clinical services review decision-making business case · 2017-09-27 · business case. september...

Clinical Services Review

Volume 2

September 2017 – version 1.4

Decision-Making Business Case

September 2017 – version 1.4

Clinical Services Review

Volume 2

Decision-Making Business Case

DMBC – CONTENTS

2

CONTENTSA. Governance and Assurance Framework .. .. .. .. .. .. .. .. .. ..4A.1 Programme Governance .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. 5A.2 Assurance .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. 13A.3 Internal Assurance .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. 19A.4 External Assurance .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. 21

B. Benefits Framework .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. 30B.1 Benefits Framework .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. 31

One Acute Network .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. 32 Integrated Community and Primary Care Services .. .. .. .. .. .. .. .. .. .. .. .. .. .. 37 Prevention at Scale .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. 41 Enabling Portfolio: Digitally Transformed Dorset. .. .. .. .. .. .. .. .. .. .. .. .. .. .. 42 Enabling Portfolio: Leading and Working Differently .. .. .. .. .. .. .. .. .. .. .. .. .. 46

C. Detailed History of Stakeholder Engagement. .. .. .. .. .. .. 55C.1 Pre-Launch Stakeholder Engagement . .. .. .. .. .. .. .. .. .. .. .. .. .. 56C.2 Appointment of External Consultancy Support .. .. .. .. .. .. .. .. .. .. 56C.3 Launch of the Clinical Services Review to Stakeholders. .. .. .. .. .. .. 56C.4 Clinical Engagement Activities. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. 58C.5 Clinical Reference Group .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. 62C.6 GP Practices and Practice Members . .. .. .. .. .. .. .. .. .. .. .. .. .. .. 62C.7 Patient and Public Engagement .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. 67C.8 Patient and Public Participation .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. 69C.9 Voluntary Sector Organisations .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. 88C.10 CCG Staff Engagement. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. 90C.11 Provider Engagement .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. 91C.12 Local Authorities .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. 97C.13 Health Scrutiny Committee .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. 99C.14 Joint Health Scrutiny Committees .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. 100C.15 Health and Wellbeing Boards .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. 101C.16 Members of Parliament .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. 102C.17 Trades Unions .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. 105C.18 Local Councillors .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. 105

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CONTENTS

C.19 NHS England . .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. 105C.20 Regulators . .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. 106C.21 CCGs and Providers in Neighbouring Areas .. .. .. .. .. .. .. .. .. .. .. 106

D. Headline ORS Consultation Results .. .. .. .. .. .. .. .. .. .. ..108D.1 Integrated Community Services .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. 109D.2 Acute Hospital Services. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. 124

E. Leading and Working Differently Strategy: Dorset’s Workforce Capacity and Capability Plan .. .. .. .. .. .. .. .. ..134E.1 Introduction and Summary of Recommendations .. .. .. .. .. .. .. .. .. 135E.2 Background .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. 137E.3 Vision . .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. 138E.4 Service Changes .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. 139E.5 Mobilisation .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. 165E.6 Engagement .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. 166E.7 Next Steps .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. 168

F. Implementation: Supporting Information .. .. .. .. .. .. .. ..169F.1 Contributing Programmes .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. 170

G. Acute Reconfiguration: High-Level Implementation Plans. ..174G.1 Acute Reconfiguration High-Level Plans. .. .. .. .. .. .. .. .. .. .. .. .. 175G.2 Acute Reconfiguration Enabling Work Streams . .. .. .. .. .. .. .. .. .. 176

H. Integrated Community and Primary Care Services: High-Level Implementation Plans .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. ..177H.1 Integrated Community and Primary Care Services High-Level Plans. .. 178

GOVERNANCE AND ASSURANCE FRAMEWORK

A

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PROGRAMME GOVERNANCE A.1

A.1 – Programme Governance

The Clinical Services Review (CSR) programme team is ultimately accountable to Dorset CCG’s Governing Body for identifying options that could be taken forward by the local system for implementation.

The programme governance arrangements are intended to provide assurance that the options have been developed in conjunction with stakeholder organisations and have been shaped by the needs of people and experience of local clinicians.

The governance structure for the CSR programme throughout the design phase is illustrated opposite.

The structure saw development of work through four Clinical Working Group areas:

• Long-term conditions and frail elderly

• Planned and specialist care

• Maternity and family health

• Urgent and emergency care

With mental health and learning disabilities running horizontally through them. Following advice from the Patient Participation Engagement Group (PPEG), mental health formed their own Clinical Working Group to discuss mental health pathways in depth following the same process as the other four pathway areas.

As illustrated in Figure 1.1 (p6), this work then progressed through the identified Reference Groups and Boards for referral and decision making.

As we move into system collaborative working, the governance structure has expanded to reflect the portfolios of work identified within our Sustainability and Transformation Plan (STP).

Throughout this transition, we have ensured the structure continues to reflect the core elements of the original CSR governance

Further development and delivery of clinical modelsAs we move into the delivery phase of the CSR, our governance structure has subsequently evolved. Work will continue to progress through mechanisms that reflect the processes used during the development of the CSR.

DMBC – GOVERNANCE AND ASSURANCE FRAMEWORKA.1

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Better Together Sponsor Board

Partnership Forums:(informed by and

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The following diagram shows how the CSR elements of the STP flow through the governance in support of the original framework.

ICPS

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Clinical Working Groups

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One Acute Network

Figure 1.3: CSR Elements in the STP The following table highlights the way in which CCG governance groups have adapted to suit the updated governance structure. This is to ensure they are able to continue to fulfil their duties and responsibilities through new phases within the CSR. The Governance Bodies displayed in bold text indicate where a group has adapted during the governance evolution.

Table 1.1: Governance bodies (CSR to STP)

Group Objectives

Governing Body • Ultimate decision-making body for the CSR Programme

Clinical Commissioning Committee (CCC)

• Support the Governing Body in developing and implementing its vision and strategic direction

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Group Objectives

CSR Control and Assurance Group

CSR Quality and Assurance Group

• Assess clinical evidence and develop best practice care pathways and models of care for the local population

• Determine clinical evaluation criteria

• Assess options against criteria

• Assure/review all outputs of the CSR work programme

• Assure the Audit and Quality Committee on the process of the transformational programme

• Ensure the appropriate governance and risk processes are in place to mitigate the risk of future legal challenge

• Assure content within reports from the transformational programme

CSR Operational Programme Group

STP Implementation and Planning Group

• Ensure programme is on track and is meeting milestones

• Recognise issues and escalate

Better Together Sponsor Board

Programme has ended

• Provided provider insights to the CSR programme

• Acted as a sense check for the outcomes of the programme

• Provided input on emerging solutions

• Made recommendations to decision-making bodies

• Identified implementation needs

CEO Reference Group

System Leadership Team

• Provide senior management insight

• Deliver the vision for transforming healthcare in Dorset

• System-wide risk management

Audit and Quality Committee

• Provide clinical and financial assurance via the CSR Control and Assurance Group to the Governing Body

Health and wellbeing board (HWB)

• Provide feedback on the proposed solutions


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Group Objectives

Shadow Joint Primary Care Committee (ceased)

Primary Care Commissioning Committee

• Provide feedback on the proposed solutions

• To make collective decisions on the review, planning and procurement of primary care services in Dorset, under delegated authority from NHS England

Accountable Officer (AO) • Delegated representative of the Governing Body

Clinical Reference Group • To provide clinical leadership to the programme

• To advise on, inform and approve clinical deliverables

• To provide inputs and steer into Clinical Working Groups

Clinical Working Groups • Provide opinion on safety and quality of the services of the proposed options

• Provide challenge and innovative thinking

Finance Reference Group

Operations and Finance Reference Group

• Provide financial insight and analysis

• Ensure delivery of the Dorset Health System Collaborative Agreement

• Provide financial oversight and assurance for the Dorset Sustainability & Transformation Plan and associated business cases/benefits realisation

• Act as a route of reporting and escalation to the Senior Leadership Team

Patient and Public Engagement Group

• Provide patient, carer and public perspective and insight to the review programme

• Feedback, critique and challenge from a patient, carer and public point of view, the Clinically-led discussions and option development

• Support the design of communications, engagement and consultation materials to support the review

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Group Objectives

Communications Reference Group

• Provide communications insight, intelligence and feedback to the review programme

• Responsible for onward cascade of key messaging and information – particularly for front-line NHS staff and supporting partner organisations with their communications about the review using core materials

Transport Reference Group

• To ensure collaborative working with local authorities to review Dorset transport services in Dorset and pool resource to develop sustainable transport services in future

Details of how this structure will be used in practice can be found in Chapter 5 of the DMBC.

Wider engagement and involvement in developing the proposalsWe describe our stakeholder engagement in detail in Appendix C.

Risk Identification Process The Clinical Services Review has a clear governance and assurance process, regulation processes and internal audit to ensure all areas of work are managed and controlled to required standards.

System-wide risk management is required for the development and implementation of agreed service changes. Involvement from across the system is required and all partners are accountable for the identification and management of risks. The System Leadership Team (SLT) has been formed as part of the governance structure for the transformation programme. This is used as a forum for system leaders to identify solutions that eliminate duplication of effort and mitigate against risks. The remit of this group is to contribute and share responsibility for assuring the programme and delivery of risk/issue logs and the associated mitigating actions.

A Portfolio Management Office (PMO) has been set up to underpin the development of the CSR (see Chapter 5). As part of this process all areas of design work are reported on regularly. Part of that mechanism is feedback on risk assessments and identifying potential risks or issues with mitigation plans. A regular highlight report provides a summary of this information for the organisation.

Identified risks have been recognised by the CCG and mitigating actions are being put in place to minimise them. A Risk Register is maintained for the transformation programme, which is aligned and feeds into the CCG’s Corporate Risk Register.


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Who we have engaged in the process of assurance and approvalThe CSR team has reached out to numerous groups including health and wellbeing boards, health oversight and scrutiny committees, NHS England (NHSE) and multiple reference groups including clinicians, engagement and communications and finance.

The remit of the CCG reference groups are defined within their respective terms of reference, and cover all elements; from models of care and finacial modelling through to guidance on approaches to consultation. This has given the CCG Control and Assurance Group (later the Quality Assurance Group) and CCG directors assurance that the outputs and outcomes have been properly developed. This assurance has allowed the CCG to make recommendations to the Governing Body and drive the CSR through its programme stages.

What steps have we approved, and when will we make the next approval?On 19 September 2014, the Governing Body approved the proposal to carry out the CSR, including the proposed approach to carrying out the review and the funding to engage an external partner.

In May 2015, the Governing Body approved the proposals to go out to consultation, pending assurance processes, based on the high-level models agreed at the time. Further progress to the design of the models continued and a subsequent decision was made at the Governing Body on 17 July 2015 to change the point at which the proposal would go out to consultation. This would then enable us to continue to develop our vision and story further.

The next approval required from the Governing Body, pending all final assurances, was approval of the outcomes from the CSR and the decision to proceed to consultation on both the changes to Integrated Community Services activity and the options for acute hospital reconfiguration. The acute hospital reconfiguration was considered for approval by the Governing Body on the 18 May 2016 and was initially approved to be taken to public consultation pending approval from the Investment Committee. On 20 July 2016, the activity for Integrated Community Services was also approved to proceed to public consultation, pending the Investment Committee decision in September 2016.

The Investment Committee sent confirmation to Dorset CCG to proceed to public consultation by way of a letter, received on the 15 November 2016.

Following the public consultation, completion of the business case and regular updates, the Governing Body will be required to make decisions as to the future configuration of healthcare services in Dorset. A public decision-making meeting will be held in the Autumn of 2017.

Pending receipt of the final decisions, should decisive action be taken, Dorset CCG will transition into an implementation phase.

Some of the options will have a small impact on neighbouring counties. We are working alongside colleagues from NHS England and West Hampshire CCG to agree an aligned process for consultation and decision-making.

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ASSURANCE A.2

A.2 – Assurance

Commissioners’ General Duties Under the NHS Act 2006We have a responsibility to meet a number of statutory assurance processes as part of the NHS Act 2006 (as amended by the Health and Social Care Act 2012). Examples of the ways in which the Clinical Services Review process has met these statutory requirements are given here:

• Duty to promote the NHS Constitution was assured by identifying the relevant elements of the constitution and checking and evidencing the activity in the CSR programme. This checklist will remain live throughout the programme

• Quality of care for the people in Dorset has been considered throughout the review process in looking at current outcome measures in the county and benchmarking against best practice and outcomes in similar health economies in the UK and overseas. This data was presented to the Clinical Working Groups throughout the engagement and development of options process, and was a key driver in developing future models of care

• Inequality, the needs of the diverse communities, the challenges of social and economic variations, as well as the challenges of urban and rural communities, were considered when examining transport times between existing and future care settings . The main mechanism by which ongoing assurance on discharging the duty to reduce inequality has been obtained was through the updated Equaliy Impact Assessments (EIA)1

• Promotion of patient choice has been considered through the development of potential care models, which were then shared with the PPEG for comments and consideration, and those comments were fed back into the Clinical Working Groups and CSR Control and Assurance Group to inform long and shortlists of models. It was recognised throughout that where there are a range of different, clinically appropriate and evidence-based treatments available on the NHS, we have a duty to ensure that people can choose the care that is right for them, supported by information about the benefits and risks . Patient choice also forms one of the four tests for reconfiguration, developed by NHSE. The CCG has been able to provide evidence to demonstrate adherence to the key tests as described later in this section

• Throughout the process of developing our potential options, we have sought to ensure that people will still have access to the right treatments, at the right place and at the right time. The CSR aims to ensure that Dorset residents have access to high quality care, in a financially sustainable healthcare economy

• The duty for promotion of integration has been fulfilled through the Better Together Sponsor Board, fulfilling an oversight of the CSR process, and co-opting onto the board membership from NHS England to ensure integration both within Dorset and relevant elements of the NHS England – South (Wessex). The Better Together Board worked to develop the integration of health and social care services across Dorset, Bournemouth and Poole local authorities. This work has been further expanded within the Integrated Community Services (ICS) programme of work

• Public and patient involvement has been integral to the review process, with public

1 NHS CCG CSR Equality Impact Assessments


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engagement events held throughout the county and through media communications. This is fully detailed in Appendix C

• Innovation and research have been considered in evidence presented to Clinical Working Groups to inform the review, and poster gallery walks and pre-read information. A wide range of research evidence and outcome data from alternative care models has been promoted throughout

• Advice in the form of analytical and programme support on carrying out the CSR has been obtained through the commissioning of a consortium of consultants led by McKinsey & Co. In addition to this, legal advice has also been sought from Capsticks as well as advice from NHS England, Monitor (NHS Improvement) and Wessex Clinical Senate in the assurance of the programme

• We have used information from local joint strategic needs assessments and the joint health and wellbeing strategies of Dorset’s three local authorities in the data gathering and analysis phase of the programme, having due regard to the specific needs of the population of Dorset. This includes the socio-economic challenges in the pockets of deprivation in the county as well as the challenges of an ageing population. This is detailed in the NHS Dorset CCG Pre-Consultation Business Case2

• NHS (Procurement, Patient Choice and Competition) (No.2) Regulations 2013 – We have ensured that this review has, and will continue to, consider our duties to procure healthcare services with a view to securing the needs of the people who use the services, improving the quality of the services and improving the efficiency in the provision of the services. We will ensure that procurement decisions following this review will be undertaken in a transparent and proportionate way, and treat providers equally and in a non-discriminatory way

• Health and Social Care Act 2012 – We have considered the application of Section 79 of the Health and Social Care Act 2012 and Section 22 of the Enterprise Act 2002 to any merger of services provided by Royal Bournemouth and Christchurch Hospitals NHS Foundation Trust and Poole Hospital NHS Foundation Trust. In this context, we have also considered the Competition Commission’s report on the anticipated merger of Royal Bournemouth and Christchurch Hospitals NHS Foundation Trust and Poole Hospital NHS Foundation Trust of 17 October 2013 and the Notice of Acceptance of Final Undertakings of 19 December 2013

We have met the requirements of Section 116B of the Local Government and Public Involvement in Health Act 2007 in engaging with the relevant local authorities in their health scrutiny capacity.

The Four Tests for ReconfigurationNHS England have assessed the service change proposals through the application of the four key tests for reconfiguration. Introduced by the Government, these tests are intended to apply in all cases of major NHS service change (during normal stable operations). The four tests are set out in the 2014/15 Mandate from the Government to NHS England and require any proposed service change to be able to demonstrate evidence of:

2 NHS Dorset Pre-Consultation Business Case

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ASSURANCE A.2

• Strong public and patient engagement

• Consistency with current and prospective need for patient choice

• A clear clinical evidence base

• Support for proposals from clinical commissioners

NHS England announced an additional test on the 3rd March 2017 in the ‘New Patient Care Test for Hospital Bed Closures’ document, stating that reconfiguration must take in to account hospital bed closures and the impact this would have on patients. In response to this request we prepared a report to provide assurance that our plans meet the requirements outlined within the new patient care test and is therefore met in the CSR plans. It is important to note, however that this test does not apply to the CSR given that approval has already been obtained from NHS England3.

We have used the four tests to guide our process as we have developed the proposed options, and to thoroughly assess the proposed options themselves. We will continue to assess against the four tests as we move towards consultation.

Examples of how we have adhered to the four key tests can be found below.

Strong public and patient engagement

We have a duty under the NHS Act 2006 (as amended by the Health and Social Care Act 2012) to arrange and secure the involvement of people who use, or may use, our services in:

• Planning the provision of services

• Developing and considering the proposals for change to the way our services are provided, where the implementation of the proposals would have an impact on the way the services are delivered or the range of services that are available

• Our decisions affecting the operation of commissioning arrangements where the implementation of the decisions would impact on either the services that are delivered or the range of services available

The engagement of the public and patients is detailed in Appendix C.

Consistency with current and prospective need for patient choice

Where there are a range of different, clinically appropriate and evidence based treatments available on the NHS, we have a duty to ensure that people can choose the care that is right for them, supported by information about the benefits and risks. For example, people can choose any NHS organisation within England for a first outpatient appointment with a consultant or specialist. The requirements are set out in the 2014/15 Choice Framework.

Throughout the process of developing our potential options, we have sought to ensure that people will continue to have access to the right treatments at the right place and at the right time, and be offered a choice of treatment as a matter of course, except where this is clinically inappropriate, infeasible or where benefits to patients outweigh patient choice. For

3 www.england.nhs.uk


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example, where consolidation of workforce on one site enables greater access to specialist provision through the delivery of high quality seven-day services, which otherwise would not be possible due to workforce constraints.

A Benefits Framework has been developed, building on the Case for Change, to describe the benefits that are expected following implementation of the recommended proposals. Details of the Benefits Framework can be found in Chapter 2.5 of the Decision-Making Business Case and Appendix B.

Choice may also need to be constrained on the grounds of value for money or affordability within the resources available to clinical commissioners in Dorset. The Clinical Services Review aims to ensure that Dorset residents have access to high quality care in a financially sustainable healthcare economy.

A clear clinical evidence base

This is assessed by the Wessex Clinical Senate, as detailed previously. To demonstrate this, the CCG has undertaken analysis of evidence and in developing models has relied on the input of clinicians across Dorset from primary care, secondary care, mental health and community services.

Oversight has been provided through a Clinical Reference Group that tested and checked the clinical models proposed.

This group is established to provide clinical leadership to the programme. It advises on, informs and approves clinical deliverables, and provides inputs and steer to the programme through the Clinical Working Groups.

Support for proposals from clinical commissioners

Our members have been fully engaged in the lead up to and during the clinical services review. They have had the opportunity to view the outputs from the Clinical Working Groups and input comments and information.

Dorset CCG’s Governing Body was engaged throughout the pre-consultation phase, through four development workshops – open to the Governing Body and Clinical Leaders – and two membership events. Membership events are also open to all GPs who are members of the CCG.

Development workshops and membership events have been used to update members on the progress of the CSR and to garner the input and further engage members in the process.

Public Sector Equality Duty and Equality Impact AnalysisWe recognise the Public Sector Equality Duty (PSED) legislation and guidance4 and to ensure the Clinical Commissioning Group comply with the requirements of the Equality Act 2010. It is a duty of the CCG to have due regard to the need to eliminate discrimination, harassment, victimisation and any other conduct that is prohibited by the Equality Act; to advance

4 Equality Act 2010: guidance, Government Equalities Office and Department for Culture, Media & Sport, 27 February 2013

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ASSURANCE A.2

equality of opportunity between people who are subject to protected characteristics and those who are not; and to foster good relations between people who are subject to protected characteristics and those who are not. This includes, but is not exclusive to, the principles for meeting the Public Sector Equality Duty, and ensuring any changes will not have a disproportionate impact on any of the protected characteristics covered by the Equality Act 20105. The Equality Delivery System 2 (EDS2) also allows us to focus on any additional groups within the Dorset community who may be impacted by this CSR. Throughout the design and consultation phase we have continually tested our models and have reviewed and updated the Equality Impact Analysis (EIA).

Following consultation, the EIA were reviewed and updated to reflect some of the feedback provided and in line with best practice. In doing this, we followed a robust process which involved review by the CCG’s leads for service delivery; independent review by the Equality and Diversity Lead for Dorset HealthCare NHS Trust; and a workshop for service leads in the provider organisations. We then arranged a second facilitated workshop for our PPEG and additional invited members of the public/staff who collectively represented the nine protected characteristics. This was to ensure that the process was inclusive and realistic. The revised and updated EIA was then sent for legal review before being scrutinised by the Quality Assurance Group and publication in July 20176.

The full methodology and findings of the Equality Impact Analysis can be found on the NHS Dorset CCG website7.

An overview of how we have complied with the PSED and EIA review process can be seen in Table 1.2:

Table 1.2: Compliance with PSED and the EIA review process

Stages of Programme What is needed Responsibility Meeting approval

details

Review StageOverarching statement on EqIA

CSR Project Management Office (PMO) team

January CSR Control and assurance Group (CAG) 22/1/15

Business Case Draft

Meeting PSED and overarching EqIA statement

CSR Quality and Assurance lead

April CAG 30/1/15 and chapter 13 of PCBC Draft 3 onwards. Governing Body meeting 21 May 2015

Pre-ConsultationStatement demonstrating meeting PSED and EqIA for the key work streams

CSR Quality and Assurance lead and heads of service CCG

July 22 2015 CAG

5 Equality Act 2010.

6 NHS CCG CSR Equality Impact Assessments

7 NHS Dorset CCG Website Policies and Plans with Equality Impact Assessments


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Stages of Programme What is needed Responsibility Meeting approval

detailsAdditional training EqIA and E&D Master class

Update for organisation on the advanced E&D issues

CSR Quality and Assurance Lead and Equality officer

N/A

Pre-Stage 2 Assurance

Refresh of the Statement demonstrating meeting PSED. Updated EqIA. Service and Speciality level EqIA where proposals developed.

CSR Quality and Assurance Lead Heads of service CCG

18 April 2016 Quality Assurance Group

Consultation

Refresh of the Statement demonstrating meeting PSED. Updated EqIA. Service and Speciality level EqIA where proposals developed.


Prior to Consultation by QAG and CCG Gov. Body approval of consultation documentsOctober 2016

Receipt of consultation results, final business case and decision-making

Refresh of the Statement demonstrating meeting PSED. Updated EqIA. Service and Speciality level EqIA for final proposals


Prior to Finalisation of business case and CCG Governing Body DecisionAutumn 2017

ImplementationService/Speciality level EqIA

Providers and service commissioners

Relevant organisational governance processes.

ImplementationHealth Impact Assessments

ProvidersRelevant organisational governance processes.

Health Scrutiny CommitteesThe role of a Health Scrutiny Committee (HSC) is to review and scrutinise any matter relating to the planning, provision and operation of health services in its area. Dorset has three HSCs:

• Dorset County Council Health Scrutiny Committee

• Poole Health and Social Care Overview and Scrutiny Committee

• Bournemouth Health and Adult Social Care Overview and Scrutiny Committee

The three local authority overview and scrutiny committees have been kept informed about the CSR programme throughout the review stage and we requested that the local authorities set up a joint scrutiny committee across Dorset for scrutiny of the CSR programme. This is in accordance with their statutory duties.

Briefing papers were sent to all the HSCs in 2014 detailing the plans to undertake the Clinical

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INTERNAL ASSURANCE A.3

Services Review. Officers of the CCG have regularly attended and presented at meetings of Dorset, Bournemouth and Poole.

Joint HSCs (JHSCs) were agreed to look at the CSR progress, and a formal JHSC took place in June 2016 to present to members of the Strategic Transformation Plan (STP) and the journey so far of the CSR. This allowed them to have full scrutiny of the proposed options and plans for consultation as well as the decision-making process followed.

The Dorset Health and Wellbeing Board and the Bournemouth and Poole Health and Wellbeing Board have received regular verbal updates and presentations on the progress of the review throughout the process. In addition, the democratic services cascade has been used to circulate relevant information and reports such as the report of the Royal College of Paediatrics to council members.

Clinical commissioning leadership and collaborative decision-makingAs previously stated, we have approached the CSR with a clear objective to ensure that it is clinically-led, and that clinicians throughout the health community have been engaged. This has been undertaken through 13 Clinical Working Group events. The outcomes of these have been fed into the governance structure of the programme.

The strategic clinical advice and oversight has been provided by the Clinical Reference Group, made up of several Governing Body members, medical and clinical directors of the Foundation Trusts.

A Finance Reference Group (now Operations and Finance Reference Group), Chief Executive Reference Group (now System Leadership Team) and groups looking at communications, transport and workforce provided specialist oversight of the process alongside the public and patient engagement, ensuring a fully transparent and inclusive process of review took place.

Throughout the process we have engaged with several primary stakeholder partners and reference groups to inform the development of our potential options. This engagement is outlined in detail in Appendix C and has ensured that the CSR programme is compliant with NHS England’s four tests, as outlined in section 1.2.

Section 1.1 includes the governance structure for the programme. Dorset CCG’s Governing Body is the decision-making authority for the CSR programme and continues to lead internal assurance.

A.3 – Internal assurance

CSR Control and Assurance GroupFrom December 2014 to July 2015 internal assurance was provided by the CSR Control and Assurance Group, which met fortnightly throughout the review period. The CSR Control and Assurance Group was an advisory body with responsibility for:


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• Advising on the shortlist of potential options for full evaluation and presentation to the Governing Body

• Assuring the process and outputs of the CSR process and approving the CSR outputs/deliverables

• Ensuring the appropriate governance and risk processes are in place to mitigate the risk of future legal challenge

To do this, the group:

• Received and reviewed financial modelling and cost assessments for the programme and potential future models

• Received and reviewed assessments of the clinical evidence and proposed care pathways and models of care to input into the potential options for consultation

• Received and reviewed updates on staff, stakeholder, patient and public engagement and how this is contributing to the development of the options

• Determined clinical evaluation criteria

• Received and reviewed a long list of options using the agreed clinical evaluation criteria

• Agreed a shortlist of options for full investigation and analysis

• Reviewed options that are not acceptable, documented their consideration, and assured that the rationale for not choosing these options is sound

• Received and reviewed reports on the top five programme risks and the actions taken to mitigate against these

• Received and reviewed reports on the quality and assurance processes underway in the PMO team relating to equality and diversity, privacy impact, information governance, NHS Constitution and legal assurances

The group also had responsibility for assuring both Dorset CCG and our partners that the review had good governance and is being undertaken in line with the NHS Constitution. Up to July 2015 the CSR Control and Assurance group assured and approved all outputs of the CSR work programme.

From July 2015, CCG Directors undertook approval of operational matters in a revised governance structure through to March 2016 when a new group, the Quality Assurance Group (QAG) was reconvened to assure the submissions to the clinical senate, NHS England and additional work undertaken with partner organisations on Integrated Community Services.

The QAG has met fortnightly since March 2016 to assure all products related to the CSR. The Group is a sub-group of the CCG’s Audit and Quality Committee, itself a committee of the Governing Body. The QAG is chaired by a Director and has membership which includes a patient and public representative.

Reports on the assurance processes undertaken, including internal audit were also made to our Audit and Quality Committee, Joint Primary Care Commissioning Committee and the Governing Body.

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EXTERNAL ASSURANCE A.4

Data protectionThe Assurance groups received statements on the adherence of the CSR to the relevant data protection laws. Dorset CCG has the appropriate information governance policies in place, and the organisation meets the requirements of the Information Governance Toolkit (IGT).

For the Clinical Services Review programme, we have developed proposals for new models of care and are not actively commissioning service changes prior to consultation. As a result, there is a Privacy Impact Assessment (PIA) for the overarching programme rather than each service area, which have been incorporated within project documentation as part of the development of the Dorset PMO. When the commissioning intentions and plans for service changes to occur are agreed with providers, each provider and each service with a change impact will have to complete individual privacy impact assessments and review their information sharing policies. This will be particularly important when service changes involve moving from one hospital to another, working is changed to a model that is networked between organisations, and/or when services move from one setting to another – for example in moving from an acute hospital to a community setting.

A.4 – External Assurance

NHS EnglandNHS England colleagues have been involved in the CSR programme from the very beginning, and have had significant input into the development of potential options through attendance at:

• Better Together Sponsor Board (now closed) – the Director of Operations and Delivery for NHS England-South (Wessex) is a member of this board, which gives insight from healthcare providers to the programme, acts as a sense check for the programme’s outcomes, provides input on emerging solutions, and makes recommendations to decision-making bodies including our Governing Body. The Better Together Programme integrated with the CSR through the STP process during 2016

• Clinical Reference Group – a NHS England representative has attended and provided input to this group, which provides clinical leadership to the programmes, advises on, informs and approves clinical deliverables, and provides input and steer to the Clinical Working Groups.

