1. Dorset CCG Clinical Services Review
February 2015

2. 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

3. How is the review being delivered?
The different stages of our review
Autumn
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.

4. Review, analyse and design stage1 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

5. 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

6. 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

7. 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

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

9. 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

10. 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

11. 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

12. 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

13. 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.

14. 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 ?

15. 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)

16. 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

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

18. Visit: www.dorsetsvision.nhs.uk
Keep involved
Visit:

19. 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.....

20. 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

21. 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...)

22. 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,

23. 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).