Welcome to the third update on the Worcestershire Joint Services Review.
The four Clinical Working Groups, looking at elderly care, emergency care, planned care and women and children’s services, held their third meeting on 19 April. They continued their discussions on how different models of care could offer high quality, safe and affordable acute healthcare services for Worcestershire into the future.
There are a number of challenges facing healthcare services, both nationally and locally, including an increasingly older population and corresponding increases in the number of patients with long term conditions, clinical guidance on quality and safety, and national pressures on the NHS to improve cost efficiency.
Over the coming weeks, the emerging options for change will be discussed, modelled and refined. The decision criteria on which they will be assessed will also be set, working with both staff and public to decide how these criteria should be weighted to ensure the best decisions are made for Worcestershire.
Listen to key clinicians talk about the Joint Services Review, how the discussions are progressing and what happens next, on our latest ‘talking heads’ video.
Focus groups made up of patient representatives and the public have met to add their thinking to the option development process. A summary of their discussions is available on the Joint Services Review website.
Further focus group sessions will be held on Wednesday 16 and Thursday 17 May, when we will be discussing the emerging options for delivering acute healthcare services into the future, and how the decision criteria should be weighted to help us decide which options would offer the best solution for Worcestershire.
Your views and opinions will help to design services that will best meet the county's healthcare needs, and so we would like to invite you to take part in these discussions:
Venue: Kidderminster Hospital, DY11 6RJ
Dates: Wednesday 16 May 2.00pm
and Thursday 17 May 10.00am and 2.00pm
If you would like to take part in one of these three focus group sessions, please contact us to book a place.
I attended some of the initial Focus Groups and found the briefings from the lead clinicians clear and succinct with explanations of the outline of the terms of reference of the groups and feedback on initial thoughts of the direction clinicians are heading with their thinking.
Whilst all the groups are considering areas which interface with other forums of health and social care in the county, the elderly care group particularly recognises the need to consider issues more holistically. Early intervention and planned social aftercare will significantly reduce the demand on acute care for the elderly. In so doing, it will also improve the health of the overall population in Worcestershire.
It seems to me that the key outcomes of the JSR are:
- the need for clinicians to come up with appropriate recommendations which achieve the key targets they have set and,
- the need for the public to recognise and accept that there has to be a fundamental change in how and where some services are delivered for us to keep the NHS a strong, vibrant, high quality service which we need and expect to keep our communities healthy in Worcestershire.
The implications of some of the changes will need to be carefully considered and addressed or they will be ‘doomed to fail’. There is a logic to good organisation of services. The British are renowned across the world for this and we need to embrace this element of the work after careful scrutiny to ensure it will deliver against the core objective themes being pursued.
I believe the JSR represents a genuine opportunity to re-shape acute care (and to some extent social and pastoral care) in the communities in Worcestershire and I believe we should actively participate with an open and scrutinising mind to ensure our local services are re-developed so they are fit for purpose for the next ten years and beyond. We need to ensure they deliver high quality standards for the citizens of Worcestershire which we can be proud of.
The over-arching question we need to be able to answer to support the forthcoming proposals is: will these changes ensure we are looked after properly when we are ill?
News from the Clinical Working Groups
We discussed how national and international best practice models could be used in Worcestershire to help us meet our ambitions for patients over the age of 65 to reduce average lengths of stay and to achieve a 10% reduction in non-elective admissions.
We considered how these models could ensure that patients:
Have rapid access to assessment by a specialist consultant
Receive care as close to home as possible
Receive care in the most appropriate healthcare setting, with effective transfer processes from acute hospital settings.
Using these models could help us to ensure that patients receive the most appropriate care by making sure that patients are seen by specialist clinicians, resulting in a more effective healthcare service offering value for money.
In terms of the location of services, we discussed how elderly care services could be adapted to suit the needs and preferences of other groups. The group discussed how services might be delivered across sites, with support from and liaison with a strong community healthcare service. There was a strong view that community hospitals offered great potential to be used even more in care of the elderly and that should be explored. Find out more about the elderly care working group
We looked at the different models that could make best use of resources in both in hospital settings and within the community. We examined issues relating to particular patients and conditions to make sure that these models could offer high quality and affordable services for the future, including how we can make sure we have a skilled workforce available 24 hours a day.
We looked at examples of 'home grown' innovation, for example using integrated teams to oversee care in care homes to avoid crisis admissions,as well as looking at lessons the Worcestershire health service could learn from other examples around the country. The headlines from the recent focus groups were also presented and discussed by the clinician who had attended the session on emergency care.
The discussion moved on to how other services, such as ambulance, critical care and pharmacy could support any new model for providing high quality and safe emergency care and how different patients and conditions could be best managed in community care settings rather than by A&E. The group was agreed that links between the various healthcare settings and approaches could be better and that getting the right care at the right time was a priority.
Looking at these specific issues is helping the group move towards likely options but further data and evidence was asked for. This additional information will help the group move toward some final recommendations. Find out more about the emergency care working group
We looked at how a range of different models of care might enable us to deliver high quality, affordable planned services, including outpatients, diagnostics and pre-planned surgery. We particularly focussed on the specialties that account for the largest percentage of our patients, including trauma and orthopaedics, general surgery, urology and ophthalmology, and looked at how we might best deliver both complex and more straightforward services across Worcestershire. We looked at how we can concentrate planned care services to protect patients from cancellations due to emergency cases.
Each of the specialties included in the planned care working group have been looking objectively at how their services are currently provided, what could be the options for delivering high quality, safe and affordable services into the future and the facilities and staff that would be needed to implement these different options. Find out more about the planned care working group
As a group, we spent time debating a number of different options for how inpatient and outpatient obstetrics, gynaecology, maternity and children’s services across Worcestershire could be delivered in the future to ensure that our patients receive a high quality and safe service that is affordable in the long term.
Discussions focused on the deliverability, quality, access and affordability of the options, with members using the views of the patient and public focus group into women’s and children’s services and looking at successful models of care in other hospitals to guide their discussions.
The outcomes from the meeting will now be taken to the review’s Clinical Reference Group and Clinical Senate, along with the outcomes from the other working groups, to determine a long list of options which we will then share more widely. Find out more about the women and children's services working group
The range of options that the four working groups have discussed will be assessed, modelled and reviewed by a reference group of senior clinicians. The options will then be incorporated into an overall set of proposals for delivering healthcare services across the Worcestershire Acute Hospitals NHS Trust. These proposals will be evaluated by the Clinical Senate before being presented to the clinical community, to other NHS Worcestershire staff and to the public.
The decision criteria on which the options will be assessed will be set, working with both staff and public who will help decide how these criteria should be weighted to ensure that the best decisions are made for Worcestershire.
Have your say on these discussions by joining in the debate on our Discussion Board