Healthy Weston programme update – October 2018

Over the summer, doctors and local health leaders have continued their work considering what services the population in Weston and surrounding areas needs in the future and how they can best be delivered. There are four key issues that need to be addressed:

  • Our population is growing, getting older, living with more long-term conditions, and there are significant inequalities in health amongst our local communities – people have changing health needs we need to meet.
  • There is variation in the way GP, primary and community care teams currently provide care across the area, with some patients finding it more difficult than others to access the right care for example
  • Some of our hospital-based services at Weston are not able to consistently meet national clinical quality standards because of low volumes of particular cases and specialist staffing shortages.
  • There is a growing financial gap between rising costs and available funding. We must live within our means, get best value and make sure we use our available financial resources most effectively to meet the needs of the whole population.

All of these mean we need to make some changes across the local health and care system.

New ways of working

The challenges and opportunities, and the ambition for local services, were set out in a ‘Commissioning Context’ document by Bristol North Somerset and South Gloucestershire Clinical Commissioning Group in October 2017.

This paved the way for many conversations with staff, patients and local people and identified three areas for change:

  • Changes we can put in place immediately and are getting on with; such as better support for people in care homes, improving home visiting by GPs, (and developing a consistent approach to frailty assessments in the community).
  • Changes we can implement imminently but require further work; for example, developing a business case to establish a mental health crisis café in the centre of Weston, and better integrating children’s services across different provider organisations.
  • Changes that would enable us to ensure we have a strong and focused hospital at Weston, able to deliver to the highest clinical quality standards and that is affordable for the long-term within our available funding; for example, developing better multi-agency working and identifying new clinical models and ways to deliver services sustainably.

In this latter area we have now started the work on looking at potential clinical models and will then have a further period of listening and co-design before going to
formal public consultation early next year.

We know we need to think about how we can design strong and focused services at Weston hospital, to make sure it can continue to deliver high quality services that best meet local people’s needs into the future. This includes identifying the services that Weston General Hospital is best placed to provide, and which services may be more effectively provided to local people by one of our neighbouring hospitals or in the community. Similarly, there may be services currently provided in other places which are better delivered and consolidated in Weston hospital. The issues we face here are common to many communities with smaller hospitals across the country and our ambition is that we make Weston Hospital an exemplar of how services can be designed and delivered sustainably by smaller hospitals in the future.

The work over the summer, led by a group of clinicians from Weston Hospital, Bristol, North Somerset and South Gloucestershire Clinical Commissioning Group, neighbouring hospitals and other partners has been focused on this element and has made good progress.

Alongside this there is work underway to make sure that the services people need in their local community – GP services, community, mental health, ambulance services, work with voluntary sector partners – are there when people need them and complement the services delivered in hospital.

Identifying ‘what good looks like’

The clinicians have looked at best practice in the way care can be delivered, internationally and nationally. From this they have identified the ideal journey a patient should take from the start to the end of their care and what treatment they should expect from a clinical perspective for different areas of care. These areas include: care for people with frailty and long-term conditions; maternity and services for unwell children; planned care services (for example, planned operations and treatments); and urgent and emergency care. They have discussed ‘what good looks like’ in terms of clinical quality, for example: how and when diagnostic tests and interventions should be started; who is best able to provide the right care; how and when to escalate to more specialist services and ease of step down from these; and how innovations in technology could support and enhance the delivery of services in new ways.

The clinicians have been discussing a wide range of possible models of care to deliver the best practice they have described, informed by practice that happens elsewhere. These models are based  on the national clinical standards that exist and what it is theoretically possible to provide in areas such as A&E, maternity care, planned surgery and children’s services.

Bringing different areas of best practice together to design potential ‘models of care’

By looking at five different potential ways to deliver A&E, four different ways to deliver emergency surgery, five different ways to deliver emergency medicine, four different models of critical care, three different ways to deliver maternity services, five models for children’s services and four different ways to deliver planned care services, over 1,000 different permutations of how services could be designed have been identified.

