CLINICAL SERVICES STRATEGY
2014 - 2019
Delivering sustainable, appropriate and high-performing services
Clinical Services Strategy 2014 - 2019
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Delivering sustainable, appropriate and high-performing services
Clinical Services Strategy 2014 - 2019
2014 - 2019
CONTENTS
Part One
1.
Introduction
2.
Our vision
3.
Our Values
4.
Our strategic objectives & clinical services strategy
5.
The strategic environment
5.1
5.2
5.3
6.
The community we serve is changing
National policy drivers
Strategic partnerships
How we developed our clinical services strategy
Part Two
7.
Clinical Services Strategy - overarching priorities
8.
Clinical Services Strategy - divisional plans
8.1
8.2
8.3
8.4
9.
Medicine & emergency care
Surgery
Women & children’s
Clinical specialist services
References
CONTENTS
CLINICAL SERVICES
STRATEGY
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Clinical Services Strategy 2014 - 2019
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PART ONE
1. Introduction
What does our strategy describe?
Our Clinical Services Strategy (CSS) describes a vision that shapes our patient’s clinical services over
the next five years. It has been developed in consultation with our clinicians - using a validated
method that led to strategic objective development, one set for each for the 62 specialty services we
currently provide. Our strategy has been influenced by changes in the external landscape, and takes
account of both national drivers for change - as well as transformation plans across the local and
regional health and social care communities.
We have set out a programme of work that will ensure we develop a portfolio of high-quality services,
which are both clinically and financially sustainable, delivering excellent care and an exceptional
experience for our patients.
A strategy for our citizens
Promoting good health and well-being is everyone’s business – including ours. One in twenty people
still smoke; more than half the population drinks too much alcohol and is overweight. The clinical
services we provide should not only focus on treating ill-health. Through this strategy we have a great
opportunity to promote better lifestyle choices, to educate our citizens and patients; and support them
to achieve improved health as part of their regular care and treatment.
How will we achieve our strategy’s goals?
Our plan to position our hospital as a model healthcare provider - with high-quality, appropriate and
sustainable services for our local community - will be achieved by challenging and changing the
traditional ways in which we have previously delivered clinical services. This means breaking down
barriers and creating new integrated models of care in partnership with mental health, social, primary,
community and voluntary care providers. And increasingly it means we will deliver specialist care as
part of a regional network of hospitals, offering complementary services, shared staffing and shared
on-call arrangements, as well as alternative ways of bringing services to our patients.
Dr Gail Collins
Medical Director
The changing needs of our patients - often frail, some with
dementia, many with comorbidities - and the changing
opportunities offered by new treatments and technologies
mean that if we think creatively and if we challenge some of
our self-imposed constraints we're going to find we've
got some new options.
Simon Stevens, Chief Executive Officer, NHS England, 4 June 2014
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2.
Our vision
Our vision is to be a first class healthcare provider serving its community with sustainable high
quality clinical care, offering an exceptional experience for patients and creating a great place to
work for our people.
3.
Our values
Under-pinning our plans are a set of values which encompass an authentic desire to treat all our
patients, their relatives and carers, our own people and our partners in a way which is respectful and
courteous and above all cherishes compassionate care.
Our Proud to Care ethos is based on:
Compassion
Care delivered with professionalism and a positive friendly attitude
Care that preserves dignity and respects the person; putting patients at the heart of all we do
Respecting the unique and individual contribution that every staff member makes
Achievement
Excellent care, safe services and a positive experience every time
Exceeding expectations by delivering first-class performance, bettering national standards through
innovation and ingenuity
Relationships
An open and honest relationship with our patients, staff partners and our communities
Working in partnership in the interests of our patients
Acting in a socially responsible way and meeting our commitments to the local community
Environment
Providing a hospital that is modern, clean and safe – conducive to care and recovery and a good
place to work
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Delivering sustainable, appropriate and high-performing services
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4. Our strategic objectives
To achieve our vision we have set ourselves six strategic objectives each supported by a
comprehensive enabling strategy that describes the actions we will take to achieve them and by
when.
Although our Clinical Services Strategy (CSS) relates specifically to the delivery of our second
strategic objective: ‘to deliver sustainable, appropriate and high-performing services’ each of
our enabling strategies are interdependent – they are designed to work together to deliver our vision.
Strategic objective
How our clinical services strategy relates to our other strategic
objectives
1.
To provide high-quality,
safe and person-centred
care
Our Quality Strategy sets out an ambitious plan to improve patient care. The
CSS will enable this by ensuring services are organised to deliver care which
is safe, high quality and person centred by design.
2.
Deliver sustainable,
appropriate and highperforming services
Clinical Services Strategy
3.
Build on existing
partnerships and create
new ones to deliver
better care
To ensure we succeed in delivering the range of services our patients need
in an integrated way, and across seven days, we will work in partnership with
other health and social care providers, including the voluntary sector. For
st
example the ‘21 Century’ programme with health and social care partners
in North Derbyshire and the ‘Working Together Programme’ with seven
acute Trusts South and Mid Yorkshire.
4.
Support and develop our
staff
Having the right people with the right skills is key to delivering sustainable
services. Our People Strategy describes how we will develop our people and
develop new roles and ways of working to achieve this.
5.
Manage our money
wisely, foster innovation
and become more
efficient to improve
quality of care
Our Transformation Programme offers a framework for the systematic
redesign of services to both improve quality and become more efficient. To
achieve sustainability many of our clinical services will require redesign
which will be managed through this framework.
6.
Provide an infrastructure
to support delivery
We intend to invest in our facilities to support the priorities in this Clinical
Services Strategy, for example, a re-design of our Emergency Department to
create an Urgent Care Village and the recent decision to build a new cancer
centre on site in partnership with Macmillan Cancer Care Support. We are
also developing our IM&T capability to underpin our Clinical Services
Strategy, for example the Clinical Portal development and East Midlands
PACs (digital imaging) Partnership.
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Compassionate care – it comes in many forms, from the volunteer buggy drivers that enhance our patient s’
experience, through to the wards teams that provide high-quality in-patient clinical care.
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5. The strategic environment
There are several drivers for change – local, regional and national - that provide the impetus to ‘do
something different’.
5.1
The community we serve is changing
The population of Derbyshire is predicted to increase by over 11% in the next 20 years, with the
largest growth within the older citizen demographic. Greater life expectancy and increased
co-morbidity will substantially raise the demand for healthcare. If we ‘stand still’ we will soon be
unable to meet all the needs of increasing numbers of patients, many of whom have complex
healthcare needs. Our desire to provide local, high-quality, sustainable healthcare to every citizen
that uses our services has been the main driver underpinning our strategy.
The following information helps to illustrate the critical challenges and factors for change we face
now, and which our clinical services need to respond to:
A growing elderly population
Latest statistics show that 18% of the Derbyshire population is over 65 years of age - compared with a
national average of 16.4% - and the proportion of patients over 65 will continue to increase. The
number of people over 65 is expected to rise by 12% in the next five years and those aged over 80 by
16%. Our clinical services will need to be designed to respond to this challenge.
Population projections in Derbyshire 2015 - 2035
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Rising demand for healthcare
Demand for hospital care has risen by 25% for those aged over 65 years; and by more than 40% for
those aged over 90. These patients, the latter group in particular is often the most vulnerable in
society have complex co-morbidities and are at highest risk of hospital associated harms. Hospital is
often not the best place for them, especially on a long-term basis. The needs of this ageing
population are social, physical and mental - and not well met by the configuration of our current
services. Integrating care with other health and social providers will help to ensure these citizens get
the right care, in the right place, at the right time.
