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 email
• 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
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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
now?
happens
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?
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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:
www.meetingthechallenge.co.uk
• Email us at: info@meetingthechallenge.co.uk
• Call us on 01924 317757