appendix dii€¦ · integrated impact assessment: pre-consultation report - stroke services...

$: Appendix Dii€¦ · Integrated Impact Assessment: Pre-consultation report - Stroke services supporting annex 1 | 1 | 1 | 13 November 2017 C:\Users\woo77433\AppData\Local\Microsoft\Windows\Temporary$
AppendixDii

StrokeReviewPreConsultationBusinessCase

IntegratedImpactAssessmentsupportingannex

Kent and Medway Sustainability and Transformation Plan Integrated Impact Assessment: Pre-consultation report - Stroke services supporting annex

13 November 2017

1 1 1 C:\Users\woo77433\AppData\Local\Microsoft\Windows\Temporary Internet

Files\Content.Outlook\9LD0NBYR\Pre-consultation report - stroke - Supporting annex_2 (003).docx

Mott MacDonald

Mott MacDonald 10 Fleet Place London EC4M 7RB United Kingdom T +44 (0)20 7651 0300 F +44 (0)20 7248 2698 mottmac.com

Kent and Medway Sustainability and Transformation Plan Integrated Impact Assessment: Pre-consultation report - Stroke services supporting annex

13 November 2017

Mott MacDonald Limited. Registered in England and Wales no. 1243967. Registered office: Mott MacDonald House, 8-10 Sydenham Road, Croydon CR0 2EE, United Kingdom

Mott MacDonald | Kent and Medway Sustainability and Transformation Plan Integrated Impact Assessment: Pre-consultation report - Stroke services supporting annex

1 | 1 | 1 | 13 November 2017 C:\Users\woo77433\AppData\Local\Microsoft\Windows\Temporary Internet Files\Content.Outlook\9LD0NBYR\Pre-consultation report - stroke - Supporting annex_2 (003).docx

Issue and Revision Record

Revision Date Originator Checker Approver Description A 24/10/20

17 M Montgomery J Peet

J Hitchcock K Scott

B 13/11/2017

J Hitchcock F Parrott

C 05/01/2017

J Hitchcock M Montgomery

Document reference: 1 | 1 | 1 Information class: Standard

This document is issued for the party which commissioned it and for specific purposes connected with the above-captioned project only. It should not be relied upon by any other party or used for any other purpose.

We accept no responsibility for the consequences of this document being relied upon by any other party, or being used for any other purpose, or containing any error or omission which is due to an error or omission in data supplied to us by other parties.

This document contains confidential information and proprietary intellectual property. It should not be shown to other parties without consent from us and from the party which commissioned it.

This report has been pr epared sol el y for use by the party which commissi oned it (the ‘Client’) i n connecti on with the capti oned proj ect. It should not be used for any other purpos e. N o person other than the Client or any party who has expressl y agreed ter ms of r eliance with us (the ‘Reci pient(s)’) may rel y on the content, i nformati on or any vi ews expressed i n the repor t. We accept no duty of care, responsi bility or liability to any other r eci pient of thi s document. This r eport is confi denti al and contains pr opri etar y intell ectual property.

No representati on, warranty or under taki ng, expr ess or i mplied, is made and no responsi bility or liability is accepted by us to any party other t han the Cli ent or any Reci pient(s), as to the accuracy or completeness of the i nformati on contai ned i n this r eport. For the a voidance of doubt this r eport does not in any way purport to i nclude any legal , insur ance or fi nanci al advice or opi nion.

We disclai m all and any liability whether arising i n tort or contrac t or other wise which it might otherwise have to any party other than the Cli ent or the Reci pient(s), in r espect of this report , or any infor mation attri buted to i t.

We accept no r esponsibility for any error or omission i n the r eport which is due to an error or omission i n data, infor mation or statements supplied to us by other par ties incl udi ng the client (‘D ata’). We have not i ndependentl y verified such D ata and have assumed it to be accurate, complete, reli abl e and current as of the date of such infor mation.

Forecasts presented i n this document were pr epared usi ng Data and the report is dependent or based on D ata. Inevitabl y, some of the assumptions used to develop the for ecasts will not be realised and unantici pated events and circumstances may occur. C onsequentl y M ott MacDonal d does not guarantee or warr ant the concl usi ons contained i n the repor t as there are li kel y to be differ ences between the for ecas ts and the ac tual results and those di ffer ences may be material. Whil e we consi der that the infor mation and opini ons gi ven i n this r eport are sound all parti es must rel y on their own skill and j udgement when making use of it .