• Clinical Working Groups – NHS England representatives have attended these meetings to provide input into the development of the clinical models and evaluation criteria

• Finance Reference Group – the Chief Finance Officer for NHS England – South (Wessex) is a member of the Finance Reference Group, which has had a role in developing financial evaluation criteria, provides assurance on the proposed models and solutions, and makes recommendations to the Clinical Commissioning Committee and the Governing Body. Following the transition to the group becoming the Operations and Finance Reference Group (see Table 1.1), members signed a two-year collaborative agreement, holding them to account to share responsibility for the delivery of CSR and STP objectives. This agreed collaborative working has relieved NHS England of their duty to attend the meetings and instead receive regular updates


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• CSR Programme Meetings – NHS England-South (Wessex) have an open invite to the weekly programme meeting, and a representative has attended on occasion

• Joint Primary Care Commissioning Committee (previously in shadow form) – members of NHS England-South (Wessex) attended quarterly meetings with the committee to provide feedback on the proposed solutions

• Governing Body Workshops – to explore the potential impact of feedback from the public consultation and listen to views on the clinical delivery of the proposed options

Assurance of the CSR process has been given through NHS England’s CCG-wide assurance process, which includes all our activities. This provides confidence to stakeholders and the wider public that CCGs are operating effectively to commission safe, high quality, and sustainable services within their resources.

As part of this process we meet with the NHS England-South (Wessex) team for quarterly checkpoint assessments and an annual review meeting. These reviews look at how well we have been delivering against our plans and allow NHS England-South (Wessex) to assess our progress against six CCG assurance domains. We also hold monthly teleconferences with the team to keep them up-to-date with progress made following the most recent quarterly checkpoint meeting.

The CSR is assured and held to account via the same assurance process and using the same six assurance domains which cover the full scope of the review. The six domains through which Dorset CCG, and therefore the review, is assured are:

• Domain 1: Are people receiving clinically commissioned, high quality services?

• Domain 2: Are people and the public actively engaged and involved?

• Domain 3: Are CCG plans delivering better outcomes for people?

• Domain 4: Does the CCG have robust governance arrangements in place?

• Domain 5: Are CCGs working in partnership with others?

• Domain 6: Does the CCG have strong and robust leadership?

In accordance with best practice guidelines, Planning, assuring and delivering service change for people, NHS England will undertake an assurance process of the plans for consultation and the models of care for the future.

Reference: Planning, assuring and delivering service change for peopleA good practice guide for commissioners on the NHS England assurance process for major service changes and reconfigurations. Version number: 2 First published December 2013 Updated October 20158.

This process consists of:

A strategic sense check, which examines the case for change and the level of consensus for

8 www.england.nhs.uk

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change. Its aim is to ensure that a full range of options are considered and that all potential risks are identified and mitigated. The proposed change must be shown to match strategic commissioning intentions and align with other priorities (such as the NHS Outcomes Framework). The impact on neighbouring commissioners will also be considered. A core requirement of the strategic sense check is assessment against the four tests, but other best practice checks can be applied. As part of this strategic sense check we took independent advice to inform the assurance process following the best practice guidelines. The programme management arrangements and strength of the business case must be assessed, along with the strength of the clinical case for change and alignment with clinical guidelines and best practice.

Assurance stage 2, which is NHS England’s formal assurance of proposed options for consultation. This stage normally involves a check of the proposed options using evidence provided by us and external bodies against the four tests and NHS England’s best practice checks. This can incorporate independent input from other external bodies such as the Clinical Senate and a Health Gateway Review. Following the local stage 2 assurance process, the CSR was then considered by the investment committee at NHS England for the investment necessary to deliver the change, and this is overseen by the NHS England Oversight Group for Service Change and Reconfiguration (OGSCR).

The Strategic Sense Check took place on 10 April 2015. At this meeting representatives from NHS England-South (Wessex) were given details on the assurance process, engagement and collaborative working that had taken place to date. Sufficient assurance was given to agree that the CSR could pass Strategic Sense Check 1.

This means that the CSR programme is entered onto the NHS England reconfiguration grid and subject to the full assurance framework. Monthly updates to the reconfiguration grid have been submitted.

The process is summarised on p24:


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Figure 1.4: NHS England service change assurance process

Alignment between CCG and/or NHS England initiated change proposals considered. Commissioner leadership established

Scheme placed on AT and RT monthly reconfiguration tracker grid. (RT, AT and NSC agree roles in process)

Issues/risks requiring attention highlighted to commissioner(s)

NHS England Business Unit informed of decision

Agree proportionate ongoing NHS England oversight arrangements for the consultation and post-consultation phase

Explore case for change, strategic alignment of proposals, early risk assessment, organisational roles, support and resources required, choice and competition issues, use of Senate advice, level of NHS England assurance likely to be required and programme timetable

Four tests applied and proportionate assurance against the key tests for service change. Products of independent assurance (e.g. Clinical Senates, NCAT, and/or Gateway Team) also inform Expert Panel discussion

Stakeholder engagement Full options appraisal & impact assessment

Further development of proposals

Expert panel recommendation

Assurance decision communicated to commissioners

CCG decision-making

framework

NHS England decision-making

framework

NHS England assurance stage 1 strategic sense check

NHS England assurance stage 2a formal assurance checkpoint

expert panel

Assurance stage 2b NHS England decision-making forum

Area Regional National

Service change proposal

Commissioner(s)

HWBB, AHSN, Provider or

other NHS England (directly

commissioned services)

Clinical leadershipBusiness case

development (finance, workforce, activity, choice)

The appropriate decision-making forum will be decided on a case by case basis in line with ongoing wider governance discussions

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The Stage 2a assurance, which included the receipt of the findings of the independent external reviews by the Wessex Clinical Senate, took place in June 2016 and NHS England-South (Wessex) received sufficient assurance to recommend that the proposals could be taken to the 12 July 2016 national OGSCR, and a subsequent 9 August 2016 OGSCR. The OGSCR accepted the proposed assurance, and the CCG proposals were then taken to the national Investment committee on 19 August and 22 September 2016. The Investment Committee agreed that they were supportive of the Dorset proposal and a confirmation of stage 2 assurance was received in a letter from NHS England on the 15 November 2016. Receipt of this letter allowed NHS Dorset CCG to formally proceed to public consultation.

Health Gateway ReviewIn line with best practice, the CSR underwent a Health Gateway Review in June 2015. This review was directly procured with the authorisation of NHS England, as the Gateway team previously at the Department of Health had withdrawn the facility. The Health Gateway has since been replaced by the NHS England Programme Assurance Team.

The Health Gateway carried out in June 2015 made several recommendations that have been integrated into the work plans for the review. The report was presented to NHS England as part of the external assurance process.

The Wessex Clinical Senate The Wessex Clinical Senate provides independent, strategic clinical advice and leadership to all commissioners across the Wessex geographical area. They take a broad, strategic view on the totality of healthcare within a particular geographical area, for example providing a strategic overview of major service change. It is a non-statutory advisory body with no executive authority or legal obligations, and it therefore works collaboratively and objectively across the health system.

Wessex Clinical Senate brings together multi-professional clinical leaders with other public sector and patient leaders. The members work collaboratively, and as an arm’s length body will advise, and where necessary challenge, all parts of the healthcare system to drive improvement.

Despite the decision-making authority remaining within the relevant statutory organisations, any recommendations made by the strategic clinical network and Clinical Senate will be endorsed, unless the relevant organisation can provide clear evidence for an alternative course of action.

The Wessex Clinical Senate has been engaged throughout the CSR process; its Chair and Wessex Area Medical Director have attended and engaged in the Clinical Working Group meetings.

The Wessex Clinical Senate provide NHS England with an independent review of clinical elements of the plans for service change. Terms of reference were agreed on 13 March 2015 and the initial review by an external review team took place in June 2015. Their report made


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16 recommendations for additional detail and information. The CCG gathered this additional information between August 2015 and March 2016 and presented to the clinical senate as part of a study day and as a formal report to explore the clinical plans for the review.

The External Review Team was reconvened in May 2016, with a subsequent terms of reference to review the progress and clinical detail, with a final determination from senate council meeting to NHS England on 24th May 2016. The report generated as a result of this process was published when the CCG went to public consultation. Details of engagement with the Wessex Clinical Senate can be found in Table 1.3:

Table 1.3: Engagement with the Wessex Clinical Senate

Date Engagement Detail

13/03/2015Clinical Review Terms of Reference

Outlined process for first External Review Team (ERT) and Clinical Senate involvement

28/04/2016Clinical Review Terms of Reference

Outlined process for second ERT and Clinical Senate involvement

10/06/2015 Wessex Clinical Senate meeting

CSR overview, finance, options, Better Care Fund and integrated working, transformation and implementation plans with accompanying presentations.

30/06/2015 Wessex Cancer SCN meetingMeeting held to feed in to the Dorset CCG Senate response

08/07/2015 Wessex Clinical Senate meetingPresentation given with update of CSR including consultation intentions and patient benefits

23/04/2015Submission to the Senate Council

PCBC version 2 submitted to Senate manager and Chair

15/05/2015Submission to the Senate Council

PCBC version 3.1.0 submitted to Senate Manager and Chair

08/07/2015Wessex Clinical Senate External Review Report

Report as issued by the ERT outlining the outcomes of the review and giving the original 16 recommendations for action by the CCG.

09/08/2015 Correspondence via letter Introductory letter received from the Wessex Clinical Senate Chair outlining remit of senate and summary of next steps

02/02/2016 Correspondence via letterLetter received by Dorset Chief Officer from Wessex Clinical Senate Chair offering guidance in completing Senate response

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11/02/2016 Correspondence via letterLetter sent by Dorset CCG in response to ERT report

21/03/2016 Correspondence via letter

Details received from Wessex Clinical Senate chair detailing expectations of further work as part of recommendations and further content to be included in the PCBC.

13/04/2016Wessex Clinical Senate Meeting

Meeting included breakout groups covering Urgent and Emergency Care, Mental Health and Learning Disabilities, Planned and Specialist Care, Maternity and Family Health, Cancer, Long-Term conditions, Frailty and End of Life. Also in attendance: specialist workforce, finance and engagement knowledge. Discussions focussed around the Senate Council Recommendations.

21/04/2016 Correspondence via letter Follow up letter from 13/04/2016 meeting.

03/05/2016 Submission to Senate CouncilSubmission by CCG in response to original Senate Recommendation Report

27/05/2016 Clinical Senate Council Report

Draft report received by Dorset CCG following second ERT submission on 03/05/2016 outlining opportunities for further work.

24/06/2016 Submission to Senate Council Supplementary submission to Senate Council following receipt of opportunities as outlined within the report on 27/05/2016.

13/07/2016Wessex Clinical Senate meeting – study session

Presentation and Q&A on ICS proposals and Governing Body paper


Letter from Wessex Clinical Senate Chair to Dorset CCG Chair regarding the CCGs intention for further use of the Senate regarding guidance, sessions ERTs, etc. following meeting on 13/07/2016.


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Letter from Dorset CCG to the Wessex Clinical Senate Chair in response to the letter dated 03/08/2016. Dorset CCG has now received confirmation from NHS England, on the basis of the four key tests and input from the Clinical Senate Council, that sufficient assurance has been provided for Dorset CCG to proceed to consultation.


Letter from Dorset CCG to the Wessex Clinical Senate Chair to update on progress of the CSR and inform on upcoming events. Confirmation of the invitation to the Clinical Senate to attend the June Clinical Working Group was also included within the letter.

NHS Improvement (Monitor)NHS Improvement is responsible for overseeing foundation trusts and NHS trusts, as well as independent providers that provide NHS-funded care. They offer the support that providers need to give patients consistently safe, high quality, compassionate care within local health systems that are financially sustainable. By holding providers to account and, where necessary, intervening, NHS Improvement help the NHS to meet its short-term challenges and secure its future.

From 1 April 2016, NHS Improvement became the operational name for an organisation that brings together:

• Monitor

• NHS Trust Development Authority

• Patient Safety, including the National Reporting and Learning System

• Advancing Change Team

• Intensive Support Teams

NHS Improvement build on the best of what these organisations did, but with a change of emphasis to prioritising support to providers and local health systems to help them improve.

During the review, analysis and design stage of the CSR, there were regular telephone meetings with NHS Improvement to ensure they are up-to-date with all developments in the CSR programme, and how the Foundation Trusts that they regulate have been engaged and encouraged to collaborate.

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In order that the assurance processes can be suitably aligned and to avoid repetition, NHS Improvement met with NHS England and CCG leads in February 2016 to ensure that the roles for the different organisations in oversight of the CSR process could be aligned.

NHS Improvement has given informal assurance that they were happy to support the programme in principle, and have remained updated with monthly meetings.

We continue to keep NHS Improvement informed of progress towards the final decision.

NHS England clinical commissionersNHS England Specialist Commissioners are responsible for commissioning specialised services that are provided in relatively few hospitals and accessed by comparatively small numbers of people. They are predominantly involved with cardiac, trauma, and cancer, as well as specialist mental healthcare and neonatal care.

NHS England is responsible for commissioning primary care services, including dentistry, ophthalmology and community pharmacy which are out of the remit of this clinical services review.

NHS England is the contract holder for general practice primary care services, and from April 2016 Dorset CCG has taken on delegated commissioning responsibility for primary care services.

The Primary Care Commissioning Committee, with NHS England oversight, has been created as part of Dorset CCG’s committee structure to support this work and a lay chair has been appointed. This new committee will provide assurance for our emerging primary care service models.

The specialist service representatives were engaged through the Strategic Clinical Networks and the Operation Delivery Networks that are linked in to the Clinical Senate and NHS England. These networks have provided advice and guidance as well as strategic direction on some of the specialist service aspects.

BENEFITS FRAMEWORK

B

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BENEFITS FRAMEWORK TABLES B.1

1.1 – Benefits Framework

Key:Health and wellbeing gap —

Care and quality gap —

Finance and efficiency gap —

1.1.1 – Portfolio Information

One Acute Network

• Acute reconfiguration

• Cancer

• Maternity

• Urgent & Emergency Care

• Acute Vanguard

Integrated Community & Primary Care Services

• Integrated Community Services (Adults and Children’s)

• Transforming General Practice

• Transforming Mental Health (Adults & Children’s)

• Transforming Learning Disabilities

Prevention at Scale

• Starting Well

• Living Well

• Ageing Well

• Healthy Places

DMBC – BENEFITS FRAMEWORKB.1

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1.1.2 – Enabling Portfolios and Programmes

Digitally Transformed Dorset

• Shared Care Record

• Intelligent Working

• Independent Self-care

• Digital Shared Service

• Enabling Technologies

Leading and Working Differently

• Development of our Leaders

• Recruitment and Retention of our Staff

• Developing our Staff

• Supporting our Staff through Change

• Workforce Supply

One Acute Network – Acute Reconfiguration

VisionTo transform acute hospital services in Dorset so that they provide consistent high-quality care that meets the complex and specialist needs of our local population.

What the Vision Will DeliverA Major Emergency Hospital with 24/7 consultant presence

A Major Planned Hospital to provide high quality and timely care for planned (elective) and day case surgery, including a single Dorset cancer service

Access to services that comply with best practice standards by consolidating skills on centralised sites

Opportunities to develop centres of excellence

Financial and workforce sustainability across the one acute network of hospital services in Dorset acute hospital services

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More services provided closer to home via 10% reduction in new outpatient appointments & 25% reduction in follow ups

3% improvement in length of stay per annum

25% reduction in Non Elective admissions cumulatively over five years (after demand increases)

20% reduction in Elective admissions cumulatively over five years (after demand increases)

Benefits of Delivering the Vision• Improved quality of care

• Improved patient access to specialised services

• Improved patient (and carer) experience and choice

• Greater clinical effectiveness will deliver better patient outcomes

• Shorter patient time in acute hospital settings

• Greater levels of positive workforce experience

• Equity of access and quality of services for the population of Dorset

• Reduction in unwarrented variation

• Reduced mortality

• More economically sustainable acute care system in Dorset

• Optimal use of workforce, physical infrastructure and equipment

One Acute Network – Cancer

VisionA single Dorset Cancer Service working to prevent cancer within our population, diagnosing cancer early, achieving best outcomes, and treating our patients as individuals – with person centred, equitable care for all. The overarching aim will be to deliver ‘Achieving World-Class Cancer Outcomes; A Strategy for the NHS 2015-2020’ and to move to commission cancer services based on outcomes with a lead or accountable provider

What the Vision Will DeliverAn increase to 75% for one year survival rate post-diagnosis by 2020

A reduction in smoking prevalence to 13% or below by 2020

Annual increase in patient satisfaction rates

An increase in the uptake of breast, bowel and cervical screening programmes


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Achievement of the 62 day referral to treatment standard at 85% or above

A minimum of 63% of patients diagnosed at stage one and two of disease by 2020

The % of patients being diagnosed with cancer for the first time in A&E reduced to less than 15% by 2020

Introduction of the Recovery Package for all patients

Introduction of risk stratified follow up for patients where appropriate with colorectal, breast, prostate and testes delivered by 2020

Patients will be informed of diagnosis within 28 days of receipt of referral (95% proposed national standard TBA)

A networked One Dorset Cancer Service delivering seamless patient pathways across Dorset

Benefits of Delivering the Vision• Reduced mortality via earlier diagnosis and increased survival rates at one, five and ten

years

• Improved access to specialised services

• Improved patient and carer experience and choice


• Reduction in unwarranted variation

• Improved patient outcomes

• Improved quality of care

• Improved rates of self management

• Increased focus on prevention

• Increased productivity and efficiency


• Improved workforce sustainability

• Increased levels of health literacy

• Improved palliative and end of life care

• Improved transition from paediatric to adult cancer services

One Acute Network – Maternity

VisionEvery women, every pregnancy, every baby and every family, will have positive experiences of seamless high quality care and be empowered to make choices to give them the best

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possible beginning to family life and to give their children the best possible start in life.

What the Vision Will DeliverIncreased number of births in a midwifery led environments (home births / birth centre / alongside midwifery unit)

An increased offer of choice of birthplace

An increase in % of women breastfeeding at six-eight weeks

A reduction in preventable admissions of mother and baby

An increased uptake of healthy start vitamins

A reduction in the number of women smoking at delivery

An increase in the number of women screened for mental health needs

Increase % of obese women (BMI >30) who reduce their BMI to at least 2kg/m2 in the first 12 months after childbirth

An improved uptake of antenatal screening

Increased rates of immunisations during pregnancy

A decrease in stillbirths, neonatal and maternal deaths, and brain injuries that are caused during or soon after birth (contributing to governments ambition to halve the rates of stillbirth and neonatal death, maternal death and brain injuries during birth by 50% by 2030)

Benefits of Delivering the Vision• Improved patient access to advice, assessment and treatment

• Improved patient, carer and workforce satisfaction/experience

• Improved patient choice and personalisation

• Improved support for patients with mental healht problems (parity of esteem)


• Improvements in safety outcomes for women, their babies and families

• Improved clinical outcomes

• More emphasis on prevention

• Reduced unwarranted variation

• Increased workforce sustainability


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One Acute Network – Urgent & Emergency Care

VisionAs outlined by Sir Bruce Keogh, provide a highly responsive service that delivers care as close to home as possible, minimising disruption and inconvenience for patients, carers and families. For those people with more serious or life-threatening emergency care needs, ensure they are treated in centres with the right expertise, processes and facilities to maximise the prospects of survival and a good recovery. This will be achieved by implementing the urgent and emergency care requirements set out within NHS England’s national ‘Five-Year Forward View’ and associated UEC delivery plan.

What the Vision Will DeliverAn increase in the % of calls to NHS 111 transferred to a clinical assessment hub

A configuration of networked urgent treatment centres across Dorset that meets local demand

Roll out of the Ambulance Response Programme including an increase in the number of ‘Hear and Treat’ and ‘See and Treat’ dispositions

An integrated model of urgent care with clear referral pathways offering alternatives to conveyance to ED

Front door streaming of people presenting to ED

Development of frailty assessment procedures and frailty units

Seven-day ambulatory care

Discharge to assess procedures that support a reduction in delayed transfers of care

Local implementation of enhanced health in care homes programme

Implementation of the eight High Impact Change Model

Implementation of NHS 111 online including the introduction of personalised triage

Benefits of Delivering the Vision• Improved patient access to advice, assessment and treatment

• Care delivered in the right place at the right time

• Improved patient, carer and workforce satisfaction/experience

• Improved patient choice and personalisation

• Improved support for patients with mental health problems (parity of esteem)


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• Improved clinical outcomes


• Reduced unwarranted variation

• Greater financial sustainability

• Care delivered closer to home

One Acute Network – Acute Vanguard

VisionDevelop networked provision of key services areas including stroke, ophthalmology , women’s health, cardiology , non surgical cancer, pathology, radiology , paediatrics, health informatics and business support services

What the Vision Will DeliverNetworked provision of clinical services

Consolidated back office functions

Informatics solution for the Dorset system

Optimal and more efficient use of the workforce

Networking and standardisation of clinical support services

The Benefits of Delivering the Vision• Improved access to specialised services – seven-day services

• Improved clinical effectiveness




• Optimal use of workforce, physical infrastructure and equipment to maximise value for money

• Improved patient, carer and workforce satisfaction / experience

• Improved levels of workforce sustainability

Integrated Community and Primary Care Services – Integrated Community Services (Adults and Children’s)

VisionImplement models of care that reduce barriers to cross organisational working alongside


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increasing the range of services on offer in the community so more people can be supported in community settings, such as in their own home or through community hubs, as an alternative to being admitted to major hospitals and long-term residential care.

What the Vision Will Deliver10% reduction in new (first) outpatient attendances

25% reduction in outpatient follow ups

25% reduction in unplanned emergency medical admissions

20% reduction in unplanned surgical admissions

A reduction in the average length of stay in community hub beds to 24 days

People (including children) will be supported by integrated health and care teams and receive the appropriate level of response and care setting according to their need

The Benefits of Delivering the Vision• Increased focus on prevention, self management, and personalised care

• Better outcomes for people, children and their families through more co-ordinated care in a broader range of settings

• Increased productivity and efficiency through reduced duplication

• People, children and their families will have a more positive experience of care

• Improved experience of care and choice






• Right care in the right place at the right time

• Access to services seven days a week

Integrated Community and Primary Care Services – Transforming Primary Care

VisionImplement the requirements as set out within the national GP Five-Year Forward View delivery plan with a view to local GP practices working in collaboration at increased scale that deliver consistent quality and improved outcomes throughout Dorset.

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What the Vision Will Deliver100% of outcome based locally commissioned enhanced services by 2020/21

80% of practices working collaboratively to provide locally enhanced services at scale by 2020

100% of population to be receiving GP Services from practices who are part of a collaboration and working at scale by 2021

40% population coverage with skill mixed teams and new roles by 2019 / 100% by 2021

30% general practice capacity commissioned at a minimum of 45mins consultation per 1000 population by 2019 / 100% by 2021

40% population have access to online consultation by 2019 / 100% by 2021

50% population to have access to care navigator/medical assistant by 2019 and 100% by 2021

The Benefits of Delivering the Vision• Increased access to primary care services

• Population based sustainable primary care services


• Improved population outcomes

• Improved experience and quality of care

• Increased emphasis on prevention and self management



• Services designed around the person


• Increased levels of health literacy

Integrated Community and Primary Care Services – Transforming Mental Health (Adult’s and Children’s)

VisionTo co-produce and implement models of mental healthcare for adults and children that provide high quality, affordable and sustainable mental health services that match local needs


40

What the Vision Will DeliverCapacity within local services that minimises the need for out of area placements for non-specialist acute care

A 25% increase in employment of people with SMI through an Individual Placement Service A two week RTT time for 60% of people experiencing a first episode of psychosis

Access to IAPT treatment for 25% of prevalent population with 75% entering treatment within six weeks

An operational all age psychiatric liaison service

Increase the rate of dementia diagnosis to 67%

Improve access to evidence based services for children with a diagnosable condition

Compliance with local RTT time in Child & Adolescent Mental Health Teams

Improve rates of physical health checks for people managed under the Care Programme Approach

The Benefits of Delivering the Vision• Access to crisis mental health services seven days a week will support a reduction in

emergency admissions

• Reduction of reliance on out of area placements

• Improved personalisation, choice, and a person’s involvement in decision making

• Improved experience and quality of care

• Parity of esteem for physical and mental healthcare


• Better outcomes for people

• Improved workforce satisfaction and sustainability


• More people with a severe mental illness in employment


Integrated Community and Primary Care Services – Transforming Learning Disabilities

Vision

41


Improve the health and wellbeing of people with a learning disability and prevent hospital admission through more robust risk assessment

What the Vision Will DeliverA reduction in the use of specialist inpatient learning disability beds

100% of Care and Treatment Reviews completed in accordance with national standards

75% of people on a GP LD register will receive an annual health check by 2020

Reduction in premature mortality of people with a learning disability

Reduced use of the Mental Health Act to detain people with needs related to their Learning Disability

Health services ensure the need for reasonable adjustment for people with a learning disability is routinely assessed and subsequently implemented

The Benefits of Delivering the Vision• More services provided closer to home

• Care will be provided at the right time in the right place

• Increased focus on prevention and early identification of risk factors for admission

• Improved experience of care

• People and carers involved in decision making

• Reduction in premature mortality



• Increased personalisation and choice

• Services designed around the person

Prevention at Scale – Starting Well, Living Well, Ageing Well, Healthy Places

VisionWe want to change our system to deliver better health and wellbeing outcomes in a way that meets the different needs of all our local people. Our ambition is to see every person in Dorset stay healthy for longer and feel more confident and supported in managing their own health.

What the Vision Will DeliverLong-term population outcomes (ten-twenty years)


42

Improve healthy life expectancy

Reduce the gap in life expectancy within Dorset

Medium term population outcomes (three-ten years)

To ensure children are resilient

To halt the rise in childhood obesity

To increase the number of people meeting the 30 minute guidance for physical activity

To reduce rates of adult obesity

To stem the rise in hospital admission for alcohol

To decrease the variation in the management of heart disease and diabetes

To improve staff sickness rates in the health and social care sector

To reduce early deaths from heart disease

To increase numbers of people using green space for exercise or health reasons

To reduce fuel poverty – warmer homes

The Benefits of Delivering the Vision• Increased focus on prevention

• Reduced health inequalities

• Increased ability for self care and self management

• Improved quality of life

• Improved health literacy amongst population


• Improved workforce experience and sustainability

Enabling Portfolio: Digitally Transformed Dorset – Shared Care Record

VisionChampion a joined up seamless experience where your story is told once and heard as needed in every care setting

43


What the Vision Will DeliverThe development, implementation and expansion of the Dorset Care Record as the new hub of the local application ecosystem

The right information for the right care at the right time

People will be more knowledgeable about their condition allowing better lifestyle choices to support wellbeing

Less clinical time spent searching for information allowing more time for direct patient care

Fewer errors in the delivery of care

More hours of specialist consultant cover for more of the Dorset population

Reduction in administrative costs and diagnostic tests associated with improved access to clinical records

Acute hospital admission avoidance and a reduction in delayed transfers of care

The Benefits of Delivering the Vision• Improved clinical effectiveness





• Reduced duplication


• Increased levels of financial sustainability

• Higher levels of health literacy amongst local population

Enabling Portfolio: Digitally Transformed Dorset – Intelligent Working

VisionTo deliver business intelligence capability and capacity that supports new and different ways of system-wide working

What the Vision Will DeliverImproved business intelligence capability and capacity to support system-wide planning and delivery


44

Use of intelligence to establish different ways of working and to focus resources in the right place

An integrated view that supports planning activities by bringing together data about the Dorset population, disease prevalence, workforce, quality and outcomes

Availability of accurate and timely information to clinical and corporate staff

System-wide trust and confidence in using data to tailor care

The Benefits of Delivering the Vision• Reduction in unwarranted variation






• Increased emphasis on prevention

Enabling Portfolio: Digitally Transformed Dorset – Independent Self Care

VisionAllow people to make the best use of technology to stay healthy for longer and confidently manage (in partnership with health and care professionals) any conditions they may develop in the future

What the Vision Will DeliverIncreased awareness of health and wellbeing opportunities, supported by an innovative evidence-based behaviour change service and digital platform (LiveWell Dorset)

Improved access for the public and professionals to care records through the ‘Patient Portal’ within the Dorset Care Record

Reduced demand for health and traditional social care services

An improved ability for people and carers to access support when they want it and in the way that they want it

Better use of the voluntary sector in supporting people

45


Reduced costs within the health and care system due to a healthier and better informed population

The Benefits of Delivering the Vision• Care will be provided at the right time in the right place

• Increased ability for self management

• Optimal use of system-wide resources including voluntary sector


• Increased emphasis on prevention

• Higher levels of health literacy

Enabling Portfolio: Digitally Transformed Dorset – Digital Dorset Shared Service

VisionTo create a model for a shared system-wide single IT service

What the Vision Will DeliverShared technical skills, knowledge and processes across a larger team which build the critical mass of expertise to improve network coverage and resilience of services

A common approach to applications, architecture and infrastructure, supporting staff that work across sites and organisations or in multi-care-setting teams.

