Clinical Strategy 2021-2025 - Northern Lincolnshire and Goole - Northern Lincolnshire and Goole NHS ...
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Northern Lincolnshire and Goole NHS Foundation Trust Clinical Strategy 2021-2025 Kindness • Courage • Respect
Contents Executive Summary 4 Foreword 5 Introduction 6 National Policy and Guidance 7 Partnership Working across the Region 8 Humber Acute Service Review 9 Principles 10 Programmes 11 Capital Investment 12 Northern Lincolnshire and Goole NHS FT Overview 13 Enabling Strategies 14 The Trust Priorities 15 Our Clinical Services 16 Our Plans and Milestones 17 Conclusion 22 Clinical Strategy 3
Executive Summary This Clinical Strategy sets out our ambition to deliver a high quality service and experience to the population that we serve. This must be set within the context in which we operate. Despite having made significant progress over the past 18 months the Trust remains in double special measures for both finance and quality. We will continue to focus our efforts on ensuring that we improve the efficiency, effectiveness and safety of our services. The strategy recognises that our We must also recognise that we will As we deliver our strategy we will local health system faces many need to partner across organisations ensure that we reflect the following challenges and that we need to to recruit and retain specialist staff. principles: work with our partners to do things Only by doing this will we be able to • Right care, right place, right time differently. Our pathways of care provide them with the opportunity often rely on in-house provision. to build their careers. • Patient centred care As we move forward we must focus We must not lose focus on the fact • Whole system thinking, whole on how we can work across primary, that we are the largest employer system practice community and social care to deliver within North and North East • Transformation of services where more services for you that are either Lincolnshire. appropriate closer to or at home. We must build on our expanding Our aim is to maintain our Trust We must harness the changes local partnerships with schools, vision and to deliver our priorities. that are taking place in the use of colleges and partners to build a local The strategy outlines the challenges, technology to deliver services. This workforce across the 150 plus roles type and range of clinical services will improve our efficiency and that we have. we want to provide, how we will effectiveness and provide new ways provide those and the outcomes we Our ambition must be set within in which you access services. will seek to achieve. the context of national and regional Recruiting and retaining staff policy whilst also being focused on Given the nature of the changes that remains a significant issue across our delivering services at pace. There are are taking place around us nationally health economy. many changes taking place whether and locally we recognise that this through the requirements of the strategy must be kept under review. We must invest and continue to National Long Term Plan or People We will therefore provide updates to look to new ways of working and to Plan. the framework and our plans on a six promoting our Trust as an “Anchor Organisation” within our local There are also changes taking place monthly rolling basis. Only by doing economy. within the NHS Commissioning this, will we maintain our focus to Landscape along with wide changes deliver improvement in what is a We must look to partner with local across the Humber. These provide rapidly changing environment. institutions to build our reputation us with significant opportunity to and to recruit, train and develop harness our collective endeavours to more local staff. deliver and implement change that We must accelerate the need to look will improve access to and quality of to new types of staff who can operate health and care services. across many pathways, for example Our Clinical Strategy describes how Advanced Care Practitioners and we will develop our clinical services. implement recruitment, training and We will ensure that no matter what development pathways for those we do that we are consistent with roles. our Trust vision ‘committed to caring for you’. 4 Clinical Strategy
Foreword This Clinical Strategy sets out our ambitious commitments to ensure the people who rely on our services receive high quality and accessible care and treatment. For our Trust to achieve this, the way services are currently delivered will need to change. Proposals have been designed with the needs of patients central to our thinking. These changes are required for a necessary change, we believe we In the past few months our Trust number of reasons set out in this will be able to provide sustainable, has been tested like never before. document. They relate to staff safe services for our local population To respond to this meant doing availability, the health needs of the and improve the quality of the care things differently. We did that and it population we serve, the fact we are and experience we provide. It is a worked. not currently delivering timely care big task which will take several years These changes have given us a to all our patients, and the poor state to achieve. strong foundation to build on over of our building and information It is also complicated because we the next three to four years to technology. need to work with our partners ensure we provide the safe, high We recognise that we have been as we cannot do what we need quality and sustainable clinical unable to provide assurance that to on our own. However, by services that our community we are providing the care and working together we can create deserves. treatment that we should be, which the catchment area of patients Our ambition is to deliver the best is not acceptable. We know from we need to offer rewarding and care to our patients and in doing conversations that people are interesting specialist jobs for future so we believe our regulators will concerned and nervous about what doctors, nurses and other health recognise those improvements. This the changes will mean for some that care professionals and ultimately document sets out in more detail use our services, as well as those improve patient care. how we intend to do this and will that deliver them. As we write this foreword the NHS, be reviewed as we progress over the We will listen to concerns and of nationally and locally, is starting to next 12-18 months. course make changes where we emerge from the most significant see there is opportunity to build crisis it has ever faced – the on the work done so far. However, Coronavirus pandemic. we suspect that not everyone will want to support making changes to deliver the improvements necessary. This doesn’t mean we shouldn’t change though. By embracing Terry Moran Dr Peter Reading CB Chair Chief Executive Clinical Strategy 5