Under no circumstances may this report or any extr act or summar y ther eof be used in connection wi th any public or pri vate sec urities offering i ncluding any rel ated memorandum or prospectus for any securities offering or stock exchange listing or announcement.



Contents

A. Medium list of proposed service models 7

B. Travel and access impacts for all proposals 8

C. Equality travel and access impacts for all proposals 21

D. GHG assessment results for all proposals 30

E. Focus Group Analysis 31



A. Medium list of proposed service models

As shown in the full report below is the medium list of proposed service models. An initial long list of options was developed, these were reduced down to a medium list of proposed service models using a hurdle criteria for subsequent evaluation.

Table 1: Medium list proposed service models Scenario Proposal

Current Four trusts providing stroke services across seven sites (Darent Valley Hospital, Kent and Canterbury Hospital, Maidstone Hospital, Medway Maritime Hospital, Queen Elizabeth the Queen Mother Hospital, Tunbridge Wells Hospital and William Harvey Hospital). 1

Proposal one

A HASU at: 1. Darent Valley Hospital 2. William Harvey Hospital 3. Queen Elizabeth the Queen Mother Hospital

Proposal two

A HASU at: 1. Maidstone Hospital, 2. Medway Maritime Hospital 3. Queen Elizabeth the Queen Mother Hospital

Proposal three

A HASU at: 1. Darent Valley Hospital 2. Medway Maritime Hospital 3. William Harvey Hospital

Proposal four

A HASU at: 1. Darent Valley Hospital 2. Medway Maritime Hospital 3. Queen Elizabeth the Queen Mother Hospital

Proposal five

A HASU at: 1. Darent Valley Hospital 2. Maidstone Hospital, 3. William Harvey Hospital

Proposal six

A HASU at: 1. Darent Valley Hospital 2. Maidstone Hospital, 3. Queen Elizabeth the Queen Mother Hospital

Proposal seven

A HASU at: 1. Darent Valley Hospital 2. Tunbridge Wells Hospital, 3. Queen Elizabeth the Queen Mother Hospital

Proposal eight

A HASU at: 1. Maidstone Hospital, 2. Medway Maritime Hospital 3. William Harvey Hospital

Proposal nine

A HASU at: 1. Tunbridge Wells Hospital, 2. Medway Maritime Hospital 3. Queen Elizabeth the Queen Mother Hospital

Proposal ten

A HASU at: 1. Tunbridge Wells Hospital, 2. Medway Maritime Hospital 3. William Harvey Hospital

Proposal eleven

A HASU at: 1. Darent Valley Hospital 2. Tunbridge Wells Hospital, 3. William Harvey Hospital

Source: Kent and Medway SEC Clinical Senate Submission

1 There is a temporary halt to emergency care provision, including stroke, at Kent & Canterbury Hospital.



B. Travel and access impacts for all proposals

The following presents the travel time analysis for the long list of stroke proposals. It presents the travel time analysis based upon blue light ambulance travel time data sourced from Carnall Farrar. This illustrates:

● Cumulative proportion of patients within travel time bands ● Number and proportion of patients experiencing an increase in journey times under each of the

proposals, and those experiencing no change ● Travel time map visualising travel times by blue light ambulance under each proposal

Table 2: BLA journey times for the patient population under each proposal Within 10

minutes Within 20

minutes Within 30

minutes Within 40

minutes Within 50

minutes Within 60

minutes Baseline (current service configuration)

29% 66% 94% 99% 100% 100%

Proposal one 13% 27% 74% 96% 100% 100%

Proposal two 19% 49% 71% 87% 98% 100%

Proposal three 23% 54% 82% 92% 96% 100%

Proposal four 21% 51% 71% 85% 96% 99%

Proposal five 11% 38% 79% 93% 96% 100%

Proposal six 8% 35% 68% 87% 98% 100%

Proposal seven 7% 22% 58% 78% 96% 98%

Proposal eight 22% 52% 82% 93% 96% 100%

Proposal nine 18% 48% 72% 87% 97% 99%

Proposal ten 21% 51% 84% 93% 96% 100%

Proposal eleven 10% 25% 71% 90% 96% 100% Source: Carnall Farrar travel time data

Table 3: Percentage point change from baseline for BLA journey times for the patient population under each proposal

