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Closure of Belhaven Hospital Minor Injuries Unit RIA Jul 12

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Closure of Belhaven Hospital Minor Injuries Unit RIA Jul 12 Audit Risk Level: High Rapid Impact Assessment summary report Each of the numbered sections below must be completed 1. Title of plan, policy or strategy being assessed. Closure of Minor Injuries Service, Belhaven Hospital, Dunbar 2. What will change as a result of this proposal? A recommendation will be made to East Lothian CHP sub committee to decommission the minor injuries service at Belhaven Hospital based on clinical governance and safety considerations. 3. Briefly describe public involvement in this proposal Through a series of meetings over several months, the Belhaven Hospital Forum, a constituency of local politicians, wide ranging community stakeholders, patients, health and social care representatives and clinicians have been involved in the planning and evolution of the proposal and have contributed thoughts and views which have been fundamental in shaping the recommendations. 4. Date of RIA 24 th July 2012 5. Who was present at the RIA? Identify facilitator and any partnership representative present Name Job Title Date of RIA Email training Carol Transformation [email protected] Lumsden and Integration Manager (Facilitator) [email protected] Thomas Partnership Miller Lead, East & Midlothian CHP [email protected] Sandra Glass Charge Nurse, Belhaven Hospital Gillian Wilson Public Partnership Forum, East Lothian CHP Steven Dunbar Bunyan Community Council 1 6. Population groups considered Potential differential impacts minority ethnic people (incl. No differential impact gypsy/travellers, refugees & asylum seekers) women, men and transgender people No differential impact people in religious/faith groups No differential impact disabled people Whilst no differential impact was noted, it was equally recognised that current disabled access to the service (situated in an open ward) is challenging and would require significant upgrading should the service be continued older people, children and young people On data analysis, no particular age group are predominant users of the current service lesbian, gay and bisexual people No differential impact people of low income Access to the current service at Belhaven Hospital is challenging via public transport and as such potentially difficult for people of low income. Decommissioning the service could potentially require travelling further to access care, although in reality “minor injury” does not, by definition, require immediate care and therefore local access through GP surgeries or similar would be readily available as is extant. people with mental health problems No differential impact homeless people No differential impact people involved in criminal justice system No differential impact people with low literacy/numeracy levels No differential impact staff No differential impact carers If the service is decommissioned, immediate access to minor injury treatment (noting the definition of minor injury) will be removed and could require travelling a few extra miles to the nearest unit at Roodlands Hospital thereby potentially affecting carer strain. There is no data to support analysis of numbers affected in this way. However, overall numbers in terms of activity are low and decreasing significantly, emergency access to treatment is always available through LUCS, and next day minor injury services are available through local GP surgeries thereby mitigating any risk. Other groups (please specify) N/A 2 7. What positive impacts were identified and which groups will they affect? Impacts Affected populations Decommissioning the service will allow the physical Staff environment in the relevant ward to improve, enhancing infection control policy implementation as well as minimising clinical risk. 8. What negative impacts were identified and which groups will they affect? Impacts Affected populations Decommissioning the minor injuries service will All people in Dunbar and necessitate the local population either travelling a few surrounds who experience miles further to access care (at Roodlands or Edington a minor injury Hospitals) or waiting until GP surgeries or community pharmacies are open (if closed at time of injury or on seeking advice). Minor injury units are, by definition, for less serious injuries or conditions that do not require immediate treatment. 9. Evidence available at the time of the RIA Evidence Available ? Comments Data on populations in need Yes A full data analysis on activity at the minor injuries unit over a period of 3 years has been undertaken. This includes age and sex as well as postcode of individual. Data on service Yes A full data analysis on activity at the uptake/access minor injuries unit over a period of 3 years has been undertaken. This includes (clinical) reason for presentation and time of presentation Data on quality/outcomes Yes A full data analysis on activity at the minor injuries unit over a period of 3 years has been undertaken. This includes clinical treatment provided and appropriate signposting or other outcome Research/literature Yes evidence Patient experience information Consultation and Yes The Belhaven Forum, with wide ranging involvement findings community representation, have been fully involved in all discussions through a series of meetings over a number of months. The agreement of this Forum to decommission the service has been 3 formally minuted Good practice guidelines Yes Other (please specify) 10. Additional Information and Evidence Required N/A 11. What communications needs were identified? How will they be addressed? The need to ensure effective communication with the local population in advance of decommissioning the service was noted. The Belhaven Forum meeting scheduled for 27 th August will consider and agree the appropriate and proportionate nature and detail of this. This forum has comprehensive local representation. 12. Recommendations Whilst the key risks to the population of Dunbar and surrounds lie in the potential removal of access to a very local minor injuries unit, this can be mitigated in a number of ways. The GP led enhanced service for minor injuries is provided 8am – 6pm Monday to Friday by local practices, Edington Hospital at North Berwick provides a 24 hour nurse led minor injury service with high activity levels, and Lothian Unscheduled Care Service (LUCS) provide a GP and extended nurse practitioner service via referral at Roodlands Hospital between 6pm and midnight every day; after midnight this transfers to Edinburgh. Each of these provide a point of access to care between Dunbar and the A&E department in Edinburgh. NHS 24 and NHS Inform provide easily accessible patient advice and information on minor injuries and ailments round the clock, and community pharmacies provide a universal minor ailments service with access to medicines as an integral part of their contract. Through these services any risks or negative impact will be minimised. The positive impacts of enhanced clinical safety are widely accepted 13. Specific to this RIA only, what actions have been, or will be, undertaken and by when? Please complete: Specific actions (as a result Who will take them Deadline for Review date of the RIA) forward (name and progressing contact details) The results of the RIA, David Small, 30 th August If along with a supporting General Manager, 2012 decommissioning paper, will be submitted to East and the MIU service East Lothian CHP sub Midlothian CHP is agreed a committee for consideration. review will be undertaken after 1 year. 4 14. How will you monitor how this policy, plan or strategy affects different groups? A review of the policy will be undertaken in conjunction with the Belhaven Hospital Forum after 1 year. 15. Who will be consulted about the findings of this impact assessment? The findings of the RIA will be shared and discussed with East Lothian CHP sub committee and the Belhaven Hospital Forum. The need to decommission the service is predicated fully on minimising clinical risk and this is an over riding consideration. However, it is also widely accepted that any potential risks in stopping the service will be mitigated by a range of safe alternatives already in place. Manager’s Name: Carol Lumsden Date: 30 th July 2012 Please send a completed copy of the summary report to: James Glover, Head of Equality and Diversity [email protected] Note that you will be contacted by a member of NHS Lothian’s impact assessment group for quality control and/or monitoring purposes. 5 .
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