Absolute and percentage increase in hospital admissions by age group
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Anticipated rise in long-term conditions
The chart below shows the anticipated rise in long term conditions affecting our patient population
over the next 15 years – and the scale of that challenge for services already running at full capacity.
We will best serve our local community by working with other health and social care providers in
North Derbyshire, to create a system with local services that keep all but the most ill patients out of
hospital. For many patients there needs to be a move away from being looked after in a ‘bed’ to
receiving support in the community. We will also need to use better technology wherever possible, to
help service users access the care and advice that can help them to successfully manage their own
conditions. Our beds can then be available only for those whose needs are best met by in-patient
hospital care.
Anticipated rise in long term conditions 2010 - 2040
Source: Department of Health, 2012; Department of Health 2012; Parkinson’s UK 2009; Diabetes UK 2012,
Association of Public Health Observatories; Osteoarthritis Nation 2012.
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5.2
National policy drivers
Smaller district general hospitals can thrive but the way services are provided to local patients must
change to guarantee quality care. The impact of sub-specialisation, recruitment, rising demand,
technological developments and the economic outlook will have a particular effect on smaller
organizations. It is essential that Chesterfield Royal Hospital identifies new models of care for patients,
for example re-designing services to improve the integration of care and move it closer to home; come
up with creative ways to address the scale challenges, such as sharing staff with nearby trusts, using
new technology, or building networks between smaller hospitals and major centres; and make sure
that the right balance is struck in local communities between redesigning services and making sure
patients are treated near to where they live.
5.2.1
The 5-Year Forward View
In October 2014, Simon Stevens, Chief Executive of NHS England, published the 5-year forward view.
This clearly articulates the challenge facing the NHS in terms of rising demand and the economic
pressures. The document also points the way some new models of care aimed at meeting this demand
whilst delivering better services that are sustainable and affordable. These new models include:
Multi-specialty community providers – integrated out of hospital care organisations made up of
GPs, nurses, community health services, hospital specialists and others.
Primary and acute care systems – combining general practice and hospital services to provide
integrated acute and primary care.
Urgent and emergency care networks - promoting links between specialist and general hospitals
as well as more integrated services locally with improved triage enabling patients to navigate the
system successfully.
Viable smaller hospitals - different models of partnership and organisational form that help retain
hospital services locally, but in a sustainable way.
Considerable emphasis is placed on the prevention of ill health and how all health organisations can
contribute to this to a much greater degree.
Our plans for greater integration with our local partners in North Derbyshire and the clinical networks
we are developing with other acute hospitals in South Yorkshire and the East Midlands provide a
framework to develop new service models that reflect the aims of the Forward View.
5.2.2
The Keogh urgent and emergency care review and transforming urgent and
emergency care services in England
This two phase report, published by Medical Director for NHS England, Sir Bruce Keogh, sets out a
vision for urgent and emergency care and describes the following approach to services:
Those with urgent but non life-threatening needs receiving care outside of hospital, as close to their
homes as possible, and those with serious or life-threatening emergencies should be treated in
centres with the best expertise and facilities.
The latter includes a vision of urgent care centres, emergency care centres and specialist
emergency centres providing tiered care, according to clearly defined pathways and within
networks. Developing our role within the East Midlands Trauma network and delivering the
emerging model for integrated urgent and emergency care in North Derbyshire, including the
creation of the on site Urgent Care Village, will help us to adopt this approach.
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5.2.3 Seven day services
NHS services – open seven days a week – aims to ensure all patients have consistently good
quality of care, regardless of what day of the week it is, the programme for delivering seven day
services across England is initially focusing on urgent and emergency care services, and the
diagnostic services that support them. By 2016/17 the NHS will need to be compliant with ten
evidence-based clinical standards (below) – and as one of 13 national pilot sites, Chesterfield
Royal Hospital is at the forefront of the 24/7 formulation.
Patient experience – seven day a week involvement of patients and carers in decision-making
Time to first consultant review – all emergency patients seen by a suitable consultant within a
maximum of 14 hours
Multi-disciplinary team (MDT) review – within 14 hours, integrated management plan with
estimated discharge date in place within 24 hours
Shift handovers – by competent senior decision maker & standardised across seven days
Diagnostics – inpatient seven-day access to diagnostic services. Consultant-directed diagnostic
tests and their reporting within one hour for critical patients; within 12 hours for urgent patients;
and within 24 hours for non-urgent patients
Intervention/Key Services – 24 hour access, seven days a week to consultant directed
interventions, either on site or through formally agreed networked arrangements.
Mental Health - assessment by psychiatric liaison 24 hours a day, seven days a week: within 1
hour for emergency care needs and within 14 hours for urgent care needs
On-going review - all patients on high dependency areas including EMU/CDU must be seen
and reviewed by a consultant twice daily. General ward patients should be reviewed during a
consultant-delivered ward round at least once every 24 hours, seven days a week
Transfer to community, primary and social care – all support services, must be available
seven days a week
Quality improvement - all those involved in the delivery of acute care must participate in the
review of patient improvement
Chesterfield Royal is one of 13 national pilot sites to develop models of care that deliver a
consistent service particularly for acute patients throughout the week. Our intention to achieve this
aim is reflected in both the overarching plans of the trust, but also in the plans we’ve developed at
specialty level.
Every Day Counts can be read in full at: http://www.england.nhs.uk/wp-content/uploads/2013/12/forum-summaryreport.pdf
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5.2.3
The Dalton Review
Sir David Dalton, Chief Executive of Salford Royal Hospital NHS Foundation Trust was commissioned
by the Secretary of State for Health to undertake a review of how different organisational forms could
accelerate service transformation - to meet the challenge of improving both the quality and
sustainability of clinical services.
The outcome of the review was published in December 2014 and describes a spectrum of potential
relationships ranging from the relatively informal, such as strategic clinical networks, through to more
formal contractual relationships between organizations; and finally consolidated organisational forms
such as multi-site hospital chains. The review proposes that the greater the degree of consolidation
the greater the efficiency gains to be made.
In developing our clinical services strategy we recognise the potential to work more much closely with
other partner organisations in order to develop more sustainable models of clinical care, which at the
same time help to preserve local access where it is clinically appropriate to do so.
5.3
Strategic Partnerships
In order to respond to the national policy direction improve the quality of care whilst ensuring that
services are sustainable the Trust recognises the importance of partnership working. Our strategic
objective 3 focuses specifically on this, seeking to ‘build on existing partnership and create new
ones to deliver better care’.
The Trust is developing a number of formal partnership arrangements both locally within North
Derbyshire with other Health and Social Care providers and regionally with other acute hospitals both
in South Yorkshire and into the East Midlands.
5.3.1
21st Century #JoinedUpCare
In May 2013 the National Collaboration for Integrated Care and Support published a framework
document on integration. It sets out how local areas can use existing structures, such the Health and
Wellbeing Board, to bring together local authorities, the NHS, care and support providers, education,
housing services, public health and others to make steps towards integration.
For healthcare and support to be ‘integrated’, it must be person-centred, well co-ordinated and
tailored to the needs and preferences of the individual, their carer and family. It means moving
away from episodic care to a more holistic approach to health, care and support that put the needs
of people at the centre of how services are organised and delivered.
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This framework underpins the #JoinedUpCare work of the 21st Century Healthcare Programme
Board in North Derbyshire. The eight organisations involved are finding smarter and new ways of
working together to improve services and use public money in the best possible way. They are
changing the way care is provided to North Derbyshire’s 380,000 citizens with an ambition to:
Provide an urgent care provision for people with serious or life threatening conditions to be
treated in the right specialist setting within a cohesive emergency and urgent care network
linked with community services.