Within 10 minutes

Within 20 minutes

Within 30 minutes

Within 40 minutes

Within 50 minutes

Within 60 minutes

Proposal one -16pp -39pp -20pp -3pp No change No change

Proposal two -10pp -17pp -23pp -12pp -2pp No change

Proposal three -6pp -12pp -12pp -7pp -4pp No change

Proposal four -8pp -15pp -23pp -14pp -4pp -1pp

Proposal five -18pp -28pp -15pp -6pp -4pp No change

Proposal six -21pp -31pp -26pp -12pp -2pp No change

Proposal seven -22pp -44pp -36pp -21pp -4pp -2pp

Proposal eight -7pp -14pp -12pp -6pp -4pp No change

Proposal nine -11pp -18pp -22pp -12pp -3pp -1pp

Proposal ten -8pp -15pp -10pp -6pp -4pp No change

Proposal eleven -19pp -41pp -23pp -9pp -4pp No change Source: Carnall Farrar travel time data



Table 4: Patient experiencing a change in journey time by proposal No change Increase No change (%) Increase (%) Proposal one 1,785 2,715 40% 60%

Proposal two 2,855 1,645 63% 37%

Proposal three 3,560 940 79% 21%

Proposal four 2,928 1,572 65% 35%

Proposal five 1,811 2,689 40% 60%

Proposal six 1,186 3,314 26% 74%

Proposal seven 1,048 3,452 23% 77%

Proposal eight 3,477 1,023 77% 23%

Proposal nine 2,793 1,707 62% 38%

Proposal ten 3,420 1,080 76% 24%

Proposal eleven 1,686 2,814 37% 63% Source: Carnall Farrar travel time data

Figure 1: Baseline travel time by blue light ambulance

Source: Carnall Farrar travel time data



Figure 2: Proposal one travel time by blue light ambulance




Figure 3: Proposal two travel time by blue light ambulance




Figure 4: Proposal three travel time by blue light ambulance




Figure 5: Proposal four travel time by blue light ambulance




Figure 6: Proposal five travel time by blue light ambulance




Figure 7: Proposal six travel time by blue light ambulance




Figure 8: Proposal seven travel time by blue light ambulance




Figure 9: Proposal eight travel time by blue light ambulance




Figure 10: Proposal nine travel time by blue light ambulance




Figure 11: Proposal ten travel time by blue light ambulance



Figure 12: Proposal eleven travel time by blue light ambulance




C. Equality travel and access impacts for all proposals

The tables below highlight the travel times for stroke services by scoped in equality group, comparing the baseline scenario with the future proposals. We have considered that equality groups who experience a five percentage point difference or more in comparison to the population overall to be disproportionality impacted by the proposal. Table 1 outlines which equality groups will be impacted by the proposals.

Table 5: Groups effected summary table Proposal Groups impacted Proposal one No equality groups will be disproportionately impacted

Proposal two No equality groups will be disproportionately impacted

Proposal three No equality groups will be disproportionately impacted

Proposal four No equality groups will be disproportionately impacted

Proposal five Those from the most deprived quintile Those who live with a LLTI

Proposal six No equality groups will be disproportionately impacted

Proposal seven Those from the most deprived quintile

Proposal eight Those from the most deprived quintile

Proposal nine No equality groups will be disproportionately impacted

Proposal ten Those from the most deprived quintile

Proposal eleven Those from the most deprived quintile Those with a LLTI

C.1 Proposal one

Table 6: Percentage able to reach stroke services within 30 and 60 minutes by blue light ambulance using patient activity data

Within 30 minutes Percentage point change from baseline

Within 60 minutes

Percentage point change from

baseline Total patients 74% -20pp 100% No change Patients aged 65 and over

74% -20pp 100% No change

Male patients 74% -19pp 100% No change

BAME patients 93% -4pp 100% No change Source: Carnall Farrar travel time data

● BAME patients will experience an overall decrease in access to stroke services with 30 minutes (-4 percentage point difference), however this is less than the patient population overall (-20 percentage point difference).



Table 7: Percentage able to reach stroke services within 30 and 60 minutes by blue light ambulance for proposal one using population data


Within 60 minutes


baseline Population overall


Females aged 16-44


Population with LLTI


Most deprived quintile


Source: UK Census 2011/IMD 2015

● There are no disproportionate impacts for the groups listed above as all equality groups are within five percentage points of the change to the population overall (-21 percentage point difference).

