKFORCE Vacancies for non-consultant grade doctors at Scarborough Hospital % (Number of FTEs)

1 Current non-consultant establishment in Scarborough Filled posts Vacant posts Percentage of vacant and filled FTEs as at end of July 2018

12 2 20 12 12 15 49 5 15 10 1 Budgeted 3% 5% 8% 10% FTE= (0) (1) (1) (1) 32% 38% (5) 40% 40% (19) (2) (6) 65% (7) 113% (14) 97% 100% 95% 92% 90% (2) (1) (19) (11) (11) 68% 62% (10) 60% 60% (30) (3) (9) 35% (4)

-13%

(-2)

& Urology & health Women’s Opthalmology Paediatrics Specialist Medicine Surgery General Orthopaedics Medicine Elderly Medicine General Anaesthetics Care Critical & & Emergency Medicine Acute Radiology

1 Includes Doctors in Training and Non-consultant Grade Doctors SOURCE: Human Resources Team, York Teaching Hospitals NHS Foundation Trust 127 WORKFORCE Percentage of consultants at Scarborough Hospital who are 55 or more years old % (Number of FTEs)

Percentage of current workforce aged 55 years or over Less than 55 55 or more Consultants as at end of June 2018

Budgeted FTE = 73 2 4 4 9 10 8 8 4 15 8 2

50% 50% (2) (2) 66% 74% 70% 75% (6) (7) 80% (54) (6) 83% 86% 87% (6) (3) 100% (13) (7) 100% (2) (2)

50% 50% (2) (2) 34% 26% 30% 25% (3) (3) 20% (19) (2) 17% 14% (2) 13%

(1) (2) (1)

medicine All All consultant posts Ophthalmology Radiology & Emergency medicine Acute medicine General surgery General Urology & Orthopaedics Women’s medicine Elderly & Anaesthetics care Critical Paediatrics Specialist

SOURCE: Human Resources Team, York Teaching Hospitals NHS Trust 128 WORKFORCE Nursing vacancies at Scarborough General Hospital % (Number of FTEs)

Current nursing establishment1 in Scarborough Filled posts Vacant posts Percentage of vacant and filled FTEs, as at end of July 2018

68 5 2 9 29 26 133 46 79 79 142 Budgeted 5% 7% FTE= 12% 13% (0) (2) 15% 18% (3) (18) 24% (7) (15) (19) 33% (47)

104% 100% 100% (71) 95% 93% (5) (2) 88% 87% (9) (27) 85% 82% (23) (116) 76% (39) (64) (60) 67% (96)

-4%

(-3)

Women’s health Women’s medicine General Radiology Opthalmology Paediatrics Specialist medicine & Anaesthetics care Critical Orthopaedics surgery General Urology & medicine Elderly & Emergency medicine Acute

1 Includes Doctors in Training and Non-consultant Grade Doctors SOURCE: Human Resources Team, York Teaching Hospitals NHS Foundation Trust 129 WORKFORCE Regional workforce for Intensive care, Emergency medicine and General surgery % (No. of FTEs)

Current filled and vacant posts in the Humber Coast and Vale ODN1 Vacant and filled FTEs General Intensive Care Emergency Medicine Surgery Consul- Band 6 Band 5 Consul- tant ACCP Nurse Nurse tant ACCP Consultant

Budgeted 54 12 73 341 49 36 72 FTE= 13% 20% 16% Vacant posts (43) (11) (8)

100% 100% 100% 98% (12) (73) 87% (36) (70) 80% 84% Filled posts (298) (43) (41)

1 Hospitals included within audit: York Hospital, Scarborough Hospital, Scunthorpe Hospital, Grimsby Hospital, Hull Royal Infirmary SOURCE: Data provided to Humber, Coast and Vale operational delivery network Staffing risk audit by HR teams 130 No change in rating relative to benchmark group Summary of staff survey (1/3) Deterioration in rating relative to benchmark group Highest/lowest Trust Average Improvement in rating relative to benchmark group

0 5 2017 relative rating vs Theme Key finding description 0% 100% benchmark group

▪ % of staff appraised in last 12 months 88%

74% 86% 95%

▪ Quality of appraisals Appraisals and 3.11 3.46 development 2.87 3.05

▪ Quality of non-mandatory training, 4.06 learning or development 4.17 3.95 4.00

▪ % of staff experiencing discrimination at work in the last 12 months 10% 22% 7% 10% Equality and diversity ▪ % of staff believing that the organisa- 90% tion provides equal opportunities for career progression/promotion 71% 85% 93%

▪ % of staff witnessing potentially harmful errors, near misses or incidents in last 22% 29% 35% month 29%