Greater adoption of common clinical systems across organisations, and greater scope for integration

Less variation in service quality meaning less time wasted for end users

Greater negotiating power to win better deals for common services and systems

Pooling of licences for common products (e.g. Microsoft Office) to reduce expenditure

A unified experience for staff, in turn supporting more ‘joined-up care’ for patients

Eliminates duplication of effort

The Benefits of Delivering the Vision• Increased levels of financial sustainability

• Optimal use of system-wide resources


46


• Better outcome for people

• Improved workforce satisfaction and sustainability

• Reduction in variation of service offer

Enabling Portfolio: Digitally Transformed Dorset – Enabling Technologies

VisionProvide high performing resilient and collaborative foundations that mean successful digital operations are the norm

What the Vision Will DeliverA resilient infrastructure to support the best delivery of care and services across the system

Common and/or interoperable platforms to support reliable communications transcending traditional organisation boundaries

The stable platform upon which other STP programmes may reside

A more seamless way of working for a highly mobile workforce

The Benefits of Delivering the Vision• Increased levels of financial sustainability

• Optimal use of system-wide resources


• Better outcome for people

• Care delivered in the right place at the right time

• Reduction in variation



• Higher degree of workforce satisfaction and sustainability

• Increased focus on prevention

• Reduced health inequalities

• Increased ability for self care and self management

Enabling Portfolio: Leading and Working Differently – Developing our Leaders

47


VisionTo develop leadership behaviours and their impact, resulting in improved organisation and staff performance and staff morale

What the Vision Will DeliverSenior leadership across health and social care are engaged in the leadership development programme and supported with coaching to maximise personal impact.

NHS (and equivalent for social care) staff survey results achieve year on year improvements in all leadership indicators

Establishment of a system-wide talent management and succession programme by the end of Q4 17/18.

The Benefits of Delivering the Vision• Enhanced leadership capability and collaboration involved and informs transformational

change

• Better communication across health and social care boundaries

• Financial sustainability

• Maximum workforce productivity and efficiency

• Improved workforce retention rates and sustainability

• Higher levels of workforce satisfaction

• Improved quality of care supported by leadership behaviours and organisational culture

Enabling Portfolio: Leading and Working Differently – Recruitment and Retention of our Staff

VisionDevelop a system-wide approach to attract new staff and retain existing staff within the health and social care sector in Dorset

What the Vision Will DeliverHealth and social care organisations in Dorset meet the system-wide vacancy and turnover rate

An established process is in place to monitor and record the increase in quality of applicants for positions in health and social care organisations by Q4 17/18.

Year on year improvements in the quality of applications to health and social care organisations in Dorset by Q1 18/19


48

NHS (and equivalent for social care) staff survey results achieve year on year improvements in all relevant indicators

Year on year reduction in absence rates across health and social care organisations

The Benefits of Delivering the Vision• Higher degree of workforce satisfaction





• Sustainable services

Enabling Portfolio: Leading and Working Differently – Developing our Staff

VisionTo improve the development opportunities for staff to increase retention of staffTo ensure the future workforce supply of health and social care staff in DorsetTo improve retention and morale of existing staff in health and social care organisations in Dorset.To work in greater partnership with education providers to ensure future workforce supply is available. What the Vision Will DeliverHealth and social care organisations meet the system-wide vacancy and turnover rate

Health and social care organisations meet the system-wide government apprenticeship target of 2.3% of the number of employees on payroll by Q1 18/19.

Health and social care staff have the flexible skills and capabilities to effectively carry out their role / meet future service demand / deliver new ways of working


Health and social care organisations meet their appraisal and statutory and mandatory training target

The Benefits of Delivering the Vision• Improved quality and experience of care


49


• Improved workforce satisfaction



Enabling Portfolio: Leading and Working Differently – Supporting our Staff through Change

VisionTo improve the working environment for staff by ensuring they are engaged and involved in changes that affect them

What the Vision Will DeliverNHS (and equivalent for social care) staff survey results achieve year on year improvements in all communication and engagement indicators

The Benefits of Delivering the Vision• Better communication across health and social care boundaries

• Financial sustainability


• Improved workforce retention rates and sustainability

• Higher levels of workforce satisfaction


Enabling Portfolio: Leading and Working Differently – Workforce Planning

VisionTo ensure that a workforce with the required skills and competencies to deliver new models of care is available

What the Vision Will DeliverThe Dorset system will maintain its current actual FTE workforce from 16/17 into 17/18 by organisation, service and staff type.

The Dorset system will meet any new FTE workforce requirements based on the agreed planned FTE for 17/18 by organisation, service and staff type.

System-wide workforce plans to reflect future organisation and system requirements are developed by Q1 18/19


50

Future training programme places and schemes are informed by system workforce plans based on future needs


The Benefits of Delivering the Vision• Improved quality and experience of care


• Improved workforce satisfaction



Emerging Performance Measures

Ref Benefit Measure/frequency Target Source

1

Improved patient access to advice, assessment & treatment

% of calls transferred from NHS111 through to clinical assessment service (frequency tbc)

Increase from baseline

Local Intelligence Reports (Business Intelligence Directory)GP patient surveyNHS England

62-day referral to treatment (RTT) standard – cancer (weekly)

85% of referrals by 2020

Two week RTT for first episode of psychosis (monthly)

60% of referrals

Access to IAPT services (monthly)

25% of prevalent population75% within six weeks

CAMHS RTT compliance (monthly)


Extending access survey (bi-annual)


GP patient survey (annual)Increase from baseline

NHS Constitution Standards (weekly/monthly)

Compliance

Access to online consultations in primary care (measure to be defined)


51



2Improved quality & experience of care

Patient satisfaction surveys (annual)


NHS DigitalLocal SurveysNHS EnglandNational patient survey

NHS Safety Thermometer (monthly)Friends and Family Test (monthly)GP Patient Survey (annual)PROMS (hip & knee replacements; groin hernia and varicose veins) (quarterly)

3Improved carer satisfaction and experience

Carer satisfaction rating (bi – annual)


Local surveysNHS Digital Indicator Portal

4Improved patient choice and personalisation

E-Referral System compliance (monthly)

100% Choose & Book (e-referral system)

Rate of Appointment Slot Issues (ASI) (monthly – tbc)

Reduce from baseline

Number of births in midwifery led environments (monthly)


5

Improved support for people with mental health problems

Number of people placed in out of area non-specialist mental health beds (monthly)

Decrease from baseline

Local Intelligence

Number of people with SMI in employment (monthly)

25% increase from baseline

Number of physical health checks for people under CPA programme (annual)


Recovery Rate Steps to Wellbeing (IAPT) (monthly)

50%


52


6Reduced mortality rates

% of neonatal, foetal, perinatal and maternal deaths per 1000 births (annual) Increase of 60

lives saved per annum Public Health

EnglandONSPublic Health local data (public health mortality file)NHS Digital Indicator Portal Domain 1

HSMR (annual)Standardised Hospital Mortality Indicator (SHMI)

Cancer survival rate (annual)

Additional 300 people surviving cancerMinimum 63% diagnosed at Stage 1 & 2

% of people diagnosed with cancer for first time in ED (tbc)

Less than 15%

Public Health Outcomes framework – Domain 4 (annual)CCG outcomes indicator set (annual)

7Reduced admission and readmission rates

Rate of unplanned emergency medical admissions (monthly)

25% reductionLocal Business Intelligence DirectorySUS dataNHS Digital Indicator Portal

Rate of unplanned surgical admissions (monthly)

20% reduction

Number of people managed via primary care streaming at ED (monthly – tbc)

Increase from baseline (new service)

8Reduction in length of stay

Average length of stay (monthly)• Acute hospital

• Community beds

Reduce from baseline 24 days

Local Business Intelligence Directory SUS data

Delayed transfers of care (days/100,000 pop)(monthly)


9Reduction in the number of serious incidents

Number of SUI (monthly)Reduce from baseline

Local IntelligenceNumber of Never Events

(monthly)

53



10Improved clinical outcomes

PROMS (quarterly) Increase from baseline NHS Digital

Indicator Portal

CROMS (tbc)Re-admission rate within 30 days (monthly)


11Reduction in unwarranted variation in care

RightCare dataBetter Care Fund Indicators (monthly)


NHS England CCG data packs

12

Reduced number of unnecessary investigations and duplication of assessment

Number of unnecessary investigations (tbc)


Local survey

13

Reduction in waiting times and the number of cancelled appointments

RTT compliance rates (monthly)


NHS EnglandLocal Intelligence

14Improved co-ordination of care

Better Care Fund Indicators (monthly)

Improve from baseline

Local AuthorityNHS England

15Greater workforce sustainability

FTE workforce vs FTE workforce requirement (quarterly – tbc)

Improve ratio from baseline

System-wide staff vacancy and turnover rate (quarterly – tbc)


Number of apprenticeship roles (tbc)

2.3% of total employees on payroll

16Higher degree of workforce satisfaction

NHS Staff Survey (annual)Annual improvements

NHS Staff Survey

17

Improved workforce productivity & efficiency

Measure to be further considered


54


18

More care provided closer to people’s homes through increased ability to treat and support people in community settings

Number of community service contacts (monthly)


Local Intelligence

Acute hospital admission rate for people with identified long-term conditions (monthly) Decrease from

baselineNumber of admissions to specialist inpatient LD beds (quarterly)

19Greater emphasis on prevention

Rate and uptake of antenatal screening (monthly)


Public Health EnglandNHS Digital Indicator PortalPublic Health local data (public health mortality file)

Number and uptake of healthy start vitamins (tbc)


Smoking status at time of delivery (quarterly)


Smoking prevalence 13% or belowNumber of people on GP LD register receiving an annual health check (annual)


Gap in life expectancy in Dorset (annual)


Childhood obesity rates in Dorset (annual)


Adult obesity rates in Dorset (annual)


Number of early deaths from heart disease (annual)

Reduce from baseline by minimum of 50

20

Optimal use of public estate and physical infrastructure

Measure to be further considered

STAKEHOLDER ENGAGEMENT ACTIVITY

C

DMBC – APPENDIX C: HISTORY OF STAKEHOLDER ENGAGEMENTC.1

56

A wide range of engagement opportunities have been made available to stakeholders during the Clinical Services Review (CSR). This appendix details the engagement work that was undertaken.

C.1 – Pre-Launch Stakeholder Engagement

C.1.1 – Gathering Public OpinionsIn 2013 Dorset CCG, along with the three acute hospitals and Dorset HealthCare commissioned The Big Ask – a significant research project amongst local residents and patients. The aim was to understand what local people value from their NHS, as well as identifying areas of improvement, awareness of services available in Dorset, and possible changes that could benefit local people. Over 25,000 surveys were distributed across health and community settings. A household postal survey was also carried out. In total, we received over 6100 responses.

Between 2012 and 2014 over 3900 people responded to at least one of the four Dorset Citizen Panels surveys that explored a range of healthcare issues.

Together, The Big Ask and Citizen Panels provide over 29,000 individual qualitative comments about services. These were collated and analysed by an independent research organisation to identify dominant themes, these were considered by clinicians during the pre-consultation phase.

There is a strong parity between the expectations of local people and the CCG’s ambitions and strategic priorities. We have built on the public insights we have collected and used them as the foundation for our vision and the development of solutions to the challenges we face.

C.2 – Appointment of external consultancy support

We decided there was a requirement for an external consultancy to enhance Dorset’s capacity and capability to undertake the Clinical Services Review (CSR). We felt it was important to have the input of stakeholders to help us develop the requirements for and appointment of this external support, including the views of those individuals and organisations with whom we expected to work closely in the delivery of the review. In April 2014, we therefore gathered feedback from stakeholders during the drafting of the consultancy support specification, and in September 2014 we invited stakeholders to attend the presentation by shortlisted providers.

C.3 – Launch of the Clinical Services Review to stakeholders

We publicly and formally launched the start of the review process with a large-scale

57

LAUNCH OF THE CSR TO STAKEHOLDERS C.3

event at the Bournemouth International Conference Centre on 22 October 2014. Over 1050 stakeholders were invited to this event, and 275 attended. A full list of invitees and acceptances is noted in Table 2. The event featured a series of presentations about the scope and process of the review and provided attendees with the opportunity to ask questions of a panel that included CCG Governing Body members and Directors.

Table 1: Stakeholder involvement in appointment of consultancy report

Stakeholders who reviewed the specificationApril 2014

Stakeholders who attended the presentations in September 2014

• Providers

– Dorset County Hospital NHS Foundation Trust

– Dorset HealthCare University NHS Foundation Trust

– Poole Hospital NHS Foundation Trust

– Royal Bournemouth and Christchurch Hospitals NHS Foundation Trust

– South Western Ambulance Service NHS Foundation Trust

• Local authorities

• Public Health

• NHS England

• Monitor

• LMC

• Healthwatch Dorset

• Legal advisors

• Providers

– Dorset County Hospital NHS Foundation Trust

– Dorset HealthCare University NHS Foundation Trust

– Poole Hospital NHS Foundation Trust

– Royal Bournemouth and Christchurch Hospitals NHS Foundation Trust

– South Western Ambulance Service NHS Foundation Trust

– Local authorities

• Public Health

• NHS England

• Voluntary sector organisations

– Bournemouth Council for Voluntary Service

– Poole Council for Voluntary Service

– Dorset Race Equality Council (DREC)

• Public and patient groups

– Healthwatch

– Health Network Group

– Weymouth & Portland Health Network

– POPP Champion, Purbeck

– Patient carer representatives ×4

– Monitor

– MP officer

– Local Pharmaceutical Committee

– GPs ×4

– Business management consultant


58

Table 2: Summary of launch invitees and acceptances

Stakeholder Group Attended Invited

Carers’ organisations 2 10

CCG Governing Body/CCP Chairs 5 20

CCG staff 87

Communications leads 3 13

Educational establishments 2 8

General public 62 511

GP member practices 4 91

GP practice managers 1 108

Health and Wellbeing Board 2 19

Local authorities 24 36

Local Healthwatch 2 3

NHS England 1

NHS provider 35 37

Other CCGs and out-of-Dorset providers 2 10

Parish Council 2 2

PPI leads 3 4

Private health providers 9 22

Professional bodies 2 12

Trade unions 1 4

Voluntary sector 26 75

Total 275 1056

C.4 – Clinical engagement activities

C.4.1 – Clinical Working GroupsSignificant clinical engagement has been an essential and central part of developing the reconfiguration options. This has been achieved through the establishment and running of Clinical Working Groups (CWGs) that met regularly during the pre-consultation period with clinical representatives from the three acute hospitals, community and mental health services, ambulance service and GP practices.

The CWGs have driven discussions to develop and determine the main deliverables for the design phase, including: the case for change, what good looks like (the clinical vision),

59

CLINICAL ENGAGEMENT ACTIVITIES C.4

models of care and service options that include a medium and a short list of options. Each of these groups was led by a GP ‘spokesperson’, responsible for chairing the group and representing the group’s discussions, agreements and concerns.

Clinicians from across Dorset and surrounding providers were invited to participate, and there was a broad spread of representation with over 100 clinicians attending each meeting. Table 3 provides a breakdown of attendees. Many clinicians chose to stay with a single group throughout the period, whilst others chose to move between groups at the different meetings. Invitees included a selection of GPs from out of county to provide their expertise on particular specialist subjects, such as palliative care, however none chose to attend.

The CWGs met regularly during the pre-consultation stage, with 12 meetings from November 2014 to September 2016. The CSR public consultation then ran from 1 December 2016 to 28 February 2017, and an additional CWG meeting took place in June 2017 where summary results from the consultation were presented.

Table 3: Summary of dates and participants of the Clinical Working Groups

Date Location Attendees Number

19/11/2014Dorford Centre, Dorchester

Total invited 134

Dorset GPs 42

Dorset provider clinicians 54

Outside Dorset health professionals* 4

Other (i.e. council non-clinical public health, NHS England)

6

Total attended 106

17/12/2014Springfield Hotel, Wareham

Total invited 178

Dorset GPs 48




7

Total attended 132


Total invited 212

Dorset GPs 46




9

Total attended 156


60


25/02/2015 BIC, Bournemouth

Total invited 252

Dorset GPs 40




6

Total attended 135

25/03/2015 BIC, Bournemouth

Total invited 251

Dorset GPs 38



Other (i.e. council non-clinical Public Health, NHS England)

4

Total attended 116

02/09/2015Queen Elizabeth School, Wimborne

Total invited 223

Dorset GPs 31




34

Total attended 122


Total invited 223

Dorset GPs 26




28

Total attended 122


Total invited 223

Dorset GPs 30




32

Total attended 95

61

CLINICAL ENGAGEMENT ACTIVITIES C.4


20/04/2016The Bourne Academy, Bournemouth

Total invited 223

Dorset GPs 25




28

Total attended 90


Total invited 223

Dorset GPs 16




29

Total attended 112


Total invited 223

Dorset GPs 3




27

Total attended 49


Total invited 223

Dorset GPs 4




22

Total attended 50


Total invited 239

Dorset GPs 12


Outside Dorset health professionals 2


21

Total attended 77


62

*Contains clinicians from NHS England, LMC, LPC, NHS West Hampshire, Salisbury, Yeovil, Southampton, North Bristol

C.5 – Clinical Reference Group

In order to obtain strategic clinical advice and oversight, Dorset CCG established a Clinical Reference Group, made up of Dorset CCG Governing Body and the medical and clinical directors of the NHS provider foundation trusts. This group, which sits within the formal governance of the review, has also advised, informed and approved the clinical deliverables and provided inputs and steer to the CWGs.

The Clinical Reference Group met regularly throughout the pre-consultation phase and continued to meet on a monthly basis throughout consultation.

C.6 – GP practices and practice members

Our GP members and GP practices have been actively engaged using a variety of methods.

In November 2014, our Chair wrote to each of the (then) 100 practices (the current number of practices now totals 91) with an overview of the review, and requested the opportunity for the review team to meet with each practice to gain their involvement in shaping the design stage. Throughout the initial months of the review we undertook a comprehensive programme of 40 visits to practices throughout the county, as outlined in Table 4.

The review was also a regular agenda item for the cluster and locality meetings that took place between autumn 2014 and the first quarter of 2015.

Each week, our e-bulletin provides practices with a general overview of relevant news and information, and this has included regular review updates.

In January 2015, we sent each practice a letter with 50 copies of the Need to Change and asked for their support in displaying the document for their patients.

Table 4: Summary of GP practice and practice manager meetings

Date of meeting Surgery

12/12/2014 Orchid House Surgery

18/12/2014 Whitecliff Medical Group

05/01/2015 Westbourne Medical Centre

08/01/2015 Cornwall Road Medical Practice

09/01/2015 Harvey Practice

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GP PRACTICES AND PRACTICE MEMBERS C.6


13/01/2015 Talbot Medical Centre

13/01/2015 Milton Abbas Medical Practice

13/01/2015 Puddletown Surgery

14/01/2015 Banks & Bearwood Medical Practice

14/01/2015 Queens Avenue Surgery

20/01/2015 Quarter Jack Surgery

23/01/2015 Hadleigh Practice

26/01/2015 Carlisle House Surgery

26/01/2015 Barton House Medical Practice

26/01/2015 Eagle House Practice

26/01/2015 Royal Crescent and Preston Rd

28/01/2015 Weymouth Community

29/01/2015 West Moors Group Practice

29/01/2015 Providence

03/02/2015 The Tollerford (Pound Piece)

04/02/2015 Wyke Regis Health Centre

06/02/2015 Walford Mill Medical Centre

10/02/2015 Stour Surgery

11/02/2015 Gillingham Medical Practice

12/02/2015 Verwood Surgery

16/02/2015 New Land Surgery

17/02/2015 Prince of Wales Surgery

11/03/2015 Penny’s Hill Practice

11/03/2015 Village Medical Practice – West Moors

16/03/2015 Highcliffe Medical Centre

16/03/2015 The Village Surgery

17/03/2015 Holdenhurst Road Surgery

24/03/2015 Northbourne Surgery

26/03/2015 Shelley Manor

30/03/2015 Rosemary Medical Centre

31/03/2015 The Alma Partnership

13/04/2015 Fordington Surgery

21/04/2015 Old Dispensary Medical Practice


64


01/06/2015 Farmhouse Surgery

18/06/2015 Lilliput Surgery

GPs were provided with the opportunity to understand the progress of the review and provide their views and comments during our regular locality and cluster meetings.

Table 5: Summary of locality and cluster meetings

Date Meeting

26/11/2014 Poole Central locality

02/12/2014 Poole Bay locality

03/12/2014 North Dorset locality

03/12/2014 Mid Dorset locality

05/12/2014 West Dorset locality

10/12/2014 Mid Dorset cluster

10/12/2014 East Dorset locality


10/12/2014 Weymouth and Portland locality

11/12/2014 Poole North locality




07/01/2015 West cluster



12/01/2015 East Bournemouth locality



21/01/2015 Christchurch locality

26/01/2015 North Bournemouth locality

28/01/2015 Purbeck locality



65

GP PRACTICES AND PRACTICE MEMBERS C.6

Date Meeting






11/02/2015 East cluster
















26/03/2015 Central Bournemouth locality




08/04/2015 Bournemouth and Christchurch locality


09/04/2015 Purbeck locality







66

Date Meeting






11/08/2016 Poole North & East Dorset (joint) localities






12/10/2016 Central Bournemouth locality






GPs were also provided with the opportunity to discuss the review at the CCG-wide membership events and development workshops, where all practice representatives are invited to attend, usually four times per year.

Table 6: Summary of other engagement activity with members

Date of meeting Activity Attendees Meeting agenda

22/10/2014Development Workshop

29

• Issues and opportunities surrounding primary care, and the potential impact of the CSR programme

• LMC’s view on the future of general practice

• How practices will engage with the review

10/2014 Membership Event 143 • Update on the review

67

PATIENT AND PUBLIC ENGAGEMENT C.7

Date of meeting Activity Attendees Meeting agenda


32• Update on the review including

potential out of acute hospital* care model

01/2015 Membership Event 125 • Update on the review

02/2015Development Workshop

41• Update on the review including


22/04/2015 Membership Event • Update on the review and



• Update on the review and potential out of acute hospital* care model

*‘Out of acute hospital’ is now known as Integrated Community Services

C.7 – Patient and public engagement

C.7.1 – Patient and Public Engagement GroupA key part of the stakeholder engagement strategy has been the formation of a Patient (Carer) and Public Engagement Group (PPEG) to sit within the formal governance arrangements for the review.

PPEG comprised of 20 individuals drawn from across Dorset’s demography, diversity and geography. Group members were selected from applicants who were members of NHS Dorset CCG’s wider patient group, Supporting Stronger Voices (SSV). PPEG was chaired by a National Patient Leader, Anya de Iongh.

PPEG met monthly throughout the review from December 2014 to June 2017. The final PPEG meeting was held on 13 June 2017. Following the success of the PPEG, a new and separate Public Engagement Group (PEG) has been developed to work alongside all partner organisations involved in Dorset’s wider Sustainability and Transformation Plan (STP).

PPEG provided a key role in steering and shaping the design stage of the review, including co-designing the evaluation criteria and our approach to consultation. They were also involved in critiquing the public facing consultation documents.

Key outputs included:

• Requesting a public facing Need to Change document (produced Jan 2015)

• Directly informing the development of the CSR Evaluation Criteria (Feb 2015)


68

• Designing consultation principles for the CSR (March 2015)

• Producing a guide to person-centred discussions – shared widely with CWGs, Clinical Delivery Groups (CDGs) and Community Vanguards (December 2015)

Table 7: Summary of PPEG meetings

Date Location Attendees Meeting agenda

03/12/2014 Dorchester 21 • Case for Change

06/01/2015 Wimborne 18 • What does good care look like?

• Co-designing the evaluation criteria03/02/2015 Sherborne 18 • Models of care for acute hospital

provision and service options

• Co-designing the consultation principles10/03/2015 Dorchester 15 • Models of care for out of acute and acute

hospital provision and site specific service options

• Co-designing the consultation activity16/04/2015 Kinson,

Bournemouth18 • Models of care for out of acute and acute

hospital provision and site specific service options

• Personal pledges to support consultation activity

08/05/2015 Wimborne 16 • Overview of CSR review, analyse and design phase

• Initial consultation document review29/06/2015 Dorchester 18 • Special three-hour meeting to review

consultation narrative

20/08/2015 Dorchester 15• CSR update and discussion of next steps

following change in timescales and plans

13/10/2015 Dorchester 16

• Update from Clinical Working Group 6

• Engagement update and exploration around extending reach of core narrative need to change narrative

• Production of PPEG Guide for Person-Centred Discussions for all CDGs and Community Vanguards

15/12/2015 Kinson 17• Focus on Integrated Community Services

(ICS) discussions, CDGs and community and Acute Vanguards

16/02/2016Frederick Treves House

12• Review and feedback on benefits

realisation document

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PATIENT AND PUBLIC PARTICIPATION C.8


30/03/2016Kinson Community Centre

15• Update on acute hospital configuration

and benefits realisation. Feedback on both

26/04/2016Allendale Community Centre

16• Presentation and feedback session on ICS

modelling and public engagement events


12• Update on ICS

• Acute and Community Vanguard update

11/07/16Canford House, Poole

14

• Update on ICS and Clinical Working Group 9

• Introduction to next phase of CSR engagement

• Acute and Community Vanguard update


12

• Introduction to and view-seeking on consultation document

• Presentation on STP

• Discussion on future of PPEG and links to PPEG

13/09/16 Allendale House, Wimborne

11

• Feedback on future PPEG model

• CDGs priorities update

• Discussion with Healthwatch Dorset

• Acute hospital vanguard update

• Primary Care Strategy presentation

15/11/16Kinson Community Centre

10

• Equality and diversity

• Consultation plan update

• Primary Care Commissioning Strategy

13/06/17Vespasian House, Dorchester

14 • Final CSR meeting

C.8 – Patient and public participation

We have been committed to providing regular and open updates on the progress of the review to the general public of Dorset via a series of open access information events. During December 2014, January 2015 and February 2015 a total of nine events were organised. The location and scheduling of the meetings was varied in order to provide people with a range of opportunities to come along. Each meeting included a presentation about the most recent CWG discussions and a Q&A session for attendees to ask their questions or raise their concerns. One of each month’s trio of events was filmed and the video uploaded to the website to provide the opportunity for the working well, seldom heard and diverse communities to gain an update. At February 2015 meetings, attendees were asked to submit ideas for consultation activities, and 57 responses were received.


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Table 8: Summary of patient, carer and public information events


08/12/2014 Ferndown 138 • Case for Change

10/12/2014 Sturminster Newton

11/12/2014 Dorchester

13/01/2015 Sherborne 217 • What does good care look like

14/01/2015 Weymouth

15/01/2015 Poole

09/02/2015 Christchurch 170• Models of care for out of acute

hospitals* and acute hospitals

• Consultation activity

10/02/2015 Bridport

12/02/2015 Blandford Forum

*‘Out of acute hospital’ is now known as Integrated Community Services

Between February 2015 and March 2016 the public were provided with extensive opportunities to receive information, become involved and provide comment.