C.2 Proposal two



Within 60 minutes







Table 9: Percentage able to reach stroke services within 30 and 60 minutes by blue light ambulance for proposal two using population data


Within 60 minutes




Females aged 16-44










C.3 Proposal three



Within 60 minutes







Table 11: Percentage able to reach stroke services within 30 and 60 minutes by blue light ambulance for proposal three using population data


Within 60 minutes



71% -28pp 98% -2pp

Females aged 16-44

73% -25pp 98% -2pp


67% -32pp 97% -3pp





C.4 Proposal four



Within 60 minutes


baseline Total patients 71% -23pp 99% -1pp Patients aged 65 and over

72% -22pp 99% -1pp

Male patients 71% -22pp 99% -1pp





Table 13: Percentage able to reach stroke services within 30 and 60 minutes by blue light ambulance for proposal four using population data


Within 60 minutes



68% -31pp 99% -1pp

Females aged 16-44

68% -31pp 99% -1pp


69% -30pp 99% -1pp




● Those from the most deprived quintile will experience an overall decrease in access to stroke services with 30 minutes (-24 percentage point difference), however this is less than the patient population overall (-31 percentage point difference).

C.5 Proposal five



Within 60 minutes







Table 15: Percentage able to reach stroke services within 30 and 60 minutes by blue light ambulance for proposal five using population data


Within 60 minutes



73% -26pp 99% -1pp

Females aged 16-44

75% -24pp 99% -1pp


68% -31pp 99% -1pp




● There will be a 39 percentage point drop in those from the most deprived quintile being able to reach stroke services within 30 minutes, this is higher than the 26 percentage point drop for the general population.



● There will be a 31 percentage point drop in those with a LLTI being able to reach stroke services within 30 minutes, this is higher than the 26 percentage point drop for the general population.

C.6 Proposal six



Within 60 minutes







Table 17: Percentage able to reach stroke services within 30 and 60 minutes by blue light ambulance for proposal six using population data


Within 60 minutes



70% -29pp 99% -1pp

Females aged 16-44

69% -30pp 99% -1pp


69% -30pp 99% -1pp





C.7 Proposal seven



Within 60 minutes



59% -35pp 98% -2pp






Table 19: Percentage able to reach stroke services within 30 and 60 minutes by blue light ambulance for proposal seven using population data


Within 60 minutes



67% -32pp 94% -6pp

Females aged 16-44

67% -32pp 95% -5pp


66% -33pp 93% -7pp


62% -37pp 95% -5pp



C.8 Proposal eight



Within 60 minutes






● There are no disproportionate impacts for the groups listed above as all equality groups are within five percentage points of the change to patients overall (-12 percentage point difference).

Table 21: Percentage able to reach stroke services within 30 and 60 minutes by blue light ambulance for proposal eight using population data


Within 60 minutes



71% -27pp 95% -5pp

Females aged 16-44

74% -25pp 95% -5pp


68% -31pp 96% -4pp


65% -33pp 99% -1pp





C.9 Proposal nine



Within 60 minutes



74% -20pp 99% -1pp



● There are no disproportionate impacts for the groups listed above as all equality groups are within five percentage points of the change to patients overall (-22 percentage point difference).

Table 23: Percentage able to reach stroke services within 30 and 60 minutes by blue light ambulance for proposal nine using population data


Within 60 minutes




Females aged 16-44








C.10 Proposal ten



Within 60 minutes






● There will be a 17percentage point drop in BAME patients being able to reach stroke services within 30 minutes, this is higher than the 10 percentage point drop for the general population.



Table 25: Percentage able to reach stroke services within 30 and 60 minutes by blue light ambulance for proposal ten using population data


Within 60 minutes




Females aged 16-44








C.11 Proposal eleven



Within 60 minutes







Table 27: Percentage able to reach stroke services within 30 and 60 minutes by blue light ambulance for proposal eleven using population data


Within 60 minutes




Females aged 16-44










● There will be a 30 percentage point drop in those with a LLTI being able to reach stroke services within 30 minutes, this is higher than the 25 percentage point drop for the general population.

