A NEW CLINICAL STRATEGY FOR HEALTH
SERVICES IN MORECAMBE BAY
Update Report
July 2013
What is better care, together?
Better care, together is a review of local health services which is being carried
out by local NHS organisations, led by:
– Lancashire North Clinical Commissioning Group
– Cumbria Clinical Commissioning Group
– University Hospitals of Morecambe Bay NHS Foundation Trust, which runs the
hospitals in Lancaster, Barrow and Kendal
– Lancashire Area Team and Cumbria Area Team
– The review is an opportunity to make sure the best possible health services
are provided across North Lancashire and South Cumbria, which meet the
needs of residents, now and well into the future.
Health professionals in the area, including GPs and hospital doctors, are
considering how the different parts of the health service can work together more
effectively to ensure individual patients get the most appropriate care.
Background and context
• Quality and Safety issues in UHMB
– Monitor intervention
• Maternity & Paediatrics; ED; Outpatients; Safeguarding
– CQC
• Financial issues in UHMB
– Monitor intervention
– Formal Recovery Plan
• Expensive / non sustainable remedies
• Health economy financial challenge
• Demographics / Austerity / Geography
• Desire for integration, moving care closer to where people live
• Recognition that certain treatments require travel to specialist centres
• National context – David Nicholson’s £20 billion
Vision
•
•
•
•
•
•
•
The provision of safe, high quality care which will be patient-centred, safe and effective,
affordable and sustainable.
Future NHS services in Morecambe Bay to be increasingly joined-up as part of an
integrated health and social care system
Safe, appropriate, accessible services delivered by the appropriate clinicians as near to
people’s homes as possible.
Some care is best provided in a hospital. We want to ensure that residents requiring
hospital care receive safe care of the highest quality possible, based on clinical evidence
and best practice to ensure the best health outcomes for them.
Where possible this hospital care would be provided by local hospitals with more
specialist care being provided by specialist centres, as is the case now.
We want to empower residents to manage their own health and care with the support
of the appropriate clinicians where necessary.
We want to engage local residents and communities in the decision making process to
improve healthcare as part of a developing clinical strategy for the population of
Morecambe Bay.
Who is involved from the local health
community?
Steering Group Membership:
–
–
–
–
–
–
–
–
–
–
–
Cumbria CCG
Lancashire North CCG
University Hospitals of Morecambe Bay FT
Cumbria Partnership FT
Lancashire Care FT
Blackpool Teaching Hospitals FT
Lancashire County Council
Cumbria County Council
North West Ambulance Service
Lancashire Area Team, NHS England
Cumbria, Northumberland and Tyne & Wear Area
Team, NHS England
Sponsor
Programme Governance Structure
Trust
Boards
Membership Council /
Governing bodies
Public Reference
Group
Steering Group
Programme Support Organisation
Programme
Workstream
Membership Council /
Governing bodies
HR &
Workforce
Finance &
Activity
Communications
& Engagement
CS Clinical Reference
Group
Estates
Transport
Informatics
Children
& Young
People
Planned
Care
Maternity
Unscheduled
care
Primary &
Community care
Task & Finish group
The four clinical workstreams
Clinical work streams looking at four key areas:
– Unplanned care e.g. emergency care
– Planned care e.g. elective surgery, long term conditions
– Maternity
– Children and Young People
They report to a Clinical Reference Group comprising of GPs, Hospital
Consultants, Medical Director and CCG Clinical Chairs.
They are also supported by cross cutting work streams e.g. Workforce
including union representation; Finance & Activity; Transport; Estates;
Communications & Engagement.
Milestones
• The programme plan and key milestones for the option appraisals
were revised to allow more time to ensure engagement
/robustness.
• A recent informal visit by the National Clinical Advisory Team in
June will be followed by a formal review later in the year
• A Health Gateway 0 (strategic assurance review) took place 15 – 18
July.
• The results of this will inform the next steps of the Programme
along with our pre-engagement work
• Partners will be kept up to date with developments and timescales
via our stakeholder briefings and our on-going engagement
programme.
The Route to Viable Options
Workstream
Clinical
Models
Combined
Clinical
Models
Generate
Options
Public Engagement
Appraise
Options
Short Listed
Options
Pre-consultation engagement to date has reached
over 5000 people via representative groups or
individual contact
Includes:
• TNS BMRB independent research company: four phases including a survey
for staff, stakeholders and the public
• St Johns Hospice focus group
• Age UK South Lakeland event
• Road show bus visits
• Cumbria Youth Alliance focus groups and questionnaires
• Manna House Centre for the homeless
• Field events in town centres
• Vox pop film bites
• Clinical engagement
In addition we have on-going engagement with OSCs, MPs, local Councils ,
staff and clinicians
Pre-consultation communication
to date
Includes:
• Launch letters
• Advertorials
• Press releases
• Radio interviews
• Newsletters
• Presentations
• MP briefings
• Stakeholder briefings
• Website
Key themes to date include:
• Travel e.g. people are used to travelling for highly
specialised care
• Proximity to facilities e.g. culture of services being local
• Patient experience e.g. positive and negative
• Perceived risk e.g. of transfer while ill
• Communication e.g. listening skills and remote contact
• Relationships e.g. with medical staff
• Access e.g. weekend access
• Staffing e.g. levels of staffing in secondary and primary care
• Level of acceptance of change e.g. sustainability and
timescales
Comments to date include:
Strengths:
• “I experienced a fast track system
at RIL – I went through 4 different
departments to get a range of
tests and results in the same day.
I was glad to get an answer at the
end of the day – I was nervous
but I walked away a free man”
• Nearly 2/3 of general public and
staff said they would recommend
services to a friend or family
member
• “Nurses get a hard time in the
media but on the whole provide
an excellent service”
Areas for improvement:
• “Felt like I was going from
pillar to post”
• “Older people need good
care today not at some
point in the future”
• “Not meant to be ill at
weekend”
Initial consultation plans
Engagement
• Full consultation document
• Summary consultation
document
• On-line and paper
questionnaire
• Launch event
• Drop in events
• Exhibitions
• Staff engagement
• Events with partners
Communication
• Webinars
• Media relations
• Hospital radio interviews
• Website
• Social media
• Advertorials
• Meetings with key
stakeholders
Next steps
• This exercise and feedback from the public and stakeholders has been
passed on to health professionals to inform their views when shaping
options for providing services in future.
• Further engagement with hard to reach groups and protected groups
(including the well majority)
• Further develop the staff engagement programme
• Consider clarity of communications e.g. clear explanations of any changes
to patient pathways
• Continued work with key stakeholders such as Health and Wellbeing
boards, elected members and OSCs
• On-going meetings of the Public Reference Group (1st held on 17th July)
to help review communication and engagement processes
• External Assurance – NCAT, Health Gateway, Legal advice and Consultation
Institute “compliance” package.
• Primary and Community Care Task & Finish group to start project work
shortly
Thank you for your time today
Your questions?