Transforming Care Services in north and mid Hampshire

In November 2017, West Hampshire and North Hampshire CCGs and Hampshire Hospitals NHS confirmed that they would continue to work together to deliver their shared vision for care for the north and mid Hampshire area: improved access to high quality, safe and clinically effective services that offer local people convenience and choice, with a greater focus on prevention and early intervention and care increasingly delivered locally.

Specifically, they agreed:

  • to continue to develop and implement plans for rolling out more joined up local health services both in and out of hospital over the next few years;
  • to continue with the current programme arrangements in order to develop proposals for the centralisation of services within the current Hampshire Hospitals’ footprint (Andover, Winchester and Basingstoke), thus ensuring that patients continue to have access to the safest and highest quality care. This will include exploring any necessary capital development to support relocation of services;
  • other options, including a standalone critical treatment hospital, will not be progressed at this time as part of the programme.

Next steps

The two CCGs and the Trust continue to work in partnership with the programme to identify how best to configure services between the three current sites (Winchester, Basingstoke and Andover) with a focus on:

  • High quality care in and out of hospital in line with national best practice
  • Joined up local care close to home or at home, focused around the patient's whole needs
  • Less reliance on acute hospitals
  • Using the benefits of rapidly developing technology.

The NHS Five Year Forward View clearly describes that the NHS and social care needs to fundamentally change how the health and wellbeing needs of local people are met. Likewise, local people have consistently told us that they want to be able to manage their health and wellbeing more effectively with services provided as close to their own homes as possible. We have started to develop a new way of providing care differently which has three key elements – keeping people well; strengthening local primary and community care; and providing specialist care where needed.

The TCS programme focuses on more joined-up local care and builds on the significant enhancements already undertaken locally.  For example, patients in Winchester, Andover and surrounding villages are now able to see a GP, nurse and healthcare assistant in the evenings and at weekends, thanks to new services recently rolled out in those areas.

Over the next year, we will develop local health and wellbeing hubs in Andover, Alton, Basingstoke, Eastleigh, Romsey and Winchester.  These hubs will bring together health, social and third sector services, including in some hubs co-location of GP practices, to provide a wide range of co-ordinated, joined-up care.  Typically, this will include community, mental health and outpatient services, so that patients have their care in one place rather than multiple appointments in different locations.  Hubs may also be able to offer a range of diagnostic services that may include X-ray, endoscopy, ultrasound and phlebotomy; physiotherapy; screening and immunisation services and some day-case surgery.  Hubs may also provide access to health and well-being services, such as a Citizens’ Advice Bureau and/or a pharmacy.

Patients will also have 24/7 access to consultant advice and support as well as step up/step down community beds for patients with long term or chronic conditions who need short-term urgent care. 

A new 10-bed hospice is planned on the site of the Royal Hampshire County Hospital in Winchester to support patients with life-limiting illnesses and their families.  The facility aims to open its doors by early 2019.  The service will also support increased Hospice@Home care for those who wish to die at home with support.

Providing this wide range of care locally will help ensure that patients have a better experience of health services, with improved local care and proactive and co-ordinated care for people who have complex needs.  This will include:support at home, with enhanced community-based care, so fewer people will go to attend or stay in hospital and more people will be able to leave hospital earlier.  People will have access to online support and apps for their mobile phones to help maintain their independence and stay at home safely. 

The learning from these approaches and others from across the county clearly demonstrate that providing care in this way means that fewer local people need to be seen in hospital and there is the opportunity to develop this even further.

Work continues to identify how best to configure services between the Trust's three current sites (Winchester, Basingstoke and Andover).  An independent estates survey of these sites was completed at the end of January.   The Trust is currently reviewing some of its clinical services to identify whether there are opportunities for further centralisation of some services.  The outcome of these reviews and the proposed next steps will form part of the next programme update to the two CCGs in April.

Background

In March 2017, West Hampshire CCG, North Hampshire CCG and Hampshire Hospitals NHS Foundation Trust began working together on a significant and intensive programme to understand how local health services could be developed to provide more joined up local care across hospital services, community, primary and social care. This included considering which options for acute hospital services within the Hampshire Hospitals NHS Foundation Trust footprint would best achieve the delivery of high quality care for the patients who require the most specialised clinical services.

The goal of the programme is to ensure that the health and social care system can meet the many opportunities and challenges facing it by empowering people to stay well and to providing safe, high quality, consistent and affordable health and care to everyone.

The work was underpinned by an engagement programme with local people supported by external independent market research (hyperlink).