Miscellaneous opportunities made available during the public consultation have now also been added to the following list (see public consultation section):

Date Location & detail Type of opportunity

23/02/2015Weymouth and Portland Health Network meeting

• CSR and Need for Change update

25/02/2015North Dorset Health Network meeting


28/04/2015Weymouth Areas Seniors Forum

• Guest speaker & information stall

• Need for Change presented & views collected

• Invitation to join Health Involvement Network (HIN)

13/05/2015Bournemouth Town Hall new councillors event



• Invitation to join HIN



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18/05/2015Dorford Centre DorchesterDorset Community Action event

• Information stall

• Need to Change booklet available


18/05/2015

Bournemouth Learning CentreLearning Disability Partnership (LDPB) meeting

• Information shared at meeting



19/05/2015Kinson Community Centre (Disability) Access Dorset AGM




20/05/2015Dorset People First, Dorchester meeting (Learning Disability)

• Information shared at meeting



21/05/2015Poole Learning Disability Partnership meeting




21/05/2015South West Multicultural Network AGM Dorchester




29/05/2015Gypsy Romany Day, Dorchester

• Information stall at public event





05/06/2015 Blandford Health Fayre




08/06/2015

Carers drop-in morning (Carers Week)Sandford Surgery, Wareham




09/06/2015Carers event (Carers Week)Lyme Regis Medical Centre




09/06/2015

New Carers Group meeting (Carers Week)Alma Road practice, Winton





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10/06/2015Carers event (Carers Week)WI Hall, Bridport




10/06/2015Mental Health patient and carers event (Carers Week)Bournemouth Library




11/06/2015

Carers event (Carers Week)Westcliffe Baptist Church, Bournemouth




16/06/2015Carers event (Carers week) Town Hall, Dorchester




23/06/2015Unison wellbeing event Bournemouth Learning Centre




24/06/2015Sherborne Health Fayre Digby Hall, Sherborne




24/06/2015

Milton Abbas GP Patient Group (PPG) Meeting Reading Rooms, Milton Abbas

• Guest speaker



25/06/2015West Dorset Community Partnership Dorchester

• Guest speaker



29/06/2015Sherborne 50+ Forum meeting Digby Hall, Sherborne




01/07/2015CCG AGMAllendale Centre, Wimborne

• Need for Change presented by CCG Chair



04/07/2015 Poole Hospital Open Day




08/07/2015Community Nursing Training Day Bournemouth

• Guest speaker




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08/07/2015

Barton Practice, GP patient group (PPG) meetingNew Forest West Hants (cross border)

• Guest speaker



11/07/2015Bourne Free Festival (LGBT+)Bournemouth gardens




18 & 19/7/2015

Dorset Sport and Wellbeing Festival Weymouth Beach




22/07/2015RBCH Council of Governors meeting Bournemouth Hospital

• Guest speaker



29/07/2015West Hants Locality Team meeting New Milton (cross border)



01/08/2015One World Festival Borough Gardens, Dorchester




19/08/2015Gillingham & Shaftesbury Show




27/08/2015Melplash ShowBridport




02/09/2015Equality Conference Arts University, Bournemouth University

• Information stall at public conference



5 & 6/9/2015

Dorset County ShowDorchester




12 & 13/9/2015

Sturminster Newton Cheese Festival




15/09/15

North Bournemouth Patient Voice Diabetes Event Kinson Hub/Library





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17/09/2015Carers Group meeting Lewis Manning Hospice



17/09/2015POPP Champions meeting Morden Village Hall

• Guest speaker




17/09/2015PPG Meeting Bridport Medical Centre

• Guest speaker




21/09/2015Lyme Forward meeting Lyme Regis

• Guest speaker




21/09/2015East Dorset Health Network meetingFerndown

• CSR and Need for Change update•Invitation to join HIN

22/09/2015

Dorset Association of Parish and Town Councils (DAPTC) seminar Kingston Maurward, Dorchester

• Guest speaker




23/09/2015

The Royal Bournemouth and Christchurch Hospitals NHS Foundation Trust Annual Members’ Meeting

• Information stall at members’ meeting



24/09/2015Supporting Stronger Voices meetingBlandford

• Guest speaker




24/09/2015Christchurch Patient Voice conference

• Information stall at public meeting



24/09/2015Annual Members meeting Poole Hospital

• Information stall at members’ meeting



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05/10/2015Pan Dorset ASC (learning disabilities) Partnership Board, Poole

• Guest speaker




06/10/2015Swanage Hospital League of Friends AGM

• Guest speaker




07/10/2015Bournemouth and Poole Equality and Diversity Forum

• Guest speaker




08/10/2015NHS Dorset CCG Equality and Diversity event Boscombe

• Information stalls at CCG arranged public event



09/10/2015World Mental Health Day event Bournemouth University

• Information stalls at public event




• CSR update


• CSR update


• CSR update

20/10/2015Youth Participation Event Bournemouth

• Information stalls at public event


• Youth posters and social media information made available


21/10/2015Young People’s conference Wimborne

• CCG arranged Dedicated Young People event

• Guest speaker



• Youth posters and social media information available



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22/10/2015CHORUS Carers Group meetingWimborne



22/10/2015WI AGM Poole Lighthouse

• Guest speaker




26/10/2015Blandford Hospital League of Friends meeting

• Guest speaker




27/10/2015NHS Dorset CCG Equality and Diversity event Dorchester

• Information provided at CCG arranged partners meeting



29/10/2015Health and Care Forum meeting (voluntary sector)Bournemouth

• Guest speaker




04/11/2015

Dorset CCG Young People’s conference Thomas Hardye School Theatre, Queens Avenue, Dorchester

• CCG arranged Dedicated Young People event

• Guest speaker



• Youth posters and social media information made available


4 & 5/11/2015

Independent Care Homes eventWimborne

• CCG arranged Dedicated Care Homes event

• Guest speaker




18/11/2015Prince of Wales GP Patient Group (PPG) meetingDorchester

• Need to change animated film shown & views collected


18/11/2015Dorset Community Action Community Lunch eventSherborne

• Need to change animated film shown & views collected


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21/11/2015Dorset-wide GP Patient Group (PPGs) eventDorchester

• Guest speaker

• Need for Change presented together with animated film & views collected


02/12/2015North Dorset Health Network meetingSturminster Newton

• Need to Change animated film shown and views collected


03/12/2015Poole Community Voluntary Sector AGMPoole

• Need to Change animated film shown


15/12/2015Tollerford Practice PPG meetingMaiden Newton

• Guest speaker

• CSR update

14/12/2015Dorset Community Action Community LunchWeymouth

• Need to Change animated film shown and views collected


10/02/2016Diabetes UK AGMDorchester

• Guest speaker


• CSR update

• Need to Change booklet made available


11/02/2016Weymouth and Portland Health Network meeting, Weymouth

• Guest speaker

• Need for Change presentation

• Update on CSR ICS programme of engagement

C.8.1 – Integrated Community Services Public EngagementIn March 2016, the CCG launched a programme of engagement specifically to inform and seek views from the public on ICS proposals.

Events were held in a variety of community settings in each of the 13 CCG localities. The Dorset Association of Town and Parish Councils provided vital support in setting up these meetings.

At the events a CCG speaker presented the Need for Change and outlined the ICS proposals. Guests were invited to view posters which provided more details, and to affix comments to them. They also had the opportunity to write their views on postcards which asked what they thought was good about the proposals, and asked if they had any concerns or questions.

Feedback from events was analysed and a summary report for each locality was produced.


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In June/July 2016, a further phase of ICS public engagement was launched to inform people and invite their views on locality-specific proposals. This was delivered via a roadshow which visited 26 locations across the county. It was advertised widely, and CCG staff spoke to hundreds of people on the tour. People were asked for their views on provision of a wider range of care services provided closer to home, and provision of bedded and non-bedded hubs.

Feedback collected during the roadshow was analysed and a summary report for each locality was produced.

As part of this ICS engagement programme the CCG has provided speakers at a range of other stakeholder events, detailed here:

Table 9: Integrated Community Services Public Engagement Events

Date Location & detail Type of Opportunity

23/03/2016Mid Dorset Locality ICS Engagement Event in Dorchester

• Speaker Presentation on Need for Change and proposals for ICS in each locality

• Focus on what local people feel we need to consider when developing health and care services in the community.

29/03/2016Weymouth and Portland Locality ICS Engagement Event in Chickerell, Weymouth

As above

30/03/2016East Dorset Locality ICS Engagement Event in Wimborne

As above

31/03/2016North Dorset Locality ICS Engagement Event in Sturminster Newton

As above

04/04/2016East Dorset Locality ICS Engagement Event in Bridport

As above

05/04/2016Purbeck Locality ICS Engagement Event in Wareham

As above

06/04/2016Bournemouth Locality ICS Engagement Event in Bournemouth

As above

07/04/2016Poole Locality ICS Engagement Event in Poole

As above

08/04/2016Christchurch Locality ICS Engagement Event in Christchurch

As above

15/04/2016Supporting Stronger Voices (CCG) Engagement Event

As above

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Table 10: Integrated Community Services Roadshow Engagement Opportunities

Date Location & detail Type of Opportunity

11/06/2016 Bridport Leisure Centre

• Explain the Need for Change

• Explain and seek views on proposals for ICS in each locality


11/06/2016 Morrisons, Bridport As above

13/06/2016 Wimborne Town Square As above

13/06/2016 Penny’s Walk, Ferndown As above

14/06/2016 Tesco, Portland As above

15/06/2016 Milborne St Andrew Village Hall As above

15/06/2016 Cerne Abbas GP Practice As above

15/06/2016 Puddletown GP Practice As above

16/06/2016 Littlemoor Library, Weymouth As above

16/06/2016Debenhams, New Bond St, Weymouth

As above

16/06/2016 Asda, Weymouth As above

17/06/2016 The Quay, Lyme Regis As above

18/06/2016 Sainsbury’s, Wareham As above

20/06/2016 Saxon Square, Christchurch As above

21/06/2016 The Co-op, Swanage As above

21/06/2016 Corfe Castle As above

22/06/2016 Poole Park As above

22/06/2016 Tower Park, Poole As above

22/06/2016 Tesco, Branksome, Poole As above

23/06/2016 River Car Park, Blandford As above

23/06/2016 Station Road, Sturminster Newton As above

24/06/2016 The Meadow, Gillingham As above

24/06/2016Rivers Meet Leisure Centre, Gillingham

As above

24/06/2016 Tesco, Shaftesbury As above

25/06/2016 Boscombe Market As above

25/06/2016 Tesco, Castle Lane, Bournemouth As above

From May 2016, many other opportunities were provided to the public to receive information, become involved and provide comment:


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Table 11: Additional Public Presentations, Events and Shows from May 2016 onwards


10/05/2016North Dorset PPG Chairs meeting, Sherborne

• Update on CSR ICS proposals


• Update on CSR

17/05/2016Weymouth and Portland Communities Groups meeting

• Guest speaker

• Presentation on Need for Change and ICS proposals


02/06/2016Sherborne Health and Wellbeing Fair (Public)

• Stall providing info on Need for Change, acute hospital and ICS proposals


07/06/2016Community Voluntary Services Health Forum meeting

• Guest speaker



08/06/2016 Highcliffe PPG meeting

• Guest speaker



20/06/2016CCG Supporting Stronger Voices (Informed Audiences) event, Dorchester

• Guest speaker



22/06/2016CCG Supporting Stronger Voices (Informed Audiences) event, Wimborne

• Guest speaker



05/07/2016 North Dorset PPG Chairs Meeting

• Guest speaker

• Update on ICS proposals

• View-seeking on consultation approach in North Dorset


• CSR consultation update

10/09/2016Royal Bournemouth and Christchurch Annual Members Meeting



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14/09/2016Dorset HealthCare University Foundation Trust Annual Members Meeting and Volunteers Awards



19/09/2016Poole Hospital Annual Members Meeting



23/09/2016 Bournemouth Older People’s Forum

• Guest Speaker

• Providing information on Need for Change, acute hospital and ICS proposals


03/10/2016 Shaftesbury Town Public Meeting

• Guest Speaker

• Presentation on ICS in North Dorset

• CSR Consultation update


18/01/2017 Bovington Health Promotion Fair



02/02/2017Weymouth & Portland Health Network meeting

• Guest speaker

• CSR consultation update

Dorset CCG’s Supporting Stronger Voices Forum of patient, public and carer and lay representatives met regularly across the review and were provided with information and opportunity to provide feedback.

Regular programme updates were provided to the Health Involvement Network (HIN), via our Feedback e-newsletter. As a result of actively promoting membership of the HIN through all our public engagement activity, membership grew to 4300 (September 2016).In January 2015, we undertook widespread distribution of 7000 copies of the Need to Change across health, social care and community settings, including acute and community hospitals, GP surgeries, sports centres, libraries, children’s centres, Citizen Advice Bureaus and the HIN.

Also in 2015, in response to public feedback, we produced a simple three-and-a-half-minute animated film providing an overview of the CSR to reach out more widely across Dorset with key messages.

In 2016, in response to public feedback, we also produced an updated, single-page, double-


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sided summary of the Need for Change. This has been widely distributed at public meetings and engagement events. It has also been made available online.

The public have had the opportunity to keep abreast of developments in the review through regular updates to the Dorset’s Vision website. This included videos of the public information events and the facility to view and download key programme documents, such as the event presentations and evaluation criteria.

We also provided regular updates to a wide range of media outlets across Dorset including print, broadcast and online outlets to help to get messages and updates into people’s homes. This included weekly activity through Dorset CCG’s Facebook and Twitter accounts.

Local people also took advantage of opportunities to correspond with the CSR team by post, email and telephone. We have a correspondence log of all contact.

245 enquiries were made with the CCG during the course of the review. Each enquiry was researched and a response given by an appropriate person. Commonly asked questions were used as a basis for the comprehensive Frequently Asked Questions section on the CCG, and latterly, the dedicated Dorset’s Vision website.

C.8.2 – Dorset Association of Parish and Town Council meetings

Table 12: Dorset Association of Parish and Town Council meetings

Meetings that took place during the public consultation phase have also now been included in this table. (See public consultation section.)

Date Location and detail Format/Information given

12/01/2016Central area meetingDorchester

• Guest speaker

• Need for Change animated film and information presented, views collected


• Invitation to join Health Involvement Network (HIN)

12/01/2016Northern area meetingDurweston, Blandford

• Guest speaker




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21/01/2016Eastern area meetingWimborne

• Guest speaker




29/01/2016Town and larger Parishes meetingBridport

• Guest speaker

• More detailed Need for Change animated film and information presented, partnership with ITN productions on Bridport virtual ward and St. Leonards-based single point of access (SPOA) film shown and views collected



24/02/2016Purbeck area meetingStoborough

• Guest speaker




25/02/2016Western area meetingBridport

• Guest speaker


• Need to Change booklet available Invitation to join HIN

03/03/2016Annual ConferenceKingston Maurward, Dorchester

• Guest speaker



05/03/2016Executive meetingDorchester

• Guest speaker

• Need for change booklet made available


05/11/2016 AGM Dorchester

• Guest speaker




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10/01/2017Central Area Dorchester

• Guest speaker



17/01/2017Area meeting Stalbridge

• Guest speaker



18/01/2017Area meeting Purbeck

• Guest speaker



04/03/2017Executive meetingDorchester

• Guest speaker



23/03/2017Annual ConferenceDorchester

• Guest speaker



The Need for Change animated film was created as a source of public information in October 2015. The following is a record of views and responses to the accompanying online survey.

Table 13: Animated Films and Survey

Date Need for Change animated film

15/10/15Need for Change animated film created and published

3029 recorded views (as of 5/10/16)

20/10/2015Need for Change animated film survey created on Survey Monkey

407 recorded responses (as of 5/10/16)

1/12/2016Integrated Community Services proposals animated film created to support proposals for public consultation

2101 recorded views

17/01/2017Main acute hospital proposals animated film created to support proposals for public consultation.

2115 recorded views

17/01/2017Young People’s animated film, ‘CSR explained’ created to support proposals for public consultation.

118 recorded views

17/01/2017Young people’s animated film, ‘Community Hubs’ created to support proposals for public consultation.

135 recorded views

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Date Need for Change animated film

17/01/2017Young people’s animated film, ‘Acute Hospitals’, created to support proposals for public consultation.

125 recorded views

C.8.3 – Dorset’s Vision websiteThe Dorset’s vision website was designed and launched to coincide with the start of the CSR public consultation. It featured a strong campaign, ‘Mine, Ours, Yours’ with the aim of getting people involved in the consultation. The public consultation survey, aforementioned films, regular news updates, details of all opportunities to get involved (including public events), social media feed and frequently asked questions were all featured on the website. The website link was quoted widely in all interactions and was the main information portal for the review. There were 64,019 views of the website during the course of the review (01/12/16–28/12/17).

C.8.4 – Public Consultation EventsThe public consultation took place between 1 December 2016 and 28 February 2017. During this time, a wide range of opportunities were made available across the county to enable members of the public and informed audiences to:• Speak to members of CCG staff and clinicians about the proposed reconfiguration of

services in Dorset

• Watch videos and access other visual aids to further explain proposed changes

• Read the consultation document and questionnaire and ask questions

• Complete the consultation questionnaire and/or take copies for family members/friends

Consultation meetings and events were also held for and with a range of diverse and disability groups and those the CCG had engaged with regularly pre-consultation, e.g. DAPTC. These are also listed in the appropriate areas of this report.

Table 14: List of events

Date Venue Event type

07/12/16 Hamworthy Club, Poole Informed Audience

08/12/16 Dorford Centre, Dorchester Informed Audience

12/12/16 Poole Old Town Community Centre Drop-in

15/12/16 Digby Hall, Sherborne Drop-in

03/01/17 Weymouth Pavilion Drop-in

04/01/17 Bournemouth Library Drop-in

04/01/17 Wareham Rugby Clubhouse Drop-in


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09/01/17 Bridport Town Hall Drop-in

09/01/17 The Exchange, Sturminster Newton Pop up

10/01/17 Shaftesbury School, Shaftesbury Drop-in

11/01/17 Allendale House, Wimborne Drop-in

12/01/17 Kinson Community Centre, Bournemouth Drop-in

12/01/17 Dorford Centre, Dorchester Drop-in

12/01/17 Ringwood, Hampshire Informed Audience

17/01/17 Emmanuel Baptist Church, Swanage Drop-in

18/01/17 New Milton Memorial Centre, Hampshire Drop-in

19/01/17 St Marys Longfleet Church Centre, Poole Drop-in

19/01/17 Blandford Corn Exchange Pop up

23/01/17 Wool GP practice Pop up

23/01/17 Bournemouth University Pop up

24/01/17 Portland Methodist Church Drop-in

25/01/17 Barrington Centre, Easton Drop-in

16/01/17 CO-OP store, Lyme Regis Pop up

31/01/17 Littlemoor Library, Weymouth Pop up

07/02/17 Ringwood, Hampshire Drop-in

07/02/17 Christchurch Library Drop-in

08/02/17 Littledown Centre, Bournemouth Pop up

09/02/17 Tesco store, Blandford Pop up

09/02/17 Dorset County Hospital restaurant Pop up

09/02/17 Weymouth College Pop up

10/02/17 Poole Hospital Pop up

10/02/17 Dikes Farm Shop, Stalbridge Pop up

13/02/17 The Exchange, Sturminster Newton Pop up

13/02/17 Sainsbury’s, Sherborne Pop up

13/02/17 Royal Bournemouth and Christchurch Hospital Pop up

13/02/17 Corfe Castle surgery Pop up

15/02/17 Bransgore Village Hall, Hampshire Drop-in

16/02/17 Highcliffe Library Pop up

17/02/17 Poppin Café, Village Hall, Marnhull Pop up

17/02/17 Tesco, Portland Pop up

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20/02/17 Cerne Abbas Surgery Pop up

20/02/17 Upton Library, Poole Pop up

21/02/17 Canford Heath Library Pop up

21/02/17 Nadder Centre, Tisbury, Wilts Pop up

23/02/17 Mere GP Practice, Wilts Pop up

24/02/17 CO-OP store, Beaminster Pop up

In addition to those meetings and drop-ins held in adjoining counties we actively engaged with cross-border Healthwatch groups and CCG Communications and Engagement teams. They both supported CSR social media promotion, featured the review on their websites, and circulated information and opportunities to their patient groups, community stakeholders and voluntary organisations via their bulletins and newsletters. Copies of the consultation document were distributed widely in Hampshire and to selected GP practices, pharmacies and libraries, in other cross-border counties.

C.8.5 – MediaThe CCG proactively engaged with the media around all aspects of the CSR by participating in a large number of television and radio interviews and by providing reactive comment on a large number of newspaper reports. Members of the local and regional media were also invited to briefings at key points in the review to explain the detail of proposals and the process in general, e.g. options for community services and the findings of the Royal College of Paediatrics and Child Health (RCPCH) clinical review on paediatric care.

Channels that carried media coverage of the review include BBC Radio Solent, Wessex FM, Breeze FM, ITV West country, ITV Meridian, BBC Spotlight, BBC South Today, Dorset Echo, Daily Echo, the View From series, and Blackmore Vale Magazine

C.8.6 – Social mediaThe CCG has two leading social media channels, Facebook and Twitter. We have proactively used social media since the launch of the CSR to target and promote key messages, inform local people, listen to what stakeholders are saying, respond to comments, encourage conversation and signpost to relevant information.

Over this time, we have grown our audiences and have developed more engaging content to help communicate key messages more effectively. For example, we have used infographics and animated GIFs to demonstrate key facts, such as the Need for Change and proposal details. The CCG Facebook audience has grown from 182 in April 2015 to 699 in October 2016. The Twitter audience also grew from 3073 to 4705 in the same period.

Social media provides an opportunity to reach a wide audience, and has been a key tool in


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raising awareness of events and opportunity for people to have their say. It has also helped drive people to sign up to our HIN to stay informed of future developments.

Regular social media messages are scheduled weekly and reviewed daily. In addition, we are reactive to conversations on other pages and take opportunities to respond and join conversations, make corrections to inaccurate details where appropriate and signpost to more information on our website.

A long-term social media strategy has been developed with a campaign and implementation plan to support key areas. Our social media channels were a key communication and engagement tool during the consultation.

C.9 – Voluntary sector organisations

We have engaged with a wide range of voluntary sector organisations, including those that represent the public, patients and people with protected characteristics. In addition, we have involved organisations which deal with the delivery of specific health or social care services. We have attended one-on-one meetings, and meetings with a range of participants, to present or discuss the review.

In addition, we provided copies of the Need to Change to a cross-section of organisations in January 2015, both for the information of the organisation and for onward distribution to their stakeholders, including members and event and meeting attendees. A range of voluntary organisations have also received the Dorset CCG stakeholder bulletin and feedback throughout the review.

Table 14: Summary of engagement with voluntary sector organisations

Date Stakeholder

11/02/2015 Presentation at Dorset Youth Council Forum

05/02/2015 Presentation at Learning Disability Forum Pan Dorset Health Action Group

26/02/2015 Presentation at Bournemouth People First’s Management Committee

22/04/2015Bournemouth, Dorset and Poole CVS attended the CSR Joint Communications and Engagement Lead meeting

04/05/2015Council Voluntary Service/ Dorset Race Equality Council Equality and Diversity Forum

Discussion with Dorset Forum’s Project Coordinator

Various Discussions with Equality and Diversity organisations

11/02/2015 Presentation at Dorset Youth Council Forum

05/02/2015 Presentation at Learning Disability Forum Pan Dorset Health Action Group

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VOLUNTARY SECTOR ORGANISATIONS C.9

Date Stakeholder

26/02/2015 Presentation at Bournemouth People First’s Management Committee

22/04/2015Bournemouth, Dorset and Poole CVS attended the CSR Joint Communications and Engagement Lead meeting

04/05/2015Council Voluntary Service/ Dorset Race Equality Council Equality and Diversity Forum

07/06/16 Bournemouth and Poole CVS Health Forum Meeting

11/09/16 Meeting with DREC to discuss approach to consultation with minority groups

12/09/16Meeting with South West Multi-Cultural Society to discuss approach to consultation with minority groups.

10/11/16 Presentation at The Anglo-Continental Language School

17/11/16 Meeting with Dorset Youth Association

28/11/16 Meeting at the Bournemouth Islamic Centre and Central Mosque

01/12/16 Meeting with Dorset Youth Council Enables

15/12/16 Presentation with People First Dorset Speaking Up Group

13/01/17Meeting with The African and Caribbean Over 50s Lunch Club (ACLC) – Dorset HealthCare Community Group

16/01/17 Presentation at Speaking Up Group meeting, Sturminster Newton

17/01/17 Presentation at Speaking Up Group meeting, Blandford

17/01/17 Presentation at Dorset Race Equality Council Forum

17/01/17 Meeting with Dorset Youth Association

20/01/17 Presentation at Speaking Up Group meeting, Christchurch

25/01/17 Presentation at Speaking Up Group meeting, Weymouth

26/01/17 Presentation at Speaking Up Group meeting, Sherborne

03/02/17 Meeting with Chinese community at Lunar Festival

04/02/17 Presentation at Getting to Know You community event

04/02/17 Presentation at Mexican Families Association meeting

15/02/17 Presentation at Speakability Stroke Survivors and Carers Group meeting

17/02/17 Meeting with Ethnicity & Diversity Forum

22/02/17 Meeting with LGBGT Network

23/02/17 Meeting with the Polish community, Bournemouth

We have had regular meetings to update and hear the views on the review from Dorset Healthwatch’s Manager and Community Engagement and Outreach Officer. Healthwatch are also members of the CSR Engagement Leads Forum.


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Table 15: Summary of Engagement with Dorset Healthwatch

Date Meeting agenda

22/12/2014 Update on public engagement

25/11/2014 Update on public engagement

18/02/2015 Update on public engagement including seeking advice on consultation plans

22/04/2015Update at CSR Joint Communications and Engagement Leads meeting including discussion of consultation principles and approach

28/04/2015 Discussed proposed consultation plans

24/06/2015Update on public engagement. Focus on public presentations and CSR and the draft consultation narrative.

12/08/2015Engagement update and focus on production of pen portraits and video clips – what does it mean to me?

14/12/2015Focus on CSR engagement with young people and CSR core messaging – including the Need to Change animation.

03/02/2016Engagement and communications update focussing on Clinical Delivery Groups, Community Vanguards, RCPCH review.

25/04/2016Engagement and communications update focussing on ICS public engagement events.

24/05/16Engagement and communications update focussing on ICS public engagement events and pre-consultation engagement

13/07/16Engagement and communications update focussing on ICS public engagement events and pre-consultation engagement

28/09/16 Healthwatch Board – CSR presentation update. CSR consultation plan update

23/11/16 Pre-consultation meeting – consultation document shared

20/02/17 Final week of public consultation – update on progress and response levels

C.10 – CCG staff engagement

Regular information on the review has been provided to Dorset CCG’s staff, along with the opportunity to provide views and comments. This has included a weekly update in the staff e-bulletin.

On 9 December 2014 185 CCG staff members attended an annual staff engagement event with a primary focus on the CSR. Since this date staff have been regularly updated through a series of regular Chief Officer staff briefings and at key points during the review, e.g. 18 May 2015 to coincide with the Governing Body meeting, which approved proposals to go to consultation, and 12 April 2016 to inform staff about the review on paediatric care which was being published by the Royal College of Paediatric and Child Health.

Information about the Need for Change has been displayed at CCG sites at Vespasian House

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PROVIDER ENGAGEMENT C.11

and Canford House.

In order to involve a wide range of CCG staff in the CSR public engagement process, the CCG has introduced a Flexible Friends programme. This is a database of staff volunteers who have offered to support the wide range of public engagement opportunities. Currently 93 staff are listed on the database and most of these have been involved in some way. In the run up to the consultation period, there was a drive to recruit more staff to the programme.

Regular staff briefings have been held throughout the consultation and post-consultation periods to offer an opportunity for CCG staff to stay informed and ask questions about the developments of the CSR.

C.11 – Provider engagement

There has been significant engagement with our five NHS Foundation Trust provider organisations. This includes regular updates and discussions through the formal CSR reference groups: Chief Executive, Finance, Human Resources, Communications as well as other groups including the Chairs, Boards, Engagement Leads Forum and the Pan Dorset Communications Leads.

Our providers received the Need to Change in January 2015 with Chief Executives, and the Communications Leads received the document during the drafting process.

Provider senior leaders received the stakeholder bulletin in February and March 2015.

The Public Information events in December 2014 and January and February 2015 were promoted to staff and patients via the providers’ intranet and websites, which resulted in some attendees. Further provider updates have been summarised in Table 13.

All correspondence undertaken by way of letters or emails has also been logged in our communications logs.

Since the launch of the CSR an update on its progress has been included at regular Pan Dorset Communications meetings and Engagement Leads meetings. These groups are made up of representatives from NHS Dorset CCG, Dorset County Hospital, Poole Hospital, Royal Bournemouth Hospital, NHS England, Dorset HealthCare and Public Health. There has also been representation from SWASFT at some meetings. At key points in the progress of the review, additional meetings have taken place to discuss issues such as staff communications and possible media interest.


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Table 16: Summary of meetings with providers

Date Meeting Attendance/content

17/09/2014Pan Dorset Communications Leads meeting

Update provided


Update provided

14/11/2014Royal Bournemouth and Christchurch Hospital Foundation Trust Board

Update provided by Tony Spotswood

25/11/2014Board of Directors and Council of Governors Away Day

Attended by Phil Richardson

26/11/2014 Poole Hospital BoardAttended by Phil Richardson and Paul White

17/11/2014 CSR Workforce Reference Group meetingUpdate provided by Charles Summers and discussion held

20/11/2014 CSR CEO Reference Group meetingUpdate provided and discussion held



Update provided


Update provided by Tony Spotswood



15/01/2015CSR Communications Lead Reference Group meeting

Update provided

21/01/2015 Dorset HealthCare Council of GovernorsPresentation by Paul Vater and Sally Shead


27/01/2015Dorset County Hospital Foundation Trust Board

Attended by Phil Richardson, Dr Karen Kirkham and Dr Forbes Watson

28/01/2015Poole Hospital Foundation Trust Board of Directors

Verbal update provided


Need to Change document presentation by Tony Spotswood


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12/02/2015 Engagement Leads ForumCSR Engagement and Comms planning


Update provided






Presentation by Jane Pike, CCG Director

02/03/2015Dorset County Hospital Council of Governors Meeting

Update provided


Update provided

11/03/2015 Dorset County Hospital Board of Directors Update provided


Update provided

23/03/2015 Poole Hospital Governors and Directors Updated provided by Jane Pike



02/04/2015 CSR CEO Reference Group meeting


14/04/2015 CSR CEO Reference Group meeting

22/04/2015Joint Communications and Engagement Leads meeting

Update provided and consultation plans shared

24/04/2015Royal Bournemouth and Christchurch Hospitals Foundation Board of Directors

Verbal update

28/04/2015 CSR CEO Reference Group meeting Update provided

28/04/2015Royal Bournemouth and Christchurch Hospital Foundation Council of Governors

Verbal update




Update provided

12/05/2015 Chief Executive Reference Group meeting Update provided



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Verbal update

02/06/2015Dorset County Hospital Council of Governors Meeting

Update provided

09/06/2015CSR CEO & Chairs Reference Group meeting

Update provided

10/06/2015Communications and Engagement Leads meeting

Overview of review, analyse and design phase.CSR communications & media update





Verbal update



Verbal update


Update provided


Verbal update

29/07/2015Poole Hospital Foundation Trust Council of Governor Meeting

Update provided





CSR update


Update provided






Verbal update

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08/10/2015 Pan Dorset Communications Lead meeting CSR update



Update provided




Verbal update


Verbal update






Verbal update


CSR update

07/12/2015Dorset County Hospital Council of Governor Meeting

Update provided

07/12/2015 Engagement Leads Forum Review ICS engagement update




Update provided


Verbal update



14/01/2016Poole Hospital Foundation Trust Council of Governor Meeting

Update provided




ICS engagement and communications plan


Verbal update


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Update provided




Verbal update




Verbal update


Update provided



Update provided



Verbal update


CSR update



Verbal update

14/04/2016System Leadership Team meeting including Chairs

Update provided




Verbal update

19/05/2016 System Leadership Team meeting Update provided




Verbal update


CSR update

09/06/2016System Leadership Team meeting with Chairs

Update provided


Update provided

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LOCAL AUTHORITIES C.12



Verbal update


CSR update





Verbal update


CSR update

18/08/2016System Leadership Team meeting with Chairs

Update provided


Update provided





CSR update




C.12 – Local authorities

We undertook engagement work with Dorset’s three upper tier local authorities through the pre-consultation phase. This included regular updates and discussions through the formal CSR reference groups: Chief Executive, Communications as well as the Better Together Sponsor Board. We have also provided updates at Children’s’ Trust Board meetings.