Provide hospital bedded care only for those patients who absolutely need it
Offer seamless pathways of care for those with long-term conditions in the community and
across organisational boundaries
21C #JoinedUpCare is a collaboration between: NHS North Derbyshire CCG; NHS Hardwick CCG, Chesterfield Royal
Hospital NHS Foundation Trust, Derbyshire Healthcare NHS Foundation Trust, Derbyshire Community Health Care Services
NHS Foundation Trust, Derbyshire County Council, Derbyshire Health United and East Midlands Ambulance Service
5.3.2
Working Together – a partnership between acute Trusts in
North Derbyshire, South Yorkshire and Mid-Yorkshire.
Working together is a formal partnership programme which brings together
seven acute hospitals in South Yorkshire and Mid Yorkshire together with
ourselves to develop sustainable models of care on a network basis and
also to work together to improve efficiency more generally.
Working
Together
The working together programme has formal key areas of focus as follows:Sharing of information
Consistency in care
Smaller specialties
Prescribed services
Locums
Procurement
Informatics
The initial focus has been on securing savings through joint procurement but also on developing
networked service models in specialties such as:Ophthalmology
ENT
Oral maxillofacial surgery
Interventional radiology
Upper GI services
The Working Together Programme provides a framework for the development of networked
approaches to delivering hospital care; pooling resources to deliver services that are sustainable,
delivered consistently through the week and provide good quality care.
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5.3.3
East Midlands Partnership Working
The Trust has also developed a number of partnership relationships with acute providers in the East
Midlands - most noticeably joining the trauma network with Nottingham University Hospital as the
trauma centre; and developing a joint vascular service with Royal Derby Hospitals.
In addition to this the Trust is also pursing a joint procurement for PACS (digital imaging) for radiology
and is seeking to develop a pathology alliance with Royal Derby Hospital and Sherwood Forest
Hospitals Trust.
During 2014 CRH also played a leading role together with the East Midlands Clinical Senate to
undertake a base lining exercise with ten acute hospitals in the East Midlands to understand the
degree to which services are currently meeting the ten national seven-day standards and to begin to
identify gaps and opportunities for partnership working to address them.
The Trust has developed a number of partnerships in the East Midlands and is also pursuing a
joint procurement for PACS (digital imaging)
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6. How we developed our clinical services strategy
In March 2013 we embarked on a detailed piece of work - engaging clinical staff from across the
organisation in a wholesale review of all our clinical services by specialty level. This enabled detailed
plans for each of the services to be developed - in line with our vision and objectives.
The plans for each of our four clinical divisions provide the basis of a framework for the Clinical
Services Strategy, where each clinical service has been reviewed – taking account of feedback from
patients, staff views and opinions, engagement with clinical commissioners, other partners and the
wider community. From this point a range of options have been used to determine what’s best for
each service element within the division, such as development and expansion, a partnership model of
working; withdrawing from a service, or providing it in a different way. Divisions may also have
considered opportunities to go into new areas of healthcare if they are viable for the Trust.
The diagram below shows how the Clinical Services Strategy would interact with the Trust’s
corporate strategy and plans:
Trust vision
Corporate (Trust level) strategy
CSS Trust level
Capacity and scenario modelling
Demand modelling
Horizon scanning
Transformation programme
CSS Divisional Overview
Specialty level strategies:
Horizon scan and demand data-driven
Vision and future state definition
Strategic options development
Specialty A
Specialty B
Etc.
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6.1
Classification - core, supporting and stand-alone services
An initial exercise, facilitated with the clinical leaders in the hospital, considered each of our 62
specialty level services. For consistency, each division classified its portfolio of services into one of
three areas (see page 18) and against four high-level strategic options:
Core
These services are essential for the delivery of the hospitals fundamental purpose of providing rapid
access to acute care for the local community when travel to an alternative provider would
compromise the clinical outcome. Core services define the Trust’s priorities for development and
further investment.
Supporting
Often more specialised services delivered alongside core services and usually by the same staff.
These services are either closely linked to the provision of the above e.g. as Trauma (core) and
Orthopaedics (supporting) are linked or provide services which if not available locally would
significantly reduce effective access to care for people in North Derbyshire e.g. chemotherapy
Stand-Alone
Those services which are important to our role in providing a comprehensive range of services to our
population, but that stand alone and not necessarily required on site for other services to flourish.
6.2
High-level strategic options
Strategic option
Invest
Acute Core
Services
Supporting Core
Services
Stand-Alone
Services




Divest
Re-design
Partner



LIMITED


6.3
Specialty review
In addition, each individual specialty in the core, supporting and stand-alone categories were reviewed
against patient experience and outcomes, financial, clinical and operational sustainability, as well as
the strength of its clinical networks or partnerships and its workforce (at that point in time). Scores
were used to help to understand where improvements were required and how these should be
factored in to divisional priorities for development. Results for each division can be found in their
individual section (page 20 onwards).
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Core, Supporting and Stand-Alone Services
Divisional
Medicine
Emergency
Department
Cancer
Services
Surgery
Specialties
Acute Core Services
Supporting Core Services
Stand-Alone Services
Acute Medicine
Cardiology
Respiratory Medicine
Acute Stroke
Gastroenterology
Healthcare for the Elderly
Haematology
Emergency Medicine
Palliative Care
Endocrinology and Diabetes
Stroke Rehabilitation
Dermatology
Rheumatology
GUM
Acute Oncology
Chemotherapy
Acute Surgery
Vascular Surgery Access
Colorectal
Endoscopy
Upper GI
Urology
Breast
Vascular Surgery
Elective Orthopaedics
Orthopaedics
Trauma
Critical Care
Acute Anaesthetists
HDU / ICU
Women and
Children’s
Acute Obstetrics &
Gynaecology
Acute Paediatrics
Neonatal Care
Elective Paediatrics
Specialist Nursing
Elective Gynaecology
Community Paediatrics
Imaging
Radiology & Interventional
radiology
CT
MRI
Ultrasound
Biochemistry
Haematology
Blood Transfusions
Microbiology
Pharmacy
Nuclear Medicine
Breast Imaging
Fluoroscopy
Pathology
Therapies &
Medicines
management
Audiology
ENT and Endocrine
Maxillofacial
Ophthalmology
Orthodontics
Chronic Pain Management
Child & Adolescent Mental
Health
Speech & Language
Therapy
Audiology
Therapy Services
Psychology
School Nursing
Looked after Children
Autopsy
Histology
Physiotherapy
Speech & Language Therapy
Occupational Therapy
Dietetics
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6.4
Themes
There were common themes running through many of the strategic workshops confirming that the
thinking in relation to our clinical services is broadly aligned across the organisation. The diagram
below illustrates the breakdown of the strategic options across the Trust:
A significant majority of services were identified for re-design. 25% of services were identified as
needing further investment - and in approximately 20% partnering opportunities were identified as the
way forward.
6.5
Seven day services compliance
During 2014 the Trust participated in a detailed baselining exercise supported by the East Midlands
Senate involving ten acute hospitals across the region. The exercise used the NHSIQ diagnostic
toolkit but also HES data analysis, structured interviews and case note reviews. This has provided
an indepth understanding of each specialties’ current level of compliance against the ten national
standards and identified the gaps that need to be addressed. The percentage scores reflect the
degree of compliance. The results can be found in each divisional section (page 20 onwards).
Note: these thresholds have not been agreed with NHS England as a measure of compliance as no
standard definition currently exists.
6.6
Strategic developments and priorities
Using the information, statistics and outcomes from the diagnostic exercise and assessments each
division was asked to determine their priority objectives for the strategy over the next three to five
years.
