- Background to the Path to Excellence programme
- The clinical review process
- Involvement of staff
- Consultation process update
Path to Excellence is a five-year transformation programme which began in autumn 2016 with the aim of improving the quality of healthcare services across South Tyneside and Sunderland. The programme is aligned to the national vision for the NHS, as set out in the Five Year Forward View, which focusses on three core areas:
- Care and quality – Closing any gaps in quality and safety which exist by reshaping how we deliver care and driving down variations in patient experience and clinical outcomes which exist
- System efficiency – Removing unnecessary organisational boundaries to create better efficiencies across the system and allow the development of truly person centred patient care
- Health and wellbeing – Focussing attention on ‘prevention’ so that people are empowered to take accountability and responsibility for their own health and wellbeing and do not become unwell with completely avoidable illnesses
The Path to Excellence programme involves South Tyneside NHS Foundation Trust and City Hospitals Sunderland NHS Foundation Trust who came together in March 2016 to form a strategic alliance known as ‘South Tyneside and Sunderland Healthcare Group’.
Both providers are working closely with commissioners NHS South Tyneside and NHS Sunderland Clinical Commissioning Groups. The programme has been set up to ensure that future services are developed in a way that provides the highest possible quality of safe patient care and the best possible clinical outcomes for patients in line with all available clinical evidence and guidance.
It is also about making sure that the local NHS in South Tyneside and Sunderland can regularly and effectively meet important national quality standards, set by the NHS, to ensure patients have quick access to specialists in emergency situations seven days a week.
By changing how some hospital services are delivered in future, it is hoped that this will also help address the difficult recruitment challenges in the workforce, which are being felt right across the NHS, by creating innovative services in South Tyneside and Sunderland which appeal to medical and nursing professionals.
The Path to Excellence programme began the first phase of public consultation in July 2017 around a range of options in three core areas of acute hospital care across South Tyneside and Sunderland. These areas are as follows:
- stroke care services
- maternity (obstetrics) and women’s healthcare services (inpatient gynaecology); and
- urgent and emergency paediatric services
The options being presented are ideas that could help solve some of the problems the services are facing – the public consultation period is the opportunity to share these proposals, for people to feedback their views – and to give alternative suggestions if they feel there are other valuable ideas to consider.
No decisions have been made about the outcome of this consultation – the final decision will be made by the clinical commissioning groups in early 2018 after consideration of the feedback gathered through the public consultation process.
All information about the public consultation, including how to get involved, is published on the programme website www.pathtoexcellence.org.uk.
The clinical review process
The options for consultation have been developed following a detailed clinical review process which has been led by small design teams of key senior clinical staff – doctors, nurses, midwives and therapy staff (where appropriate) – working in both South Tyneside and Sunderland hospitals.
This process involved asking service-specific clinical teams covering stroke, maternity, gynaecology and paediatric staff, in both hospitals, to describe how they think these services should be delivered in the future.
Each clinical team reviewed their service, looked at the clinical evidence base and local data, and developed a long-list of potential options. Each option was then assessed against key areas in line with the aims published in the Path to Excellence issues document and includes the following:
- providing a wide range of safe, high-quality and accessible healthcare services
- making the best use of our senior medical staff at all times
- providing value for money
- further investment in services that are of most benefit to patients
- sharing resources and services in areas where patient numbers are low.
The table below summarises the key tests to develop options that will deliver long-term effective solutions to secure improved health outcomes in our area:
|key criteria||Sub-criteria questions|
|Supports sustainability/service resilience||• Does this option support service sustainability from a clinical workforce perspective?
• Does this option support service sustainability from a population and activity perspective?
|Will deliver high quality, safe care||• Does this option deliver improved quality than that delivered in the current service configuration?
• Does this option deliver applicable quality/safety/experience standards and regulatory requirements for service?
|Is affordable||• Is this option deliverable without any significant additional cost impact to commissioners and the wider healthcare system?|
|Is deliverable||• Is this option deliverable within the next 1-2 years?|
Only options that satisfied the key criteria outlined in the previous table were developed further. Options were then further evaluated to fully assess the clinical quality, accessibility and choice, deliverability and affordability implications of the proposals and to inform any decisions around options which could be subject to formal, public consultation.
Clinical and non-clinical staff from both South Tyneside NHS Foundation Trust and City Hospitals Sunderland NHS Foundation Trust were equal parties in this process, with different groups of clinical staff involved over the past 18 months.
