NHS North Kirklees Clinical Commissioning Group NHS Wakefield Clinical Commissioning Group MEETING THE CHALLENGE Improving NHS services in North Kirklees and Wakefield District

SETTING THE SCENE Jo Webster Chief Officer NHS Wakefield Clinical Commissioning Group

How we are engaging with people Eight public meetings Summary document with questionnaire to 242,000+ homes Website (with on-line questionnaire) Around 36 roadshows Dozens of meetings with groups and individuals Drop-in sessions Dedicated phone line and Media

Dr Phil Earnshaw Chair of NHS Wakefield Clinical Commissioning Group (CCG) CCGs = local GPs Responsible for local NHS services Wakefield and North Kirklees CCGs are leading ‘Meeting the Challenge’

Things are not what they used to be!

Moving forward

The future?

Putting the pieces together Promotion of good health Strong primary care Integrated community & social care Communicating well High quality hospital facilities

Care outside hospital BMJ survey 2013 – 84% of doctors believe hospital is not the best place for the frail elderly CCGs have a duty to promote integrated care All authorities agree this is the key to a sustainable health service

Care outside hospital – key principles You have more control Care based on your needs Available when you need it One assessment Seamless Using and sharing information better

Care outside hospital – new ways of working Breathing problems Specialist teams of nurses caring for people in their own homes Telehealth for the most vulnerable. Daily link to the team

Diabetes Most of care in your surgery or your home Consultants & nurses support GP clinics Standard is national best practice

Joined-up care Person at the centre with a single contact Social care & health in one team Community-based teams improving care for people with long-term conditions Intermediate Care Teams giving urgent short-term support in a crisis People feeling much more in control but supported all the way

CHANGES TO HOSPITAL SERVICES Dr Richard Jenkins Medical Director Mid Yorkshire Hospitals NHS Trust

Proposed Hospital changes 1.Maternity (births) 2.Children’s inpatients 3.A&E and unplanned care 4.Surgery

1. Births – what happens now? Low risk (60%) and High risk (40%) births Pontefract ‘Low risk’: Home/Pontefract /Pinderfields ‘High’ risk : Pinderfields Wakefield ‘Low risk’ : Home/Pinderfields ‘High risk’ : Pinderfields Dewsbury ‘Low risk’ : Home/Dewsbury ‘High risk’ : Dewsbury require NICU : Pinderfields

Births – proposed changes Pontefract –no change, midwife-led unit Pinderfields –‘high risk’ births – all to consultant-led unit –‘low risk’ births – midwife-led unit Dewsbury –midwife-led unit –‘low risk’ : home, midwife unit or Pinderfields –‘high risk’ : deliver at Pinderfields Local antenatal/postnatal care Home births still an option for all ‘low risk’

Why is this better? Low Risk Births Midwife-led units are as safe for low risk births and provide better experience (local expertise) Changes promotes choice for mothers High Risk Births at Pinderfields National recommendations met More consultant presence (increased safety) More specialist obstetricians Improves care for high risk births & sick babies More flexibility for women who need Caesarean section

2. Children’s Inpatients - what happens now? Pontefract Outpatient and emergency care If child needs to stay in hospital they go to Pinderfields Dewsbury Outpatient and emergency care Inpatient care, but children who need surgery already go to Pinderfields Pinderfields Outpatient, emergency care and inpatient care All neo-natal intensive care (since 2010) All inpatient surgery (since 2010) (Very specialist care in Leeds)

Children – proposed changes Pontefract : no change Pinderfields: no change Dewsbury: inpatient care at Pinderfields Urgent assessment & outpatients at all 3 hospitals

Why is this better? Less poorly children Treated locally, more quickly Able to go home sooner Sicker children Seen sooner by senior doctors More consultant presence on wards Safer service Keeps as much of a child’s care as local as possible

3. Emergency care – what happens now? People needing emergency care go to Dewsbury, Pinderfields or Pontefract People with very serious conditions are taken by ambulance to nearest appropriate hospital People who attend Pontefract A&E who need admission go to Pinderfields or Dewsbury

Emergency care : proposed changes Pinderfields –continue to see full range of cases –specialist trauma and emergency care centre for Mid Yorkshire –centre for emergencies who require inpatient care Dewsbury and Pontefract –open access for emergency care –full resuscitation facilities –able to treat a wide range of conditions –some ambulance attendances –Around 70% of current patients

In an emergency If you call 999 : trained paramedics will assess and start treatment straight away they will decide which is the best place if you need further treatment more serious conditions will go to either Pinderfields or regional centre

Why is this better? Patients treated in right place, by right teams, with the right support Seriously ill patients get straight to specialist care Inpatients : seen and managed by specialists quicker (eg cardiologist) Consultants on site for longer periods where they are most needed People would not travel further than Pontefract to Wakefield, or Dewsbury to Wakefield, for emergency and inpatient care Patients with less serious conditions seen more quickly and locally Development of ‘emergency day care’

“Emergency Day Care” Many patients have very short stay in hospital (0-2 days), often waiting for tests In many cases, treatment could be carried out safely as “day care” Rule out more serious conditions quickly (eg chest pain) Aim to keep patients at home Reduces admissions + need for beds Works well in other places Due to start in Wakefield 2013

4. Surgery – what happens now? Dewsbury has short stay & day surgery, inpatient general surgery, orthopaedics & gynaecology Pontefract has planned orthopaedics, (from April 2013), short stay & day surgery Pinderfields has short stay & day surgery, inpatient general surgery, gynaecology, orthopaedics, specialist surgery, trauma surgery :

Surgery : proposed changes Dewsbury –Planned inpatient surgery (more specialties) –Day surgery –Some unplanned surgery Pontefract –Planned orthopaedics, ophthalmology and some short stay surgery –Day surgery Pinderfields –Emergency surgery, complex surgery (critical care) –Day surgery

Why is this better? Separation of emergency from planned surgery is better for patients Rapid access for urgent surgery More senior & specialist care for sickest patients More specialist consultant rotas Less variation & better weekend care Less risk of cancellations Less risk of infection Local treatment for straightforward planned surgery Reduces the time people need to stay in hospital Increases available specialties at Dewsbury.

What changes in Pontefract? The most serious A&E cases would be taken directly to Pinderfields The Clinical Decisions Unit will be retained and expanded to provide emergency day care and step up/down beds All other services remain as they are

OTHER ISSUES Stephen Eames Chief Executive The Mid Yorkshire Hospitals NHS Trust

From mid March you will only need three phone numbers: – 999 for serious emergencies – 111 for non-emergencies –your local GP surgery

Travel A group made up of patients and their representatives, councils, bus companies, the local NHS and the voluntary sector has identified some ways we might be able to help:

More flexible appointment times Training staff to give better Extending the shuttle bus and route 111 bus Bookable community transport for some patients More use of voluntary transport Support to get home for patients arriving by ambulance Free Metro cards for A&E patients with no alternative Better travel information Travel helpline Travel information with outpatient appointment letters

Some common concerns addressed It’s all about saving money Pinderfields won’t be big enough to cope There won’t be enough beds This is the thin end of the wedge leading to Pontefract Hospital closing There is a hidden agenda to close A&E at Pontefract Hospital

How you can make your voice heard Fill in the questionnaire in the summary being delivered to people’s homes and send back using the FREEPOST address Fill in the questionnaire online at: us at: Call us on