Dorset’s Council leaders, Cabinet Members and key officers received an invitation to the launch event on 22 October 2014. They also received the Need to Change in January 2015 and were sent the stakeholder newsletter in February and March 2015.

The Public Information Events in December 2014 and January and February 2015 were promoted to staff and local residents via the three Councils’ intranet and websites, which resulted in some attendees.

All correspondence undertaken by way of letters or emails has also been logged in our communications logs.


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Table 17: Summary of engagement with local authorities

Date Meeting agenda

11/11/2014 Better Together Sponsor Board

12/12/2014 Directors of Adult Social Services at Bournemouth, Dorset and Poole LA




12/03/2015 Poole Children’s Trust Board

16/03/2015 Dorset Children’s Trust Board

14/01/2015 Bournemouth Children’s Trust Board

14/04/2015 Better Together Sponsor Board and Programme Board

14/04/2015 Bournemouth Children’s’ Trust Board

27/04/2015 Better Together Outcomes Based Commissioning Workshop










03/12/2015 Better Together Sponsor Board Workshop








06/05/2016 Dorset Children’s’ Trust Board



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HEALTH OVERVIEW AND SCRUTINY COMMITTEES C.13

Date Meeting agenda



C.13 – Health and Scrutiny Committees

Members of Dorset’s three Health and Scrutiny Committees (HSCs) have been informed and involved throughout the review.

Dorset CCG has provided updates in the papers of a number of HSC meetings, and has had the opportunity to present updates at several meetings.

HSC members were invited to the launch event on 22 October 2014. They also received the Need to Change in January 2015 and were sent the stakeholder newsletter in February and March 2015.

Table 18: Summary of engagement with HSCs

Date Activity

17/11/2014Briefing paper submitted to Dorset HSC meeting and presentation from Phil Richardson

04/12/2014 Briefing paper submitted to Bournemouth HSC meeting

08/12/2014Briefing paper submitted to Poole HSC meeting and presentation from Dorset CCG Deputy Director

25/03/2015Meeting of Bournemouth, Dorset and Poole HSC Chairs and Officers to discuss consultation plans and agree the formation of a joint HSC in July 2015

20/02/17 Poole HSC pre-meeting/workshop for CSR

06/09/2016 Dorset HSC

29/09/2016 Bournemouth HSC

17/10/2016 Poole HSC





23/01/2017 Poole HSC Briefing


20/02/2017 Poole HSC Briefing


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Date Activity






26/06/2017 Poole HSC headline presentation of CSR consultation responses

10/07/2017Dorset HSC brief update on CRS consultation given to new HSC following DCC elections in May 2017

C.14 – Joint Health Scrutiny Committee

The Joint Health Scrutiny Committee (JHSC) is formed by bringing together representatives of each of the three HSCs in the area and, if necessary, in neighbouring boroughs. It has responsibility for scrutinising the programme and its proposals for service change and agreeing whether or not the proposals are considered substantial and therefore whether public consultation is necessary and, if so, the planning of the consultation exercise.

The CCG wrote to the officers at the three HSCs on 4 February 2015 to request a Joint Health Scrutiny Committee meeting so that their duties to form a JHSC and consider the CCG’s plan could be undertaken in good time. Following this approach, the HSCs agreed on 9 February 2015 for their Chairs and Vice Chairs to meet with the CCG to discuss the forming of a JHSC. The meeting date was subsequently set for 25 March 2015.

The meeting took place on 25 March 2015 at which the consultation approach was discussed and it was agreed that a JHSC meeting would take place on 20 July 2015. JHSC members were advised as to how the evaluation of options for change had been based on clinical criteria and on patient and public feedback, and how this has been used to develop the recommendations for consultation. The scope of consultation and intended activity was also provided.

Table 19: Key engagement with the Joint Health Scrutiny Committee

Date Activity

20/07/2015Explanation of the role of JHSC for future consultation. JHSC also received update from the Dorset CCG Governing Body meeting. The reasons for service transformation were outlined.

02/12/2015 An update of the milestones achieved by the CSR was provided.

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HEALTH AND WELLBEING BOARDS C.15

Date Activity

02/06/2016JHSC provided with an update from the Dorset CCG Governing Body meeting explaining the preferred options for consultation.

14/07/2016Informal non-public meeting to discuss the Integrated Community Services for Dorset.

20/02/2017 Informal JHSC relating to the consultation response

23/02/2017Formal meeting to provide members with the opportunity to submit their views on the CSR proposals

01/03/2017 JHSC briefing to discuss the Mental Health Acute Pathway review

23/03/2017 JHSC formal meeting to respond to the consultation

03/04/2017 JHSC formal meeting

03/08/2017Opinion Research Services (ORS) presented the responses to the CSR public consultation (NB new JHSC members present following the DCC elections in May 2017)

C.15 – Health and Wellbeing Boards

On 4 February 2015 Dorset CCG had a joint development workshop with the two Health and Wellbeing Boards (HWBs) that formed part of the committee arrangements for Dorset’s three upper tier local authorities.

Health and Wellbeing Board members were invited to the senior leaders meeting that took place on 12 March 2015.

Members were invited to the launch event on 22 October 2014. They also received the Need to Change in January 2015 and were sent the stakeholder newsletter in February and March 2015.

Health and Wellbeing Board meetings have had regular updates on the process and progress of the CSR, as outlined in Table 20.

Table 20: Summary of engagement with the Dorset Health and Wellbeing Board

Date Activity

10/09/2014Dorset HWB received a briefing paper including a synopsis of the case for change and advising that Dorset CCG will be using an external consultant to start the process.

10/09/2014Bournemouth and Poole HWB provided with an introduction to the CSR and the reasons behind the review.


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Date Activity

04/03/2015Dorset HWB received an explanation of the Need for Change. Dorset CCG asked the HWB members to consider their role in the review.

10/06/2015Dorset HWB provided with a report which was presented to the Dorset CCG Governing Body in May 2015, providing a detailed update of the CSR.

10/09/2015An update was provided to the Bournemouth and Poole HWB on the CSR including a discussion about engagement.

11/11/2015Dorset HWB provided with a CSR progress update presentation, including timings for public consultation, plans and assumptions when planning and a summary of the Dorset Vanguard and the Acute Care Collaboration Vanguard.

10/12/2015

Bournemouth and Poole HWB received an update on CSR development including timings for formal consultation, plans and assumptions when planning and a summary of the Dorset Vanguard and the Acute Care Collaboration Vanguard.

02/03/2016 Dorset HWB

10/03/2016 Bournemouth and Poole HWB

08/06/2016 Bournemouth and Poole HWB extraordinary meeting












C.16 – Members of Parliament

The CCG’s Chief Officer, with GP and Director leads holds a quarterly meeting for Dorset’s eight local MPs where they are given on update on the progress of CSR. Correspondence and meetings with individual MPs also takes place outside of these quarterly meetings.

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MEMBERS OF PARLIAMENT C.16

Table 21: Summary of engagement with Members of Parliament

Date Meeting attendance

24/10/2014

• Annette Brooke

• Tobias Ellwood

• Robert Syms

• Robert Walter (with Diana Mogg, Constituency Manager)

13/02/2015• Christopher Chope

• Constituency Manager

19/06/2015

Invited to attend:• Tobias Ellwood

• Simon Hoare

• Robert Syms

• Tim Goodson

• Dr Forbes Watson

• David Jenkins

• Dr Chris McCall

• Paul Vator

27/08/2015

• Oliver Letwin


• Tim Goodson

• Dr Blair Millar

17/09/2015

• Richard Drax


• Tim Goodson

• Phil Richardson

01/10/2015

• Conor Burns


• Tim Goodson

• Phil Richardson

• Dr Stephen Tomkins


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Date Meeting attendance

16/10/2015

• Tim Goodson

• Phil Richardson

• Dr Karen Kirkham

• Mike Wood

• Christopher Chope

• Conor Burns

• Michael Tomlinson

• Tobias Ellwood

• Robert Syms

• Simon Hoare

• Richard Drax

19/02/2016

Invited to attend:• Conor Burns

• Tobias Ellwood

• Tim Goodson

• Phil Richardson

• Mike Wood

28/10/2016

Invited to attend:• Conor Burns

• Dr Karen Kirkham

• Phil Richardson

• Mike Wood

• Ken Wenman

10/02/2017

Attended by:• Richard Drax

• Christopher Chope

• Tim Goodson

• Dr Phil Richardson

• Pauline Malins

All eight Dorset MPs were invited to the 22 October 2014 launch event and on 9 January 2015 they were sent a copy of the Need to Change with a covering letter offering to meet to discuss in further detail or to answer questions.

On 12 March 2015, a letter was sent providing an update on the programme’s developments and outlining the ambition to undertake public consultation. Dorset MPs and those in neighbouring constituencies are included in regular CSR communications cascades and sent copies of media releases.

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TRADE UNIONS C.17

MPs also receive copies of the programme stakeholder newsletter regularly.

C.17 – Trades unions

Trades unions meetings with recognised representative members from UNISON, Unite, BMA and RCN are arranged quarterly with the CCG. A meeting was arranged for 13 October 2014 however it was cancelled by the trade unions due to limited availability. Subsequent meetings took place on 12 January 2015 and 16 April 2015 and a review update was provided.

Trades unions were invited to the launch event in October 2014 and sent the Need to Change in January 2015.

RCN and Unison had stalls at Dorset CCG staff event in Bovington on 9 December 2014.

Engagement with trades unions has continued throughout the CSR programme. All organisations within the scope of the programme have met locally with trades union and staff side colleagues with transformation as a regular agenda item.

A system-wide partnership conference with trade unions was held on the 19 June 2016, with a follow-up conference on 3 November 2016.

C.18 – Local councillors

Dorset’s Council leaders, Cabinet Members and key officers received an invitation to the launch event on 22 October 2014 and the Senior Leaders meeting on 12 March 2015. They also received the Need to Change in January 2015 and were sent the stakeholder newsletter in February and March 2015.

In addition, the CCG has attended a number of meetings with councillors. Updates have been regularly provided through the HSC and JHSC meetings outlined in previously within this appendix.

C.19 – NHS England

NHS England have been actively involved throughout the pre-consultation period through the regular attendance at the Chief Executives’ Reference Group meeting by the Director of Operations and Delivery.

Specific one-to-one briefing meetings have also been held.

NHS England received an invitation to the launch event on 22 October 2014 and the Senior Leaders meeting on 12 March 2015. They also received the Need for Change in January 2015 and were sent the stakeholder newsletter in February and March 2015.


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There has also been ongoing liaison throughout the pre-consultation phase with NHS England as part of the CSR Governance and assurance processes (details can be found in the PCBC, Chapter 14 ).

C.20 – Regulators

The CCG has continued to hold conversations with Monitor (now known as NHS Improvement) throughout the pre-consultation review period.Monitor (NHS Improvement) received an invitation to the launch event on 22 October 2014 and also received the Need to Change in January 2015.

C.21 – CCGs and providers in neighbouring areas

In recognition of the patient in/outflows to Dorset we have engaged with neighbouring health commissioning areas in Hampshire, Wiltshire, Somerset and Devon.

Clinicians from surrounding providers attended the CWGs, as outlined section 1.4.1, including representatives from Salisbury Hospital, Yeovil Hospital, Royal Devon and Exeter Hospital and North Bristol.

The Need to Change was circulated in January 2015 and invitations sent for the launch event in October 2014.

In December 2014, we were scheduled to meet with West Hampshire CCG Director of Commissioning Acute Services but the meeting was cancelled. A meeting was rescheduled for 21 May 2015.

We provided Liz Kite at West Hampshire CCG, Paul Courtney at Somerset CCG, Helen Robinson-Gordon at Wiltshire CCG, Patrick Butler at Salisbury Hospital and Simon Blackburn at Yeovil Hospital with a pre-launch briefing about the Need for Change on 7 January 2015 with advance sight of the press-release. Invitations were sent for the Public Information Events, and the Poole meeting in January 2015 was attended by Associate Director of Communication and Corporate Affairs, West Hampshire CCG.

In February 2015, we provided tailored briefing materials, including a syndicated article, key messages and FAQs for cascading to local people and patients in West Hampshire. Additional telephone updates have also taken place.A meeting also took place with the Engagement Lead at West Hampshire CCG in March 2015 to plan outreach to West Hampshire residents during the consultation phase. Further discussions are ongoing with their Locality Lead in the Ringwood area.

The Communications Lead at West Hampshire CCG, Salisbury Hospital and Yeovil Hospital are members of the Pan Dorset Communications Leads Forum and have therefore participated in regular meetings throughout the CSR pre-consultation. The West Hampshire CCG

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CCGS AND PROVIDERS IN NEIGHBOURING AREAS C.21

Communications Lead is also a member of the CSR Communications Reference Group. All Communication Leads were invited to the Joint Communications and Engagement Leads meeting on 22 April 2015, and a representative from Salisbury Hospital also attended.

Meetings with the West Hampshire CCG Steering Group were attended on 11 November 2015, where an update on primary and community services, acute hospitals and priorities was provided. A further meeting took place on the 11 May 2016 where the background of the CSR, acute reconfiguration, the options and how they were reached and assurance and public engagement were discussed.

Liaison with Yeovil Hospital also commenced following an independent review by the Royal College of Paediatrics and Child Health published in April 2016. It was recommended that Dorset County Hospital open talks with Yeovil District Hospital with a view to providing an integrated service to ensure safe and sustainable services for the future. These talks are ongoing.

HEADLINE ORS CONSULTATION RESULTS

D

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INTEGRATED COMMUNITY SERVICES D.1

D.1 Integrated Community Services

The proposal: We believe that there is the potential to deliver better care in or closer to people’s homes using community teams based at local community hubs. We will continue to provide a wide range of healthcare services at community hospitals, but we do not believe that inpatient beds are needed at every one.

Q:To what extent do you agree or disagree that our proposal to provide services closer to people’s homes using community teams based at local community hubs will deliver better care?

Responses

Open questionnaire

More than two-fifths (41%) of the 15,768 individuals who responded to the open questionnaire agreed that providing services closer to home using teams based at local community hubs will provide better care. Just over half – 52% – disagreed.

NHS employees (1957) showed higher levels of agreement than other individual respondents did. Almost two-thirds (65%) agreed while 28% disagreed. Of the 90 organisations that responded, 68% agreed with the proposal, 28% did not.

While overall less than half of all individual responses agreed that providing services closer to home using teams based at local community hubs will provide better care, responses differed by CCG locality and the overall result is disproportionately affected by the 5410 responses from North Dorset.

Responses from the Shaftesbury Save Our Beds (SOB) campaign made up around a third (32%) or 5017 out of the 15,768 responses to this 97%of these disagreed with the question. By comparison, around three-fifths (59%) of those not part of the campaign agreed that the proposal would provide better care.

Other than the responses from North Dorset, more than half the residents for all CCG localities agreed that the proposal would provide better care.

Christchurch had the highest level of agreement (80%); Bournemouth localities (76%); East Dorset (72%); Mid Dorset (70%); and Purbeck (66%): West Dorset (62%); Poole localities (58%) and Weymouth and Portland (56%).

Only 20% of respondents from North Dorset overall agreed with the question – 77% disagreed.

Out-of-area responses: West Hampshire – about three-quarters of respondents agreed that the proposal would provide better care whilst in Somerset 20% agreed and in Wiltshire

DMBC – APPENDIX D: HEADLINE ORS CONSULTATION RESULTSD.1

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only 6%. It should be noted that a high proportion of responses from Wiltshire were submitted through the SOB campaign – 1277 out of 1497. Some 97% of the SOB responses from Wiltshire disagreed with the proposals and 64% of those who were not part of the campaign also disagreed.

Residents’ survey

The household telephone survey asked 1004 residents aged 16 and over from across Dorset and areas in West Hampshire, Somerset and Wiltshire a number of key questions from the consultation questionnaire.

More than four-fifths of a base of 995 residents who answered this question agreed that the provision of services closer to people’s homes using teams based at local community hubs would provide better care. One in ten – 10% – disagreed.

Residents in the East of Dorset, especially Christchurch (91%), North Dorset and in West Hampshire, Somerset and Wiltshire were more likely to agree with the principle with lower agreement in the West (but still 65%).

Focus Groups

ORS facilitated 14 focus groups across Dorset and West Hampshire. Each was attended by an average of ten to 12 randomly selected participants, with 133 people taking part in all.

Many who took part in the focus groups acknowledged the need for change and in general, the principle of creating community hubs welcomed and saw the main benefits as:

• More local access to health and less travel to acute hospitals

• Quicker access to appointments, diagnostic tests and minor surgery

• Great continuity of care for patients who would be treated in one place by the same staff

• A reduction on pressures on A&E departments, acute hospitals and GP surgeries

• Better after care following discharge from acute hospitals

• More easily accessible medical records

A minority disagreed with the need to change saying the changes should already be happening/not needed/would be a waste of money.

There were many questions and significant doubts across all groups as whether the hubs could be implemented properly and successfully in practice:

• Staffing, levels of care and affordability

• Current levels of social care could prevent adequate home care

• Doubts about joined-up working, based on previous experiences/attempts

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Written submissions

In principle, many people were positive about the creation of community hubs and integrated community working. However, there were reservations about the practicalities of implementing the plans i.e. how they would be financed/resourced; how they would improve joined-up working; travel and transport; whether residential and home care would be better financed; whether hubs would replace GP surgeries (not desirable); level of care in Urgent Care Centres may not be adequate if GP-led. It was also argued that all proposed hubs should have beds to cater for the growing elderly population and rural communities.

1.1.1 – Community hub locations

P: We are proposing 12 hubs across Dorset. Seven of the hubs would have beds, the other five would not. All sites would offer a range of outpatient services such as tests and scans.

The questionnaire asked about the extent to which respondents supported or opposed each of the proposals by locality. Respondents were asked separate questions were asked for each area, but not all residents answered all questions – many preferred to respond to only one or some.

Opinions differed by area and participants tended to focus on their own locality – although people in Central and North Bournemouth thought it important to consider the plans on a county-wide level.

Q:Our draft proposals for NORTH DORSET include community hubs with beds at Blandford Hospital and at Sherborne Hospital, and a community hub without beds at Shaftesbury, possibly at a different site to the existing hospital. To what extent do you agree or disagree with our draft proposal for NORTH DORSET?

Responses

Open questionnaire

The proposal for North Dorset received the highest level of response – in part due to the 5103 responses from the Shaftesbury ‘Save Our Beds (SOB)’ campaign. These responses represented 37% of the total responses to this question.

The proposal also received highest levels of opposition. Only 21% of the 13,887 respondents agreed with the proposal, while 63% disagreed. Of the 1805 NHS employees who responded 47% agreed and 28% disagreed. 71 organisations responded of which 47% agreed and 28% disagreed.


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Comments

From the 6307 respondents to this question, 17,669 different comments have been classified or coded under the themes of:

• General comments: e.g. patients discharged from other hospitals such as Salisbury need to use Shaftesbury Hospital/the use of Shaftesbury Hospital will reduce pressure on other hospitals (6%); negative impact for the elderly (6%); keep things as they are (4%); these proposals will risk lives (2%)

• Travel and access: e.g. concerns about increased travel times/distance and isolation of Shaftesbury/need for local services (32%); public transport (15%); ease of access for visitors (15%); poor access to Blandford Hospital (9%); access for the elderly (9%); poor access to Sherborne Hospital (9%)

• Quality and safety: e.g. retain beds at Shaftesbury Hospital (33%); retain beds (non-specific) (17%); good quality services/retain services at Shaftesbury Hospital (15%); reduced level of service will not support current and increasing population (9%); bed losses = bed blocking (7%)

• Cost and funding: e.g. cost of implementing changes/waste of money/minimal savings (2%); increase funding instead of making cuts (1%)

• Other comments: e.g. more information/evidence needed (2%); consultation is biased/flawed/leading questions (1%)

A small number of people suggested alternatives such as saving money in other ways such as charges for delayed discharges, reducing management cost and medicines costs or retaining Shaftesbury’s hospital for inpatient beds and creating a new outpatient hub on a vacant site or at a GP surgery in the town.

Residents’ survey

From the 286 people who responded, 59% agreed with the proposal and 24% disagreed.

Focus groups

There was particular concern about how the planned loss of beds at the Westminster Memorial Hospital (WMH) in Shaftesbury would cause accessibility problems for residents, based on the size of the area, increased travel and unreliability of public transport.

There was a view that local residents had been ‘side-lined’ because they use Yeovil or Salisbury acute hospitals rather than those in Dorset.

Written submissions

Many of the submissions received were about North Dorset and specifically expressed opposition to the proposed removal of beds from the Westminster Memorial Hospital in Shaftesbury. Generally, it was felt that people in North Dorset had ‘the raw end of the deal’ and many respondents accused the CCG of disregarding local opinion.

People argued that beds should be retained at the WMH because:

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• They were needed to meet needs of projected population increases, especially in Gillingham

• The hospital is well used by Dorset residents and those from Somerset and Wiltshire

• The rurality of the area and poor transport merits a bedded facility locally

• Long travel distances to bedded hubs in Sherborne and Blandford have not been considered

• The quality of care and location of the WMH meant it should be expanded not contracted.

• Concerns about the use of care home beds

• Removing beds would increase bed blocking and pressure on acute hospitals

• Removing beds would not save sufficient money

• Concerns that WMH would close in the long-term if beds were removed

Additional suggestions included:

• Removing beds from Sherborne rather than Shaftesbury

• Reducing rather than removing beds

• Locating a major hub near Gillingham

The lack of mention of over-the-border services in the consultation document and the perceived lack of consultation with Wiltshire and Somerset residents apparently led many people in the area to feel ‘ignored’ by the CCG.

Petitions

Westminster Memorial Hospital, Shaftesbury (2991 signatures)

The petition urges the CCG:

• To change its proposals to ensures the hospital becomes a hub with beds as close of the 16 bedded inpatient unit would result in hardship and inconvenience for the communities of Shaftesbury, Gillingham and the surrounding area

• Signatories believe that patients returning after treatment in Yeovil or Salisbury Hospitals will be ‘ill-served’ if they have to go to community hubs in Blandford or Sherborne

Q:Our draft proposals for MID DORSET include a community hub at Dorset County Hospital with access to community beds in proposed hubs at Wimborne, Bridport, Sherborne and Weymouth Community Hospitals. To what extent do you agree or disagree with our draft proposal for MID DORSET?


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Responses

Open questionnaire

Almost half (49%) of the 8932 individuals who responded agreed with this proposal; 31% disagreed.

Nearly two-thirds (64 %) of the 1743 NHS staff who responded to the question agreed with the proposal. Of the 69 organisations that responded, 64% agreed and 19% did not.

Comments

From the 1831 respondents to this question, different comments have been classified or coded under the themes of:

• General comments: e.g. keep things as they are/maintain current quality of services (7%); general agreement (4%); general disagreement (4%); concerns over effectiveness of the proposals/no proof they will work (4%)

• Travel and access: e.g. concerns about increased travel times/distance and isolation of Shaftesbury/need for local services (21%); public transport (12%); ease of access for visitors (5%); access for the elderly (4%); access for people living in rural areas (3%)

• Quality and safety: e.g. retain beds (non-specific) (13%); increase beds (7%); retain beds at DCH (6%) reduced level of service will not supported current and increasing population (6%); inadequate levels of staff (5%)

• Cost and funding: e.g. cost of implementing changes/waste of money/minimal savings (3%); increase funding instead of making cuts (3%); proposals are just a cost-cutting exercise (2%)

• Other comments: e.g. more information/evidence needed (6%); other criticism of the consultation (2%); consultation is biased/flawed/leading questions (1%)

Some comments criticised the cost involved in creating community hubs and suggested alternative ways of saving money such as building a new hospital somewhere between Dorchester and Weymouth with the room and capacity to expand and reduce underlying operating costs. One respondent suggested a focus on improving care rather than reducing beds and another suggested building a ‘super hub with a travelling doctor services and nurses to clients’ homes’.

Residents’ survey

Of the 436 residents who responded to this question, 79% agreed and 13% disagreed with the proposal.

Focus groups

There were mixed views: some considered the proposed provision in the wider area to be adequate; while the majority who commented felt people living to the North of Dorchester would be too far away from a hub with beds. They considered sensible to co-locate a hub with beds at DCH to allow ‘step-down care’

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One participant argued that all hubs should have beds to ease the pressure on acute hospitals.

Q: Our draft proposals for WEST DORSET include a community hub with beds at Bridport Hospital. To what extent do you agree or disagree with our draft proposal for WEST DORSET?

Responses

Open questionnaire

47% of the 8093 individual respondents agreed with the proposal and 23% disagreed.

64% of NHS employees (1695) who responded agreed with the proposal, 12% disagreed. Of the 67 organisations, 57% agreed with the proposal and 21% did not.

Comments

From the 1057 respondents to this question, comments have been classified or coded under the themes of:

• General comments: e.g. keep things as they are/maintain current quality of services (9%); concerns over the effectiveness of the proposals/no proof that they will work/improve services in the long run (7%); general disagreement (6%); general agreement (5%)

• Travel and access: e.g. concerns about increased travel times/distance/need for local services (23%); public transport (including Lyme Regis) (15%); ease of access for people in West Dorset (6%); access for the elderly (6%); poor access to Bridport Hospital (3%)

• Quality and safety: e.g. retain beds (non-specific) (11%); good quality services/retain services at Bridport Hospital (6%); insufficient beds (5%); inadequate levels of staff (5%)

• Cost and funding: e.g. cost of implementing changes/waste of money/minimal savings (4%); increase funding instead of making cuts (3%) cost-cutting exercise/will not improve services (2%)


Some respondents suggested alternatives such as bringing back NHS convalescence homes and extending GP surgery opening hours. There were multiple suggestions for Lyme Regis including a further hub with beds and/or community hospital in the town, outreach workers for Lyme Regis based at the Bridport hub and questions about the use of acute services in Devon rather than travelling to Bournemouth or Poole for emergency or planned care.


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Residents’ survey


Focus groups

Generally, the proposal for a hub with beds at Bridport Hospital was supported, but there was some concern that it would be too small to accommodate extra staff and facilities.

Written submissions

There was general support for the plans for Bridport Hospital in West Dorset, especially because of its accessible location, with one suggestion that it be expanded further with its own A&E.

Q:Our draft proposals for WEYMOUTH & PORTLAND include a community hub with beds at Weymouth Hospital and a community hub without beds at Portland, possibly at a different site to the existing hospital. Westhaven Hospital would not be used as a community hospital hub, but the future of mental health beds at the Linden Unit will be considered as part of a separate review.

Responses

Open questionnaire

Just over one-third (36%) of 7767 individual respondents agreed with the proposal and 32% disagreed.

49% of NHS employees (1659) who responded agreed with the proposal, 22% disagreed. Of the 65 organisations that responded, 46% agreed with the proposal and 34% did not.

Comments

From the 1469 respondents to this question, comments have been classified or coded under the themes of:

• General comments: e.g. general disagreement with the proposals including doubts about how hubs will work in reality, concern about the future of GP services in the area and the removal of beds from Portland and Westhaven (7%) keep things as they are (5%); these proposals will risk lives (2%)

• Travel and access: e.g. concerns about increased travel times/distance/need for local services (12%); public transport (7%); ease of access for elderly, visitors and people without their own transport (4%); access for vulnerable/deprived background/low income people (3%); poor access to Weymouth and Portland Hospitals (2% each)

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• Quality and safety: e.g. retain beds at Portland Hospital especially as it is a socially deprived, isolated area and many residents do not own cars (19%); retain beds (non-specific) (10%); concern about the loss/future of mental health beds (9%); good quality services/retain services at Westhaven Hospital (9%); insufficient/retain beds (6%); good quality of services/retain services at Portland Hospital (6%)


• Other comments: e.g. review of mental health beds/services should have been included in this consultation (6%); more information/evidence needed (5%); other criticism of consultation (1%)

A small number of people suggested alternatives such as having a hub at Westhaven hospital but not at Weymouth Hospital, largely due to perceived greater cost of making Weymouth ‘fit for purpose’, and making increased use of Portland Hospital. Other suggestions included closing Weymouth, Portland and Westhaven Hospital and building a new hospital between Weymouth and Dorchester where Dorset County Hospital should be relocated; using Westhaven Hospital as a mental health facility; and replacing the MIU at Portland with good access to GP services.

