Hospital Services Review: Report for Governing Bodies Hospital Services Review South Yorkshire, Bassetlaw and North Derbyshire: Considering the case for change Report for Governing Bodies1 June 2019 Hospital Services Review: Report for Governing Bodies Contents 1 Executive Summary................................................................................................ 5 1.1 Introduction ...................................................................................................... 5 1.2 Background ...................................................................................................... 5 1.3 Summary of the Case for Change ........................................................................ 6 1.4 Proposed models ............................................................................................... 7 1.5 Analysis and conclusions .................................................................................... 7 1.6 Decision for Governing Bodies ........................................................................... 10 1.7 Next steps ...................................................................................................... 10 2 Background .......................................................................................................... 13 2.1 The Hospital Services Review (HSR) Process ....................................................... 13 3 The case for change: across all services ............................................................... 15 3.1 Challenges in the NHS at national level .............................................................. 15 3.2 Challenges identified within South Yorkshire and Bassetlaw .................................. 16 3.3 Public engagement on the challenges ................................................................. 16 4 The Case for Change: Care of the Acutely Ill Child ............................................... 18 4.1 Findings in the original HSR case for change ....................................................... 18 4.2 National paediatrics workforce challenges ........................................................... 18 4.3 Public views on paediatrics ............................................................................... 18 4.4 Metrics used to assess performance ................................................................... 19 4.5 The picture in SYB(ND) currently ....................................................................... 20 4.6 Future demand for Care of the Acutely Ill Child services ....................................... 23 5 The Case for Change: Maternity ........................................................................... 27 5.1 Findings in the original HSR case for change ....................................................... 27 5.2 National maternity workforce challenges ............................................................ 27 5.3 Public views on the Case for Change .................................................................. 27 5.4 Metrics used to assess performance ................................................................... 27 5.5 The picture in SYB(ND) currently ....................................................................... 29 5.6 Future growth in Maternity services ................................................................... 31 6 The Case for Change: Gastroenterology and Endoscopy ....................................... 34 6.1 Findings in the original HSR case for change ....................................................... 34 6.2 National gastroenterology workforce challenges .................................................. 34 6.3 Feedback from public engagement .................................................................... 34 6.4 Metrics used to assess performance ................................................................... 35 6.5 The picture in SYB(ND) currently ....................................................................... 36 6.6 Future demand for Gastroenterology services ..................................................... 38 7 The Case for Change: Summary of pressures on individual sites .......................... 39 7.1 Barnsley Hospital NHS Foundation Trust ............................................................. 39 7.2 Chesterfield Royal Hospital Trust ....................................................................... 39 7.3 Doncaster Royal Infirmary ................................................................................ 40 7.4 Bassetlaw District General Hospital .................................................................... 40 7.5 Rotherham NHS Foundation Trust ...................................................................... 40 7.6 Sheffield Children’s Hospital NHS Foundation Trust .............................................. 40 7.7 Sheffield Teaching Hospital NHS Foundation Trust ............................................... 41 2 Hospital Services Review: Report for Governing Bodies 8 CAIC and Maternity: the opportunities for change ............................................... 43 8.1 Evaluation criteria ........................................................................................... 43 9 CAIC and Maternity: Transformation .................................................................... 45 9.1 Building the infrastructure to support transformation ........................................... 45 9.2 Identifying areas for focus for transformation ..................................................... 45 9.3 How likely is transformation to address the challenges? ....................................... 47 10 CAIC and Maternity: Reconfiguring Services ........................................................ 48 10.1 Models that the Hospital Services programme has considered ............................... 48 10.2 Changing Inpatient Paediatric Units on 1 or 2 sites .............................................. 48 10.3 Changing inpatient paediatrics services and obstetric services on 1 or 2 sites ......... 50 11 The advantages and disadvantages of making changes to paediatrics ................. 52 11.1 Quality and safety ........................................................................................... 52 11.2 Workforce....................................................................................................... 53 11.3 Affordability .................................................................................................... 58 11.4 Access ........................................................................................................... 59 11.5 Interdependencies ........................................................................................... 62 11.6 Summary ....................................................................................................... 63 12 The advantages and disadvantages of making changes to obstetrics ................... 64 12.1 Quality and safety ........................................................................................... 64 12.2 Workforce....................................................................................................... 64 12.3 Affordability .................................................................................................... 65 12.4 Access ........................................................................................................... 66 12.5 Interdependencies ........................................................................................... 67 12.6 Summary ....................................................................................................... 67 13 Gastroenterology and Endoscopy: the opportunities for change .......................... 68 13.1 Elective Endoscopy .......................................................................................... 68 13.2 General Medical Gastroenterology ..................................................................... 68 13.3 Out of hours GI Bleeds ..................................................................................... 69 14 Equalities implications ......................................................................................... 73 14.1 Engagement with the seldom heard groups ........................................................ 73 14.2 Implications for different equalities groups ......................................................... 73 15 Monitoring and early warning signals .................................................................. 75 15.1 Objectives of monitoring .................................................................................. 75 15.2 Context .......................................................................................................... 75 15.3 Current monitoring .......................................................................................... 75 15.4 Developing the current approach into monitoring ................................................ 76 16 Conclusions .......................................................................................................... 79 16.1 Decision for Governing Bodies ........................................................................... 79 17 Next steps ............................................................................................................ 80 17.1 Overview ........................................................................................................ 80 17.2 Agreement of this paper