Developing potential models for Weston

Clinicians have looked at the links between different services; how services work together and what different supporting services each needs. Thinking in this way and applying some high level evaluation criteria enabled the clinicians to rule out many of the permutations to arrive at a more realistic set of potential models of care for Weston.

Systematically and carefully over the summer the clinical group narrowed the number of potential options down to six clinically distinct and different ways of delivering urgent and emergency care along with a combination of frailty, maternity, children’s services, and planned operations for the people of Weston.

Common features amongst all the models of care

All the models of care include bringing together services for frail older people in a joined up way as this was one of the most important things we heard from our engagement with local people earlier this year. This will mean that in future, for example, an older person who may be confused, has had a fall, and is struggling to cope at home alone could be cared for by a team that links their GP, community based clinicians, and social care services together, as well as hospital staff, in a more comprehensive way. In this way people will be supported to stay healthy, well and independent in the community. And, where they do need hospital care, they will be supported to get back to independent living as soon as possible.

In addition, all the models include outpatient services, diagnostic imaging (x-ray, ultrasound, CT, MRI scans) and pathology services (for example for blood or urine testing) and joined up services for those with long-term conditions. They would all seek to maximise the opportunities to use technology to improve access to services and to enhance closer working between specialist teams.

All the models rely on good, comprehensive GP, community and mental health services across the local area, working more closely with hospital teams and the ambulance service, and with those who provide day-to-day home and social care support for local people.

Applying the models of care to Weston

The six clinically possible models have been singled out for further detailed analysis and work because they are distinctive and different enough to be explored, tested,
analysed and compared further as part of a rigorous process to identify the best potential way of delivering services. The clinicians deliberately agreed to identify models that were significantly different from one another and covered the full range of possible models for Weston. This has been done purposefully so we can be confident we have looked at all possibilities thoroughly and robustly. It is important to emphasise none of these models have been selected for Weston. The next stage of the design work is to look at the models and apply them specifically to the needs of people in Weston, looking at current services delivered across North Somerset, the workforce needs and costs of each and so on, and to determine and describe the best, most viable, workable options that meet local needs.

Next steps in the process

Those options identified with the best potential will undergo more detailed analysis until we are able to identify preferred option(s) for public consultation next year. Building on the outcomes of our earlier public listening exercise, criteria to evaluate and compare each option have been developed and agreed in discussion with clinicians, staff, patients and local people. They cover quality of care, access, deliverability, workforce and affordability. The clinical group, and ultimately the Governing Body at Bristol, North Somerset and South Gloucestershire CCG, will use these to assess the options and to support their decision-making.

An ongoing conversation

It has been clear for some time that we need to change the way we design and deliver services; to meet changing needs, to improve care outside of hospitals, to embrace new technologies and advances in medicine, to ensure we live within our financial means, and to secure a strong and dynamic future for Weston Hospital.

We have been talking with staff, stakeholders, patients and local communities for some time about how we can meet the challenges and embrace the opportunities.

We want to continue to hear views from the public, patients, staff, and stakeholders on the work to date and to ensure over the coming weeks that concerns, feedback, opportunities and benefits are captured to inform the work as it progresses.

No final decisions have been made on the future of services and won’t be until after a formal public consultation next year. In the meantime, we are continuing the conversation and there are a number of ways you can get involved and continue to give your views over the autumn and winter.

We will be holding public meetings and ‘drop-in’ sessions where you can come and find out more and give your feedback on our work so far, and will be providing information online and through leaflets and posters in GP surgeries, hospital waiting rooms and local community spaces.

Details for these will be publicised over the coming weeks on the Get Involved page. For further information, please contact us on 0117 900 2198 or by email at bnssg.healthyweston.enquiries@nhs.net.

We will continue to give regular updates on this important work and the progress we are making.

Find out more about how you can get involved