Dorset CCG Clinical Services Review February 2015

Why are we doing Clinical Services Review in Dorset? NHS Dorset Clinical Commissioning Group (CCG) wants to ensure that everybody in Dorset has access to healthcare that is: SAFE HIGH QUALITY SUSTAINABLE

How is the review being delivered? The different stages of our review Autumn 2015 - 2017 October 2014 – Spring 2015 Summer 2015 Autumn 2015 Review Analyse Design Formal public consultation Implementation CCG Decision Making We are currently discussing potential options for new ways of delivering care to meet changing needs. No decisions have yet been made.

Review, analyse and design stage 1 2 3 4 5 6 What are people’s needs? How are the services currently provided? What services and models of care can best meet the needs? What are the potential service configuration options? What are the potential organisational solutions? Develop future options & pre-consultation business case Quantify and describe patient needs over the next 10 years Engage the public to gather opinions Assess current clinical quality and performance of all services – primary, community & acute care Develop a commissioner & provider financial baseline Work with key stakeholders to develop and agree a view on the services and clinical models (acute & out of hospital) which will best serve the evolving needs of the population Identify & evaluate a set of potential service configuration options Identify the full range of prospective providers for the proposed service configuration for Dorset Set out clear proposal for the future Engage stakeholders 7

How is this first stage being delivered? 19/11/14 17/12/14 21/01/15 25/02/15 18/03/15 Case for change and best practice Emerging clinical models Service options Preferred options Clinical Reference Group Clinical Reference Group Clinical Reference Group Assurance Assurance Assurance Agree options to consult on Clinical data input Clinical Working Groups Clinical Working Groups Clinical Working Groups Clinical Working Groups Locality Clusters x 3 Locality Clusters x 3 Locality Clusters x 3 Stakeholders/partners Stakeholders/partners Stakeholders/partners Public Patient Engagement Public Patient Engagement Public Patient Engagement CCG Staff Engagement CCG Staff Engagement CCG Staff Engagement

Completed activity The case for change in Dorset Identifying what ‘good’ looks like Core principles and themes informing models of care Key enablers in delivering emerging models of care

The case for change in Dorset Growing elderly population with changing health needs Variable quality of out of hospital care with patients reporting difficulty accessing care Variable quality of hospital based care, particularly for some more specialist services Difficulty staffing services, particularly some specialist services requiring consultants on site 24x7 Growing financial challenge with a projected deficit of around £200m by 2020/21 1 2 3 4 5

Clinicians have set out what good health care for Dorset looks like in key service areas

Summary of core principles and themes across Clinical Working Groups informing models of care Greater focus on prevention and early targeting More clinical management of patients in the community Collaborative working across primary, secondary and social care More and better use of multi-disciplinary teams 24/7 services where required Meeting national guidance on speciality services More effective senior level assessment and signposting to services

Key enablers in delivering emerging models of care Integrated information systems Contracts, regulation and tariffs to align incentives across the health economy Improved performance management Better structure for segmenting the population’s need for health services based on their risk factors (risk stratification) Patient education and information sharing

Current and ongoing activity Summary of emerging models for out of acute hospital care Developing potential options for out of acute hospital models of care across Dorset Summary of emerging models for acute hospital care Developing potential options for acute hospital based services across Dorset

