Case study: Lessons learned from the commissioning of a clinical review Professor Ashley Dennison East Midlands Clinical Senate Chair October 2018

Introduction 2 Background Lincolnshire is a large, rural county, the fourth largest in England with an aged and aging population Lincolnshire has the fourth most dispersed population which together with the geography results in challenges, particularly travel times and equity of access Rural deprivation is particularly prevalent on the edge of the county from the East coast The system described its own position as “challenging” specifically around quality, staffing, and finances Lincolnshire is a system of concern nationally at a ministerial level and ULHT is in special measures for quality for a second time Recruitment which has been a ubiquitous and significant long-term challenge for the Trust in all areas and a number of disciplines becomes even more acute towards the periphery of the county 2

Chronology Clinical Senate originally approached on 17th April 2018 by NHS England to conduct an independent Clinical Review of the United Lincolnshire Hospitals (ULHT) options for reconfiguring paediatrics services at short notice on the grounds of patient safety Extensive panel convened at relatively short notice for 21st May 2018 Pre-panel teleconference call on 14th May. Panel members would require evidence to demonstrate why the preferred option was to keep the service as it is currently configured, as the Trust’s own evidence suggested that it was not clinically sound (safe or sustainable) Decision taken to reschedule panel (NHS England asked if it could be before end of May) Panel reconvened for 20th June 2018 Panel stepped down by NHS England and NHS Improvement “as the Trust successfully recruited to its Middle Grade and Consultant rotas during the previous 2-3 weeks […] given the forthcoming review of Children’s and Young Person’s services by the Royal College of Paediatricians” Clinical Senate engaged by STP on 1st June to review the totality of the changes proposed including Women’s and Children’s Services (Panel held on 11th July 2018) 3

Conclusion Women’s and Children’s Services was the only proposal where it appeared that geography had been allowed to overrule quality and staffing Panel not assured that some of the solutions proposed will solve Lincolnshire’s challenges Panel concluded that it did not have sufficient data and supporting evidence to comment definitively, particularly given the workforce challenges for the STP to safely and sustainably operate two specialist units The panel were of the opinion that further work needs to be completed for: Urology, Grantham Hospital and Women’s and Children’s STP re-engaged Clinical Senate 20th July 2018 Supplementary clinical review panel held on 12th September 2018 to enable the clinical senate to offer a more definitive clinical opinion on the medical beds at Grantham Hospital and Women’s and Children’s Services 4