The overarching priorities and specific service level plans that were identified can be found in part two
of this document (page 20 onwards).
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CLINICAL SERVICES STRATEGY
PART TWO – OVERARCHING PRIORITIES AND DIVISIONAL PLANS
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7. Overarching priorities
7.1 Seven day services
MDT review
Shift handovers
Diagnostics
Intervention/Key
services
Mental health
On-going review
Transfer to
community,
primary and
social care
Quality
improvement
Average across
standards
Average %
Time to first
consultant
review
All Trust
specialties
Patient
Experience
An analysis of the current service provision against the ten seven day service standards has
identified the following gaps in compliance across the Trust(5). Results for individual divisions and all
their specialties can be found in section 8 of this strategy:
64.3
49.1
41.7
68.4
66.2
41.6
51.3
35.9
36.5
49.5
34.9
The analysis identified a number of standards that pose particular challenges, such as consistent
clinical reviews, multi-disciplinary input and consistent access to continuity and primary care
services.
Achieving the seven day standard will require workforce investment and there are a number of issues
that currently act as barriers to developing cost effective solutions to identified gaps. These include:
On call / out of hours type local agreements and payments that may need to change;
Pay protection – i.e. if as a result of the changes, employees will be financially worse off, pay
protection may apply;
Recruitment to some roles;
Flexibility in contracts;
Access to training and development.
These issues (and others) exist across the country and whilst work taking place at a national level may
help to address some of the workforce challenges, there is no guarantee at present that key workforce
related enablers will be in place to allow preferred solutions to identified gaps to be implemented in the
timescales for compliance set out by NHS England.
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Total Additional
Investment
Additional
Administrative &
Clerical Staff
Additional Allied Health
Professional Staff
Additional Nursing Staff
Additional
Staffing Group
(WTE all grades)
Additional Medical Staff
To deliver consistent seven day services at Chesterfield Royal Hospital using conventional models of
care would require the following additional whole time equivalent staff and investment:
Division
Medicine &
Emergency Care
17.69
4.0
1.8
5.9
2,608,079
Surgical
Services
17.48
2.1
0.0
4.13
2,287,154
Women’s Health
and Children
4.0
3.45
0.0
2.48
888,389
Clinical Specialist
Services
4.0
0.0
96.85
0.0
3,643,172
In working towards compliance the Trust will seek to explore innovative service and workforce models.
We will use our networks to find ways of providing consistent access to care where pooling of
resources can help. We will further develop new roles to provide advanced practitioners, for example,
in nursing, reporting radiographers, prescribing pharmacists etc. to carry out tasks previously the
preserve of doctors. Where investment is required we will work with our commissioners to prioritise
this – and also seek to re-invest any savings that are achieved through the improved efficiency
generated from providing more consistent seven-day care.
7.2 Urgent and emergency care
Reflecting the direction of the Keogh review the Trust will continue to develop its role as an emergency
centre working in partnership with the specialist emergency centre in Nottingham as part of the East
Midlands Trauma Network but also with Sheffield Teaching Hosptials. In addition through the 21st
Century care project we will ensure that our emergency services fully integrated within the wider
urgent care system in North Derbyshire. In addition as part of our investment in infrastructure we will
seek to develop an urgent care village co-locating key services at the “front door” of the hospital. This
will include a refurbishment of the current emergency department, a co-located clinical decisions unit
and a paediatric assessment unit. In addition we will also develop an urgent care facility which
combines minor injuries and primary care services. The UCV will also incorporate access to social
care and mental health services. The fundamental principle underpinning the design is to improve
senior decision making at the beginning of the pathway seeking to avoid admission where possible.
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Delivering sustainable, appropriate and high-performing services
Clinical Services Strategy 2014 - 2019
In addition we will also develop our acute medical service increasing the provision of acute physicians
and developing a dedicated facility which combines acute assessment, short stay beds and
ambulatory care.
7.3 Planned care
The Trust will continue to deliver a comprehensive portfolio of planned care which is complementary to
the delivery of our core acute services. We will develop models of care which support the translation
of elective surgical work from main theatres to day case provision to office base based treatment
where clinically appropriate.
As part of our transformation programme we will develop ways of organising planned care to improve
the quality of the service provided whilst at the same time making it more efficient.
7.4 Cancer care
The delivery of effective cancer care remains a core service for the hospital. We will continue to work
as part of a cancer network seeking to deliver as much care locally as possible but supporting
centralisation where necessary.
We will seek to increase the volume and range of chemotherapy provided locally and through the
development of the Chesterfield Royal Macmillan Centre we will be able to provide additional capacity
and a significantly improved environment for patients.
We will continue to work with close partnership with Weston Park Hospital to support this strategic
direction.
We will also explore with network partners the potential to develop a decentralised radiotherapy
service on the hospital site adjacent to the new cancer unit.
7.5 Critical care
In anticipation of the new clinical standards for critical care provision the Trust will move towards a
model whereby we deliver integrated level 3 (ITU) and level 2 (HDU) services. This will include level 2
patients being managed under the care of the intensivists. We will also explore the development of a
physically integrated unit which will provide greater flexibility in the management of a varying mix of
level 2 and 3 patients.
7.6 Education and research
We have a strong reputation as a teaching centre for both medical and nursing education. To build on
this, our ambition is to become a centre of excellence; developing the role of the clinical educator to
support in-patient settings, as well as developing specialist medical educators across the hospital.
Over the next five-years we will increase the capacity we have to ensure we can train, educate and
develop the clinicians of the future.
Supporting this, high-quality clinical research is vital to provide the evidence we need to transform
services and improve clinical outcomes. We will continue to be involved in the Clinical Research
Network, giving our patients the chance to participate in research, and to access the latest clinical
trials and developments. We will work in partnership with others to use our clinical assets
appropriately to strengthen evidence based practice for the future.
23
Delivering sustainable, appropriate and high-performing services
Clinical Services Strategy 2014 - 2019
8. Divisional Plans
8.1
Medicine and emergency care division
Our division
We provide a broad range of acute specialist and general medical care to citizens over the age of 17.
Our emergency department sees over 60,000 patients each year. Along with medical in-patient wards
our services include the Emergency Management Unit and Clinical Decisions Unit, as well as a full
complement of out-patient and day care services.
Our specialties and services
General Medicine
Care of the Elderly
Cardio-Respiratory
Cardiac Angiography
Cardiac Rehabilitation
Acute Stroke Services
Stroke Rehabilitation
Cancer Services
Dementia Services
Clinical Haematology
Rheumatology
Respiratory Medicine
Genito-Urinary Medicine
Sexual Health
Endocrinology & Diabetology
Gastroenterology & Endoscopy
Dermatology/Skin Surgery
Night Matrons
Acute Medicine
Ambulatory Care
Medical Day Care Unit
Emergency Medicine
EMU/CDU
Palliative Care
Cavendish Suite/Chemo
Bed Management Team
Medical Wards
“We want to change the way we assess and manage
the health and social needs of people on urgent care
pathways – as we believe that a single day wasted in
hospital is a day too many.”
