Supporting a Struggling Acute Trust Ben Clarke Associate Director / Senate Manager, Northern England Clinical Networks and Senate Dr Robin Mitchell Clinical Director, Northern England Clinical Networks and Senate

Northern England Clinical Senate – advice and support to Southport and Ormskirk Hospital NHS Trust Dr Robin Mitchell Northern England Senate Council Member / Clinical Director – Northern England Clinical Networks Ben Clark Interim Associate Director North England Clinical Networks and Clinical Senate

What we’ll cover in the presentation Background to Southport and Ormskirk Hospital NHS Trust How the Northern England Clinical Senate became involved The format and findings of Phase 1 the work Where we are currently and what does the future hold Lessons learnt

Southport and Ormskirk Hospital NHS Trust Split site trust with one site in Southport and one in Ormskirk (hence the name) One hot-site – Southport - serving a very old population in a building with limited capacity in need of significant capital investment with an Adult ED, emergency surgery but no maternity or paediatric services A second lukewarm site – Ormskirk – serving a very deprived population with a Paediatric ED, no emergency surgery but with consultant-led maternity, neonatal and inpatient paediatric services Has two main commissioners – West Lancashire CCG (within which Ormskirk Hospital sits) and Southport and Formby CCG (within which Southport Hospital Sits) – Southport and Formby share a join management team with neighbouring South Sefton CCG The trust recently lost the contract to provider community services to the CCGs now Lancashire Care NHS Trust provide community services to the patients of Southport and Formby and Virgin provide community services to the patients of West Lancashire

Southport and Ormskirk Hospital NHS Trust

Commissioning arrangements

Where it sits in relation to STPs Cheshire and Merseyside STP Lancashire and South Cumbria STP The trust sits in two STPs that face different directions and the sites are on the margins of both

Lack of stable leadership Nearly two years of managerial turnover and uncertainty

The Care For You programme Programme in place to bring about change Chair (at that point in time) was the Regional Medical Director for NHS Improvement

This wasn’t the first time…. Formal independent review by eminent surgeon Professor Sir Robert Shields in 1999. This report produced the recommendations that led to the configuration of services in place today. Professor Sir Robert Shields recognised that a hot-site, cold-site model was the ideal service configuration for the future, but that consensus couldn’t be reached on which site should be the hot-site and which the cold so the mixed-model introduced instead.

Or the second…. In 2015 Deloitte’s were commissioned to develop a case for change and options appraisal for a sustainable model of care: Commissioners and the provider agreed on the need to go to a hot-site cold site model Commissioners thought that this should be Southport but the provider thought Ormskirk Then leadership at the time had included a substantial number of “red lines” at the onset of the work that meant that the optimum solution would never be considered Nothing happened as a result of this reivew

Or the third… Women and Children’s Vanguard across Cheshire and Merseyside Reviewing potential for services to be organised within three locality groups Implications for provision of services at Southport and Ormskirk S&O clinicians had fed into the Vanguard work but had heard nothing since that input.

Phase 1 – clinical advice to the Trust Board / STP What the Northern England Clinical Senate was asked to support: To provide practical clinical advice to Southport and Ormskirk NHS Hospital Trust in regards to how improvement could be made in the following clinical areas: Emergency Department and Acute Medicine Frail Elderly Maternity Paediatrics Following an initial presentation by the Senate Chair to the Southport and Ormskirk Clinical Leadership Group the scope was expanded to include Emergency Surgery Whilst the work progressed the scope expanded again to include Elective Surgery

Clinical support for the work 15 Clinicians over a rolling programme from 7th – 9th December 2017

Recommendations made by the Senate Panel The advice and recommendations of the Senate were provided to the Trust in December 2017. Advice on issues that could be addressed in the short-term / without the need for service reconfigurations centred around: Improving flow for acute medical patients through Southport Hospital supported by a coherent Urgent Care strategy agreed and owned by commissioners and providers Improving emergency surgery facilities in Southport counter-balanced by modernising practice and increased usage of Ormskirk for day case surgery. Developing an over-arching plan for the implementation of the Frail Elderly Pathway Advice was also given on the determination of the future configuration of services within Southport and Ormskirk (retaining the current service offer) A revised version of the report was provide to the Trust Board in January 2018 when the provider and STP Chair asked for additional comment on what further changes may need to be considered for the long-term sustainability of the provider (which were out-of-scope of the original Terms of Reference).

Facing the future New permanent chief executive in post and recruitment to other executive posts to start soon Many improvements put in place or due to start in the very near future Cheshire and Merseyside STP have put in place a support offer to Southport and Ormskirk as one of their priority pieces of work

Recommendations for improvements in the short-term

Supporting development for the medium-term

What did we learn from this piece of work The issues in Southport and Ormskirk are systemic, organisational, cultural and technical in nature Clinicians and other health and care professionals can pay the price for the “turmoil of planning” that fragmented systems and un-tackled issues can cause Incredibly positive response from the clinicians in Southport and Ormskirk for both the findings of the report and for the “critical friend” role taken during the first phase of the work Clinicians left the Cumbria, the North East and Yorkshire (for free) to provide this support toe S&O because they wanted to help. Many recognised the situation the S&O clinicians found themselves in and were able to offer practical and appropriate advice for improving things in the short-term. The Senate were able to provide the Clinical route-map to improvement – something the local clinicians can believe in and get behind Who else would have been able to provide this support?