MEDIA RELEASE: Issue date 21st February 2018
FOR IMMEDIATE USE
Vulnerable services to become safe and secure with the future of three areas of hospital care decided – first phase of Path to Excellence public consultation for NHS service changes concludes
More people will survive a stroke, mothers can choose to have their baby in a new holistic birthing centre, and sick children will have access to the right paediatric doctors and nurses under new reforms to vulnerable local health services in South Tyneside and Sunderland – making them safe for the future.
NHS South Tyneside Clinical Commissioning Group (CCG) and NHS Sunderland CCG, the two bodies responsible for the commissioning of local health services, have decided the future of three areas of acute hospital care in South Tyneside and Sunderland as part of the Path to Excellence consultation.
At their extraordinary meeting in common of the two statutory NHS organisations held on Wednesday 21st February, in Hebburn, South Tyneside – which was also broadcast live on the internet – they 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.
The governing body members, who are made up from senior GPs, doctors, nurses health professionals and lay members with expertise, have responsibility for making decisions about ensuring that local NHS services are safe and of a high quality for local people.
Safe and high quality services means care that treats your medical condition by the correct professional, with access to the best diagnostics and treatment to give people the best possible chance of recovery and if patients are not able to recover, does not make them worse or do harm.
Stroke, obstetrics (maternity) and gynaecology and paediatrics (children’s) emergency services are amongst those South Tyneside and Sunderland hospital based services that are facing the most severe workforce sustainability challenges, driven predominantly by a shortage of medical staff resulting in service continuity, quality and financial pressures.
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.
The two clinical commissioning groups decided:
Stroke 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.
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.
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 as the most sustainable long-term model.
However, the clinical commissioning groups recognise that it will take a period of time 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 as a result 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.
Travel and transport
Travel and transport impact was a key theme through-out the consultation, and partnerships have been established with a working group plan improve access to and information about travel and transport to the hospital sites.
Dr Matthew Walmsley, chair of NHS South Tyneside CCG and a local GP said he recognised the high level of public interest in the final decisions.
He said: “As local doctors and nurses who are in charge of NHS service planning, we do our jobs because we believe local people deserve the best NHS care they can possibly get – whichever building it’s based in.
“We’ve been very clear that the current situation cannot continue, and I know that these changes to these important local services are absolutely the right thing to do that will have a direct impact on people’s experiences of care and the clinical outcomes they will have. With the decisions we have made, we will have saved more people’s lives today than I have done on any other day in my medical career so far.”
Dr Walmsley continued: “So there is no element of doubt and to be categorically clear, retaining the status quo and not making any changes is simply not an option for these services – and as local health care leaders we must act in the best interests of patients as our first duty of care to our patients is do no harm.
“It is extremely likely that a failure to act now could compromise the safety of patients in our care and lead to unplanned closures of services across South Tyneside and Sunderland under crisis circumstances, as we have already seen with stoke and our special care baby unit in South Tyneside in order to keep patients safe.”
Dr Ian Pattison, clinical chair of NHS Sunderland CCG and a local GP, said there was a very positive future for hospital care across South Tyneside and Sunderland.
He said: “We recognise the fundamental importance and value to patients and their carers of having local hospitals that can provide a range of safe, high quality and sustainable services, we wish to see both hospitals develop over the coming years.
“However it is clear that the consequences of continued service duplication across South Tyneside District Hospital and Sunderland Royal Hospital not least in terms of workforce availability, is presenting great challenges to the delivery of the safe, high quality services our patients rightly expect.
“We fully understand that local people are passionate about retaining very localised services but we are sure that everybody will understand that we are responsible for ensuring we get the best possible services across South Tyneside and Sunderland both now and into the future. This means that we are sometimes faced with difficult decisions and we must do the right thing in the best interests of everyone, this sometimes requires making very difficult decisions such as those taken today…
“We would like to thank everyone who took the time to get involved because it is the information they have provided to us that has helped make the best decisions we can in order to make the changes needed to ensure these vulnerable services become strong and vibrant services into the future providing the top quality care we know our NHS staff want to deliver for their patients.