▪ % of staff reporting errors, near misses 94% or incidents witnessed in the last month 90% Errors and 80% 91% incidents ▪ Fairness and effectiveness of procedures 3.63 3.73 for reporting errors, near misses and incidents 3.50 3.93

▪ Staff confidence and security in 3.57 3.67 reporting unsafe clinical practice 3.44 3.84

SOURCE: National NHS Staff Survey, 2017 131 No change in rating relative to benchmark group Summary of staff survey (2/3) Deterioration in rating relative to benchmark group Highest/lowest Trust Average Improvement in rating relative to benchmark group 0 5 2017 relative rating vs Theme Key finding description 0% 100% benchmark group

▪ % of staff suffering work related stress in 30% 34% last 12 months 45% 38%

Health and ▪ % of staff feeling pressure in the last 3 47% 51% wellbeing months to attend work when feeling 60% unwell 53%

▪ Organisation and management interest 3.63 3.63 in and action on ▪ health and wellbeing 3.41 3.83

▪ Recognition and value of staff by 3.42 3.44 managers and the organisation 3.27 3.62

▪ % of staff reporting good 29% Managers communication between senior 43% management and staff 22% 33%

3.70 3.76 ▪ Support from immediate managers 3.57 3.99

▪ Staff satisfaction with the quality of 3.83 3.90 work and care they are able to deliver 3.73 4.16

Patient care & ▪ % of staff agreeing that their role makes 89% 93% experience a difference to patients / service users 86% 90%

▪ Effective use of patient / service user 3.69 feedback 3.43 3.53 3.93

SOURCE: National NHS Staff Survey, 2017 132 No change in rating relative to benchmark group Summary of staff survey (3/3) Deterioration in rating relative to benchmark group Highest/lowest Trust Average Improvement in rating relative to benchmark group 0 5 2017 relative rating vs Theme Key finding description 0% 100% benchmark group

▪ % of staff experiencing physical violence 9% 15% from patients, relatives or the pubic in 19% last 12 months 14%

▪ % of staff experiencing physical violence 2% from staff in 4% ▪ last 12 months 2% 1%

▪ % of staff / colleagues reporting most 60% recent experience of violence 59% 82% Violence, 67% harassment, bullying ▪ % of staff experiencing harassment, 19% 26% bullying, abuse from patients, relatives or 33% the pubic in last 12 months 27%

▪ % of staff experiencing harassment, 20% bullying, abuse from staff in last 12 32% months 24% 25%

▪ % of staff / colleagues reporting most 43% recent experience of harassment, bullying 41% 54% or abuse. 47%

▪ % of staff satisfied with the 41% 47% opportunities for flexible working 61% patterns 51% Working patterns ▪ % of staff working extra hours 68% 63% 77% 71%

3.78 Trust overall engagement score (this is a product of three of the findings for job satisfaction) 3.73

SOURCE: National NHS Staff Survey, 2017 133 No change in rating relative to benchmark group

Summary of staff survey 2015-2017 (1/2) Deterioration in rating relative to benchmark group Statistically significant improvement Statistically significant deterioration Improvement in rating relative to benchmark group from previous year from previous year

2017 relative Change to trust rating vs benchmark position in benchmark group, Theme Key finding description 2015 2016 2017 group 2016-17 ▪ Staff recommendation of the 3.70 3.71 3.65 organization as a place to work ▪ or receive treatment

3.92 3.90 3.88 ▪ Staff motivation at work

71% 71% 67% ▪ % of staff able to contribute towards improvements at work Job satisfaction 3.91 3.98 3.89 ▪ Staff satisfaction with level of responsibility and involvement

3.71 3.73 3.70 ▪ Effective team working

3.32 3.34 3.28 ▪ Staff satisfaction with resourcing and support

SOURCE: National NHS Staff Survey, 2017 134 No change in rating relative to benchmark group

Summary of staff survey 2015-2017 (2/2) Deterioration in rating relative to benchmark group Statistically significant improvement Statistically significant deterioration Improvement in rating relative to benchmark group from previous year from previous year

2017 relative Change to trust rating vs benchmark position in benchmark group, Theme Key finding description 2015 2016 2017 group 2016-17

3.42 3.47 3.42 ▪ Recognition and value of staff by managers and the organisation

▪ % of staff reporting good Managers communication between senior management and staff 3.69 3.72 3.70 ▪ Support from immediate managers

▪ % of staff satisfied with the 47% 50% 47% opportunities for flexible working patterns Working patterns 69% 70% 68% ▪ % of staff working extra hours

3.78 3.78 3.73 Trust overall engagement score (this is a product of three of the findings for job satisfaction)

SOURCE: National NHS Staff Survey, 2017 135