Mott MacDonald | Kent and Medway Sustainability and Transformation Plan 30 Integrated Impact Assessment: Pre-consultation report - Stroke services supporting annex


D. GHG assessment results for all proposals

Table 28: GHG assessment results for all proposals Emissions Category

Proposal one

Proposal two

Proposal three

Proposal four

Proposal five

Proposal six

Proposal seven

Proposal eight

Proposal nine

Proposal ten

Proposal eleven

Change in Building energy use (tCO2e)

507 350 223 122 451 364 683 231 286 219 514

Change in patient Travel (tCO2e)

5 7 7 7 7 6 7 7 7 7 7

Change in all Travel (tCO2e)

11 16 16 15 16 15 15 17 15 16 15

Total Change in emissions (tCO2e)

517 366 239 137 467 379 698 248 301 235 529



E. Focus Group Analysis

The presentation below covers the outputs from the focus groups undertaken as part of the IIA.

It is a high-level report outlining the perceived positive and negative health, equality, travel and access impacts of the proposed changes discussed by members of the community in a series of focus groups across Kent and Medway. It highlights enhancements or mitigations to these impacts where relevant and discussed.

Ten focus groups were conducted across Kent and Medway between w/c 7th August and w/c 21st August. In total 77 members of the public were engaged with through this process.

Integrated Impact Assessment: Focus Group Analysis

Kent and Medway Sustainability and Transformation Plan

1

Section Slide

Scope 3

Methodology 7

Health impacts 10

Equality impacts 16

Travel impacts 21

Next steps 23

Contents

Integrated Impact Assessment

In May 2017, the Kent and Medway STP Programme Board commissioned Mott MacDonald to undertake an IIA of wave one of the Kent and Medway’s Sustainability and Transformation Plan (STP). The objectives of this IIA are to: • Understand the overall demography and the protected characteristic groups of the different patient populations affected• Undertake a health impact assessment (HIA)• Undertake an equality impact assessment (EqIA) • Undertake a travel impact assessment (TIA) • Undertake a sustainability impact assessment (SIA)

The aim is to explore the positive and negative consequences of different options and produce a set of evidence-based, practicalrecommendations, which can then be used by decision-makers to maximise the positive impacts and minimise any negative impacts of proposed policies or projects.

The purpose of impact assessments is not to determine the decision about which option would be selected; rather they act to assist decision-makers by giving them better information on how best they can promote and protect the well-being of the local communities that they serve.

It is regarded as best practice to assess impacts for the whole population and highlight the sections of the population which will be disproportionately affected by the impacts. These might be geographical communities or certain socio-economic or ‘equality’ groups. Assessment of impacts and recommendations for opportunities and mitigations, are drawn in part from evidence providedby representative and informed stakeholders. In this way, the impact assessment process provides a certain level of independent scrutiny and democratic legitimacy.

4

The integrated impact assessment (IIA) Scope

5

Stages of the IIA Scope

Scoping report

• Identify protected characteristics to be scoped into the next stages of the assessment • Provide a high level description of potential health impacts• Provide a high level description of potential travel impacts• Map the distribution of residents from population groups likely to be impacted• Engage with strategic stakeholders, such as clinicians and equality leads

Pre-consultation report

• Undertake community engagement (focus groups and one to one interviews with groups identified in the scoping phase)

• Appraise the positive and negative equality, health, travel and carbon impacts of the options, mitigations and enhancement opportunities

Wave one of the STP sets out the priority services for transformation. These service areas are:

6

Wave oneScope

Stroke services across Kent and

Medway

Vascular services across Kent and

Medway

Emergency care in East Kent (including

acute medicine, A&E, critical care)

Elective orthopaedic services in East Kent

Specialist service areas*

*These specialist service areas are clinical haematoncology including haemophilia outpatients, gynae-oncology, head and neck cancer, interventional radiology, primary percutaneous coronary intervention (PPCI), also known as coronary angioplasty, renal, trauma level 2 and urological cancer.

The focus group analysis note covers the outputs from the focus groups undertaken as part of the IIA.

It is a high-level report outlining the perceived positive and negative health, equality, travel and access impacts of the proposed changes discussed by members of the community in a series of focus groups across Kent and Medway. It highlights enhancements or mitigations to these impacts where relevant and discussed.

The note is in addition to the scoping report and pre-consultation reports that have been produced as part of the IIA. The outputs from the focus groups will also form part of the evidence that will inform the pre-consultation reports.

Purpose of the focus group analysis note

Methodology

The IIA scoping report identified that following groups may experience a disproportionate or differential need for services which are proposed to change as part of the STP.

