AGENDA ITEM 7
BOROUGH OF POOLE
HEALTH SCRUTINY COMMITTEE
17 APRIL 2007
BRIEFING PAPER ON THE PROVISION OF A PAN DORSET SPINAL SERVICE IN DORSET
1. INTRODUCTION
1.1 This paper sets out the opportunities to improve access to spinal services for patients in Bournemouth and Poole through expanding the existing services available in West Dorset and providing more local services in East Dorset. Bournemouth and Poole PCT has been working with colleagues in Dorset PCT who are leading on the commissioning of services from West Dorset General Hospital NHS Trust (WDGH). There is an existing spinal services infrastructure already in place at WDGH, under Mr Hilton, that can be used to provide safe and cost effective services to meet local needs.
1.2 Dorset and Bournemouth and Primary Care Trusts have now agreed to an additional £1m investment to provide additional local services for patients. This development has been welcomed by local patients including the East Dorset Arthritis and Musculoskeletal Alliance (a consultation group with patient and provider representatives).
2. BACKGROUND
2.1 Back pain places an enormous burden on society in terms of health, social and economic costs. It can cause acute and chronic pain as well as in some cases associated long- term disability. The management of back pain and provision of high quality cost effective care is a priority for the NHS.
2.2 Bournemouth and Poole patients have always had to travel outside the area, many as far as London, for specialist spinal surgery. However, some routine spinal treatments were previously available locally, provided by an orthopaedic surgeon, with a special interest, Mr John Dinley. Since his retirement a few years ago, the options available for patients have been more restricted.
2.3 Development of a Pan Dorset Spinal Service will enable patients to once again access expert local care. The new service will provide choice and convenience for patients and shorten waiting times for treatment, providing both surgical and emergency care which meets the demands of local people. This is in line with the principles of commissioning a patient led NHS, care closer to home and the 18 weeks referral to treatment programme.
2.4 It is anticipated that a new service will:
improve outcomes of care, reduce back pain and associated disability, lessen the health, social and economic cost, improve patient safety, quality, access and choice,
1 provide local surgical treatments, provide quality early intervention for patients admitted following trauma
3. LOCAL NEED
3.1 In 2005/06 over 500 surgical spinal procedures were commissioned and provided for Dorset residents, around 50% of this for patients living in the Bournemouth and Poole conurbation. In addition, around 200 patients are admitted to Poole hospital each year for spinal trauma care. Although these numbers are not high clinical care requirements are often complex and as such the costs are high if care is managed out of area.
4. SERVICE OPTION APPRAISAL
4.1 In 2005 Dr Susan Turnbull (previous Director of Public Health) completed a full service option appraisal. The outcome of this was to identify a preferred model for a pan Dorset service. This is based on a team of Spinal surgeons providing a Dorset centre of excellence for spinal care with outpatient services and trauma care in East Dorset based in Poole. If no new service is developed patients will have to continue to travel out of area for their care reducing patient access, convenience, choice and potentially impacting on patient outcomes. Out of area or a stand-alone Bournemouth and Poole service would increase cost and reduce efficiency. The pan-Dorset model improves patient access, choice, and convenience. It also enables service integration, quality control, as well as efficiency gains and reduced costs to be realised. Most importantly, a pan Dorset model improves clinical governance by creating a team of spinal surgeons avoiding isolated clinical working.
5. OBJECTIVES OF A NEW SERVICE
5.1 The objectives of a new service is to:
allow patients who require hospital based spinal services to be treated locally improve access times for spinal surgical services provide robust governance arrangements to ensure quality of care make the most efficient use of scarce specialist skills and resources make further investment to meet local need and build local capacity provide a high quality service for patients requiring surgery provide local and responsive trauma care ensure effective clinical outcomes and high levels of patient satisfaction as part of a network refer patients to a tertiary centre for specialist spinal surgical services
6. DESCRIPTION OF SERVICE
6.1 West Dorset General Hospitals Trust has been commissioned by Bournemouth and Poole and Dorset Primary Care Trusts to provide a pan-Dorset service based at Dorset County Hospital. The service includes clinics and ward based care for patients in Poole and Bournemouth. This will enable patients currently treated out of area to be repatriated to a local spinal services centre to be based at Dorchester and for outpatients to be seen at Poole and Bournemouth. Inpatients at Poole will also receive a trauma service with spinal ward-based assessment and treatment. Patients will continue to have a choice of where they receive their care but this choice will be local
2 and more responsive to local need. Links between service providers will be maintained to ensure service standards and continuity of care.
