The Mid Yorkshire Hospitals NHS Trust
MY Five-year Clinical Services Strategy
Delivering safe, high quality, sustainable
healthcare
October 2011
Purpose of briefing
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Vision for MY future and context
The journey so far
The need for change
Principles and process
Emerging options
Benefits
Three strong hospitals
Achieving our targets
Next steps and timeline
Your views
The Mid Yorkshire Hospitals NHS Trust
Vision for MY future
and context
The Mid Yorkshire Hospitals NHS Trust
Vision: to deliver high quality, integrated healthcare
Several key strands of work:
• Strong clinical services: transforming and integrating services,
Clinical Services Strategy and partnerships.
• Developing the organisation around shared vision and values and
having a ‘can do’ culture that is focused on quality, safety,
efficiency and delivery.
• Achieving FT status: being a strong, viable, fit for purpose
organisation that provides high quality patient care in the most
efficient and effective way.
• Achieving targets – financial, 95% emergency and 18 weeks
The journey so far
The Mid Yorkshire Hospitals NHS Trust
• 1999/2000 - ‘Grasping the Nettle’ consultation - new hospitals
reconfiguring services across Wakefield and Pontefract.
• 2009/10 - consultation created 3 specialist centres in Wakefield Neo-natal Intensive and High Dependency Care, Inpatient Surgery
for Children and Inpatient Orthopaedic Trauma Surgery.
• Some medical patients from Wakefield and Pontefract are now
admitted to Dewsbury for their care.
• 2010 National Clinical Advisory Team (NCAT) re-validated our
plans as safe but recommended we review services as they had
doubts about sustainability of some services in the long-term:
Children’s inpatient medical services
Acute surgery
Emergency care at Pontefract.
Our journey (con’t)
The Mid Yorkshire Hospitals NHS Trust
• March 2011, fully opened our new hospitals and new
specialist centres in Wakefield.
• We had planned in some time to consolidate this but the
Department of Health brought forward Mid Yorkshire’s
requirement to develop the next five year’s strategy.
• We have now started a review of how we organise
services - next stage of development and are responding
to NCAT recommendations.
The need for change
National
• Policy
• Workforce supply
• Quality and safety
• Increasing subspecialisation
• Efficiency
• Meeting standards and
guidance
The Mid Yorkshire Hospitals NHS Trust
Local
• NCAT report
• Rising demand
• Changes in health
needs
• Integrating care
• Performance
• Sustainability
Clinical Services Strategy
– principles
The Mid Yorkshire Hospitals NHS Trust
• Patient safety is the top priority.
• Outpatient, diagnostics and day case services will be provided
from all three hospitals – Dewsbury, Pontefract and Pinderfields.
• The three specialist centres continue to be provided at Pinderfields.
• Focus should be on caring for people at home and in the
community, only treating people in hospital where clinically
necessary and enabling discharge from hospital sooner.
• Unplanned transfers between the Trust’s sites should be kept to the
minimum.
• Patients should be able to use the Trust’s services closest to them.
Clinical Strategy
– development process
The Mid Yorkshire Hospitals NHS Trust
• Clinically-led by hospital clinicians and GPs.
• Robust appraisal and analysis by a Clinical Advisory Group,
using safety, quality, patient experience and sustainability
criteria.
• Emerging options developed through discussions with hospital
clinicians, local GPs and other key stakeholders.
• Ongoing engagement with key stakeholders, including
Overview and Scrutiny Committees.
• Now engaging with staff, public and other stakeholders to
discuss options and take needs and views into account.
Common features of the
emerging options
The Mid Yorkshire Hospitals NHS Trust
• Pontefract Emergency Department could change to a minor illness and
injury service. It would provide care for around 80% of people who
currently use it with the sickest 20% going to Pinderfields for their care
• Consolidate care for sick children who need to stay in hospital for over 24
hours in purpose built facilities at Pinderfields, with easy access to
specialist advice. There would be a dedicated assessment service for
children at Dewsbury which would cater for the vast majority of children
who stay in hospital for up to 24 hours
• Consolidate planned adult inpatient orthopaedic surgery at Dewsbury with
rehabilitation in Pontefract and Dewsbury
• Rehabilitation for patients who need to stay in hospital after a stroke
provided at Dewsbury and Pontefract
• Routine eye operations would be provided from Dewsbury and Pontefract
and not Pinderfields
• Outpatients and day case surgery on all three hospital sites
In addition
The Mid Yorkshire Hospitals NHS Trust
• Three of the five options consolidate consultant-led maternity care
and neonatal care for premature or very poorly babies at
Pinderfields, with midwife-led units at Dewsbury and Pontefract
• Three options see specialist care for Acute Haematology and
Complex Chemotherapy centralised at Dewsbury
• One option sees higher risk inpatient surgery centralised at
Pinderfields to concentrate skills and improve patient outcomes.
• There is also work underway looking at how Spinal Injuries,
Neurology and Neuro-rehabilitation (Neurosciences) could be
provided in future, with the possibility of some or all of the services
moving to other hospitals from Pinderfields. There is also a review of
the best way to provide hospital care for people with heart problems
(Cardiology care).
Main emerging options
Minor
Injuries
Unit and
Urgent
Care
Centre at
Pontefract
Inpatient
Paediatrics
at
Pinderfields
and
Paediatric
Assessment
at Dewsbury
Adult
Inpatient
Planned
Orthopaedic
surgery at
Dewsbury
Planned
Ophthalmology
at Dewsbury
and Pontefract.