Residents’ survey


Focus groups

There were mixed views with half the group supporting the proposals and others asking for more information about hubs.

Written submissions

Respondents rejected the proposals. They commented that:

• Closing Westhaven makes little sense because of its modernity

• Closing Westhaven and removing beds from Portland would result in insufficient healthcare for local people

• Accessibility and the condition of Weymouth Hospital raised questions about its suitability as a bedded hub

Q:Our draft proposals for PURBECK include a community hub with beds at Swanage Hospital and a community hub without beds at Wareham, possibly at a different site to the existing hospital. To what extent do you agree or disagree with our draft proposal for PURBECK?


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Responses

Open questionnaire

Just over one-third (37%) of the 7826 individual respondents agreed with the Purbeck proposal and 36% disagreed. Around half, 51% of NHS employees (1681) who responded agreed with the proposal, 25% disagreed. Of the 68 organisations that responded, 46% agreed and 28% disagreed.

Comments

From the 1696 respondents, different comments have been classified or coded under the themes of:

• General comments: e.g. generally disagree with these proposals (mainly concerning the loss of beds at Wareham) (12%); keep things as they are (beds at both hospitals) (8%); negative impact for the elderly (5%)

• Travel and access: e.g. concerns about increased travel times/distance/need for local services (17%); public transport (10%); poor access to Swanage Hospital (9%); good access to Wareham Hospital (7%); concerns about traffic congestion affecting travel times (6%)

• Quality and safety: e.g. retain beds at Wareham Hospital (30%); retain beds (non-specific) (10%); good quality services/retain services at Wareham Hospital (9%); retain beds at Swanage hospital (8%); reduced level of service will not be able to support current/increased populations (6%); there will not be enough beds/increase beds (5%)

• Cost and funding: e.g. cost of implementing changes/waste of money/minimal savings (2%); increase funding instead of making cuts (2%); cost cutting exercise/will not improve services (1%)

• Other comments: e.g. more information/evidence needed including why the use of care home beds instead of inpatient beds were thought to be more beneficial (4%); consultation is biased/flawed/leading questions (1%) local views/opinions need to be heard (1%)

The main alternative suggested (1%) was to remove beds from Swanage rather than Wareham (mainly due to Wareham’s perceived better location and high demand). A further 1% proposed a new site for a hospital with beds in Wareham, and outpatient services at Swanage. There were also suggestions for a hub at Bere Regis or one placed to take account of proposed large housing developments at Wareham, Lytchett Minster, Lytchett Matravers and Wool.

Residents’ survey


Focus groups

Generally, Purbeck participants accepted the proposal, particularly given Wareham’s proximity to Poole and the acute hospital. However, there were discussions about the lack of

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accessible public transport especially for the elderly and disabled and others without cars.

One asked if the CCG had included hospital buses in its proposals. Some argued that it made no sense as Wareham hospital had been refurbished.

Written submissions

Most submissions from Purbeck opposed the CCG’s proposal to remove beds from Wareham Hospital. People argued this made little sense because:• %The hospital is centrally located (for patients and staff), has good public transport links

and offers excellent quality healthcare and facilities

• Better justification than size was required for ‘downgrading’ Wareham Hospital

• In comparison, Swanage Hospital was considered too isolated and prone to traffic congestion in the summer

• There were concerns about more care in the community and the use of care home beds (under-funded and under-staffed)

• Increased housing development (especially retirement complexes) in Purbeck means that the area will require more facilities, not fewer and argued for beds at Wareham and Swanage

• It would increase bed blocking and pressure on acute hospitals

• Several supported the bedded hub in Swanage

Q:Our draft proposals for EAST DORSET are for a community hub with beds at Wimborne Hospital. St Leonards Hospital would close. To what extent do you agree or disagree with our draft proposal for EAST DORSET?

Responses

Open questionnaire

7875 individuals responded to this question, of whom 33% agreed with the proposal, 42% disagreed. Of 1724 NHS employees, 42% agreed and 39% disagreed. Organisational (68) responses were evenly balanced – 35% agreed and 35% disagreed.

Comments


• General comments: e.g. keep things as they are mainly because people saw no sense in shutting any beds or closing a hospital (9%); negative impact for the elderly (4%); generally agree/support proposals (4%); generally disagree with the proposals (3%)

• Travel and access: e.g. concerns about increased travel times/distance /need for local services (13%); public transport (7%); ease of access for the elderly (6%); poor access to


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Wimborne Hospital (5%); access for people in the East of Dorset (3%); good access to St Leonards Hospital (3%)

• Quality and safety: e.g. good quality services/retain services at St Leonards Hospital (31%); reduced level of service will not supported current and increasing population (10%); retain beds (non-specific) (9%); proposals will put more pressure on overstretched hospitals (8%); insufficient beds/increase beds (7%); retain beds at St Leonards Hospital (7%); bed losses would lead to increased bed blocking (6%); good quality of services/retain services at Wimborne Hospital (5%); increase services at Wimborne Hospital (4%)

• Cost and funding: e.g. cost of implementing changes/waste of money/minimal savings (2%); increase funding instead of making cuts (2%) cost cutting exercise/will not improve services (2%)


Some respondents offered alternative proposals for saving money such as getting rid of administrators, redirecting management costs into front-line staff and stopping ‘privatisation’. Others suggested: a new building on the St Leonards site with primary care, MIU and physiotherapy; a multi clinic based at one of the GP surgeries in Verwood or West Moors; extended GP access; a home care campus at St Leonards or that St Leonards should be made into a dementia home, caring for the most serious cases until death.

Residents’ survey


Focus groups

In general, people in the East Dorset group accepted that there were significant problems with St Leonards Hospital and expressed little opposition to its closure. However, they questioned where elderly patients would go in its absence to avoid making ‘bed-blocking’ in acute hospitals worse.

The proposal for a community hub with beds at Wimborne Hospital was supported but concerns expressed about its current size and capacity but also that it might feel more like an acute hospital if enlarged.

Written submissions

Submissions relating to the proposals for the eastern Dorset area were mainly opposing the closure of St Leonards Hospital because of:

• The range of services it offers to a large, growing population (many of which would struggle to travel elsewhere)

• The additional pressure closure would place on other hospitals

• For similar reasons a small number of responses said Alderney Hospital should be retained

• Two people raised concerns about access to Wimborne Hospital, its capacity to cope with

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additional development and suggested that a community hub at Ringwood Health Centre would be better for location and access

Petitions

There was one petition relating to St Leonards Community Hospital (6326 signatures).

Respondents urged the CCG:

• Not to close the hospital which provides rehabilitation from hospital to home services, a ‘very busy’ physiotherapy and outpatients department and is a community facility

Q:Our draft proposals for the POOLE LOCALITIES include a community hub with beds at Poole (only if this is the Major Planned Hospital). Alderney Hospital would not be used as a community hub and proposals for its future would form part of a separate review of dementia services. To what extent do you agree or disagree with our draft proposal for the POOLE LOCALITIES?

Responses

Open questionnaire

7897 individuals responded to this question. 35% agreed with this proposal, but 41% disagreed. Of the 1730 NHS employees who responded (45%) agreed with the proposal and 36% disagreed. 40% of organisations (70) agreed with the proposal and 31% disagreed with it.

Comments


• General comments: e.g. Poole should be the Major Emergency Hospital and Bournemouth should be the Major Planned Hospital (14%); concerns over the future of dementia services (10%); keep things as they are (7%); generally disagree with the proposals (6%); these proposals would risk lives (6%); negative impact for the elderly (3%); generally agree/support proposals (3%); cannot support proposal without knowing if Poole or Bournemouth will be the Major Planned Hospital (3%); Poole should be the Major Planned Hospital and Bournemouth the Major Emergency Hospital (1%)

• Travel and access: e.g. concerns about increased travel times/distance /need for local services (13%); poor access to Royal Bournemouth Hospital (11%); traffic congestion affecting travel times (7%) good access to Poole Hospital (6%); public transport (5%); parking concerns (4%); poor access to Poole Hospital (3%)

• Quality and safety: e.g. good quality of services/retain services at Poole Hospital (21%); good quality of services/retain services at Alderney Hospital (9%); reduced level of service


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will not supported current and increasing population (7%); retain beds (non-specific) (5%); retain beds at Poole Hospital (4%); retain beds at Alderney Hospital (2%)

• Cost and funding: e.g. cost of implementing changes/waste of money/minimal savings e.g. from moving staff from one site to the other (3%); increase funding instead of making cuts (2%)


A small number of people suggested alternatives such Alderney Hospital becoming a community hub (2%) and saving money by getting rid of unnecessary managers and cutting salaries and expenses of managers. Others suggested knocking down Poole Hospital, selling the land and using the money to build a new hospital outside the town and extended GP access.

Residents’ survey


Focus groups

The majority of people in the three Poole groups were satisfied with the community hub proposals both locally and county-wide which they thought were ‘logical’ and ‘made sense’. There was question (from Christchurch) about whether there would be enough beds?

No concerns were raised about any proposed closure of community services at Alderney.

Q:Our draft proposals for the BOURNEMOUTH and CHRISTCHURCH LOCALITIES include a community hub with short-term care home beds at Bournemouth (only if this is the Major Planned Hospital) and a hub without beds at Christchurch. To what extent do you agree or disagree with our draft proposal for the BOURNEMOUTH and CHRISTCHURCH LOCALITIES?

Responses

Open questionnaire

32% of 7725 individual respondents agreed with the proposal and 42% disagreed.

Of the 1707 NHS staff who responded, 45% agreed and 34% disagreed. 70 organisations responded to this question, of which 43% agreed and 33% disagreed.

Comments


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• General comments: e.g. Christchurch has an ageing population (implying the proposals were not compatible with this) (10%); keep things as they are (5%); generally disagree with the proposals (4%); Poole should be the Major Emergency Hospital and Bournemouth should be the Major Planned Hospital (4%); negative impact for the elderly (4%); generally agree/support proposals (3%); cannot support proposal without knowing if Poole or Bournemouth will be the Major Planned Hospital (3%); Poole should be the Major Planned Hospital and Bournemouth the Major Emergency Hospital (3%)

• Travel and access: e.g. concerns about increased travel times/distance/need for local services (9%); poor access to RBH (6%); public transport (5%); traffic congestion (4%); parking concerns (3%); access for the elderly (3%); poor access to Poole Hospital (1%)

• Quality and safety: e.g. retain beds at Christchurch Hospital (21%); retain beds (non-specific) (7%); reduced level of service will not support current and increasing population (6%); there will not be enough beds/increase beds at Christchurch Hospital (5%)


• Other comments: e.g. more information/evidence needed (5%); other criticism of the consultation (1%)

A few respondents suggested alternatives to the proposals such as using the New Forest Lymington Hospital; and removing the community hub from Bournemouth and having a community hub with beds at Christchurch, St Leonards, Wimborne and Poole.

Residents’ survey


Focus groups

The majority of people in central and North Bournemouth were fairly satisfied with the local plans, but most of those in the Bournemouth East group and some in West Hampshire were concerned about not having a community hub at all if Bournemouth becomes the majority emergency hospital. They argued for a hub with beds in either Bournemouth or Christchurch and said that the consultation document ‘misled’ residents into presuming they would have a hub with beds within the cluster, which was not necessarily the case.

Other comments:

• West Hants wanted hubs organised on a cross-county basis

• Some people felt they needed more information on the finer details to make a judgement on their merits/disadvantages e.g. how the hubs would work with GP surgeries; referrals process; what the hubs would treat; exact locations, level of consultant cover; overall bed numbers (reductions?); would there be out of hours cover; would Urgent Care Centres be very different or the same as minor injury units and would they be open overnight


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Written submissions

One response raised concerns about the lack of a bedded hub for Bournemouth and Christchurch should Poole become the Major Planned Hospital, as both areas have large elderly populations and require intermediate provision (between an acute hospital and a care home).

D.2 Acute hospital services

Q: To what extent do you agree or disagree with our vision for acute hospital care in Dorset?

Responses

Open questionnaire

Around half (51%) of the 9116 individual respondents agreed with the vision for two specialist hospitals. However, two-fifths (39%) disagreed. There were slightly higher levels of agreement among the 1849 NHS staff who responded to the questionnaire (59%) while 34% disagreed. Of the 90 organisations that responded, 47% disagreed with the proposal and 46% agreed.

Residents’ survey

Of the 979 residents who responded to the telephone survey, 66% agreed with the proposal, 24% disagreed.

Q: To what extent do you agree or disagree with the proposals to provide a Major Emergency Hospital and a Major Planned Hospital in the East of the county?

Responses

Open questionnaire

Half of the 9075 individual respondents (50%) agreed with the proposal to provide a Major Emergency Hospital and Major Planned Hospital in the East of the county: 40% disagreed. Again, NHS staff (1852) had a more favourable view with 64% agreeing with the proposal and 30% disagreeing with it. Of the 89 organisations that responded, 52% agreed and 34% disagreed.

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ACUTE HOSPITAL SERVICES D.2

Residents’ survey

998 residents responded to this question in the telephone survey. 51% agreed and 41% disagreed.

Focus groups

The proposal was non-controversial and most people appreciated the proposal as a ‘natural and sensible form of specialisation which is standard and good practice. Specific benefits:

• Being treated in a specialist hospital quickly in an emergency saves lives

• They can develop as centres of excellence, undertake more research and make significant medical advances

• Less likelihood of planned operations being cancelled

• Providing more specialist services could result in some patient being treated in Dorset rather than travelling out of county e.g. to Southampton

• More consultants/specialist medical staff would be attracted to the area

• Duplication of resources minimised

Concerns• Minority of people in West Dorset, East Dorset and Weymouth and Portland were

disappointed that this could not be done at Dorchester County Hospital but were pleased it will remain a district general hospital

• Development in the East could leave DCH as a ‘poor relation’ unable to attract the best staff

• Problems with travel and transfers between Poole and Bournemouth with traffic congestion causing long delays

• Increased pressure on SWAST to transfer patients

• Lack of appropriate public transport between Bournemouth and Poole: strong suggestions that bus services and car parking capacity will need to be improved

• There could be controversy/poor morale among medical staff who do not want/refused to relocate

• CCG has not considered people who use services in Yeovil, Salisbury and Exeter

• Will separating services address staffing shortages or potentially make it worse

• Cultural differences between the two hospitals could create barriers to joint working

Written submissions

There was some support for the principle of separating acute emergency and planned services, but more respondents questioned whether such a division would be suitable or safe for the large, growing population of Dorset and the need for good access to an acute hospital.

Regardless of the specific options, the proposals were criticised for:


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• Being financially motivated

• Focusing provision in the East of the county (introducing a ‘postcode lottery’ that would increase variations in care)

• Not taking the lack of public transport and poor road infrastructure in rural North and West Dorset into sufficient account

Other concerns:

• The future of Dorset County Hospital in terms of services and staff recruitment and retention

• The apparent lack of consideration given to cross-border acute services used by Dorset residents (e.g. Yeovil and Salisbury Hospitals)

• Increased pressures on a struggling ambulance service

• The possibility that the major emergency site might struggle to cope with increased demand

Q: To what extent do you agree or disagree with the proposals to provide a Major Emergency Hospital and a Major Planned Hospital in the East of the county?

Responses

Open questionnaire

Of the 8861 individual respondents, almost two-thirds (64%) agreed with the proposal for Dorset County Hospital to be a Planned and Emergency Hospital, while 24% disagreed. 76% of NHS employees (1833) agreed with the proposal, 14% did not agree. Of the 84 organisations responding to this question, 64% agreed and 26% disagreed.

Residents’ survey

From a base of 991, 80% of residents agreed with the proposal and 11% disagreed.

Focus groups

People were pleased that Dorset County Hospital is to remain a district general hospital but some expressed concerns that it may become a ‘poor relation’.

Written submissions

There was some concern that not separating services in the West may have an impact on healthcare and training, recruitment and retention of staff. However, most supported the proposal as it demonstrated an understanding of the geographical needs for this service.

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Option A – Two centres: one at the Major Emergency Hospital in the East of Dorset, and an integrated service across Dorset County Hospital and Yeovil District Hospital for residents in the West

Option B – Single specialist centre at the Major Emergency Hospital in the East of Dorset

Another option

Responses

Open questionnaire

Of the 6674 individual respondents, 63% supported Option A and 13% supported Option B. However, 23% said that they would prefer an alternative option and were given the opportunity to give specific comments on other options the CCG should consider. 66% of NHS staff (1629) supported Option A, 21% supported Option B and 13% preferred another option.

Comments

From the 2782 respondents who provided comments on the above, 8955 different themes were extracted from the comments and have been classified or coded under the following:

• General comments: e.g. retain the current 24 hour, consultant-led maternity and paediatric services at Dorset County Hospital (26%); retain current consultant-led maternity and paediatric services at Poole Hospital (18%); these proposals will risk lives (16%); keep things as they are (10%); retain midwife-led maternity and paediatrics at Bournemouth Hospital (8%)

• Travel and access: e.g. non-specific concerns about increased travel times/distance/need for local services (23%); negative impact on sick children/families who will have to travel further (13%); concerns about access to services for people in the West of Dorset (13%); concerns about increased travel times and distances to Bournemouth (10%); there will be a negative impact on women in labour/pregnant women who have to travel further for maternity services (8%); concerns that services will not be central enough/too far East (5%)

• Quality and safety: e.g. the proposals will lead to lower quality services and the quality of services should come first (3%); a reduced level of service will not be able to support the population or an increased population (2%); the quality of maternity services at Poole Hospital is good (2%); the proposals will create additional pressure for paramedic/ambulance services (2%); increase the level and provision of services at Dorset County Hospital (2%)

• Cost and funding: e.g. increase funding instead of making cuts (3%); cost of implementing

Q: Which option do you prefer for the delivery of consultant-led maternity care and inpatient paediatric services for the sickest children?


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changes/waste of money/minimal savings (2%); cost cutting exercise/will not improve services (1%)

• Other comments: e.g. more information/evidence needed (2%); comments relevant to acute care (2%); criticism of the consultation (1%); consultation is based on false information (1%)

Of the 12% of respondents who suggested alternatives options, the most commonly occurring comments were that two major centres were needed to provide maternity and paediatric services: one in the West and one in the East.

Other suggestions included:

• Creating smaller maternity units in other locations such as Weymouth, Wimborne, and between Shaftesbury and Gillingham

• To have a consultant on-call at the midwife-led maternity unit (based at Yeovil or Dorchester)

• Set up a paediatric retrieval team like at Southampton Hospital to transfer sick children and babies to the major emergency centre

• The enhanced day and evening services for children at Dorset County Hospital should also provide low-dependency overnight care for children allowing families to stay closer

Residents’ survey

Of the 939 residents who responded to this question in the telephone survey, 72% supported Option A, 24% supported Option B and 4% preferred another option.

Focus groups

The proposals for consultant-led maternity care and inpatient paediatric services were the most contentious among the public and received little support.

The dominant perception was that women need prompt access to emergency consultant-led care, even if their pregnancies are considered uncomplicated.

Some felt that the lack of consultant cover across the county means the proposed change ‘still holds no guarantee of better services’. They sought reassurance that the CCG has done all it can to recruit consultant obstetricians.

Many participants rejected both options. Overall, Option A was considered the fairer of the two – providing quicker access to specialist care and services more locally for more people.

Several participants felt it was difficult to make a judgement on Option A without knowing where the consultant-led care would be located – Dorchester or Yeovil. The potential provision of consultant-led services at Yeovil was considered particularly unfair and unsafe for people in West and South Dorset due to travel distances.

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There was some recognition that having a specialist care centre (Option B) would result in more people being treated in East Dorset rather than having to transfer to Southampton.

Written submissions

Both options were criticised, mainly regarding accessibility for people living in the West of Dorset.

Comments and suggestions included:

• Support for new High Risk Maternity Unit on whichever site is the emergency hospital as centre of excellence that will attract and retain high calibre staff

• Support for locally delivered services but centrally managed and supported within a single paediatric unit (based either in Bournemouth and Poole

• Travel times would significantly increase for many – the most vulnerable mothers and babies would be placed at enormous risk

• Reassurance requested that maternity and paediatric services will be maintained to serve the West Dorset area

• Difficult to fully consider proposals due to ongoing discussions with Yeovil

• Poole should be designated specialist emergency and maternity hospital to overcome concerns over travel times and staff disruption

• DCH should have consultant-led maternity services.

• Placing consultant-led maternity services at Bournemouth not Poole exposes those on the Isle of Purbeck who are in need of critical emergency maternity services to severe risk by significantly increasing the chance that they will not be treated within the ‘golden hour’

Petitions

20,755 people signed the Dorset Echo’s petition against the closure of Kingfisher Children’s Ward (and special care baby unit)

This mainly concerns:

• Parents and their sick children having to travel to the East of the county for their care

7029 people signed a petition organised by a local parent (and service user) against the closure of Kingfisher ward.

This reflects:

• The experience of this parent and ‘many more’ living with a life-threatening illness and who ‘rely’ on the open access to Kingfisher ward. They fear extra travelling times would not be in the best interests of their children and increase suffering

1512 people signed a petition entitled ‘Hands off our wards’ organised by the Dorset Echo in support of Dorset County Hospital.


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Option A – Major Emergency Hospital with 24/7 A&E services in POOLE

Major Planned Hospital with an 24/7 Urgent Care Centre in BOURNEMOUTH

Option B – This is our PREFERRED OPTION – Major Emergency Hospital with 24/7 A&E services in BOURNEMOUTH. Major Planned Hospital with a 24/7 Urgent Care Centre in POOLE

Another option

Responses

Open questionnaire

Around one-third (34%) of individuals supported Option A (Poole as the Major Emergency Hospital and a Major Planned Hospital in Bournemouth) while over two-fifths (44%) support Option B (Bournemouth as the Major Emergency Hospital and Poole as the Major Planned Hospital).

Around one-fifth (22%) preferred another option and were given the opportunity to provide specific comments about any alternatives that the CCG should consider.

An overall preference for a particular option for the major hospital configuration in the East was less clear among NHS staff then other respondents with 42% choosing Option A and 47% supporting Option B. 10% suggested they would prefer another option. Of the 86 organisations that responded to this question 37% preferred option A, 43% preferred Option B and 20% preferred another option.

Residents Survey

51% preferred Option A and 40% preferred Option B, 9% preferred another option.

Focus groups

Preferences for Options A and B varied between groups and individuals (based on geographical proximity to the emergency hospital) but in general the CCG’s arguments for preferring option B were understood and accepted.

Majorities in East Dorset, Weymouth and Portland, Bournemouth East, Bournemouth Central, Christchurch and West Hampshire favoured Option B from the outset.

Most people in North Dorset, Bournemouth North, Poole Bay and Poole Central supported Option A. Opinion in West, and Mid Dorset and Purbeck and Poole North was mixed with

Q: Which option do you prefer for the Major Emergency Hospital and Major Planned Hospital in the East of the county?

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many more people undecided and typically saying they would be happy for the decision to be made by the CCG that has better knowledge than the public.

Those who supported the preferred Option B agreed that Bournemouth was more suitable as a Major Emergency Hospital because of:

• Better access

• Enhanced facilities e.g. helipad

• More modern and spacious with room for expansion

• Allows quicker transfers to specialist services at Southampton

People in the Bournemouth East, Purbeck and Weymouth and Portland groups said that easy access to the Major Planned Hospital was imperative for patients and visitors and that Poole’s town centre location was better than Bournemouth for this.

The fact that Option B would be cheaper to implement was persuasive for many.

Those with reservations about Option B were mainly concerned about the distance to Bournemouth for residents in the North and West of Dorset, and there were specific concerns about ambulance waiting and transfer times.

The need to educate people about the proposed changes to acute hospitals and the reasons for them was stressed by some groups.

Written submissions

A minority of respondents agreed with the Royal Bournemouth Hospital becoming the Major Emergency Hospital because:

• It has scope to expand

• Has a helipad

• Is accessible to people in the East of Dorset and West Hampshire

However, most relevant submissions were concerned with travel to and from Bournemouth – poor road infrastructure (only one road from Purbeck), heavy traffic congestion (Bournemouth has been named as one of the most congested towns in the UK), delays and lengthy and difficult journeys from North and West Dorset (up to 1.5 hours).

There was significant concern that more lives would be lost through longer response times and more patients not reaching RBH within the ‘golden hour’.

Other concerns:

• Poor public transport links from other areas of the county

• Poor parking

• Out of town location


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• Scepticism about whether skills and expertise could be transferred effectively from Poole to RBH

• Concerns that if Poole becomes the Major Planned Hospital it will decline in terms of staff recruitment and retention, expertise and quality of services

• Implementation costs are inaccurate (e.g. does not include cost of the new road from the A338, increased use of the air ambulance or staff redundancy costs)

• RBH is already too busy and has little scope to expand

• Finance is being prioritised over healthcare

• Increase in emergency work at DCH

Views on Option A:

Some respondents in support of Option A said that Poole has much more experience in delivering emergency care, which, in turn, is more skilled at delivering planned care.

Mostly Poole was considered more accessible as it is not so far East in location; can be reached via more direct main routes; town centre location on a main road near transport hubs; and closer for more of Dorset’s population than RBH.

Other points:

• Dedicated workforce at Poole with effective teamwork

• Poole Hospital could expand upwards

Alternative suggestions

• If status quo cannot be maintained there should be two major combined emergency and planned sites: one in the Bournemouth/Poole conurbation (combining RBH and Poole Hospitals) and one in Dorchester

• A new purpose-built hospital located outside of the ‘congested urban sprawl’ of Bournemouth and Poole with the existing three hospitals re-designated for A&E, planned, outpatient and rehab services within their own communities

• A compromise between the two options that provides a better service and cost savings without downgrading Poole Hospital

• The draft business case in the supporting documents shows that the choice between Bournemouth and Poole is balanced on all factors except for capital costs. I thought the evaluation criteria had Bournemouth as better for access as well as cost. The capital costs are not based on detailed evaluation, only on national cost per bed. If Poole was chosen as the emergency hospital and both Bournemouth and Poole beds were jointly managed, the financial case becomes less strong

• Poole and Bournemouth Trusts should merge to save on management costs while keeping the two operational units

Petitions relating to Poole Hospital (36,146 signatures in total):

We, the people of Poole, want Poole Hospital A&E and maternity to stay open (online and postal) = 27,487 signatures.

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Swanage and Purbeck Labour Party – 8048 signatures from (mainly) Swanage residents, visitors and people in Wareham and Corfe Castle plus 305 signatures from Poole Labour Party.

Respondents demanded/argued that:

• Poole Hospital 24-hour trauma A&E and maternity services are retained and we oppose any reduction in the number of A&E departments across Dorset

• Poole Hospital is more accessible for more of Dorset’s population than Bournemouth

• Moving A&E and maternity could result in fatal or life-limiting consequences for Purbeck patients (esp. Swanage) as increased travel times will mean they are not seen within safe treatment guidelines

Unite the Union – ‘Please don’t axe Poole’s A&E’ – 4070 signatures.

The petition included a narrative from staff explaining why they felt services should be retained:• Possible relocation of cancer services

• Too many trolley to ambulance to bed transfers for patients

• Longer journey times for patients

• Poole is more central than RBH – locating the Major Emergency Hospital in the extreme East is unfair to those in Poole and the West

• Transport links to and parking at Poole are better than RBH

• Poole Hospital staff are already trained in acute services RBH would need massive retraining

• Moving maternity and paediatrics to RBH would run the risk of losing skilled staff from Poole

LEADING & WORKING DIFFERENTLY STRATEGY: DORSET’S WORKFORCE CAPACITY AND CAPABILITY PLAN

E

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INTRODUCTION AND SUMMARY OF RECOMMENDATIONS E.1

E.1 – Introduction and summary of recommendations

The Workforce Capacity and Capability Plan provides a background to the workforce challenges faced in Dorset along with the vision to address these challenges; as set out in the Leading and Working Differently Strategy which is a collective health and social care response to Dorset’s Sustainability and Transformation Plan.

The aims of the Workforce Capacity and Capability Plan are to:

• Ensure we have the right staff in the right places to deliver services across Dorset

• Identify and address the workforce challenges where there are existing gaps and shortages, as well as in areas where there is likely to be a future challenge in workforce supply

• Work in partnership to address these challenges together, through recruitment, networking and development of roles and skills

• Work across organisational boundaries to deliver services

• Influence key stakeholders and partners to ensure a future sustainable workforce; such as with education partners and providers to secure the right number of training places, occupancy levels and to ensure the content of training programmes aligns to the skills needed

• Align workforce planning to service planning and transformation

These aims need to be achieved in a challenging financial climate and at no additional cost, as set out in Dorset’s Sustainability and Transformation Plan. The importance therefore of considering alternatives and different workforce solutions to the current challenges is critical.

This plan has been co-produced with support from clinicians and service managers across Dorset’s providers. It is an iterative and developing document and will inform the development of a Workforce Capacity and Capability Plan for each service area over the next 12 to 24 months, the pace at which will be dependent on the readiness of the services and the timescales for changes set out in the Clinical Services Review implementation plan. In the meantime, work will continue to deliver the recommendations set out in this Workforce Capacity and Capability Plan and in Dorset’s Leading and Working Differently Strategy.

