Children and young peoples (urgent and emergency paediatrics) healthcare services
Option 2 the development of a nurse-led paediatric minor injury and illness facility at South Tyneside District Hospital – open 8am to 10pm – and 24/7 paediatric emergency department at Sunderland Royal as the most sustainable long-term model.
However, the clinical commissioning groups recognise that it will take a period for the development work for this be deliverable therefore approve option 1 for implementation in the short-term which is the development of a daytime paediatric emergency department at South Tyneside District Hospital and 24/7 paediatric emergency department at Sunderland Royal.
For clarity, option 1 has been approved as a transitionary step towards option 2. The South Tyneside daytime paediatric emergency department service and future nurse-led paediatric minor injury and illness facility will be open from 8am to 10pm – extended from 8pm because of public consultation feedback.
The new models will ensure that every minute of every day that the new service is open there will be paediatric consultant cover – this is not the case at the moment.
The decision follows a public consultation into the future of four hospital services, which launched in July last year.
The decisions mean that clinical leaders at South Tyneside NHS Foundation Trust and City Hospitals Sunderland NHS Foundation Trust can start to work with local staff teams to make changes over the next several months.
CCGs decision-making process on Children and young peoples (urgent and emergency paediatrics) services
Option 2 the development of a nurse-led paediatric minor injury and illness facility at South Tyneside District Hospital – open 8am to 10pm – and 24/7 paediatric emergency department at Sunderland Royal Royal is recommended as as the most sustainable long-term model.
However, the clinical commissioning groups recognise that it will take a period for the development work for this be deliverable therefore approve option 1 for implementation in the short-term which is the development of a daytime paediatric emergency department at South Tyneside District Hospital and 24/7 paediatric emergency department at Sunderland Royal.
For clarity, option 1 has been approved as a transitionary step towards option 2. The South Tyneside daytime paediatric emergency department service and future nurse-led paediatric minor injury and illness facility will be open from 8am to 10pm – extended from 8pm because of public consultation feedback.
The Governing Body members of South Tyneside and Sunderland CCGs are asked to note implementation of option 1 will aim to be complete by April 2019, as a transitionary step. Implementation of option 2 should include an independent, external group to review the transition and proceed at an appropriate pace over the medium-term, for likely completion by April 2021.
This recommendation is made based on all evidence considered, not least that:
- There are conflicting views about the preferred options across local clinical teams and external clinical partners, including the Northern Child Health Network and Northern England Clinical Senate.
- The Northern Child Health Network noted that both options are credible attempts to address the significant workforce challenges, but that option 2 is most likely to support medical staff retention and deliver long-term workforce sustainability due to the concentration of paediatric acute emergency services. It identified no issues to question the safety and clinical efficacy of the proposals and its view was that both options are in line with the available clinical evidence base and are informed by appropriate clinical standards.
- The Northern England Clinical Senate noted that option 1 was the closest to being a workable solution and could potentially be implemented incrementally to build confidence in it. It noted that option 2 had unquantified risks that needed to be addressed, however it is felt that these risks can be properly mitigated through taking a long-term approach to implementation, with option 1 as a transitionary model.
- While option 1 is more deliverable in the short-term, it does not address the underlying issues relating to medical staffing that are the fundamental driver for change. Although option 2 will take longer to become deliverable, it is felt to be more sustainable in the long-term, not least because it addresses the medical staffing issues. Clearly, medical staffing concerns will mean paediatric services remain vulnerable throughout implementation.
- Suitable assurance has been provided by NEAS around patient transfers.
- Whilst the Independent Integrated Equality, Health and Health Inequalities Impact Assessment (IIA) are positive for both options, the scoring is somewhat higher for option 1.
- There will be a need to properly assess the implementation of the model, in terms of staffing competencies and confidence, patient behaviour and capacity at the SRH site in particular.
Public feedback
In terms of the public engagement and consultation, it was noted that option 1 had greater support than option 2 and consideration was given to the feedback about:
- Concerns around the opening hours as outlined in the public consultation – it was noted that concerns were raised about the proposed 8pm finish time. This has therefore been revised and it is now proposed that the unit stay open until 10pm.
- Clinical model – particular concerns were noted about the ability of the adult emergency department team at STDH to deal with paediatric issues out of hours. It is clear that there will be a need to ensure sufficient paediatric life support skills to manage this under both options.
- Communication – feedback was noted about the need to clearly communicate any change in service to the people of South Tyneside and Sunderland. The need for a clear communication and engagement strategy around this is self-evident.
- Travel – it was noted that there would be a travel impact for South Tyneside patients under both options, although potentially significantly less under option 1 and that a significant amount of work is being undertaken to help mitigate this. It was also noted that key assurance had been received from NEAS in terms of deliverability of the options, not least with respect to transfer of patients.
Maternity and gynaecology decision
The two CCGs came to decisions based on their review and consideration of all the clinical evidence and feedback from a process of public consultation over the past year. You can read the consultation feedback, evidence and supporting information here.
Now, changes have been agreed on how these services will be arranged in the future, this means they can improve and, ensure better care for patients as well as provide the new opportunity to develop a modern holistic birthing centre for the first time in South Tyneside and Sunderland. The decisions mean that clinical leaders at South Tyneside NHS Foundation Trust and City Hospitals Sunderland NHS Foundation Trust can start to work with local staff teams to make changes over the next several months.