Different types of hospital based service models Green hospital services Yellow hospital services Purple hospital services Hospital with an A&E/ urgent/emergency/Minor Injury Unit department with consultant presence Able to admit patients for acute assessment and treatment Level 3 critical care High risk obstetrics 24x7 Inpatient paediatrics 24x7 Consultant delivered hyperacute & specialist services 24x7 Complex low volume elective care Outpatient services Full range of diagnostic support including interventional radiology 24x7 Hospital with an A&E/ urgent/emergency/Minor Injury Unit department with consultant presence Able to admit patients for acute assessment and treatment Critical care Consultant delivered service for some/most of the day but not necessarily 24x7 Outpatient services Full range of diagnostic support Maternity & Paediatrics Clinical Workng Group: Could include obstetric unit – need to consider a range of models with appropriate consultant cover alongside midwifery (and SCBU/neo natal support) Could include paediatric services – might be paediatric assessment unit or inpatient paediatrics Will need anaesthetic cover Elective paediatrics should be co-located with emergency services Hospital with an urgent/emergency/Minor Injury Unit department Able to admit patients for acute assessment and treatment Outpatient services Diagnostic support Maternity & Paediatrics Clinical Working Group: Potential to provide assessment for children – possibly 16 hour unit Will need mental health services Consider midwife led unit Potential to be a community hub for midwife, health visitors, GP, paediatric teams , secondary acute and community and mental health etc PLUS …… Mental health services Routine Elective Services Primary care, community care services, social care services Elective paediatric services should be co-located with emergency services

Dorset’s existing acute hospital provision Delivering three variations of the yellow hospital based service model No hospitals in Dorset currently have 24/7 consultant delivered on site services across the range of key specialties where national quality standards identify this as important for best outcomes.

level assessment evaluation criteria Process for narrowing down long list of potential acute hospital based service options SHORT LIST of potential options FULL LIST of potential options MEDIUM LIST of potential options Models of care help to shape the breadth of potential options High level questions level assessment evaluation criteria Potential options to include in public consultation Full assessment evaluation criteria ~60-70 ~20-30 ~6 ?

High level questions 1 2 3 4 5 6 Quality of care for all Do any of the potential options fail to support the delivery of high quality care in line with standards for high quality services/best practice care pathways, or in line with specific criteria referred to? 1 Quality of care for all 2 Access to care for all Do any of the potential options have an excessive impact on travel times? Are any of the potential options likely to be highly unaffordable – for example will they require a considerable amount of capital expenditure for minimal positive impact on running costs? 3 Affordability and value for money 4 Workforce Are any of the options likely to not be deliverable and/or sustainable from a workforce perspective? Are any of the potential options not deliverable within a reasonable time frame? E.g. within next 5-10 years? 5 Deliverability Are there other factors which would justify removing any potential options at this stage? 6 Other (e.g., research and education)

Next steps Ongoing analysis of the medium list of potential hospital based options Ongoing discussion and debate to describe the out of acute hospital models of care Assessment of the medium list of potential hospital based options using the evaluation criteria Conduct analysis to understand the impact of out of acute hospital models of care on acute hospital potential options CCG to make decision on potential options to take to consultation Run public consultation in summer 2015 to get people’s views about the potential options CCG to decide what changes to commission in autumn 2015 Implementation of any agreed changes from autumn 2015

What are the workforce challenges we need to consider: Recruitment and Retention Capacity and Capability Key Policy changes Training and Development

Visit: www.dorsetsvision.nhs.uk Keep involved Visit: www.dorsetsvision.nhs.uk Email: involve@dorsetccg.nhs.uk

What are the key workforce challenges that need to be considered in the clinical services review and the Better Together programme? Please capture your ideas on paper and hand them in.....

Your key point....... The lead times for educating and training people in a new role need to be taken into consideration when planning services.... (eg with new roles there will be commissioning/training times.) Implementing the Care Certificate together so that staff becoming naturally transferable and smaller organisations benefit from working with organisations with more resources

Need to develop a professional group with generic skills, building on the work going on in pathways already eg OT working in community “nursing” roles Work on the retention of current staff, develop new career pathways, rotations, (make sure that we include Ambulance Trust in all this work...)

Commissioning development programmes and making roles attractive and keeping people in the area – looking at building a local workforce (rewards, retention etc) Need to ensure good communication across the system, don’t duplicate effort, honest conversations about money,

Work on recruitment (thinking more creatively) – get good messages out (eg look at good practice of the Army), work with schools and colleges to open people’s minds to working in health and social care IN DORSET and S WILTS! Need to do that together to get more bang for our buck. Look to reduce barriers for people coming into the HSC (look at evidence).