Summary of RecommendationsDorset’s Workforce Capacity and Capability Plan provides recommendations for each service area to ensure the sustainability of the workforce now and in the future. Many of these recommendations show consistent themes regardless of the service or organisational setting. It is expected that the recommendations in the Workforce Capacity and Capability Plan will form part of the action plan which will be overseen by the Dorset Workforce Action Board, responsible for Dorset’s Leading and Working Differently Strategy, and will be embedded in each organisation’s people/ workforce strategy.

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It is important to note that a number of these recommendations have already started to be implemented across Dorset.

Table 1: Summary of Workforce Recommendations

Capacity Capability

Establish a Dorset approach to recruiting and attracting all staff groups including:• International recruitment campaigns

• Campaigns to attract people from an early age through school initiatives

• Building on the success of local initiatives (Doorway to Dorset and Proud to Care)

• Relocation plans and incentives to attract people to Dorset

• For clinical and non-clinical staff including the third sector

Establish one bank for temporary staff.

Complete a system-wide training needs analysis to understand the skills required by teams and individuals, with a supporting timescale for implementing.Complete a system-wide review to inform one talent management strategy across organisational boundaries and services.

Develop training programmes, placements, job rotations and employment offers across organisational boundaries and services, ensuring people have the right skills to deliver safe care.

Work in partnership to influence partners regarding barriers to recruiting staff including affordable housing and transport.

Increase the number of training places in identified professions to ensure the future supply of the workforce.

Engage and support the transfer of staff to ensure the right numbers are in the right places. Ensure a consistent approach is in place through a shared memorandum of understanding.

Offer as a system, incentives to promote training places and vacancies in Dorset including flexibility in hours and rotas.

Encourage the recruitment to new and additional roles across organisational boundaries and services, in response to the service workforce plans.

Engage trainees and students early to encourage them to work in Dorset, matching them to roles and opportunities based on their skills and requirements.

Organise and develop rotas to give more flexibility to staff and respond to fluctuations in service activity. Consider system-wide annual leave planning to support this, whilst ensuring staff have a good work life balance.

Work as a system to develop new roles and supporting training programmes including apprenticeships.

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WHO WE ARE AND OUR VISION 1.2

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BACKGROUND E.2

Capacity Capability

Provide a collective approach to incentivising staff beyond normal retirement age; for example, through flexible working arrangements, rota cover and step-down roles.

Develop the skills of the public, families and carers through patient engagement and education.

Engagement

Develop a one Dorset approach to engaging and involving staff, including one Organisational Change Policy and supporting documentation.

Produce positive communication both for staff and for the media to promote the transformational changes in Dorset and the current and future opportunities for staff, showcasing best practice and innovation.

E.2 – Background

The case for change is set out in the Pre-Consultation Business Case for Dorset’s Clinical Services Review. To enable any service changes to take place, an understanding of the workforce and its challenges is important. In Dorset, we have described those workforce challenges in Dorset’s Workforce Plan which informed the Pre-Consultation Business Case and through the Leading and Working Differently Strategy.

Dorset’s Workforce Plan reflects what we know about the service areas where we struggle to ensure there are enough staff to cover the work. This is causing pressure on teams and the delivery of services currently. Some of the roles Dorset is experiencing challenges in securing sufficient numbers of staff include:

• GPs – in practice roles and covering rotas across the system

• Consultants and middle grades doctors – in a number of service areas

• Paramedics

• Registered nurses – particularly in mental health, primary care practices and social care settings

• Support staff – particularly domiciliary care

We know we need to be organised differently and we know we need more front line staff to deliver care. We also know we need to consider new types of roles and skills to support future service changes; not only to ensure the right people are delivering the right care in the right place, but also to respond to the reducing numbers of people wanting to train in key roles and to respond to people retiring such as trainers.

We know our staff are passionate about what they do, but often struggle with the way things are done, the duplication of effort and computer systems which do not talk to each other.

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We know we need to work more closely across different organisational boundaries for the benefit of patients and to help address our workforce challenges; this may be through shared recruitment, networking across organisations and sharing rotas, or developing portfolio roles which span organisations and services.

We know staff may be concerned and uncertain about the future; what the changes mean for their jobs, for the services they deliver to people and the teams and organisations they work in. We know staff recognise and understand there is a need to make changes and we know they want to be engaged and involved in the journey ahead. How we support staff through these changes is critical and therefore a consistent and equitable approach to implementing organisational change and transition will go some way to maintaining the trust of our staff and teams.

E.3 – Vision

The Leading and Working Differently Strategy is a collective response to the Sustainability and Transformation Plan on behalf of all health, social and primary care organisations, carers and Dorset’s voluntary service organisations. The Sustainability and Transformation Plan sets out how we will deliver changes to health and social care services in Dorset together. The impact of this vision on our staff workforce will be far reaching; however, it won’t happen all at once. We will need to ensure safe staffing levels are in place now and in the future. We also know that to enable change to happen, our staff need to be supported to lead and work differently.

The aim of the Leading and Working Differently Strategy is to:

• Break down the barriers in our organisations to enable change to happen, whilst being mindful of our individual organisation’s values and identities

• Identify collective solutions to meet the workforce needs for each service

• Work together on development programmes which cross organisational boundaries, sharing resources and expertise

• Actively try to do things once and well as health and social care organisations, stopping the repeated time and effort spent by staff

• Actively learn to ensure what we do is right and meets the needs of what we want to achieve together

The Leading and Working Differently Strategy identifies the priority areas to tackle these challenges. In summary, the priorities identified are:

• Developing our leaders – working more closely together, building relationships based on trust and confidence, ensuring the right leadership behaviours across all organisations and roles

• Recruitment and retention of our staff – working together to ensure we attract new staff whilst ensuring our existing staff stay and work in Dorset. Working together to ensure safe and sustainable staffing levels

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SERVICE CHANGES E.4

• Developing our staff – working together to ensure there are great development opportunities for staff which are accessible to all

• Supporting our staff through change – being open, honest and transparent in our conversations with staff, engaging and involving them in the changes

• Workforce planning – ensuring we have safe and sustainable staffing levels now and in the future and that staff and working in the right roles and in the right places

E.4 – Service Changes

The Workforce Capacity and Capability Plan focuses on priority service changes; due to the size and scale of the proposed changes or in relation to their impact on wider service changes. In the first iteration of the Workforce Capacity and Capability Plan, the services covered are:

• Emergency and Urgent Care

• Critical Care

• Pathology

• Maternity and Paediatrics

• Integrated Community and Primary Care

For some services indications of recommended staffing levels are provided; however, this requires significantly more work between clinicians, service managers, HR professionals and Health Education England Wessex to ensure they reflect the true workforce requirements in Dorset.

These plans will inform the development of a wider Workforce Capacity and Capability Plan for each service area over the next 12 to 24 months, the pace at which will be dependent on the readiness of the services and the timescales for changes set out in the Clinical Services Review implementation plan.

E.4.1 – Emergency and Urgent CareThis section of the Workforce Capacity and Capability Plan responds to these proposals to ensure suitable levels of staffing are in place to deliver this service.

Workforce CapacityThe current workforce across the three Dorset acute hospitals providing emergency services totals 294 full time equivalent (FTE); in the East of the county it is 221.5 FTE; in the West it is 72.8 FTE. This is set out in more detail in Table 2. Note: The workforce profiles provided include medical and support staff only. Administration and clerical staff have been excluded, with the exception of pathology.


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Table 2 – Workforce profile for emergency and urgent care at June 2017

Royal Bournemouth

and Christchurch Hospitals

Poole Hospital FTE East TotalDorset County

Hospital

Consultants 9 8.3 17.3 6.9Middle grade doctors

12.7 7 19.7 9

Junior doctors 10.6 10 20.6 8Nursing 68.7 49.9 118.6 36.1Additional clinical services

0 11.7 11.7 1

Healthcare assistants

18.3 15.3 33.6 11.78

TOTAL 221.5 72.78

25

17.3

19.720.6

6.9

98

Consultants

Middle

Junior20

15

10

5

0

East West

This workforce is made up of medical staff and non-medical staff including registered nurses, advanced nurse practitioners and healthcare assistants. The consultant medical workforce establishment is 24 FTE; 17 FTE in the East, seven FTE in the West. The vacancy rate (budget

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versus actual establishment) for the medical workforce is currently 22.6% at Poole Hospital, 18% at Royal Bournemouth and Christchurch Hospitals, and 10% at Dorset County Hospital.

In the Major Emergency Hospital and in line with the College of Emergency Medicine1, the recommendation would be to have 16 whole time equivalent (WTE) working in a 24/7 service in the East with 16 hours of consultant presence working seven days per week. NICE2 recommend one WTE nurse to four patients.

A sustainable rota in the East will therefore require 16 WTE consultants; based on the current workforce in the East, this would mean a potential surplus of one WTE consultant. A review to inform a sustainable rota for nursing is soon to be conducted in Dorset.

For the West of the county, a sustainable rota will require ten WTE consultants in line with the College of Emergency Medicine recommendations (the medical workforce in the West recommend 14 WTE to achieve a 14/7 consultant presence). In the West, it would mean a potential gap of at least three WTE consultants.

In an urgent care centre, North West London3 recommend one WTE doctor and at least one WTE nurse to cover the opening hours of the service. In the West of the county, a comparable service in Weymouth was established in July 2016. The current workforce totals 18.5 FTE; 2.3 FTE doctors and 16.2 FTE registered nurses. This is set out in more detail in Table 3:

Table 3: Workforce profile for urgent care service Weymouth at June 2017

Weymouth

Doctors 2.3

Nursing 16.20

Total 18.5

Based on this comparator, and taking into account the East minor attendances in 16/17, a sustainable rota for the East urgent care centre is likely to require a potential workforce of up to 51.2 FTE; 6.4 FTE doctors and 44.8 FTE registered nurses. This is set out in more detail in scenario 1:

Scenario 1: Workforce model for urgent care centre• Weymouth had 34,000 attendances between July 16 and June 17. The minor attendances

for the East during 16/17 totalled 94,000. The proposed workforce model for the East is based on the maximum number of attendances until further analysis is completed:

1 The College of Emergency Medicine (2010): Emergency Medicine Consultants workforce recommendations

2 NICE draft guidance for safe staffing in A&E (2015)

3 North West London (2013): Shaping a healthier future: Decision making business case


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East

Doctors 6.4

Nursing 44.8

Total 51.2

In addition, the recommendation would be to ensure the East emergency medicine consultants form part of the urgent care centre rota as it is established; this is in line with national recommendations4. This workforce is likely to be met by existing staff working in hospital and/or community services.

In terms of the age profile of this workforce, most professions have less than 15% of staff who are over 55.

In terms of numbers of future consultants in training in Wessex:

Speciality Emergency Medicine

Length of training programme 3 years

No. training posts 2013 29





Occupancy rates for Aug 17 84%

In summary, the current workforce challenges across the county to deliver emergency and urgent care services are as follows:

• The number of medical staff available in both parts of the county to meet the required levels – this is reflected nationally with the challenge to recruit consultants

• The increasing challenge of recruiting consultant and middle grade doctors; the supply of trainees is not at its full occupancy rate

• As the medical workforce age profile increases, this reduces the numbers available for on-call rotas particularly middle grade doctors

• The medical workforce supports wider rotas including the air ambulance and therefore the gap in numbers has a wider impact across the system

• There is an increasing demand for different terms of appointment including attractive job plans to balance the intensity of the work and the weekend shifts

• The increasing challenge of securing adult registered nurses in the county; students are no longer qualified in specialist areas so everyone is competing for the same pool of adult registered nurses

4 Healthcare for London (2010): A service delivery model for urgent care centres: Commissioning advice for PCTs

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Addressing the Workforce CapacityTo start to address the challenge of ensuring the right numbers of staff are available, the following recommendations are made:

• Explore opportunities to encourage new or existing medical staff to transfer to the West of the county; it has been suggested by existing staff that covering rotas across Dorset would not be sustainable due to the travel required and they would not be attractive for the workforce

• Organise and develop rotas to ensure cover across services in the East including the urgent care centre and air ambulance service

• Look at ways to use the existing multi-disciplinary staff from the hospitals and general practice to secure the resource required for the urgent care centre – for example physiotherapists, pharmacists and paramedics

• Work with Health Education England Wessex on solutions to address gaps in medical rotas. These may be filled by medical trainees or by other advanced and specialist staff;

• Work with Health Education England Wessex to ensure that medical training numbers and achieved occupancy rates reflect future demand for consultant; the consultant workforce (all specialties) in Dorset has increased by 23% over the past five years and the supply of qualified consultants continues to increase year on year

• Set up a Dorset approach to recruiting and attracting medical and non-medical staff from the UK and internationally

• Expand and increase portfolio roles for medical and non-medical staff to develop variety and an attractive offer which reflects demand; these roles could span organisational boundaries including hospitals, the community and primary care and the ambulance service – for example with a number of recommended streaming roles such as GPs or paramedics

• Recruitment of new and additional roles – for example the West is currently piloting a pharmacist post, the East has extended the role of Advanced Nurse Practitioner through training to work in the major team, and a primary care and physiotherapist work as part of the minor team. Other trusts have also recruited nurse consultants to support middle grade rotas. These roles could span organisational boundaries including hospitals, the community and primary care and the ambulance service

• Ensure rotas have flexibility and more bank staff are recruited to and available, to respond to fluctuations in service activity

• Agree a collective approach to incentivising staff to stay beyond their normal retirement age – where there are shortages or for those who are in training posts offer enhanced terms around flexible working, hours and rotas

Workforce CapabilityThere is an opportunity to look across professional groups and organisational boundaries to ensure staff have the right skills and that there are enough staff to fill the roles required across emergency and urgent care services in Dorset. This will ensure sustainability not only in terms of staffing numbers for all services but will ensure all staff have the right skills to make the right clinical decisions.


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The emergency and urgent care services across the county already have highly skilled and trained staff, attracting future staff through development and training offers is key to ensure the future sustainability of the workforce.

Addressing the Workforce CapabilityTo address the capability needs of the workforce in emergency and urgent care services, a number of recommendations are made. These include:

• Combined training programmes, placements, job rotations and employment offers across different settings and organisations including hospitals, the community and primary care and the ambulance service ensuring staff at all levels have the right training to provide safe care

• Developing effective streaming and triage skills across each service to ensure patients go to the right service or are redirected if required

• Offering as a system, incentives to promote training places and vacancies in Dorset including the promotion of the major emergency site and flexibility in hours and rotas

• Engaging trainees and students early to encourage them to work in Dorset

• Working together as a system to develop new roles including Physician Associates, Advanced Nurse Practitioners and apprenticeships

• Allocating sufficient funds locally to support the back filling of registered nurses to train in emergency care

E.4.2 – Critical CareThis section of the Workforce Capacity and Capability Plan responds to these proposals to ensure suitable levels of staffing are in place to deliver this service.

Workforce CapacityThe current workforce across the three Dorset acute hospitals providing critical care services totals 213 FTE; in the East of the county it is 151.3 FTE; in the West it is 61.6 FTE. This is set out in more detail in Table 3:

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Table 3: Workforce profile for critical care at June 2017

Royal Bournemouth



Hospital

Consultants 7 6 13 14.25Middle grade doctors

0 12.9 12.9 0

Junior doctors 0 22.6 22.6 11Nursing 49.8 45.5 95.3 33.3Additional clinical services

0 1 1 0


0.9 5.6 6.5 3

TOTAL 151.3 61.55

25

13

East West

12.9

22.6

14.25

11

Consultants

Middle

Junior20

15

10

5

0

This workforce is made up of medical staff and non-medical staff including registered nurses, advanced nurse practitioners and healthcare assistants. The consultant medical workforce establishment is 27 FTE; 13 FTE in the East, 14 FTE in the West. This includes critical care


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consultants only for the East and critical care and anaesthetists covering the critical care ward in the West. It is important to note that the consultant workforce in the West has a more hybrid rota to cover a number of wards and clinical services; for example, only 6.75 FTE consultants in the West cover the weekly day time rota, others provide on-call.

The vacancy rate (budget versus actual establishment) for the medical workforce is currently nil at Dorset County Hospital, 6.2 % at Royal Bournemouth and Christchurch Hospitals, and 6.8 % at Poole Hospital.

The vacancy rate (budget versus actual establishment) for the nursing workforce is currently 8% at Dorset County Hospital. There are no vacancies at Royal Bournemouth and Christchurch Hospitals, and at Pool Hospital it is 13%.

The proposal for critical care services is to have a large Level 3 critical care unit on the major emergency site. In line with the Care Standards for Intensive Care Units5, the recommendation is for one WTE to eight patients working in a 24/7 service. The Royal College of Nursing6 recommend one WTE nurse to one patient for a Level 3 unit and one WTE to 1.2 patients for a Level 2 unit. The workforce model for critical care nursing is set out in scenario 2:

Scenario 2: Workforce model for critical care nursing• For a Level 3 unit, 24/7 nursing cover is required with one nurse to one patient. This

equates to 207 hours cover, including a 23% uplift to cover annual leave, sickness and training, and 5.52 WTE per bed

• For a Level 2 unit, a one nurse to two patients is required. This equates to 2.76 per bed

• Note the assumptions on future beds required at the major emergency site

East West

Level 3 (assumes 14 beds in East, four in West) 77.28 22.08

Level 2 (assumes 16 beds, four in West) 44.16 11.04

Additional Nurse Leads 5.52 1.4

TOTAL 126.96 34.52

A sustainable rota in the East will therefore require 16 WTE consultants and 127 WTE registered nurses. Based on the current workforce in the East, this would mean a potential gap of at least three WTE consultants and a potential gap of at least 32 WTE registered nurses.

For the West of the county, a sustainable medical rota in the West is being met by

5 Care Standards for Intensive Care Units (2013)

6 The Royal College of Nursing (2010): Guidance on safe nurse staffing levels in the UK

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existing workforce numbers. A sustainable nursing rota will require 35 WTE registered nurses; based on the current workforce this is a potential gap of at least one WTE nurse (the number of critical care registered nurses in the West is also below the Wessex average).

In terms of the age profile of this workforce, most professions have less than 15% of staff who are over 55. The exception is with middle grade doctors in the East of the county where 31% are over 55 and healthcare assistants where 44% are over 55.


SpecialityIntensive care

medicineAnaesthetics

Length of training programme 5 years 5 years

No. training posts 2013 8 87





Occupancy rates for Aug 17 60% 93%

In summary, the current workforce challenges for both parts of the county to deliver critical care services are as follows:

• The increasing challenge of recruiting consultant and middle grade doctors; the supply of trainees is not at its full occupancy rate, notably for intensive care medicine, and the age profile of the workforce is increasing

• As the medical workforce age profile increases, this reduces the numbers available for on-call rotas

• The medical workforce cover rotas outside of critical care and any changes in the workforce or service might have a wider impact

• There is an increasing demand for different terms of appointment including part time and more flexible working arrangements

• The increasing challenge of securing adult registered nurses in the West of the county


• Work with Health Education England Wessex to increase the number of training places and occupancy rates for intensive care medicine


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• Widen rotas to include all medical professionals and to maintain and build medical skills and knowledge

• Ensure rotas have flexibility and more bank staff are recruited to and available, to respond to fluctuations in service activity

• Expand and increase portfolio roles for medical and non-medical staff to develop variety and an attractive offer which reflects demand

• Recruitment of new and additional roles – for example care could be delivered by a Physicians Associate, Allied Health Professional, or Advanced Nurse Practitioner


• Align the high dependency unit and critical care service in the West to manage the workforce more effectively

Workforce CapabilityCritical care services are seeing an increased intensity in the acute needs of patients being admitted often with multiple co-morbidities. The changing shape of the service means for both medical and non-medical staff training and development needs to evolve.

The critical care services across the county already have highly skilled and trained staff, attracting future staff through development and training offers is key to ensure the future sustainability of the workforce.

Addressing the Workforce CapabilityTo address the capability needs of the workforce in critical care services, a number of recommendations are made. These include:

• Developing training programmes for all staff to ensure they reflect the increasing skills needed to care for the increase in acute needs of patients with often multiple co-morbidities ensuring staff at all levels have the right training to provide safe care

• Developing portfolio placements to attract medical and non-medical trainees to develop variety and an attractive offer which reflects demand

• Rotating medical and non-medical training placements across hospital providers in Dorset

• Offering as a system, incentives to promote training places and vacancies in Dorset including the promotion of a major emergency site and flexibility in hours and rotas


• Working together as a system to develop new roles including Physician Associates, Advanced Nurse Practitioners and apprenticeships

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E.4.3 – PathologyThe vision for pathology services is to have an integrated approach across provider organisations, with capital investment secured for a new pathology unit. Although identified under the Clinical Service Review proposals, the progression of this work has been led under the One Dorset Vanguard programme. The inclusion of this service as part of the Workforce Capacity and Capability Plan reflects the need to ensure this service is in place and established on the right site(s) before wider service changes can take place.A Strategic Outline Case was submitted in June 2017 for pathology services and this section of the Workforce Capacity and Capability Plan provides a summary outline of the proposals in order to set out how suitable levels of staffing will be achieved.

ProposalsThe two options for pathology services are:

• Option 1: 1 on-site hub at one of the acute sites with essential service laboratories at the other two hospitals

• Option 2: A distributed network with essential service laboratories at each site and GP and outpatient activity consolidated partly at one acute site and partly with the essential service laboratories. This is the preferred option for existing staff

Workforce CapacityThe current medical workforce across the three Dorset acute hospitals providing pathology services totals 31 FTE; 22 FTE in the East and nine FTE in the West. This is set out in more detail in Table 4:

Table 4: Workforce profile for medical pathology staff at November 2016

Royal Bournemouth



Hospital

Consultants 7.8 11.4 19.2 8.1Middle grade doctors

2 0 2 1

Junior doctors 0 1 1 0

TOTAL 22.2 9.1

The current non-medical workforce across the three Dorset acute hospitals providing pathology services totals 294 FTE. This is set out in more detail in Table 5:


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Table 5: Workforce profile for non-medical pathology staff at November 2016

WTEBlood

sciencesImmunology Microbiology Molecular Histology Cytology Central Total

Band 2 34.30 1.00 20.70 – 8.85 2.93 – 67.78

Band 3 7.60 1.00 1.47 1.40 9.75 0.40 – 21.62

Band 4 4.87 – 4.00 1.00 5.00 – 1.00 15.87

Band 4 CS – – – – – 4.60 – 4.60

Band 5 25.03 1.00 4.00 2.00 9.00 3.64 – 44.67

Band 6 45.66 1.00 23.31 – 10.68 0.64 1.00 82.29

Band 7 18.21 1.00 8.00 1.20 4.00 2.16 3.00 37.57

Band 8a 4.00 – 1.00 – 1.00 1.00 1.00 8.00

Band 8b 2.94 0.20 2.00 1.00 0.80 1.00 2.50 10.44

Band 8c – – 1.00 – – – 0.50 1.50

Band 8d – – – – – – – –

Band 9 – – – – – – – –

OOH – – – – – – – –

Total 142.61 5.20 65.48 6.60 49.08 16.37 9.00 294.34

The workforce is made up of staff across NHS pay bands 2-9.

The future workforce for Option 1 is 265 FTE. The future workforce for Option 2 is 273 FTE. This is set out in more detail in Table 6:

Table 6: Future workforce options for pathology staff at November 2016

Option 1:

WTEBlood


Band 2 32.50 1.00 17.00 – 15.23 1.88 – 67.61

Band 3 3.00 1.00 – 1.40 – 0.40 – 5.80

Band 4 4.00 – 6.00 1.00 4.48 – 1.00 16.48

Band 4 CS – – – – – 4.89 – 4.89

Band 5 15.00 1.00 7.00 2.00 16.01 4.10 – 45.11

Band 6 54.00 1.00 17.31 – 8.90 0.83 – 82.04

Band 7 14.00 1.00 4.00 1.20 4.00 1.00 4.00 29.20

Band 8a 3.00 – 1.00 – 1.00 1.00 2.00 8.00

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SERVICE CHANGES E.4

WTEBlood


Band 8b 1.00 – 1.00 1.00 1.00 – – 4.00

Band 8c – – – – – – 1.00 1.00

Band 8d – – – – – – – –

Band 9 – – – – – – 1.00 1.00

OOH – – – – – – – –

Total 126.50 5.00 53.31 6.60 50.62 14.10 9.00 265.13

Option 2:

WTEBlood


Band 2 32.50 1.00 19.00 – 15.23 1.88 – 69.61

Band 3 3.00 1.00 – 1.40 – 0.40 – 5.80

Band 4 4.00 – 6.00 1.00 4.48 – 1.00 16.48

Band 4 CS – – – – – 4.89 – 4.89

Band 5 15.00 1.00 12.00 2.00 16.01 4.10 – 50.11

Band 6 54.00 1.00 18.00 – 8.90 0.83 – 82.73

Band 7 14.00 1.00 5.00 1.20 4.00 1.00 4.00 30.20

Band 8a 3.00 – 1.00 – 1.00 1.00 2.00 8.00

Band 8b 1.00 – 1.00 1.00 1.00 – – 4.00

Band 8c – – – – – – 1.00 1.00

Band 8d – – – – – – – –

Band 9 – – – – – – 1.00 1.00

OOH – – – – – – – –

Total 126.50 5.00 62.00 6.60 50.62 14.10 9.00 273.82

The vacancy rate (budget versus actual establishment) for the medical workforce is currently 9% at Poole Hospital, 37% at Royal Bournemouth and Christchurch Hospitals, and 19% at Dorset County Hospital.

The vacancy rate (budget versus actual establishment) for the non-medical workforce is currently 8% at Poole Hospital, 13% at Royal Bournemouth and Christchurch Hospitals, and 0% at Dorset County Hospital.

Based on the current workforce this would mean a surplus of between 21 to 29 FTE staff, however the vacancy rates are high across the county.


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In terms of the age profile of the workforce, a number of professions do have an increasing number of staff over 55:

East West

Consultants 30% 32%

Registered nurses 33% –

Healthcare assistants 19% 22%

In summary, the current workforce challenges across the county to deliver pathology services are as follows:

• The number of small labs currently in Dorset is too lean to run the service, this includes not enough staff in key areas to respond to service demands and turnaround times, such as the histopathology labs

• Out of hours cover, including lone working in blood sciences in the West of the county

• The increasing age of consultants and other key professional groups

Addressing the Workforce CapacityAlthough the workforce in pathology services is fairly stable, with many having been in post for some time, the proposals to change the existing service provision will ensure the right staff are in the right places and at the right numbers. The proposals address the workforce capacity and identify an overall reduction in numbers required which will in turn be available to be redeployed across the wider hospital or community services; we would not want to lose these valuable skills and resource from Dorset’s services.

As part of the implementation, a more robust out of hours arrangement will need to be in place under either proposal to ensure sufficient numbers of staffing are in place 24/7.

E.4.4 – Acute Maternity and Paediatrics

This section of the Workforce Capacity and Capability Plan responds to these proposals to ensure suitable levels of staffing are in place to deliver these services.

Acute Maternity

Workforce CapacityThe current workforce across the three Dorset acute hospitals providing maternity services totals 384 FTE; in the East of the county it is 284 FTE; in the West it is 100 FTE. This is set out in more detail in Table 7:

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SERVICE CHANGES E.4

Table 7: Workforce profile for maternity services at June 2017

Royal Bournemouth



Hospital

Consultants 0 11.2 11.2 7.8Middle grade doctors

0 2 2 3

Junior doctors 0 17.8 17.8 8.6Nursing 40.4 149.3 189.7 62.9Additional clinical services

0 1.8 1.8 0


11.5 50.1 61.6 17.7

TOTAL 284.1 100

20

11.2

East West

2

17.8

7.88.6

Consultants

Middle

Junior16

12

8

4

0

3

This workforce is made up of medical staff and non-medical staff including midwives and healthcare assistants. The consultant medical workforce establishment is 19 FTE; 11 FTE in the East, eight FTE in the West. The vacancy rate (budget versus actual establishment) for the medical workforce is currently -1.4% at Poole Hospital, there are no vacancies at Royal


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Bournemouth and Christchurch Hospitals, and the rate is 4% at Dorset County Hospital.

In the Major Emergency Hospital and in line with the Royal College of Obstetricians and Gynaecologists7, the recommendation would be to have nine WTE working in a 24/7 service equating to 168 hours ward cover. The existing rota at Poole Hospital provides 60 hours consultant cover with additional medical staff ensuring 24/7 cover for the service out of hours.

For the West of the county, the recommendation would be to have 60 hours ward cover. The existing rota at Dorset County Hospital provides 60 hours consultant cover with additional medical staff supporting the on-call rota.

A sustainable medical rota in both parts of the county is being met by existing workforce numbers however there is a requirement to increase the consultant presence in the East to 168 hours ward cover. This would need to be planned over a phased period.

In terms of the midwifery workforce, it is recommended by Safer Childbirth8 that for an obstetrics led unit 1:28 midwives should be employed, for a midwife led unit or home birth 1:35; so for every 28 or 35 births, one WTE midwife would need to be employed. In Dorset the birthrate plus tool9 is used to benchmark and monitor staffing levels. The birthrate tool10 shows that Poole operate at 1:30, Dorset County at 1:34, RBCH 1:40. The vacancy rate (budget versus actual establishment) for midwives is currently 3% at Poole Hospital, there are no vacancies at Royal Bournemouth and Christchurch Hospitals, and the rate is 4% at Dorset County Hospital.

This shows there is a gap in the number of midwives across the system.