6.2 Elective surgery will be undertaken at Dorset County hospital with patient choice of follow-up clinics at Dorset, Poole and Bournemouth. Simple trauma care will be undertaken at Poole and Dorchester. In order to improve current care for patients admitted following trauma to Poole hospital, regular spinal ward rounds will be undertaken at Poole as well as at Dorchester.
6.3 Patients will be treated as individuals and receive appropriate and timely packages of care. Care will be co-ordinated between providers and enable patients to play an active role in their care. A care pathway model will be used with referral to spinal surgery via rheumatology in East Dorset, to ensure appropriate treatment is commenced at the right stage and that care is integrated and responsive to need.
6.4 Patients requiring more specialised treatments, including complex and congenital conditions, paediatric spinal care or neuro-surgery, will continue to benefit from the services provided at Southampton University Hospitals Trust.
6.5 Service standards will be adopted to ensure patients hospital stay is optimised with trauma patients receiving an opinion within 1 day and all patients seen within 3 days of admission. Care pathways will be designed around the needs of patients with staff training and audit to optimise outcomes. This will reduce the risk of adverse incidents and hospital acquired infection. Care will be based on best practice guidance respecting individual choice and providing equity of access for all patients. Continuous review and improvements will be made based on clinical outcomes, patient feedback and national benchmarking for quality standards.
7. BENEFITS FOR PATIENTS
7.1. The most important benefit associated with the new service is that patients will be able to access a range of spinal treatments locally, without having to travel outside Dorset.
7.2. The new service will ensure a consistent approach to service provision in Dorset. Patients will be cared for by an integrated team, rather than by a range of providers across a wide geographical patch. A local Dorset service will increase service provision, lead to shorter waiting times and reduce unnecessary transfers between hospitals.
7.3. Spinal Consultant led ward rounds will take place at Poole Hospital, so that patients admitted there for trauma care or conservative treatment will receive speedy access to an expert opinion, which is not currently available. Patients will also be able to receive expert assessment and treatment through the provision of an outpatient service at Bournemouth and Poole. With a dedicated centre of excellence for spinal surgery in Dorset there is an opportunity to increase the range of procedures carried out to reduce the need for patients to travel to tertiary centres. This local service can also support the establishment of local resources for training and development of the health and social care workforce.
7.4. Local spinal services will enable more timely access to care ensuring patients have their back pain dealt with to enable them to return to work and home life as quickly as
3 possible. Providing simple trauma care, outpatient and diagnostic services in the east of Dorset, will mean that the majority of care can be provided closer to home.
8. CONCLUSIONS
8.1. The Pan-Dorset spinal services model has the support of hospital providers across Dorset and is the model of choice for Bournemouth and Poole. Commissioners are confident that this model will significantly enhance the health and well-being of the local population with spinal problems and make the most efficient use of specialist skills and resources.
8.2. A local Spinal Services centre providing clinical support for patients in Bournemouth and Poole ensures access and choice for patients as well as the highest possible standards and clinical outcomes of care.
8.3. The proposed service will meet the predicted demand for the whole of Dorset for adult non-complex spinal surgical care for both surgery and emergency care.
9. RECOMMENDATIONS
9.1. Members are asked to support the development of:
an integrated pan-Dorset spinal service a local specialist centre which builds on the current provision an additional Consultant led service to support patient care across Bournemouth and Poole working closely with local hospitals and primary care services
Robert Payne Elective and Diagnostics Commissioning Manager Bournemouth and Poole Primary Care Trust
April 2007
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