Dr Kevin Fairburn, Divisional Director,
Medicine & Emergency Care
24
Delivering sustainable, appropriate and high-performing services
Clinical Services Strategy 2014 - 2019
Divisional self-assessment
Service classification and specialty review
This chart illustrates the medicine and emergency care division’s service classification, as well as the
output from the specialty review against the criteria of: patient experience and outcomes, financial,
clinical and operational sustainability. The strength of the division’s clinical networks and workforce
(people) was also assessed:
Clinical
sustainability
Patient
experience
and
outcomes
Financial
sustainability
Operational
sustainability
People
Networks
and
partnerships
Emergency care
3
3
1
3
2
2
Acute medicine
1.5
3
1
2.2
1.5
2.2
Stroke
2
4
4
3
4
3
Integrated medicine
3
3
3.5
4
3.5
4
Cardiology
2
3
2.5
3.5
3
4
Respiratory
1
2.5
1.5
1
1
2
Cardiorespiratory
support
2
3
2
1
2.5
2
Haematology
2
3
3
2.5
2
4
Gastroenterology
2
3
4
2.5
4
2
Acute oncology service
1
4
2
1
3
4
3
2.5
4
2.3
3.4
2
Dermatology
3
4
3
2
3
4
Rheumatology
3
4
1
2
2
3
Acute Core Services
Supporting Core Services
Diabetes/endocrinology
Stand-Alone Services
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Delivering sustainable, appropriate and high-performing services
Clinical Services Strategy 2014 - 2019
Seven day services compliance
Analysis of the current divisional service provision against the ten seven day service standards
identified the following gaps against achieving compliance:
Strategic developments and priorities
Using the information, statistics and outcomes from our self-assessment diagnostic exercise the
medicine and emergency care division’s priority objectives within the clinical services strategy are set
out below.
Acute core services
Objective
Priority
Acute medicine
To recruit a workforce that is skilled, knowledgeable and
adaptable.
Year 1
To provide a full seven day acute medicine assessment and
ambulatory care service that is compliant with NICE
guidance, meets best practice tariff and become a centre of
excellence for Acute Medicine.
Year 1
To have consultant establishment/senior decision makers on
the shop floor for 12 hours over seven days a week.
Year 1
To have a sustainable workforce model for middle grade
staffing.
Year 1
To have consultants available on call throughout 24 hours to
deliver an Emergency Care Centre offer.
Year 1
To work with partners in public health and other provider
organisations including mental health and social care to
create pathways that ensure we admit patients whose needs
can only be met in hospital.
Year 1, 2, 3
Emergency medicine
26
Delivering sustainable, appropriate and high-performing services
Clinical Services Strategy 2014 - 2019
Through our site development strategy, ensure that the
environment is re-designed to accommodate all our
Emergency care centre services (including those for
children) in an Urgent Care Village.
Year 3
To develop a range of integrated care services for the frail
elderly - working with partner providers to build on the Acute
Frailty Unit pilot (AFU) and develop this model further in
settings outside the hospital.
Year 2
Lead seamless pathways of care development across
st
organisations, for frail elderly patients on behalf of the 21
century healthcare board.
Year 2
Recruit volunteers for our inpatient wards to ensure that we
offer a great experience for patients.
Year 1
To deliver our service from an upgraded and fully equipped
department in April 2015.
Year 1
Set out a targeted recruitment programme to establish a
consultant team with the specialist skills to deliver a modern
comprehensive cardiology service on site compliant with
NICE guidance.
Year 1
To develop and extend the Cardiology Catheter Lab to
increase the capacity for Angiogram and provide earlier
intervention for patients with acute cardiac symptoms.
Year 2
To develop a new service for the assessment and
management of patients with syncope.
Year 2
Invest in the professional development of our staff to ensure
we have established a sustainable workforce.
Year 2
To work closely with provider colleagues to ensure the
success of early supported discharge for stroke patients to
enable them to complete their rehabilitation at home and
expedite their recovery.
Year 1
Respiratory
To explore opportunities to invest in a local EBUS service so
that patients on the cancer pathway can have more timely
access to diagnosis and treatment.
Year 2
Gastroenterology
To review and restructure our gastroenterology service
enabling increased specialisation in the care of liver and
inflammatory bowel disease to further improve outcomes.
Year 2
Through service re-design and partnership establish a highquality, safe and sustainable 24/7 service for the
assessment and treatment of acute gastrointestinal
haemorrhage.
Year 2
To ensure there is access to a specialist nutrition service for
all our inpatients.
Year 1
Integrated medicine –
healthcare of the elderly
Cardiology
Acute stroke service
27
Delivering sustainable, appropriate and high-performing services
Clinical Services Strategy 2014 - 2019
Haematology
To invest in the development of a new cancer centre and
redesign pathways for integrated haematology care ensuring
they are high quality, clinically effective and sustainable,
enabling us to repatriate more patients requiring
chemotherapy so that they can be treated close to home.
Year 2
To continue to consider the feasibility of developing a
service for radiotherapy as our service evolves.
Year 3
To work with our colleagues in partner organisations to
deliver an integrated and sustainable acute oncology and
palliative care service over seven days.
Year 2
To fully establish an acute oncology team to provide rapid
identification of patients and access to services for urgent
symptomatic care.
Year 1
To ensure that all our clinical staff are trained and confident
in the provision of compassionate care at the end of life
support.
Year 1
Supporting core services
Objective
Priority
Endocrinology and
diabetes
To design a seamless pathway of care across primary,
secondary and tertiary services for our patients with diabetes
including a specialist diabetes ward on site.
Year 2
Through training and education the specialist diabetes
nursing team will ensure that all staff have access to advice
and support in their care of patients with diabetes across the
hospital.
Year 3
To establish a second Multidisciplinary clinic for the care of
diabetic foot problems supported by telephone access
outside clinic times.
Year 1
Stand-Alone Services
Objective
Priority
Genitourinary medicine
To contribute to the success of the new partnership with
other providers to deliver a high quality, comprehensive and
sustainable service across Derbyshire
Year 1
Dermatology
To complete a full service review of the current service
maximising opportunities for use of telemedicine, and to
establish a workplan to take the service forward.
Year 1
To develop pathways across primary and secondary care for
effective joined up management of skin diseases and deliver
enhanced cancer services working in partnership with
surgery.
Year 2
Acute oncology and
palliative care
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Delivering sustainable, appropriate and high-performing services
Clinical Services Strategy 2014 - 2019
Rheumatology
We will strengthen a partnership model for the delivery of
high quality rheumatology services with patient receiving
local care where appropriate on agreed pathways to deliver
the best outcomes with the right monitoring.
Year 1
To develop the current blood monitoring system to improve
both the quality and efficiency of the Rheumatology
service.
Year 2
Medicine and emergency care division – strategic transition plan
Do now
(2014/15)
Year 1
2015/16
Year 2
2016/17
Year 3
2017/18
THE FUTURE STATE
Networks & Partnerships
People
ED
staffing
Compliant
with 7DS
Standards
Plan for
seven day
service
(7DS)
Urgent care
village
pathways
ARU service
model
Syncope
service
Inpatient
nutrition team
Acute oncology
service
CURRENT POSITION
New cancer
centre
Tele -medicine
for dermatology
Respiratory
pathways and
consultant
Additional MDT for
diabetic foot care
Patients and Outcomes
Specialist
pathways for
gastro / liver
Refurbish
cardiac cath
lab
Operating Efficiently
(systems and
processes)
Clinical
Sustainability
Financial
Sustainability
29
Delivering sustainable, appropriate and high-performing services
Clinical Services Strategy 2014 - 2019
8.2
Surgical services
Our division’s profile
We provide a broad range of acute surgical care to children and adults. Our division includes surgical
wards and orthopaedic wards, along with ITU and HDU. We also have a full complement of
outpatient and day surgery services.