Maternity (obstetrics) and women’s healthcare (inpatient gynaecology) services
Option 1 will be implemented which is the development of a free-standing midwifery-led unit (FMLU), known as a birthing centre, at South Tyneside District Hospital and medically-led obstetric unit at Sunderland Royal Hospital. Gynaecology care requiring an overnight hospital stay will be carried out at Sunderland Royal Hospital, and care for minor gynaecology conditions, including day case surgery and outpatients’ clinics, will continue at South Tyneside District Hospital.
This provides an exciting new opportunity for both South Tyneside and Sunderland women as they said they wanted the choice of a home away from home birthing experience, a birthing centre for pre and post-natal care, with more holistic therapies.
This new centre will be developed with staff, women and other interested partners, and the ambition would be to create a vibrant new birthing centre at South Tyneside District Hospital which offers more choice for women across both South Tyneside and Sunderland.
CCGs decision-making on maternity and gynaecology services
This decision is made based on all evidence considered, including that a strong preference for choice and to retain births in South Tyneside was expressed by patients and the public, through both the pre-consultation and consultation processes.
Both options were supported by the Northern England Maternity Clinical Network, but it was recognised that option 1 offered greater choice of birth options to expectant mothers.
It presents the opportunity to develop a new free-standing midwife led unit that could become a holistic, community-facing birthing centre, with the potential to be right at the heart of the South Tyneside community and provide more choice to both South Tyneside and Sunderland women on where and how to have their baby.
Public feedback
In terms of the public engagement and consultation, it was noted that option 1 had greater support than option 2 and particular consideration was given to the feedback about:
- Low to high-risk births, it was noted that this was a key concern, but also that the national clinical evidence is clear, that free-standing midwife led units are at least as safe as obstetric units and may also be associated with better outcomes. Clear assurance about the transfer of patients has been provided by North East Ambulance Service and the local clinical teams.
- Sustainability of free-standing midwife led units – concerns about the sustainability of these units were noted. However, it is clear that there are a large number of these units around the country that are sustainable. Furthermore, it is proposed that a group of patients, staff, elected members, and other partners be established to develop a co-produced model seeking to ensure sustainability. This group should also continue to monitor and assess the success and viability of the FMLU post-implementation. It is also recognised that new clinical protocols will need to be implemented and that midwives would need to be supported to working within a new clinical environment.
- Travel and local services – it was noted that there would be a travel impact for South Tyneside patients under both options, but that this was lessened under option 1. It was felt that the increased consultant presence through colocation of obstetrics and inpatient gynaecology offers a substantial opportunity to improve quality, but also that a significant amount of work is being undertaken to help mitigate the travel and transport impact.
Decision on Stroke care
Stroke care services
The two clinical commissioning groups decided:
Consultation option 1 will be formally implemented which is all acute strokes are directed to Sunderland Royal Hospital (SRH), with the consolidation of all inpatient stroke care at Sunderland. This model has been running temporarily since December 2016 due to service vulnerability and is showing improvements in patients accessing key diagnostics and treatment earlier. For example, the rate of the use of clot busting drugs (thrombolysis) has doubled for South Tyneside residents, and with the percentage of eligible patients thrombolysed within an hour has gone from 0 to 60 per cent, meaning fewer people will die or have serious disability and more people have the chance to fully recover from their stroke.
This is based upon a very clear and compelling clinical evidence base, universally supported by clinicians. The change will aim to be fully complete by April 2019.
CCGs decision making process on stroke care services
Option 1 will be implemented which is all acute strokes are directed to Sunderland Royal Hospital (SRH), with the consolidation of all inpatient stroke care at Sunderland.
This was based upon the clear clinical preference for option 1 by the local clinical team, unequivocal support from Northern Cardiovascular Disease Network and the National Clinical Director for Stroke. In terms of reducing health inequalities, option 1 was most likely to deliver greatest improvement in quality and safety for both populations, building on the substantial increase in the key stroke quality indicators known as SSNAP scores for South Tyneside patients since December 2016.
In terms of the public engagement and consultation feedback, it was noted that option 1 had broad support and particular consideration was given to the feedback about:
- Delay in treatment – it was noted that the key consideration is timely transport to the right hospital that can deliver excellent hyper-acute stroke care, rather than getting to any hospital
- Capacity at Sunderland Royal Hospital (SRH) – while people in the consultation have raised concerns about this it has not been an issue since the temporary changes, nor is it expected to be, with at least 90% of patients spending at least 90% of their stay on a stroke unit for residents of both South Tyneside and Sunderland, since the temporary change in December 2016 carried out on safety grounds.
- Increase in travel for South Tyneside residents – all the stroke options had South Tyneside patients to be directed to Sunderland in the first instance, but that patients would stay longer at Sunderland under option 1. The clinical benefits were felt to outweigh the increased time for the approximately 500 visitors for those patients per year. (Stroke patients would be likely taken to hospital by ambulance). Also, recognised was the significant amount of work being undertaken on travel and transport would help to mitigate the travel impact
- Patient repatriation – the clinical team shared the concerns expressed by the public that repatriation, under options 2 and 3, would itself hamper recovery.