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"Excellence As Standard" Configuring Services to Achieve the Best Patient Treatment and Care

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A "EXCELLENCE AS STANDARD" CONFIGURING SERVICES TO ACHIEVE THE BEST PATIENT TREATMENT AND CARE Briefing for the South Yorkshire Health Scrutiny Meeting on 18 March 2010 and Sheffield City Council Health and Community Care Scrutiny Board Meeting on 19 April 2010 A: INTRODUCTION This paper has been prepared to facilitate a discussion in the form of a brief presentation followed by a question and answer session for approximately one hour. Mike Richmond, Medical Director and Chris Linacre, Director of Service Development will be present from the Trust. For both meetings officers of Sheffield Primary Care Trust and possibly the North Trent Specialised Services Commissioning Group will be present. We suggest that the focus of the meeting on 18 March 2010 should be those proposed changes that involve the services delivered by the Trust to the whole North Trent area which are Gastro-Intestinal Surgery, services for heart attacks and other acute Cardiology services, Plastic surgery and elements of Spinal surgery. These are explained below. The other proposals are more associated with the services provided by the Trust to those who live in or close to Sheffield and therefore rely on the acute and emergency services and should therefore be discussed in more detail at the meeting on 19 April. B: BACKGROUND The Trust (STHFT) was formed in 2001 following a merger of the former Central Sheffield University Hospitals and Northern General Hospital NHS Trusts. This followed a major exercise running through the 1990's when the Sheffield Health Authority, with the co- operation of the two Trusts re-aligned many of the clinical services provided in the city in order to achieve optimal patient care and make best use of resources and facilities. Merger saw the Royal Hallamshire (RHH), Weston Park (WPH), Charles Clifford Dental (CCDH), Jessop Maternity Wing (JW) and Northern General (NGH) Hospitals brought under a single NHS Trust and in 2004 a NHS Foundation Trust. As part of this exercise the former Lodge Moor, Nether Edge Hospitals and old Jessop Hospital for Women were closed. At the end of that process of service realignment there was en element related to the main acute services left unfinished, principally General Medicine and General Surgery. This reflected the major change that had taken place but preserved both direct emergency medical and surgical admissions on both sites following the move to a single A&E department at NGH. This has held constant from 1997 but there is a number of new drivers for change in the NHS that have caused the Trust to propose some further, relatively small changes, that will finalise the exercise. We believe that the time is now right to complete the 1 VERSION : 5 March 10 alignment to further improve the quality and safety of patient care in the Trust and to respond positively to new national initiatives to introduce "gold standards" of care for heart (cardiac), brain (stroke) and emergency care. In addition the role of the Trust as the Cancer Centre for North Trent which includes the whole of South Yorkshire, Bassetlaw and North East Derbyshire has resulted in many specialist cancer services being located in Sheffield and the proposed alignment exercise will, we believe, further improve those services involved. The subject of major trauma is being addressed by the Yorkshire and Humber Strategic Health Authority but is not a part of these proposals. The proposals under discussion are based on: 1. A clear commitment to retain all clinical services currently available to the public of Sheffield and other areas in North Trent (Doncaster, Rotherham, Barnsley, Chesterfield, Worksop). Indeed the options under discussion seek to give the opportunity to develop appropriate services but in the right place and with the right supporting services/facilities for the very best patient care. 2. Retaining both current hospital complexes, Central Campus including the RHH, WPH, CCDH, JW and the Northern Campus represented by the NGH. The majority of other services will not change and will be considered only in terms of how the impact of the proposed changes would affect them. 3. One decision has been made at this point which is the future of Acute Cardiology services caused by our meeting the requirements of the national strategy for heart attacks. This has seen the phased introduction of a centralised provision of Primary Angioplasty or Primary PCI from the Chesterman Wing at the NGH for the populations of Sheffield, Rotherham, Barnsley, Doncaster, Bassetlaw and shortly Chesterfield. 