Matt Brown, Director of Operations 6th April 2018 Path to Excellence Matt Brown, Director of Operations 6th April 2018

Hospital Services (Maternity, Paediatrics, Stroke)

Background Workforce sustainability Safety and quality Critical need for decision, given fragility of services

Workforce Gaps Service Workforce gaps Obstetrics and Gynaecology Significant senior doctor gaps, with a third of obstetrics units across the country considering reconfiguration within the next 3 years. Across STDH and SRH, there are 17 funded middle grade posts established, but only 10.5 posts filled. Unsustainable use of consultants ‘acting down’ and expensive locum doctors. Paediatrics Similar problems nationally to those of O&G. STDH currently has only 2 suitably qualified medical staff working on to the middle grade rota. Royal College guidance recommends each training grade rota should have a minimum of 10. Acute nursing workforce pressures in SCBU at STDH. Stroke Nationally 40% of consultant vacancies unfilled. STDH has only 1 permanent part time consultant. National guidance outlines the need for a minimum of 2 full time consultants for day time work (assumes out of hours is covered by networking arrangements). Ongoing recruitment effort at STDH since 2014.

Decisions Obstetrics and gynaecology services Paediatrics services Free-standing midwifery-led unit (FMLU) at South Tyneside District Hospital (STDH) and medically-led obstetric unit at Sunderland Royal Hospital (SRH) April 2019 Paediatrics services Nurse-led paediatric minor injury and illness facility at STDH and 24/7 paediatric emergency department (PED) at SRH April 2021 However, daytime PED at STDH and 24/7 PED at SRH as transitionary step, aiming for April 2019 Stroke services All acute strokes and inpatient stroke care at SRH

Stroke (since December 2016) Indicator Performance prior to the temporary change Most recent published data (Apr-Jul 2017) Patients receiving a CT scan within 1 hour 34% 51% Thrombolysis rate within 1 hour 0% 64% Patients who go direct to a stroke unit < 4 hours 18% Patients who spend > 90% of their inpatient stay on a stroke unit 53% 95%

Next steps – a broader discussion

Questions