In terms of the age profile of the workforce, most professions have less than 15% of staff who are over 55. The exception is with consultants in the West of the county where 26% are over 55 and healthcare assistants in the East where 20% are over 55.In terms of numbers of future consultants in training in Wessex:

SpecialityObstetricians and

gynaecologists

Length of training programme 7 years (5 years from ST3-7)






Occupancy rates for Aug 17 74.4%

7 The Kings Fund (2011): Staffing in Maternity units; getting the right people in the right place at the right time.

8 The Kings Fund (2011)

9 The Royal College of Midwives: Working with Birthrate Plus: How this midwifery workforce planning tool can give you assurance about quality and safety

10 Dorset’s Workforce Plan (January 2016): Section 2 Maternity and Family Health

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SERVICE CHANGES E.4

In summary, the current workforce challenges for both parts of the county to deliver maternity services are as follows:

• The increasing challenge of recruiting consultant and middle grade doctors; the supply of trainees is not at its full occupancy rate, the age profile of the workforce is increasing and the supply from overseas is reducing

• If under the proposals one 24/7 obstetrics unit is agreed for the county; it has been suggested by existing staff that transferring staff or covering rotas across Dorset would not be sustainable due to the travel required and they would not be attractive for the workforce

• The increasing challenge to secure agency staff and with the restrictions by trusts (numbers and cost) which is impacting the supply

• As the medical workforce age profile increases, this reduces the numbers available for on-call rotas particularly middle grade doctors which has seen an impact locally and an increase in the use of locums

• The increasing challenge of securing midwives, particularly in the West of the county


• Look at how consultant presence can be extended to meet 168-hour ward presence over a phased period and also to cover on-call rotas

• Work with Health Education England Wessex to increase the number of training places and occupancy rates


• Expand and increase portfolio roles for medical and non-medical staff to develop variety and an attractive offer

• Recruitment of new and additional roles – for example care could be delivered by a Physicians Associate and Consultant Midwives


Workforce CapabilityMaternity services across the county already have highly skilled and trained staff, attracting future staff through development and training offers is key to ensure the future sustainability of the workforce. There is an increasing demand for wider skills and role profiles for midwifery and support staff, therefore ensuring sufficient training places are available and that programmes meet the current and future skills requirements of the workforce is crucial.


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Addressing the Workforce CapabilityTo address the capability needs of the workforce in maternity services, a number of recommendations are made. These include:

• Combined training programmes, placements, job rotations across different organisations both in and out of hospital ensuring staff at all levels have the right training to provide safe care



• Working together as a system to develop new roles including Physician Associates and apprenticeships

• Develop the skills of families and carers through patient engagement and education

Acute paediatrics

Workforce CapacityThe current workforce across the three Dorset acute hospitals providing general acute paediatric services totals 159.5 FTE; in the East of the county it is 94.7 FTE; in the West it is 64.8 FTE. This is set out in more detail in Table 8:

Table 8: Workforce profile for acute paediatric services at June 2017

Poole HospitalDorset County

Hospital

Consultants 8 8Middle grade doctors

6 5 (registrars)

Junior doctors 7 9.7Nursing 51.05 31.3Healthcare assistants

22.6 10.8

TOTAL 94.7 64.8

Note: the medical numbers reflect staff covering the acute paediatric rota

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SERVICE CHANGES E.4

This workforce is made up of medical staff and non-medical staff including registered nurses and healthcare assistants. The consultant medical workforce establishment is 16 FTE; eight FTE in the East, eight FTE in the West. It is important to note that the consultant workforce in the West has a more hybrid resident rota to cover a number of wards and clinical services. The vacancy rate (budget versus actual establishment) for this workforce is currently 1.9% at Poole Hospital and 2% at Dorset County Hospital (Royal Bournemouth and Christchurch Hospitals do not have specific Acute Paediatric Services).

In the Major Emergency Hospital and in line with the Royal College of Paediatrics and Child Health11, the recommendation would be to have 10.9 WTE working in a 24/7 service. In line with the Facing the Future standards 201512, a patient should be reviewed within 14 hours by a consultant, four hours by a middle grade doctor. These standards also confirm that all paediatric training rotas should be made up of at least ten WTE posts.

A sustainable rota in the East will therefore require 11 WTE consultants. Based on the current workforce in the East, this would mean a potential gap of three WTE consultants. For the West of the county, if the inpatient unit is retained, the recommendation would be to have ten WTE 24/7. In the West, it would mean a potential gap of two WTE consultants.

In terms of the training rota, both the East and the West of the county would require ten

11 The Kings Fund (2014): The Reconfiguration of Clinical Services; what is the evidence?

12 The Royal College of Paediatrics and Child Health (2015): Facing the Future Standards for Acute General Paediatric Services

10

8

East West

6

7

8

9.7Consultants

Middle

Junior8

6

4

2

0

5


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WTE. Locally, clinicians confirm that there are sufficient numbers of staff to support the lower level training rota but not the higher level consultant rota.

In terms of the nursing workforce, a minimum of two WTE registered nurses is required; one WTE nurse to three patients under the age of two, for older children one WTE to four patients in the day one WTE to five patients at night13. Further work to produce a workforce plan for nursing to ensure sustainable staffing levels are in place is required.

In terms of the age profile of the workforce, a number of professions do have an increasing number of staff over 55. Professions with less than 15% of staff over 55 are not included.

East West

Consultants 22% –

Registered nurses – 100%

Healthcare assistants 26% 31%


Speciality Paediatrician

Length of training programme 8 years (5 years from ST4-8)






Occupancy rates for Aug 17 88.3%

In summary, the current workforce challenges for both parts of the county to deliver general acute paediatric services are:

• The supply of trainees is not at its full occupancy rate and the age profile of the workforce is increasing (the East do not report a challenge in recruiting medical staff)

• As the medical workforce age profile increases, this reduces the numbers available for on-call rotas particularly middle grade doctors

• Recruiting registered nurses to meet the demands of rotas

13 Royal College of Nursing (2010): Guidance on safe nurse staffing levels in the UK

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SERVICE CHANGES E.4


• Work with Health Education England Wessex to increase the number of training places and occupancy rates

• Over scribing on nurse placements; particularly in the West of the county to guarantee filling places


• Expand and increase portfolio roles for medical and non-medical staff to develop variety and an attractive offer

• Recruitment of new and additional roles – for example care could be delivered by a Physicians Associate and the East employ Nurse Practitioners and Advanced Nurse Practitioners to support specific care needs


Workforce CapabilityGeneral acute paediatric services across the county are seeing an increased intensity in the acute needs of patients being admitted often with multiple co-morbidities. Services already have highly skilled and trained staff, attracting future staff through development and training offers is key to ensure the future sustainability of the workforce. Therefore, ensuring sufficient training places are available and that programmes meet the current and future skills requirements of the workforce is crucial.

Addressing the Workforce CapabilityTo address the capability needs of the workforce in general acute paediatric services, a number of recommendations are made. These include:

• Combined training programmes, placements, job rotations across different organisations both in and out of hospital ensuring staff at all levels have the right training to provide safe care



• Working together as a system to develop new roles including Physician Associates and apprenticeships

• Develop the skills of families and carers through patient engagement and education

E.4.5 – Integrated community and primary care servicesThis section of the Workforce Capacity and Capability Plan responds to these proposals to


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ensure suitable levels of staffing are in place to deliver this service.

Workforce CapacityThe current clinical workforce to deliver services in the community is employed in Dorset’s main community and mental health provider, general practices, acute hospitals and in social care services. The current and future clinical workforce numbers are set out in more detail in Table 9:

Table 9: Workforce model for integrated community and primary care services at March 2017:

GP

Current workforce WTE

Future workforce required, WTE

Projected shortage/

surplus, WTE

493 497 -3

116 -102

422 -251

169 -111

572 -131

484 -136

410 -135

19 2

40 -30

13

171

58

441

348

275

21

10

Practice Nurse

Nurse Practitioner

Community Nursing

H&C Assistants

Therapist

Psychiatrist

Pharmacist

Consultant/GPSI

Notes on workforce model for integrated community and primary care services:• Assumptions on the type and duration of patient contacts, imply some areas of primary

and community workforce shortages

• GP capacity in line with need

• Consultant/GP with Specialist Interest resource will need to shift from acutes to meet shortage but increased need for frail elderly

• Need for outpatient as well as LTC’s and rapid response and urgent primary care. Skill mix 70% qualified assumed

• No assumptions made at this point for psychiatry as subject to separate review

• Mental health nursing, Social Care and Pharmacists excluded as workforce assumptions for relevant activity

• Future shortage does not include the additional therapy support provided to community

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SERVICE CHANGES E.4

inpatients

• Does not include therapists from or activity delivered in acute settings

The current known workforce totals 1830 FTE; this includes the workforce for the main community provider and general practices and excludes students, social care staff, acute hospital staff, GP locums and registrars. The future workforce required based on workforce modelling for the new services is circa 2500 FTE.

Based on the current workforce this would mean a potential gap of at least 670 FTE, in addition to the 14% vacancy rate for Dorset HealthCare’s community service teams.

Part of this total current workforce includes the support to the 13 community hospitals; this totals 468 FTE, with an additional seven FTE providing in-reach support. This includes nursing, ward and medical staff and excludes theatre and outpatient staff and community service teams for the main community and mental health provider. The future workforce required based on the clinical workforce modelling for the new community hospitals with beds is 616 FTE, with an additional 100 FTE providing in-reach support. This is not an additional workforce gap to the total numbers provided here.

In order to address this gap in workforce capacity, a strategic modelling assumption regarding the shift in acute bed numbers has been agreed in principle. As a result of the new models of care and acute bed reconfiguration, the estimated net reduction in bed numbers is 17814. This reduction would be used as an estimate of the likely workforce shift from the acute setting to primary and community setting. A high-level assumption of 1.2-1.4 FTEs per bed would release 200-250 FTEs from the acute setting to support new models of care.

This agreement has been made with the following caveats:

• Resources can only be released with a whole bay change and similarly the highest level can only be released on ward basis

• Recognition that the high-level seven wards assumptions may not fall equitably across wards, so the number of wards that could be released can also go down and subsequently the resources aligned to it

• Other staff groups related to the ward based services, e.g. therapists are not included within the high-level assumption so will need further consideration

• High-level modelling will then need to be tested against the bottom up costing approach

• Some of the resource may need to be targeted to non-bed based acute models of care, such as delivery of seven-day services or ambulatory care

The current workforce supporting outpatient services is employed across Dorset’s four NHS providers. It is proposed that there will be a reduction in outpatient appointments by circa 30,000 as services are modernised and some move to the community. Therefore, the future workforce may reduce in line with the reduction in appointments.

14 Decision-Making Business Case Chapter 5.3.5.


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In terms of the requirements of the future workforce, the workforce modelling confirms a shortage of staff in key roles. These include:

• Geriatricians – numbers available as well as the need for them to work across organisations and services

• Registered nurses with specific skills like long-term conditions management, and diabetes;

• Pharmacists and Pharmacy Technicians

• Paramedics

• Health coaches

• Allied Health Professionals, particularly physiotherapists and those who can also support urgent and routine primary care

• Primary care mental health workers

• Healthcare Assistants and Nurse Associates

• Domiciliary care workers

• Trainers – numbers available as well as the numbers who may retire over the coming five years

In terms of the age profile of the workforce, a number of professions do have an increasing number of staff over 55:

Over 55 Source

GPs 16%HSCIC at March 2015

Practice registered nurses 32%

Registered managers 36%

Skills for Care (2015): The size and structure of the adult social care sector and workforce in England, 2015

Registered nurses 28%

Outreach and community support workers

35%

Senior care workers 23%


Speciality Geriatrician

Length of training programme 5 years






Occupancy rates for Aug 17 88%

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SERVICE CHANGES E.4

In summary, the known workforce challenges which impact on the proposed integrated community and primary care services include:

• A significant gap in terms of current versus future workforce numbers

• A shortage of staff in key roles

• An ageing workforce in a number of professions

Addressing the Workforce CapacityTo address the challenge of ensuring the right numbers of staff are available, it is expected that a significant number of staff will transfer from the hospitals as services currently delivered in hospitals move to the community. This is in line with the reduction of beds required in the acute hospitals. A review of the numbers of staff involved is currently being undertaken.

In addition, there is a planned reduction in outpatient appointments which will then result in a further reduction of staff who can then be redeployed across the wider integrated community and primary care services. There is also a planned closure of a number of community hospitals where further staff can be redeployed. In addition, there is proposed national funding, for example regarding the over 75s investment and the planned growth in primary care, which could be targeted towards the recruitment of additional staff.

Based on the anticipated workforce shortage between the current and proposed service model, these suggested methods will need to realise significant numbers of staff from the hospitals and from within the community.

In addition, to address the numbers of staff, the shortage of staff in key roles and the ageing workforce, a number of additional actions will be implemented. These include:

• Movement and transfer of staff to new locations to ensure the right distribution of skills and staff

• Networking and sharing rotas across organisational boundaries (health and social care) and groups – for example Allied Health Professionals, registered nurses and Geriatricians working in both hospital and community services which will in turn lead to the transfer of skills and knowledge

• Recruitment of new and additional roles – for example not all services in the future will need to be provided by a Consultant, GP or nurse, but may be delivered by a Physicians Associate, Allied Health Professional, Nursing Associates, Healthcare Assistant or Health Coach

• Recruitment across organisations (health and social care) and services, including portfolio roles – for example the GPs of the future are looking for variety in roles and this can be provided across different services both in and out of hospitals

• Reorganising the time spent by clinical teams – increasing the time spent on patient facing activity across roles which are patient facing and reducing the time spent on administration


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• Supporting the development of more integrated teams (health and social care) which will in turn lead to a transfer of skills and knowledge


Workforce CapabilityStaff delivering services in the community in Dorset already have a wealth of skills and knowledge which will be required within the proposed new services. However, there are knowledge and skills in some roles and in some organisations which are not widely shared.

In the proposed integrated community and primary care services, there will be a requirement for additional and/ or enhanced skills across all professional groups including:

• Frailty, care of the elderly, co-morbidity, long-term conditions, dementia and mental health

• Urgent care management and proactive management for those frequently using services

• Community working and working as part of an integrated health and social care team

• Supporting people to self-manage and with behaviour and lifestyle changes

• Information skills and use of technology to support greater self-management

• Interpersonal skills for compassionate end of life care

• Skills to improve clinical decision making to reduce length of stays

• Time management to help increase patient facing time

Addressing the Workforce CapabilityTo ensure staff have the right skills to deliver the services, a number of recommendations are made. These include:

• Working with education partners and existing trainers to provide training programmes which cover the breadth of skills all roles required, such as those listed here, as well as enhanced development for key roles

• Expand and increase portfolio roles and placements to increase the long-term sustainability of knowledge and skills across all roles

• Through the transfer of staff from hospitals with ward based skills, and the transfer of outpatient staff with long-term conditions management skills, increase the long-term sustainability of knowledge and skills across all roles



• Working together as a system to develop new roles including apprenticeships.

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MOBILISATION E.5

E.5 – Mobilisation

The impact of the proposed service changes set out in the Clinical Services Review will be far reaching however they won’t happen all at once. This section of the Workforce Capacity and Capability Plan sets out how the teams will be mobilised in line with this implementation plan.

The movement of staffIt is recognised that a large number of staff may have to move and work in different locations as a result of the proposed service changes as set out here. The numbers provided for the transfer of staff between hospitals includes those working in the emergency departments including emergency surgery, acute medicine, critical care, trauma, maternity and paediatric services and elderly care wards as at January 2016.

• If the acute hospital reconfiguration in the East of county, Option A is implemented approximately 500 FTE staff will need to move from Bournemouth hospital to the major emergency site and approximately 200 FTE staff from Poole hospital to the major planned site

• If the acute hospital reconfiguration in the East of county, Option B is implemented approximately 1300 FTE staff will need to move from Poole hospital to the major emergency site and approximately 500 FTE staff from Bournemouth hospital to the major planned site

• For acute maternity and paediatric services in the East, there is likely to be a number of moves for staff including as part of the options set out here, then to a newly built site as part of the capital development programme

• Under the proposals for integrated community and primary care services, these are heavily dependent on a significant number of staff being released from the hospitals and from within the community (outpatient services)

• In line with the proposed closure of a number of community hospitals, a number of staff will need to be released to be redeployed across the integrated community and primary care services

• Under the proposals for integrated community and primary care services, a large number of staff from community, primary and social care services will need to integrate together as a team and in many cases co-locate to ensure the implementation of the proposed changes

These are the larger scale movements of staff though and additional transfers of staff are expected across many organisations and services.

As a system we will need to work together during the implementation of these proposed changes as in many situations, services will need to continue for a period of time before they move to a new site. This will mean for that period of time staff will be required to sustain services in more than one location.

The development of leaders and organisationsAs health and social care organisations, we need to come together to enable change to happen in a consistent and clear way. The Leading and Working Differently Strategy sets out our ambitions to start to develop our leaders and our organisations with a focus on:


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• Working in partnership

• Breaking down the barriers between organisations

• Developing relationships built on trust and confidence

• Learning from shared experiences ensuring a direct impact on quality and safety outcomes

• Communicating and engaging with transparency, no matter how hard the message may be

With these principles in mind, we will work together to support staff and teams to:

• Work differently and across different sites

• Transfer and be part of new, integrated teams

• Learn new skills and develop the way they work

• Become champions of change, improvement and innovation

• Work together to manage the transition and implement the changes

The recruitment and retention of staffAs a Dorset system, the significant risk of implementing the proposed changes is the recruiting of staff to work in Dorset and the retention of staff to stay. Staff are concerned about the proposed changes and the impact this will have on them individually and as a team. For example:

• Moving to a different organisation and organisational culture

• Loss of the current team and service which need to change significantly in the future

• Additional time and travel to a new base

• Working in a community setting

• Working in a hospital setting

• Working as part of an integrated team where there are differences in terms of appointment

Evaluating and reviewing It is recognised that at each stage of the implementation plan and on completion of each service change, evaluation and review of the changes will be important to learn what could have been done differently and what needs to be replicated to ensure the successful implementation of future service changes.

E.6 – Engagement

Engaging and communicating with staff is going to be crucial to ensure staff are supported, involved and are able to contribute to any changes in the current terms of appointment. It will also help staff to work through their concerns with regards to the proposed changes.

Methods of engagementThe Dorset Workforce Action Board, in partnership with the Dorset Social Partnership Forum,

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ENGAGEMENT E.6

will ensure the following principles are in place, overarching all organisations, to engage and involve staff. Key to delivering these principles will be the role of line managers who need to be empowered to support staff:

• Providing clear and timely information to staff, trade unions and representatives in relation to the service changes, as well as the specific details that affect their work area

• Providing the information in a consistent and transparent manner across the system so all staff receive the same information at the same time

• Providing the opportunity for staff, trade unions and representatives to engage in the change process through working groups on service changes

• Providing a range of methods for staff, trade unions and representatives to feedback throughout the change process in a timely manner which will ensure this feedback informs the change proposed

• Providing a range of methods to respond to the feedback which are clearly accessible;

• Ensuring staff, trade unions and representatives are invited to formal meetings as part of the change process and that staff have access to individual meetings, with the appropriate support in place

• Communicating widely the support available to staff through line managers, human rescources (HR) and development colleagues, trade unions and representatives, Employee Assistance Programme and Occupational Health

• Providing training and development to support staff through change including resilience, managing change through to meditation and wellbeing based activities

• Monitoring and reviewing the approach to staff engagement and consultation regularly to ensure it continues to be in line with legislative requirements and organisational change policies

In partnership with the Social Partnership Forum, HR colleagues in Dorset will develop a Dorset Organisational Change Policy with a defined process and supporting documentation to ensure a consistent approach to changes and consultation with staff. Staff will also be involved in engagement and organisational development workshops to support the development of the right culture and behaviours in the new service models. This will be supported by access to training and development.

Methods of communicationKey to retaining and attracting staff to work across organisations and services will be effective and positive communication. There is an opportunity to share positive experiences, showcase the innovative practice and the success of teams across Dorset both internally and externally in the media. It is also important to promote the benefits of change, the opportunities for staff and the positive impact as the changes are realised.

To support this communication, developing change and communication champions across organisation boundaries and services will be crucial and ensure people at the heart of services are involved in staff engagement and communication.


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E.7 – Next steps

This Workforce Capacity and Capability Plan is an iterative and developing document. The next steps to implement this plan over the next 12 to 24 months are to:

• Produce a set of principles from which to develop a Workforce Capacity and Capability Plan to ensure consistency in workforce planning for Dorset and including alignment to the financial challenges as set out in Dorset’s Sustainability and Transformation Plan

• Develop a Workforce Capacity and Capability Plan for each service area over the next 12 to 24 months, the pace at which will be dependent on the readiness of the services and the timescales for changes set out in the Clinical Services Review implementation plan

• Develop an agreed workforce modelling tool(s) for services, co-produced with clinicians and service managers and reflecting Dorset’s services, service activity, Dorset’s population and demographics

• Align with the mental health transformational changes, primary care transformational plans, the social care and third sector workforce to influence a system-wide workforce plan

• Align to the workforce planning activity which is being progressed for mental health services and general practices to ensure recommendations are progressed collaboratively

• Develop intelligence on local demographics which will influence community service provision and in turn influence the types of staff and skills required to deliver those services

• Work with local authorities to improve the decision making around affordable housing and transport to encourage staff to live and work in Dorset

• Develop a system-wide action plan to ensure delivery of the recommendations of this plan, overseen by the Dorset Workforce Action Board, reported through to the Senior Leadership Team and held in the public domain

IMPLEMENTATION: SUPPORTING INFORMATION

F

DMBC – IMPLEMENTATION: SUPPORTING INFORMATIONF.1

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1.1 Contributing Programmes

Whilst the following areas are out of scope of this business case, it is important to understand the context and full extent of the models to appreciate the holistic and dynamic configuration of them. For this purpose, we have described the other areas of work currently ongoing which contribute to providing the future community services.

Accountable Care Communities Accountable Care Systems (ACS) will be an ‘evolved’ version of an STP that is working as a locally integrated health system. They are systems in which NHS organisations (both commissioners and providers), often in partnership with local authorities, choose to take on clear collective responsibility for resources and population health. They provide joined-up, better coordinated care. In return, they get far more control and freedom over the total operations of the health system in their area; and work closely with local government and other partners to keep people healthier for longer, and out of hospital.

Dorset has been announced as one of nine areas in England which will be the forefront of nationwide action to provide joined-up, better coordinated care breaking down the barriers between GPs and hospitals, physical and mental health. ACSs’ will bring together local NHS organisations, often in partnership with social care services and the voluntary sector. We will build on the learning from and early results of NHS England’s new care model ‘vanguards’, which are slowing emergency hospitalisations growth by up to two-thirds compared with other less integrated parts of the country.

We have agreed with national leaders to deliver fast-track improvements set out in Next Steps on the Five-Year Forward View, including taking the strain off A&E, investing in general practice making it easier to get a GP appointment, and improving access to high-quality cancer and mental health services, social care and the NHS.

From this, two Accountable Care Communities (ACCs) are emerging (East and West), aligned to the existing clusters as referenced earlier in this chapter, and will be a core part to delivering health and social care provision for Dorset’s population.

Urgent Treatment CentresUrgent Treatment Centres are community and primary care facilities providing access to urgent care for minor injuries and illness to a local population.

Urgent Treatment Centres should normally have a medical or non-medical prescriber present throughout their hours of operation. They will support the local community and provide quick competent assessment and treatment, linking to Rapid Response services.

Urgent Treatment Centre to be co-located within the Planned Acute Site or within community hubs. In non-co-located units use of telemedicine should be considered to develop and enhance services to prevent the need for transfer to the Emergency Department where clinically safe.

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CONTRIBUTING PROGRAMMES F.1

Urgent Primary CareFuture blueprints are being discussed locally within Primary Care. There is the potential to ‘stream off’ urgent primary care, providing it differently, perhaps at scale as part of a multi-disciplinary approach as part of an urgent care system.

The urgent primary care offer may include a range of options for patients to access same-day care including telephone consultations, e-consultations, walk-in clinics and face to face appointments.

A clear mechanism is in place to ensure primary care takes part in the discharge planning of frail and vulnerable patients following an urgent / unplanned presentation.

Urgent Care visiting serviceProvided by the Multi-Disciplinary Teams, supporting people with very high and high-intensity needs to provide an immediate response to people in the community, the aim of the service is to prevent patients, in their own home and under the care of their GP, from being admitted into hospital if they become unwell and are safe to remain at home.

Senior nurses, mental health nurses, therapists, rehabilitation assistants and social workers make up the teams. A person in need can be rapidly assessed by a senior nurse or therapist and a care plan and care package put in place to help the person remain at home. The community urgent care response team can also help in rehabilitation of people once home from hospital ensuring that people return to their daily routine as soon as possible.

An urgent care response here would result in rapid assessments by either health or social care either in the home or in a unit, and the right level of intervention undertaken. This way of working will ensure people access the services quickly and are assessed and enabled effectively.

Integrated Urgent Care Access, Advice, Assessment and Treatment Service (NHS 111/GP OOH/Clinical Hub).An enhanced 111 will act as a Single Point of Access (SPoA) working in an integrated way with GP OOH, which will be required to use a visiting model which interfaces with Community Hubs and integrated locality teams.

Primary care out of hours’ services need to have arrangements in place with NHS 111 to enable call handlers to directly book appointments where appropriate.

Additional clinical expertise will be available in/via NHS 111 call centre (e.g. Pharmacy, dental, MH and GPs, Dorset labour line).

Special Patient Notes (SPNs), end-of-life and anticipatory care plans are available at the point in the patient pathway which ensures appropriate care.

A Local Directory of Services that holds updated accurate information across all acute,

DMBC – IMPLEMENTATION: SUPPORTING INFORMATIONF.1

172

primary care, community, and social care services including third sector organisations.

Clear protocols to direct patients to community pharmacies where these can appropriately respond to patients’ needs.

Ambulance ServiceMaximising appropriate non-conveyance rates to the Emergency Department is an important enabler to keeping patients out of hospital. By developing integrated community and primary care services, the ambulance service can become a “mobile urgent treatment service” (NHSE, 2014).

Primary CareThe vision for General Practice is that it will continue to be the foundation of the health system, maintaining its position as the leaders of primary care, retaining its identity and registered list. It will build on these strengths and past successes by working in larger groups, as part of wider primary and community teams across a range of sites, delivering care with improved quality, outcomes and access, whilst recognising the importance of continuity of care and building long-term relationships with patients (Pereira Gray et al, 2016). This is to address the issues of vulnerability and sustainability (workload, workforce and investment) and (unwarranted) variation in quality, outcomes and access.

The main Primary Care projects are:

• Access – extended hours, weekend and evenings, 45 minutes and link with urgent care, gaps in access to services

• Estates – Estates and Technology Transformation Funds, local feasibility studies, local estates forums, joint working with Local Authorities, voids, Premises Improvement Grants, Rents, lease queries, facilities management. One Public Estate: Dorset County Council Living and Learning Projects x7

• Technology enabling care – mobile technology, WebGP – patient online access, pharmacy links, digital Dorset

• Transforming primary care (provider development) – cultural change, blueprints, transformation plans, GP resilience – diagnostics, Skill mix, leading and working differently, locality working at scale, hub models

• Prevention at Scale – learning disability health checks, hypertension and cholesterol screening, local Health and Wellbeing plans, self-care programmes, reduction in deaths form preventable causes, LiveWell, diabetes

• Workforce – workforce planning aligned to locality transformation plans and the Integrated Community Services proposals, workforce sustainability, education, training and development

• Workload – in line with the ten high-impact changes, releasing time for care, training for medical assistants and care navigators’ receptionist training

• Commissioning and contracting at scale

• Directly Enhanced Services (DES) – mergers, contract management, Calculating Quality

173

CONTRIBUTING PROGRAMMES F.1

Reporting Services, Business Intelligence, reviews, outcome based commissioning, multi-specialty Community Providers, at scale General Medical Services/Personal Medical Services, GP contract +

• New Care Models – Locally Enhanced Services (LES), DES – Integrated Community Services, Lyme Regis, care pathway development

• RightCare – profiling, demand management – gynaecology and cardiology, Clinical Commissioning Local Improvement Plan – Chronic Obstructive Pulmonary Disease, Atrial Fibrillation, medicines management tool, RightCare focus on dermatology, diabetes – foot care

• Primary care investment – payments, LES, DES, New funding streams, draw down, General Practice Forward View streams

This work supports the six key priority areas as laid out at the beginning of the Decision-Making Business Case Implementation Chapter, which contributes towards closing the financial and efficiency gaps within the Dorset system.

ACUTE RECONFIGURATION: HIGH-LEVEL IMPLEMENTATION PLANS

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DMBC – ACUTE RECONFIGURATION: HIGH-LEVEL IMPLEMENTATION PLANSG.2

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INTEGRATED COMMUNITY AND PRIMARY CARE SERVICES: HIGH-LEVEL IMPLEMENTATION PLANS

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DMBC – INTEGRATED COMMUNITY AND PRIMARY CARE SERVICES: HIGH-LEVEL IMPLEMENTATION PLANSH.1

178

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DMBC – INTEGRATED COMMUNITY AND PRIMARY CARE SERVICES: HIGH-LEVEL IMPLEMENTATION PLANSH.1

180

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clinical services review decision-making business case · 2017-09-27 · business case. september...

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