4. The model for a high standard of Stroke Care has also been finalised and the proposed location for the Acute Service in Sheffield will be the RHH. Currently Stroke care is also provided from the NGH but the national strategy requires acute service provision from a single location. Both these services have been the subject of national and local consultation although the final location of the Stroke service is a part of these proposals. 5. The remaining components of these proposals have been put forward following comprehensive clinical input from staff of Sheffield Teaching Hospitals NHS Foundation Trust (STHFT), consultation with Trust Governors and briefing of Primary Care Trust Commissioners. Further planned consultation will include groups representative of service users and with staff. The proposals are the subject of continuing detailed analysis and for that reason and for the reason of wishing to take account of consultation, are not finalised. This paper sets out in summary form the reasons for proposing the reconfiguration (alignment) of services and the benefits and risks that we see arising from it. This complex and interdependent series of changes have been shared with the Trust’s Governors who have been supportive of the work done to date. The history and current service configuration is covered briefly below but can be explained further at the meetings. C: RATIONALE FOR CHANGE • To provide "optimal patient centred care" taking into account "best practice", clinical guidance and patient experience. • To ensure that the provision of care will be as safe as possible. 2 VERSION : 5 March 10 • Having determined the structure to deliver optimal patient care we need to ensure it is delivered in the most efficient and cost effective way. • To ensure that services are as accessible as possible consistent with safety and sustainability. D: DRIVERS FOR CHANGE • The review by Lord Darzi which introduced "gold standard" care for those suffering a heart attack or stroke. • Safest arrangements for major surgery. • Minimising the impact of the European Working Time Directive (since August 2009 doctors can only work a maximum of 48hrs per week) which can be challenging when providing medical staff for two sites admitting direct emergency care and the duplication of other supporting services that make this possible. • Ensuring maximum efficiency from our operating theatres to ensure we can meet the growing demand for elective surgery without compromising access by urgent or emergency surgery. • Ensuring the most efficient use of our beds to provide "the right care in the right place by the right specialist first time". • Ensuring that the balance of activity between elective (planned) activity and emergency unplanned activity is maintained in such a way that we can cope with high emergency demands without causing detriment to planned operations or care which will limit as far as possible the cancellation of operations. • Meeting the need for additional Intermediate and continuing health and social care. Not only could discharge be more effective with appropriate capacity for these patients, we believe that many admissions could be avoided if these services are designed with an enhanced clinical capability. • Responding to the anticipated slowing of growth in NHS resources which will require greater efficiencies to maintain existing services delivered at the same high standard. E: EXISTING CONFIGURATION OF SERVICES The service alignment referred to in the introduction that started in the mid 1990’s has resulted in the following distribution: Central Campus • Maternity and Women's services - Jessop Wing • Head & Neck services (ENT, Ophthalmology, Neuro-services, Oral and Maxillo- Facial surgery) - RHH • Breast services - RHH • Upper Gastro Intestinal surgery - RHH • Haematology - RHH • Urology - RHH 3 VERSION : 5 March 10 • Dermatology - RHH • Infectious Diseases and Tropical medicine - RHH • Clinical and Laboratory Haematology - RHH • Oncology/Radiotherapy - WPH • Dental - CCDH Northern Campus • A&E - NGH • Cardiology and Cardio-thoracic surgery - specialist unit (Chesterman) at the NGH • Spinal Injuries - specialist unit at the NGH • Vascular surgery - NGH • Orthopaedics - NGH • Metabolic bone services - NGH • Acute and End Stage Renal services - NGH • Lower Gastro Intestinal (Colorectal) surgery – NGH Both Campuses • Acute and General Surgery - RHH and NGH • Acute General Medicine - NGH and RHH • General Critical Care - NGH and RHH including a new state of the art £23m Critical Care Unit at the NGH • Laboratory and Clinical Imaging services - RHH, NGH, WPH F: THE CHANGES THAT ARE PROPOSED Very few of the service described above are involved directly with these proposals but we are careful to be aware of and deal with the impact that the changes may have on all services. For this reason the Programme Board membership is drawn from all the major services, and also includes Patient Governors. The services directly affected are set out below and
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