IIA engagement is being undertaken via focus groups and also one to one interviews with the groups identified above. This report focuses only on the focus group activity conducted.

The focus groups sought to understand from those likely to be affected what they think the impacts of those proposals are, how negative impacts can be mitigated and positive impacts can be enhanced.

The focus group activity is not part of the public consultation, which will be run by the CCGs. The sole purpose of this engagement is to inform the IIA. The demographic groups selected for engagement were older people, people from a BAME background and those from deprived communities, as theses groups were felt to be most sensitive to the impacts of the proposed changes.

Following discussions with client the focus groups were held in the following areas: Ashford CCG, Canterbury and Coastal CCG, South Kent Coast CCG, Swale CCG, Thanet CCG and West Kent CCG. Two focus groups were held in more rural areas of South Kent Coast CCG and Swale CCG.

8

ScopeMethodology

Age:16 years and

under 65 years and

older

Disabled people

Gender: Male

Female

Gender reassignment

Pregnancy and

maternity

Race and ethnicity:

Afro-CaribbeanSouth Asian Caucasian

Sexual orientation:

Lesbian, gay and bisexual

Deprived communities

Ten focus groups were conducted across Kent and Medway between w/c 7th August and w/c 21st August. In total 77 members of the public were engaged with through this process. The table below details the location, service area covered and the composition of each focus group, which were agreed with the client in advance. Ten participants were invited to participate in each focus group, recruited via an external recruiter.

Each focus group lasted for one hour and was facilitated by two members of the Mott MacDonald project team, using agreed semi-structured topic guides and stimulus. The topic guide and stimulus were agreed in advance by the STP.

9

ApproachMethodology

Location Service area covered Composition Participants

AshfordAcute, urgent and emergency care and planned orthopaedic care in east Kent

People from deprived communities 9

CanterburyOlder people (aged 65 or over)

8

Romney Marsh 9

Isle of Sheppey

Stroke in Kent and Medway

Older people (aged 65 or over)7

Tunbridge wells 7

Dartford and GraveshamPeople from a BAME background

7

Medway 5

Margate People from deprived communities 6

Dartford and GraveshamVascular in Kent and Medway

People from a BAME background 9

Sittingbourne People from deprived communities 10

Health impacts

Improved outcomes for patients as a result of concentrating specific services and expert clinicians on certain hospital sites. This benefit would be delivered from creating the new specialist centres such as the Hyper-Acute Stroke Units (HASU) or the vascular centre.

Improved confidence for patients and families as a result of concentrating expertise or creating new specialist centres (e.g. HASU or the vascular centre), as they feel they are receiving the best possible care.

Improved capacity of wards and hospitals as a result of the early supported discharge (in stroke services) and increased diversionary pathways (in acute, urgent and emergency care).

The top three positive health impacts identified across the focus groups were:

Positive health impacts

Improved patient experience through access to joined up and co-dependent care and rehabilitation facilities.

Improved patient experiencethrough the potential increases to continuity of care.

Improved staff resourcing levels as a result of the concentration of expertise, such as in the HASUs.

The following positive health impacts were also identified across the focus groups:

Positive health impacts

Improved staff satisfaction, retention and recruitment as a result of the creation of larger, more coordinated and resilient teams, increasing availability of specialisation and training.

13

Capacity of the ambulance service is likely to be impacted by proposed relocation of services as ambulances are likely to be required to travel further.

The physical capacity of the services proposed for change to deliver care to patients may be impacted as services are consolidated into fewer units.

Choice of services would be limited and patients will not be able to get a second diagnosis/opinion as a result of consolidation. This was felt to be more of an issue for vascular services due to its consolidation on one location.

The top three negative health impacts mentioned across the focus groups were:

Negative health impacts

Staff may experience negative impacts if they are required to change their permanent place of employment. This may have an impact on the retention of staff if they have to travel further to their place of work (which may affect costs as well as time incurred).

Consolidating services onto fewer hospitals will negatively impact the resilience of care to in terms of the ability to deal with emergencies or incidents such as IT failure or an MRSA outbreak. This was felt to be more of risk for vascular services in particular due to its consolidation to one location.

The following negative health impacts were also mentioned across the focus groups:

Negative health impacts

Potential transitional impacts could be experienced during the implementation of planned service changes. Participants felt that there may be confusion for clinicians and members of the community about where to go, especially in emergency situation. This could lead to negative clinical outcomes if there is delayed access to care.