On Thursday 30 November 2017, the Boards of both West Hampshire Clinical Commissioning Group and North Hampshire Clinical Commissioning met in public in Winchester and approved the recommendations resulting from the work.

The programme had considered a number of options, informed by public research, which were evaluated against agreed criteria.

The work looked at the potential for further centralising some hospital services, particularly for patients who need specialised clinical services.  It explored a number of potential options and took input from clinicians from the Trust, local GPs and neighbouring NHS Trusts and local authorities.  The options included the Trust's original proposal for a new critical treatment hospital on a green field site near junction 7 of the M3. 

A detailed appraisal of options concluded that, compared to the current position, all of them would offer better clinical services and some would offer improved access to services and have a positive impact on the workforce.  However, it also ruled out a large number of them, including the Trust’s proposal for developing a critical treatment hospital on a new site.

The appraisal concluded that the critical treatment centre was not affordable, given the financial challenges facing the local NHS.  Therefore, the recommendation to the two CCG Boards is that it is not appropriate at this time to proceed to formal consultation on a future configuration of acute services for the people of north and mid Hampshire.

The key recommendations presented to the Boards were:

  • To continue to develop and implement plans for rolling out more joined up local health services both in and out of hospital over the next few years.
  • To continue with the current programme arrangements in order to develop proposals for the centralisation of services within the current Hampshire Hospitals’ footprint (Andover, Winchester and Basingstoke), thus ensuring that patients continue to have access to the safest and highest quality care. This will include exploring any necessary capital development to support relocation of services.
  • That other options including a standalone critical treatment hospital will not be progressed at this time as part of the programme.

These were all accepted at the joint Boards meeting on 30 November.

  • This includes an exercise led by Hampshire Hospitals NHS Foundation Trust to survey the three hospital sites and provide a report to the Transforming Care Programme Board in January 2018.
  • Hampshire Hospitals NHS Foundation Trust to provide a current positon statement on clinical safety and sustainability for the five services identified in the ‘case for change’.
  • Hampshire Hospitals NHS Foundation Trust to continue to be partners in the co-design a future model of care that will secure the long-term development and provision of out-of-hospital services.

The results of this engagement are now available in the full report and in a summary report and slide pack.

Outcome

The joint board of North Hampshire CCG and West Hampshire CCG met on 30 November 2017, when they decided not to recommend consultation on a new critical treatment hospital.

Click here to read a press release issued by the CCGs

 

In response to this decision, Alex Whitfield, chief executive of Hampshire Hospitals NHS Foundation Trust, said:

“We support the commissioners’ focus on improving care outside of hospital and we continue to work collaboratively with partners towards that goal. We are pleased that commissioners are supportive of centralising some services for the benefit of patients. However, we are disappointed that the recommendation of our clinical commissioners is not to consult with the public on a new critical treatment hospital at this time.

“Our clinical strategy, which has been developed over the last seven years, has concluded that the best option is to centralise some of our critical care services at a separate site (a critical treatment hospital). We believe this will ensure even better patient care into the future and as such a critical treatment hospital remains a central consideration in our strategy. Indeed joint work completed this year recognised that this plan would improve quality and accessibility for our patients. However, it concluded that it is not affordable – a finding based on ambitious assumptions for reducing the money spent on hospital services.

“While we support the commissioners’ focus on improving care available outside of hospital, there will always be a need for some hospital based services for the seriously unwell, for emergency care, complex surgery, maternity care and children's services. These services are best provided in a facility that is accessible for everyone and is fit for future generations, taking into account the planned increase in our local populations.  

“In the meantime, our dedicated and compassionate staff will continue to focus on providing great care for our patients within our existing buildings. We are fully committed to working with our health and care partners in Hampshire to provide the best care we can.

“We remain committed to creating a cancer treatment centre for the people of north and mid Hampshire and are hugely grateful to all those who have generously donated. Our fundraising campaign is active and ongoing.

“Hampshire Hospitals NHS Foundation Trust is rated Good by the CQC and Outstanding for care, which is demonstrated  daily  by the Trust’s dedicated and compassionate staff. We will continue to engage with our staff and our communities in Andover, Basingstoke and Winchester whenever we consider our services and how they may develop.

“Meanwhile, we continue to work in close partnership with commissioners, GPs and primary care, social services and Southern Health as part of our Local Care System and we are all committed to working together to provide the best care for our population in the most appropriate place.”

 

 

 

 

 


updated 23 March 2018

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