The BHRUT
Clinical Strategy
Presentation for stakeholders, patients and the public
Contents
1
Background
3
2
Strategic Context
4
3
Clinical Model: Unplanned Care
5
4
Clinical Model: Planned Care
6
5
Clinical Model: Children
7
6
Strategic implementation plan
8
7
Next Steps
9
2
1
Background
• Clinically-led Health for North East London plans (HfNEL) set out by
our commissioners in 2010 following major public consultation
• Objective is to improve quality of care, generate benefits in
centralising specialist services and strengthening staffing levels, while
enhancing urgent care and out of hospital care where appropriate
• Secretary of State signed off the plans in October 2011 following
review, subject to conditions to ensure they were not implemented
until safe to do so
• Work since then to plan safe implementation, improve performance
and to review assumptions to reflect current service needs
• Development with staff, our commissioners and patient
representatives
• Clinical strategy is the outcome of this work
• Approved by the Board 6 November 2013
3
Strategic Context
2
Strategic
Objectives
Aims
Address poor performance
in the Queen’s Emergency
department (ED)
Deliver safe,
quality, effective
care
Decompress the Queen’s
site and promote integrated
care
BHRUT Clinical Strategy
Radically redevelop the Queen’s ED to improve performance and
address the forecast additional demand
Develop BHRUT’s intermediate care and rehabilitation at KGH
Utilise sufficient space at KGH to provide a high quality of patient
care across both sites
Complete the vision for paediatric services
Move all emergency medicine and surgery to Queen’s Hospital
Implement HfNEL Base
Case
Maintain an urgent care centre (UCC) on both sites
Move critical care beds from KGH
Ensure BHRUT
is financially
secure with a
viable and
sustainable
future
BHRUT to implement new services from the space liberated on
the KGH site
Implement Extension to
HfNEL
Maximise the use of KGH for day case, short stay elective and
diagnostic activity
Maximise the use of the Queen’s site for complex inpatient activity
Centralise all breast services into a dedicated unit located on the
KGH site
4
3
Clinical Model: Unplanned Care
• Move all emergency medicine and surgery to Queen’s Hospital by mid 2015
• Maintain and develop 24/7 urgent care centres on both sides as per HfNEL
• Radically redevelop the Queen’s ED to address the current performance issues
and address the forecast additional demand. Key changes are:
► Introduce a Senior Streamer
► Route patients arriving at the ED to the UCC, ED area, four speciality
assessment centres and short stay beds as appropriate
► Physically remodel the existing ED to accommodate the four speciality
assessment areas, cope with the increased demand and support the proposed
clinical model
► Provide dedicated facilities for children, including a paediatric specific entrance
5
4
Clinical Model: Planned Care
•
Maximise use of the Queen’s site for complex inpatient activity
•
Maximise the use of KGH for day case, short stay elective and diagnostic activity
•
Develop provision of BHRUT’s intermediate care and rehabilitation at KGH such as
orthogeriatrics, stroke, neurosurgical (rehabilitation – proposed new service), aiming to:
•
Reduce pressure on Queen’s site so we can improve patient experience, cope with winter
pressures, and reduce delays for patients
•
Develop further integrated care and community interventions
•
Centralise all breast services into a dedicated unit located on the KGH site with co-localised
breast histopathology at KGH
•
Move critical care beds from KGH, supporting the strategy of complex inpatient activity at
Queen’s
•
Utilise sufficient space at KGH to provide a high quality of patient care across both sites.
This will be the subject of detailed capacity modelling and is subject to assumptions on likely
length of stay (LOS) improvement and impact of integrated care initiatives, but initial estimates
place this at around 55-60%
•
Implement new services on the space liberated on the KGH site (BHRUT), or provide
alternative uses for the space, through a range of identified opportunities.
6
5
Clinical Model: Children
Complete the vision for paediatric services, as per HfNEL. Specifically:
Strategic component
Rationale
Special care baby unit
(SCBU) to be relocated
to Queen’s
All births now at Queen’s. Relocation will help staff to attend labour ward emergencies and neonatal
care, and avoid the need for transfers of sick babies from Queen’s, potentially away from their
mothers
Move paediatric
inpatients to Queen’s
Maximise the use of the Queen’s site for complex inpatient activity as per HfNEL
Paediatric day case and
elective and planned
diagnostics to KGH
Maximise use of KGH for day case, short stay elective and diagnostic activity
Roll out of Hot Clinics
Extend the existing successful Hot Line providing direct access to advice and guidance for GPs to
paediatric consultants at the KGH and Queen’s site
Develop the Paediatric
ED clinical pathways
Provide dedicated facilities for children including a paediatric specific entrance, as covered in the
unplanned care section of the strategy
7
6
Strategic Implementation Plan
A high level strategic implementation plan by clinical directorates has been developed
► Business cases for major capital investments in Emergency department, critical care &
SCBU, Queen’s infrastructure
► Further work on bed requirements will be developed and regularly refreshed to match
current need
► Key milestones / dependencies are:
►
BHRUT’s intermediate care beds to be established at KGH in spring 2014. This will
free up space on the QH site to support reconfiguration
2. Renal dialysis to be moved off the QH site in summer 2014 to allow work on the
Queen’s Hospital ED to commence as soon the full business case is approved in August
2014
3. Emergency department redevelopment and critical care bed provision at QH to be
completed in autumn 2015, allowing the majority of the day case activity to move to the
KGH site, and majority of the inpatient activity to move to the QH site in early 2016
1.
8
7
Next Steps
•
Feedback invited on the clinical strategy and questions/clarifications:
email feedback@bhrhospitals.nhs.uk
•
BHRUT progressing bids for funding for the major capital works
required
•
Work underway to finalise the long term financial model (LTFM), which
brings together the financial and clinical planning
•
Further work to make the strategy operational, working with clinicians
in each of the Trust’s clinical directorates, and planning in their detailed
business plans.
9