15

• Encourage consultative and collaborative working between specialist clinicians and to support services. This could be facilitated through better communications, knowledge sharing events and IT infrastructure.

• Encourage and preserve long-term patient clinicians relationships wherever possible in the consolidated centres and support services.

• Communicate the benefits of the consolidated services to patient groups to increase their confidence in the way the new services are delivered.

Health impacts

Additional measures to enhance positive health impacts

Measures to minimise negative health impacts

• Communicate about the capacity and ability of the new configuration to treat greater numbers of patients as a way to ensure that patients do not lose confidence in the consolidated system.

• Communicate about and ensure that there are emergency or secondary systems in place to deliver care in the event of emergency or situations where wards/service delivery centres close.

• Ensure the capacity of the ambulance and emergency transport is sufficient to meet the increased travel and journey times.

Equality impacts

Patient groups that have been identified as having a greater need for the services under review that attended the focus groups (such as older people, people from a BAME background and those from deprived areas) are likely to use these services more and are likely to experience improved clinical outcomes.

Participants who were aged 65 or over felt that a centre of excellence for planned orthopaedic care would potentially be able to deliver more appointments at the time originally scheduled. This would deliver increased benefits for older people who tend to be more reliant on people for transport and after care. This reliance requires planning so cancellations and delays can cause issues.

The two positive equality impacts mentioned across the focus groups were:

Positive equality impacts

18

An increase in stress and anxiety when attending appointments or services in emergency situations due to increased journey times or the need to make different and/or unfamiliar journeys to access care. This is likely to disproportionately impact groups such as older people, or those who have learning difficulties.

An increase in the associated travel costs for attending appointments due to increased journey times is likely to affect some patients and visitors, including carers. This is likely to disproportionately impact groups such as those on lower or fixed incomes.

An increase in the travel time for attending appointments or care due to increased travel times is likely to disproportionately impact those who have limited free time such as those on non-flexible work patterns or with care requirements, such as single parents.

The top three negative equality impacts mentioned across the focus groups were:

Negative equality impacts

Increased journey times for visitors and carers may inhibit visits. This could affect patient comfort and overall experience. This could disproportionately impact those who are more reliant on assistance and support such as older people or disabled people.

Some patients and visitors can become confused or disorientated when they are at an unfamiliar hospital. This can particularly affect older people and disabled people including those who have learning difficulties.

The following negative equality impacts were mentioned across the focus groups:

Negative equality impacts

19

20

No additional measures to enhance positive equality impacts were identified during the focus groups.

Equality impacts

Additional measures to enhance positive equality impacts

Measures to minimise negative equality impacts

• Encourage flexible appointment times to allow patients to make journeys conveniently and in off-peak hours. This will benefit groups such as those on fixed incomes, time-limited or more likely to experience stress allowing them.

• Maximise public transport accessibility of specialist centres through engagement with local transport providers.

• Ensure the effective communication of the future model of care to the local population, especially those with additional accessibility needs, so they understand how to access and use services.

Travel and access impacts

• Patients may have to travel further to receive care. This was highlighted specifically for acute, urgent and emergency care and stroke care. Visitors may also have to travel further to visit those receiving care. This may limit the frequency or length of visits.

• Patients from rural or isolated areas, such as the Isle of Sheppey or Romney Marsh, felt they may be negatively impacted by increased travel times from poorly connected areas or areas with limited connectivity in events such as bad weather or accidents.

Negative impacts

Travel and access impacts

Mitigations

• Maximise public transport accessibility of specialist centres through engagement with local transport providers. In particular for more remote, rural or isolated areas locations.

No positive travel and access impacts were identified during the focus groups.

Next steps

The outputs from the focus groups will form part of the evidence that will inform the pre-consultation IIA reports, due to be submitted in Autumn 2017.

The pre-consultation IIA reports will appraise the Kent and Medway STP of both the positive and negative health, equality, travel and access and sustainability impacts which require consideration and/or action during the decision-making process. There will be three separate standalone reports covering: stroke services, vascular services and emergency services (including elective orthopaedics and specialist services.)

24

Next steps

Mott MacDonald | Kent and Medway Sustainability and Transformation Plan 1 Integrated Impact Assessment: Pre-consultation report - Stroke services supporting annex


mottmac.com

appendix dii€¦ · integrated impact assessment: pre-consultation report - stroke services...

Documents