Our specialties and services
Operating Theatres
General Surgery
Urology Services
Breast Surgery
Colorectal Surgery
Endocrine Surgery
Upper GI Surgery
Vascular Surgery
Paediatric Surgery
Ear, Nose and Throat
Bowel Cancer Screening
Diabetic Retinopathy Screening
Ophthalmic Specialties
Audiology
Endoscopy
Pre-Assessment
Oral & Maxillofacial
Orthodontics
Orthopaedic Wards
Trauma
Plaster Theatres
Orthoptics
Holywell Daycare
PACU
ITU & HDU
Pain Services
Anaesthetics
Theatre Admissions Unit
Surgical Wards
Head & Neck Services
“We will continue to draw on the most up to date
ideas in medical care and clinical service design in
order to work with all our stakeholders in
implementing a portfolio of sustainable and high
quality clinical services fitted to the surgical care
needs of our patient population.”
Dr Duncan Farquharson, Divisional Director,
Surgical Services
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Delivering sustainable, appropriate and high-performing services
Clinical Services Strategy 2014 - 2019
Service classification and specialty review
This chart illustrates the surgical division’s service classification, as well as the output from the
specialty review against the criteria of: patient experience and outcomes, financial, clinical and
operational sustainability. The strength of the division’s clinical networks and workforce (people) was
also assessed:
Clinical
sustainability
Patient
experience
and
outcomes
Financial
sustainability
Operational
sustainability
People
Networks and
partnerships
2.5
3.5
3,5
2.5
4.5
2.5
Acute surgery
2
2
2
2
1.5
1.5
Trauma
3
2.5
0.5
1.5
2
2.5
Theatre & anaesthetics
3
3.5
1
2.5
1.5
3
Colorectal
2.5
3.25
3
2.75
1.25
3.25
Upper GI
1.5
2.5
2
1
1.5
3.5
2
3.5
3.5
2.5
2.5
2.5
2.5
4.5
3
2.5
3
3.5
Elective orthopaedic
3
4
2
3
4
3
Urology
2
2.5
2.5
2
2
4
Surgical endocrinology
& ENT
3
4
3
2
2
4
Ophthalmics
3
3
2
3
2
2
Orthodontics &
maxillo-facial
3
5
3.5
1
2
4
Audiology
3
3.5
3.5
3.5
4.5
2.5
Acute Core Services
Critical care
Supporting Core Services
Endoscopy
Breast
Stand-Alone Services
31
Delivering sustainable, appropriate and high-performing services
Clinical Services Strategy 2014 - 2019
Seven day services
An analysis of the current divisional service provision against the ten seven day service standards
has identified the following gaps against achieving compliance:
Strategic developments and priorities
Using the information, statistics and outcomes from our self-assessment diagnostic exercise the
surgical division’s priority objectives within the clinical services strategy are set out below.
Acute core services
Objective
Priority
Acute surgery
To review the acute general surgical service and introduce
pathways for surgical ambulatory care and access to rapid
assessment in outpatients.
Year 1
To review the capacity in anaesthetics and theatres for the
assessment and management of those patients who need
access to emergency surgery.
Year 1
To develop a specialist service for patients with fractured
neck of femur to improve quality, safety and efficiency of the
service.
Year 1
To provide a fracture clinic service from new redesigned
facilities which will improve our patient experience.
Year 2
Deliver a productive theatre, with efficient stock
management, an equipment inventory with a process for
renewing equipment and credentialising staff in its use.
Year 1
We will provide theatre service from a fully refurbished
theatre suite by April 2016.
Year 2
Orthopaedic trauma
services
Acute anaesthetics
32
Delivering sustainable, appropriate and high-performing services
Clinical Services Strategy 2014 - 2019
Critical care
Working with our commissioners we will complete a
redesign of our critical care service to deliver a combined
ITU/HDU model of care by creating an anaesthetist-led
HDU
Year 3
To develop a new workforce for this new service
Year 1
To continue to review our critical care capacity to ensure we
can fully support the anticipated increase in the number of
patients receiving chemotherapy at risk of complications;
and in the context of planned changes in the profile of
elective surgery in the Trust.
Year 1, 2, 3
Supporting core services
Objective
Priority
Gastrointestinal surgery –
colorectal and upper GI
To increase access to laparoscopic surgery and develop
our range of subspecialty interests to increase patient
choice.
Year 1
To redesign outpatient pathways, embracing principles of
enhanced recovery, we will improve access to the service,
reducing waiting times to enable us to repatriate activty.
Year 2
To develop a pathway of care for patients requiring stoma
care.
Endoscopy
Urology
Elective orthopaedics
To improve the environment in which we care for patients
we will refurbish our endoscopy suite.
Year 2
To introduce a new service - Bowel scope screening - to
provide local access for patients to a service for early
detection of bowel cancer.
Year 1
To continue to deliver a service, accreditated by the JAG
and compliant with NICE giudance, with sufficient capacity
to meet demand and explore partnership working to ensure
a sustainable model of medical staffing is in place
Year 1, 2, 3
To invest in additional capacity for the service to improve
access to specialist care over seven days.
Year 1
To invest in clinical nurse specialist support for patients
with urological cancers.
Year 1
To provide a high quality service compliant with NICE and
cancer network standards.
Year 2
To providing our outpatient service in a redesigned
environment.
Year 2
To complete a review of pathways for care to deliver
improvements in patient experience improving access to
day case care where ever possible and for our inpatients,
early mobilisation to reduce length of stay.
Year 1
33
Delivering sustainable, appropriate and high-performing services
Clinical Services Strategy 2014 - 2019
Breast surgery
To redesign the paediatric service for elective orthopaedic
care to ensure future sustainability as a local service for
patients.
Year 1
To introduce lipomodelling to extend the current oncoplastic
service available to our patients.
Year 2
To review the environment in which the service is
delivered to ensure it continues to be fit the purpose of
delivering a clinically effective breast service.
Year 2
Vascular
We continue to develop our vascular service in partnership
with Royal Derby hospital and will contribute towards the
development of high quality care for the patient with
diabetic foot problems.
Stand-Alone Services
Objective
Priority
Audiology, ENT and
Endocrine
To work in partnership with other acute Trusts, to redesign
our ENT service to make it sustainable for the next five
years and improve the quality and sustainability of the out
of hours service for our patients.
Year 1
To support the introduction of a wax removal pathway.
Year 1
To develop a new model for local surgery for thyroid and
parathyroid disease.
Year 1
To explore commercial opportunities for the development of
the audiology service to provide non-NHS hearing aids and
accessories including noise defending ear plugs and a
service for private hearing testing.
Year 2
To work in partnership to ensure there is a sustainable and
high quality trauma service.
Year 1, 2, 3
To collaborate with STH to create a combined service for
excellence in the management of head and neck cancer.
Year 1
To explore opportunities to introduce a 7 day service for
elective care to better utilise physical assets and
infrastructure through service redesign.
Year 2
To develop a sustainable alternative workforce to support
the consultant team.
Year 2
To work in partnership with colleagues in South Yorkshire
and mid-Yorkshire Acute Trusts to improve out of hours
services to our patients.
Year 2
Maxillofacial and
orthodontics
Ophthalmology
34
Delivering sustainable, appropriate and high-performing services
Clinical Services Strategy 2014 - 2019
Surgical services division – strategic transition plan
Do now
(2014/15)
Year 1
2015/16
Year 2
2016/17
Year 3
2017/18
Urology review
Compliance
with priority
seven day
standards
Stoma care
service
Partnership working
for ENT and
ophthalmology
Networks &
Partnerships
People
THE FUTURE STATE
Critical care
outreach
team
CURRENT POSITION
Laparoscopic
surgery
Theatre
refurbishment
complete
New Fracture
clinic
Acute surgery
ambulatory care
Review orthopaedic IP
pathways
Patients and Outcomes
Operating
Efficiently
(systems and
processes)
Clinical
Sustainability
Review urgent
theatre capacity
Financial
Sustainability
35
Delivering sustainable, appropriate and high-performing services
Clinical Services Strategy 2014 - 2019
8.3
Women and children’s
Our division
We cover a wide range of services across acute and community settings:
Our specialties and services
Chesterfield Birth Centre
Ante-natal/Post-natal Ward
Community Midwifery service
Antental Clinic
Occupational Therapy
Physiotherapy
Children’s Psychology
Children’s Speech & Language Therapy
Children’s Hearing Services Children’s Community Nursing
School Health Services
Orthotics
Child & Adolescent Mental Health
Child Development Nursery
Paediatric Services
Neo-natal Services
Gynaecology Services
Women’s Health Unit
Community AHPs
Orthoptics
Children’s Diabetes
“Our divisional strategy is formed to provide a modern, caring, high-quality
service provision across a broad range of acute and community based
paediatric and maternity services.