The clinical review process has also had involvement from the clinical commissioning groups in South Tyneside and Sunderland, in particular GP clinical directors, who hold leadership positions and are also local practising GPs. External bodies have also been involved in reviewing the clinical options being developed these include:
- NHS England
- NHS Improvement
- Health Education England
- Northern England Cardiovascular Disease (CVD) Clinical Network
- Clinical leads from the North of England Maternity Network
- The North of England Neonatal Network
- Independent clinical representatives from the North of England Child Health Clinical Network
- The Consultation Institute
A pre-consultation business case for change has been through a rigorous external assurance process by NHS England, the body responsible for ensuring local transformation plans are robust in order to proceed to public consultation.
All the key documents, including the pre-consultation business case, are published on the pathtoexcellence.org.uk website.
Involvement of staff
The clinical service reviews for the three areas currently being consulted upon began in late summer 2016 and from the outset this has involved a small number of key senior clinical leaders in both hospitals working together to discuss how they think services should be delivered in the future.
This process began with a ‘case for change’ being developed which incorporated all the clinical evidence base and data available in order to develop potential future options.
Design teams made up of representatives from the consultants, senior nurses, midwives and therapy staff groups (where appropriate) working in the three service areas in both hospitals were invited to get involved with dedicated time to discuss and develop potential future models. Together, these clinical teams have led the development of the proposed options which have passed the tests and are now being consulted upon.
As part of the formal consultation process that is now underway, staff working in both hospitals are being actively encouraged to share their views and to submit any further ideas they might have as to how services could be best delivered in the future.
Whilst some members of staff have attended public consultation events, further service specific clinician-led engagement events are being held across both hospitals in September so staff can easily share their views. All feedback gained will be shared with the CCGs for inclusion in the independent analysis of consultation feedback and any ideas arising from these will be assessed in line with the key test criteria described above.
The consultation process
The Path to Excellence programme wants to ensure that staff, patients, the public and other stakeholders are able to give their views on the options under consideration. As part of the consultation there are a number of different ways to do this.
- Public events – question and answer style events and deliberative style events (with more being planned for September and October)
- Staff events across both trusts
- Self-completion questionnaire – on-line and paper with freepost
- On-street survey for tax payer/resident opinion
- Direct mailing survey to patients with experiences of current services
- Focus groups with specific interest groups
- Individual submissions from any interested party, individual or organisation
As part of the public consultation, public events play a key role. The events have been developed as part of the best practice approach for consultation as recommended by The Consultation Institute.
The events have been organised to allow people the opportunity to hear directly from the NHS about key issues under consideration so they can give their views in a way that allows them to be captured, analysed, reported and therefore influence the outcome of the consultation decision.
In order to ensure that attendees have a good experience at the events, it is important to ensure they are appropriately staffed which is why participants have been asked to register in advance. For every eight participants, one trained table facilitator and one scribe is needed – again in line with best consultation practice. Key data monitoring information is also asked for because the NHS is legally obliged to do so, however respondents can choose whether or not they wish to give it.
The current consultation programme has been planned to ensure there is flexibility to do additional activity in the latter part of the consultation phase in September and October. Additional events are being planned and the details of these will be shared soon
In line with consultation being a ‘continuous dynamic dialogue’, the programme team review how the public events have been running and what can be changed as a result in order to respond to public feedback on the event delivery and opportunities to have additional events – this is all to ensure people have the opportunity to give their views and for them to be recorded in a meaningful way in order to influence the consultation outcome. It is very important that all feedback is captured.
So far the consultation has had:
- 329 people attended an event
- Over 1000 comments received from events
- 3836 website visits
- 142 survey responses
How to get involved
- Attend a public event – visit pathtoexcellence.org.uk for details with more being planned
- Attend a staff session – check out trust intranet for details
- Complete a survey – available online (click here) or contact us for a paper copy
- Offer to hold a focus group or event – please contact the programme if you are interested
- Provide an individual or organisational response or submission via email or post (contact details below)
How to contact the Path to Excellence Programme
- Email: firstname.lastname@example.org
- Facebook: Search: nhsexcellence
- Twitter: @NHSexcellence
- Call on: 0191 217 2670
- Write to:
The Path to Excellence
North of England Commissioning Support
Newcastle upon Tyne
People have until midnight on 15th October to return a survey or to provide a submission.
All feedback will be collated and analysed by an independent organisation (not the NHS) and a draft feedback report published in December. Further public events will be organised to share this feedback, and the next steps will be shared in detail at the point.
The final decision will be made the two clinical commissioning groups at their governing bodies held in public in early 2018, dates to be advised.