“In particular we would like to thank partners such as Health Watch and new partners at Nexus as well as the bus and travel companies who have engaged so positively with the NHS to help come up with real and meaningful solutions around travel and transport.”
Dr Pattison continued: “We hope local people will continue to engage positively in NHS reform over the coming months and years.
“As we celebrate our NHS’s 70th birthday this year – It is difficult and important decisions like those just made that will ensure our NHS continues to adapt and modernise to ensure it is there when we need it, providing free and safe care for our children, grandchildren and generations to come.”
Statements from South Tyneside and City Hospitals Sunderland NHS Foundation Trusts
Ken Bremner, Chief Executive at South Tyneside NHS Foundation Trust and City Hospitals Sunderland NHS Foundation Trust said:
“We welcome the very important decisions taken today by both CCGs which will not only help safeguard local NHS services for many future generations, but also improve the quality of care and clinical outcomes for people living in South Tyneside and Sunderland today.
“Two years ago we began discussions with staff and the public about the challenges facing local hospital services and since then we have seen, first-hand, the very real vulnerabilities within our workforce which resulted in temporary changes in stroke services and within our special care baby unit in South Tyneside. Today’s decisions are therefore very welcome news as we can now start looking to the future with certainty and begin building resilient models of care that will withstand the pressures facing us, as well as offering the very highest standards of care for our patients.
“Once again I want to be absolutely clear, as I have been throughout this process, that our hospitals in both South Tyneside and Sunderland will both continue to play vital roles in the future and I remain more confident than ever that by working together we can secure better care and outcomes from services that are safer and more sustainable for our patients, staff and local communities.”
Dr Shahid Wahid, Medical Director at South Tyneside NHS Foundation Trust and clinical lead across both Trusts for the Path to Excellence programme said:
“We very much welcome the decisions made by both CCGs today and now look forward to working with our staff to think about how we can begin to implement the recommended future service models.
“We recognise the strength of public feeling and passion that people have for their local NHS which has been expressed throughout the public consultation period and is something which everyone working in the NHS shares, including me. Providing the safest and highest possible quality of care to the people we are responsible for in South Tyneside and Sunderland will always be our guiding principle and as leaders, this means we must also continually evolve our services to meet the ever growing demands and pressures being placed on our hardworking frontline NHS teams.
“As we look to the future, we are fully committed to working together with our staff, patients and partners in the months ahead to truly transform these much valued local services into outstanding new models of care which we can all be proud of and which I have no doubt will help us attract the very highest calibre of staff to come and join us in the future.”
Notes to editors:
More detailed information about the decisions is contained below
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 is able to 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.
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 (STDH) and medically-led obstetric unit at Sunderland Royal Hospital (SRH).
This decision is made on the basis of 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.
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.
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 of time 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 as a result of public consultation feedback.
The Governing Body members of South Tyneside and Sunderland CCGs are asked to note implementation of option 1 will aimto 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 on the basis of 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.
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:
- 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.
Travel and transport
Two meetings of the working group to tackle travel and transport issues identified from the Path to Excellence first phase public consultation have taken place, with terms of reference being agreed and a work programme underway.
Membership includes the NHS organisations, Health Watch Sunderland, Health Watch South Tyneside, Sunderland City Council, South Tyneside Borough Council, Nexus, Go North East, Stagecoach and Tyne and Wear public transport service users group. The work programme to date includes
- Travel planning resources
- Mapping and leaflets
- Personalised journey planning
- Discounted staff travel tickets
- New patient/visitor travel tickets
- Bus stop information
- Co-ordinated communications and marketing strategy with NHS and travel organisation
- Bus information displays in hospitals
The terms of reference are available on: www.pathtoexcellence.org.uk/travel-and-transport
Links to a recording of the live broadcast is available via the programme website www.pathtoexcellence.org.uk
ENDS
For further information please contact:
Emma Taylor
Senior communications officer
North of England Commissioning Support
07769 643 453