“Its aim is to develop new models of care and pathways – as well as
modernize, extend and integrate key services.
“We will achieve our aim through a number of strategic developments, such
as an IT system development in community paediatrics, seven day service
provision of acute paediatrics and obstetrics, extended hours provision of
ante-natal clinics and EPAU, increasing the Outreach of CAMHS into
community hubs.”
Dr Unnikrishnan Anoop, Divisional Director, Women and Children’s
36
Delivering sustainable, appropriate and high-performing services
Clinical Services Strategy 2014 - 2019
Service classification and specialty review
This chart illustrates the women and children’s division’s service classification, as well as the output
from the specialty review against the criteria of: patient experience and outcomes, financial, clinical
and operational sustainability. The strength of the division’s clinical networks and workforce (people)
was also assessed:
Clinical
sustainability
Patient
experience
and
outcomes
Financial
sustainability
Operational
sustainability
People
Networks
and
partnerships
3
4
3
2
2
3
1.75
3.25
1.7
2.2
3
3.5
4
4
3
4
3
4
Community paediatric
nursing
2
3
3
3
3.5
3
Elective paediatrics
4
4
3
3
3
3
Elective gynaecology
3
3
3.5
4
3
3.5
Looked after children
3
3
3
3
4
4
CAMHS
2
3.5
2.5
3
3.5
4
LD CAMHS
3
4.5
4
3
3.5
4
Child therapies
2.7
3
2
2
1.3
2.5
School nursing
3.5
4
3
2
4
5
3
1.5
2
2
3.5
4
Core Services
Acute O&G
Acute paediatrics
Neonatal care
Supporting Core Services
Stand-Alone Services
Clinical psychology
37
Delivering sustainable, appropriate and high-performing services
Clinical Services Strategy 2014 - 2019
Seven day services
An analysis of the current divisional service provision against the ten seven day service standards
has identified the following gaps against achieving compliance:
Strategic developments and priorities
Using the information, statistics and outcomes from our self-assessment diagnostic exercise the
women and children’s division’s priority objectives within the clinical services strategy are set out
below.
Acute core services
Objective
Priority
Acute paediatrics
To maintain a consultant of the week model we will
maintain a high quality safe and sustainable service
consistent with royal college and seven day service
access standards
Year 1, 2, 3
To eliminate unnecessary inpatient admissions by
providing rapid access to outpatients within 48 hours and
a paediatric assessment unit within the urgent care village.
Year 1
To establish an inpatient transitional care service to
ensure we are continuing to provide high quality services
for young people aged 16-19 with chronic or complex
health needs.
Year 3
To maintain the highest quality maternity service for our
patients accredited at CNST level 2.
Year 1, 2, 3
To improve access to antenatal care with extended hours
opening.
Year 2
To develop a pathway of care to provide 7 day access to
the specialist early pregnancy assessment service.
Year 2
To invest in training of our midwifery staff to enable them
to undertake newborn examinations in all birth settings.
Year 2
To implement a fully electronic patient record for our
maternity care pathway.
Year 1
Acute obstetrics
38
Delivering sustainable, appropriate and high-performing services
Clinical Services Strategy 2014 - 2019
Neonatal care
To develop a service for supporting home tube feeding.
Year x
To develop a transitional support service to improve the
experience of care for parents whose babies require
additional support in the new born period.
Year x
To develop an acute Gynaecology service, which will
eliminate unnecessary inpatient admissions - providing rapid
access to the emergency service and allowing self-referrals
Year x
To review the provision of emergency beds by April 2017.
Year 2
To offer robust and seamless pathways of care for women
experiencing early pregnancy loss by providing a
comprehensive scanning and assessment unit for early
pregnancy, operational 7days a week.
Year 2
Supporting core services
Objective
Priority
Elective paediatrics
To review and redesign the current pathways for the
diagnostic assessment and continuing care of children and
young people with neuro-developmental concerns - to
outreach into community hubs providing services as close to
the patient as possible and maximize opportunities for nurse
led clinics.
Year 2
Community paediatric
nursing
To further define clear pathways for delivery of high quality
and sustainable care to children and young people with
complex medical needs to be supported by the team.
Introduction of an electronic record will improve efficient and
effective working within the team and facilitate information
sharing.
Year 1
Elective gynaecology
To continue to develop a specialist service for gynaecology
outpatient care within the women’s health unit, reviewing
utilization of the space and explore opportunities to use
technology to continuously improve care.
Year x
Children’s adolescent and
mental health services
(CAMHS)
To develop a service model in partnership with service
users. We will utilize new opportunities for increasing the
outreach of CAMHS into community hubs to improve access
for service users.
Year x
Paediatric clinical
psychology
To redesign services to enable more timely access for
children and young people within current capacity.
Year x
To adopt an electronic record to further improve efficiency
and effective working within the team and facilitate
information sharing.
Year x
Acute gynaecology
39
Delivering sustainable, appropriate and high-performing services
Clinical Services Strategy 2014 - 2019
Stand-alone services
Objective
Priority
Looked after children
To ensure the continuing delivery of high quality care
compliant with national standards.
Year 1, 2, 3
Children’s therapy services
To redesign the current service to develop and implement
care pathways for common conditions to support the
continuing delivery of high quality and sustainable
services
Year 1
School nursing
To explore opportunities for partnership working in the
delivery of a seamless and consistent offer for children
and young people across Derbyshire, which is of high
quality and sustainable.
Surgical services division – strategic transition plan
Do now
(2014/15)
Year 1
2015/16
Year 2
2016/17
Year 3
2017/18
THE FUTURE STATE
Networks & Partnerships
People
Compliant
with 7DS
standards
Paed
assessment
unit in UCV
7DS EPAU
CURRENT POSITION
Paed
assessment
pathway in
place for 7DS
compliance
Elective
gynaecology
service
Electronic
record
Community
Transition
service for
16-19
Electronic
maternity care
record
Patients and Outcomes
Operating Efficiently
(systems and
processes)
Clinical
Sustainability
Financial
Sustainability
40
Delivering sustainable, appropriate and high-performing services
Clinical Services Strategy 2014 - 2019
8.4
Clinical specialist services
Our division
The division covers all the disciplines of pathology and imaging as well as the therapies and a broad
range of supporting services:
Our specialties and services
Phlebotomy
Blood Services
Biochemistry
Cytology
Transfusion Services
Histology
Microbiology
Mortuary
Bereavement Services
Radiology
Ultrasound
General Radiography
MRI
CT Radiography
Medical Physics
Medical Photography
Mammography
Nuclear Medicine – DEXA
Pharmacy & Medicines Management
Physiotherapy
Occupational Therapy
Speech & Language Therapy
Orthotics
Nutrition & Dietetics
Podiatry
Clinical Engineering
Decontamination
Clinical Specialist Services support almost every
clinical pathway within our organisation.