Inpatient
Stroke and
Orthopaedic
Rehab at
Dewsbury and
Pontefract
Inpatient
Inpatient
Inpatient
ConsultantAcute
Acute
Led Mid
Maternity
The
YorkshireHaematology
Hospitals NHS Surgery
Trust
and Neonatal
and Complex
Unit
Chemo
1
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Pinderfields
2
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Dewsbury
3
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Pinderfields
Midwife-led
Units (MLU) at
Dewsbury and
Pontefract
Pinderfields
4
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Pinderfields
MLUs at
Dewsbury and
Pontefract
Dewsbury
5
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Pinderfields
MLUs at
Dewsbury and
Pontefract
Dewsbury
Pinderfields
Benefits
The Mid Yorkshire Hospitals NHS Trust
• Concentrating expertise to improve access to specialist
teams
• Quicker recovery, better outcomes
• Better meet the needs of emergency and planned
patients:
– Shorter waiting times
– Reduce number of cancelled operations
– Achieving lower rates of infection
• Improving consistency of care and standards
• Ability to focus resources on improving services
Three strong hospitals
The Mid Yorkshire Hospitals NHS Trust
Three hospitals providing local services – each with a
clear purpose and role as part of MY integrated care
organisation
Pinderfields – major acute hospital
Emergency Department (ED) for Trauma, Surgery and
Medicine and full acute Surgical and Medical facilities.
The increasing focus on acute care at Pinderfields would
allow greater separation of planned and emergency care,
speeding up and improving care and outcomes for both.
NHS Kirklees
NHS Wakefield District
The Mid Yorkshire Hospitals NHS Trust
Three strong hospitals
The Mid Yorkshire Hospitals NHS Trust
Dewsbury – strong District General Hospital
Non-trauma Emergency Department with Surgery, Medicine
and Paediatric Assessment in accordance with status as a
DGH. Under all options, Dewsbury takes on a new role as a
centre for elective surgery, with Orthopaedics, Ophthalmology
and in some variations Colorectal surgery moving to the site.
There would be a minimum of a Midwife-led Maternity Unit.
There are also variations for either some or all of
Neurosciences (Spinal, Neuro and Neuro Rehab) and Acute
Haematology and complex Chemotherapy cancer services to
be provided at Dewsbury – potentially creating new
Neuroscience and Cancer Centres.
Three strong hospitals
The Mid Yorkshire Hospitals NHS Trust
Pontefract – the elective centre
Under all options, Pontefract provides a Minor Injury Unit
and Urgent Care Centre and Midwife-led Maternity Unit –
ensuring it continues to provide these critical services to
local people.
The new, purpose-built facilities provide an ideal setting for
short-stay and day-case planned surgery across a number of
specialties. There is also an increased focus on the
management of long term conditions and rehabilitation, with
all options including Stroke and Orthopaedic Rehabilitation
and a variation to provide Neuro Rehabilitation on the site.
This is in line with NCAT’s recommendations.
Next steps and current
timeline
The Mid Yorkshire Hospitals NHS Trust
• Start of a long process.
• Oct/Nov 2011 – fully engaging with staff, local people and key
stakeholders to discuss options and listen to views.
• Develop detailed business cases.
• As a result - some options may go forward to formal
consultation and some may not.
• Feb to early April 2012 – NCAT review to ensure that proposals
offer safe, effective and accessible services for patients.
• Late spring/summer - Public consultation.
• Autumn 2012 – analysis of consultation. Consideration and
decision at relevant Boards and feedback outcome.
How we are engaging
people
The Mid Yorkshire Hospitals NHS Trust
• Events for groups who may be affected by possible
changes
• Questionnaires
• Focus groups
• Briefings for councillors, local MPs and voluntary
groups
• Events for staff
• Media briefings
• A range of feedback mechanisms including email,
Internet and telephone.
The Mid Yorkshire Hospitals NHS Trust
How to give us your views
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Call our Patient and Public Engagement Team on 01422 281473
(this is an answerphone service and messages will be responded to within two working days)
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Or email dawn.pearson@calderdale-pct.nhs.uk
Current issue –
Pontefract Emergency Department (ED)
The Mid Yorkshire Hospitals NHS Trust
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There is a national shortage of doctors with the right ED experience. Mid Yorkshire has
experienced difficulty in filling gaps for a long time, due to needing to cover 3 EDs.
From the start of November this will impact further, when Mid Yorkshire will see a large
number of posts unfilled.
Extensive and repeated efforts have been made to recruit with no success so far.
This leaves the Trust no choice but to consider taking urgent and immediate action to
avoid risking patient safety.
After considering all the options, senior clinicians are reluctantly recommending to the
Trust Board that it should agree temporarily to close the Pontefract ED between 10pm
and 8am every day.
The recommendation was based on patient needs across the whole District. Pontefract
ED sees the lowest numbers of patients and the vast majority (85%) use it up to 10pm.
The Trust Board is considering the proposal at its meeting next week and will send out an
update following that.
If the Board agrees the temporary overnight closure, there will be a public information
campaign to ensure that local people know what they need to do.
The overnight closure will be kept under review, but the end point is likely to be the
outcome of the public consultation outlined in this briefing.