Our clinical services strategy aims to strengthen this support through the
development of high quality, sustainable and cost-effective specialist
services across 7 days where appropriate.
We will build on existing partnerships and aim to create exciting new ones
to support local clinical services.
In conjunction with our quality and workforce strategies, we will improve
clinical outcomes and deliver better patient and staff experience.
Dr Roger Start, Divisional Director, Clinical Specialist Services
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Delivering sustainable, appropriate and high-performing services
Clinical Services Strategy 2014 - 2019
Service classification and specialty review
This chart illustrates the clinical specialist services division’s service classification, as well as the
output from the specialty review against the criteria of: patient experience and outcomes, financial,
clinical and operational sustainability. The strength of the division’s clinical networks and workforce
(people) was also assessed:
Clinical
sustainability
Patient
experience
and
outcomes
Financial
sustainability
Operational
sustainability
People
Networks and
partnerships
MRI
2
3.5
1
1.5
1
4
USS
1
2
1
1
1
2
CT
3
4
2
2.5
2
4
X-ray
3
3
3
3
3
1
Breast imaging
4
3.5
3
3
2.5
3.5
Physiotherapy
3
3
4
2
3
2.5
Occupational
therapy
3
3.5
3.5
3
3
2
SLT
3
3.5
3
3.5
3.5
1.5
Blood sciences
4
4
3.5
4
3
3
Dietetics
2.75
2.5
3
2.75
3
2.5
Histology
1
3
2
3.5
3
3
Interventional
radiology
2
4
2
2
2
3
Microbiology
3
4
2.5
4
2
2
Fluoroscopy
4
3.5
3
3
2
2.5
3
3
2.5
2
4
Phlebotomy
2
2
2
1
1
Pharmacy
3
4
3.5
2.5
3
4
Nuclear
medicine
1
4
2
3
2
3
Core Services
Mortuary
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Delivering sustainable, appropriate and high-performing services
Clinical Services Strategy 2014 - 2019
Seven day services
An analysis of the current divisional service provision against the ten seven day service standards
has identified the following gaps against achieving compliance:
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Delivering sustainable, appropriate and high-performing services
Clinical Services Strategy 2014 - 2019
Strategic developments and priorities
Using the information, statistics and outcomes from our self-assessment diagnostic exercise the
clinical specialist services division’s priority objectives within the clinical services strategy are set out
below.
Acute core services
Objective
Priority
Cross sectional imaging
To procure a second MRI scanner before September 2016
to support the delivery of the highest quality, NICE
compliant, pathways of care.
Year 1, 2
To work in partnership with other acute trusts to look at a
shared solution for a sustainable approach to addressing
shortfalls in reporting capacity.
Year 1
To an electronic appointment management system in
order to optimize efficiency and accessibility of the
service.
Year 2
To explore opportunities for redesign by review of skills
mix and provision of specialist elements of the service.
Year 1
Histology
To work in partnership with colleagues in STH and DRI to
ensure there is continuing access to a high quality
sustainable specialist service.
Year 1
Blood sciences
To work in partnership with colleagues in RDH and SFH
we will ensure there is continuing access to a high quality,
efficient and sustainable service.
Year 1
Phlebotomy and near
patient testing
To explore opportunities for developing outreach capacity
of this service, review current access to phlebotomy
service and consider opportunities for redesign and
extended roles
Year 2
Microbiology
To explore opportunities for redesign of the service
including evaluation of value of partnership working
Year 1
Mortuary and bereavement
services
To explore opportunities for redesign of the service
including evaluation of possibilities for partnership working
Year 2
Plain film and fluoroscopy
To explore opportunities to increase responsiveness of
service, seeking user views and consider redesign to
develop extended practitioner roles including reporting
Year 1
Breast imaging
To review environment and equipment to ensure fit for
purpose in delivery of a sustainable high quality service for
patients. Explore opportunities for partnership working to
ensure sustainability of workforce
Year 1,2
Dietetics
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Delivering sustainable, appropriate and high-performing services
Clinical Services Strategy 2014 - 2019
Interventional radiology
Redesign service to ensure robust delivery of extended
hours over 7 days with increased opportunities for
reducing length of stay and improving patient experience
Year 1
Nuclear medicine
Review and redesign current service to ensure access to
a safe, effective and sustainable service for our patients.
Year 1
Physiotherapy
To be compliant with the requirements of seven day
service standards.
Year 1
To deliver a robust accessible service for the
multidisciplinary assessment of patients in outpatient,
inpatient and ED settings to facilitate patient flow and early
discharge.
Year 1, 2, 3
To provide a modern and well equipment environment for
treatment to be provided to provide a positive experience
for patients.
Year 3
To pursue opportunities to work in partnership with other
providers and by redesign of pathways, identify
opportunities for closer collaboration with PT.
Year 1
To explore opportunities to ensure the workforce is
sustainable by enabling a clear career structure following
skill mix review and opportunities for specialisiation.
Year 1
Speech and language
therapy
To utilise opportunities for telehealth and other innovative
practice, we will develop and enhance the profile of SLT ,
develop further clinical pathways and optimizing use of
skill mix to provide a high quality and sustainable service
Year 1,2
Pharmacy
To achieve compliance with priority seven day service
standard utilising a model of ward based pharmacy
support over 7 days
Year 2
To explore commercial opportunities with wholesalers that
will be of value to our patients.
Year 2
To review the development of a business case for aseptic
services.
Year 1
These services did not go through the Clinical Services
Strategy process. A similar process will undertaken to
determine future strategic developments and priorities.
Year 1
Occupational therapy
Clinical Engineering
Decontamination
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Delivering sustainable, appropriate and high-performing services
Clinical Services Strategy 2014 - 2019
Clinical specialist services division – strategic transition plan
Do now
(2014/15)
Year 2
2016/17
Year 3
2017/18
THE FUTURE STATE
Review
staffing and
skill mix
People
Networks & Partnerships
Year 1
2015/16
Address
reporting
capacity
shortfall
Clinical
Engineering/Deco
ntamination
review
Histology
partnership(S
TH/DRI)
Phlebotomy
+NPT
opportunities
Support local
7DS
Therapy
pathways
CURRENT POSITION
Suite 5
environment
MRI capacity
Urgent care
village input
Breast
accommodatio
n
Patients and Outcomes
Imaging
Nuclear
med review
Operating Efficiently
(systems and processes)
Pathology
Electronic
appointment
systems for
dietetics
East Mid
Pathology
Alliance
Clinical
Sustainability
Pharmacy + Therapy
Financial Sustainability
Clinical Engineering
and Decontamination
11. References
1.
Derbyshire County Council (2014) Population Projections. [Online] Last accessed on 27th October
2014 at
http://www.derbyshire.gov.uk/community/about_your_county/population/population_forecasts/
2.
Keogh B (2014) Transforming urgent and emergency care services in England. Department of
Health, London.
3.
Department of Health (2014) Five Year Forward View. Department of Health, London.
4.
Monitor (2014) Developing Strategy. Department of Health, London.
5.
Seven Day Services Baseline Assessment and Gap Analysis, Final Report, Chesterfield Royal
Hospital NHS Foundation Trust, December 2014, Version 1.
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Delivering sustainable, appropriate and high-performing services
Clinical Services Strategy 2014 - 2019
47
Delivering sustainable, appropriate and high-performing services
Clinical Services Strategy 2014 - 2019
Find our more about our strategies and plans at: www.chesterfieldroyal.nhs.uk
You might also like to:
Chesterfield Royal Hospital NHS Foundation Trust
Calow, Chesterfield S44 5BL
Telephone: 01246 277271
48
Delivering sustainable, appropriate and high-performing services