Introduction We understand that we do not always deliver the timely care and treatment we should. Tackling this problem means looking at our clinical services differently. We have made many improvements over the past 18 months but we must continue our focus and drive for continuous improvement in our clinical services. As an organisation we face many and multiple challenges. This strategy sets out not only the nature of the challenge we face but the actions we will take to respond and the impact that we will seek to have. These actions are focused on ensuring that we deliver high quality, safe and accessible services for all when you are in need. Challenges Where we are now Where we will be How we will get there • Recruitment of multiple grades and • Accelerate to recruit local, national and • Develop new roles with partners Workforce types of specialist staff international • Different ways of working • Challenges with recruiting and • Training partnerships • Training partnerships retaining non-specialised staff • Continue to ‘grow our own’ where we • Local recruitment can with the right investment and infrastructure • Cross provider specialist recruitment • Working with Health Education England to support new courses • Long waiting times to be seen and • Delivery of national access waiting • New models of care Quality of Care treated times • Integrated pathways of care • Lengths of stay in hospital • Improved partnerships with • Increased use of digital healthcare • People at end of life not consistently community, primary and social care to – self-help, monitoring, early identified reduce length of stay in hospital and intervention end of life support • Advanced care planning between • Partnerships with community and community and hospital services is • Maintain the progress made with the other providers sometimes inconsistent hospital level mortality indicator • Utilise benchmarking and best • Addressing challenges in the care • Embedded mental health care as part practice models and outcomes for mental health care of core services • Working collaboratively across organisations to implement the five year forward view for mental health • £97.7m backlog maintenance across • Invest in our existing infrastructure to • Continuous funding applications Estates and our hospital sites reduce backlog – digital, Emergency Departments, specialist, sustainability Infrastructure • Ageing infrastructure • Access national funding to redevelop our hospital sites • Strategic Capital Business Cases • Buildings which are not environmentally sustainable • Lack of investment in Digital • Access digital accelerator funding to • Digital Accelerator Funding Digital Technology drive infrastructure improvement • Interoperable ICT Platforms Technology • Lack of interoperable Information and Communications Technology • Look to implement technology solutions to improve efficiency and • Investment in Patient Administration System • Limited use of technology to deliver access • Investment in Informatics and services • Increased access to IT equipment Analytics • Reliance on paper based systems • Use of Artificial Intelligence technologies • Inconsistent pathways of care in • Integrated pathways of care • Implementation of the Humber Service some areas • Improved out of hospital services Acute Services Review Sustainability • Poor deployment of specialist resources • Implementation of Humber Acute • Implementation of the Out of Hospital Programmes Services • Updated the outgoing Sustainable • Have a clear defined action plan to • A clear action plan of work Management Plan with the Trusts achieve carbon reduction in line completed, ongoing, and scheduled Green Plan delivering a “Net Zero” National Health to reduce all scopes of carbon Service emission areas • Underlying cost base challenges • Improved cost management to ensure • Shared corporate services Finances delivery of control total • Reduced overheads • Sustainable financial position • Reduced agency spend • Minimised variation on service delivery • Clinical productivity and pathway improvements 6 Clinical Strategy
National Policy and Guidance Our Clinical Strategy reflects national policy and guidance: The environment within which the NHS operates is changing. Our population is increasingly ageing, there are significant advances in medicine and surgery, patient expectations are changing and there is a need to harness research, innovation and technology in delivery. We need to focus on how we support the delivery of out of hospital services and that our population only access secondary care when they need to do so. Our services must be provided more closely to home, or indeed at home. The NHS Long term plan published in January 2019 sets out the policy context and guidance for the delivery of services over the next 10 years. Our experience during the pandemic has resulted in changes in practice, new ways of working and introduced use of technology. The NHS Long term plan framework below provides a summary of the principles, priorities and initiatives that we will be considering as we implement our Clinical Strategy; Integrated Approach to Deliver a New Service Ensure a Sustainable Strategic and Operational Priority Areas Model System Planning Principles • Clinically led • Transformed out of • Increased focus on • Ensure that the NHS is hospital care population health the ‘Best Place to Work’ • Locally owned • Support for Primary • Better care for major • Improve leadership • Realistic workforce Care Networks conditions and culture plans • Relieve pressure • Cancer • Transforming the • Financially balanced on emergency workforce • Cardiocascular disease • Place based on local departments • Investing in digital need • Diabetes • Give people more transformation • Reduced variation choice about their care • Respiratory conditions • Improving productivity • Focused on prevention • Research and • Focus on long term • Reducing variation innovation based conditions • Delivers innovation • Ensuring that research • Maternity Services • Smoking • Engaged with partner and innovation drives local authorities • Obesity new models of care • Quantified impacts • Alcohol • Mental Health services • Air pollution • Addressing inequalities • Anti-microbial resistance Our strategy is set within not only national requirements but also the programme of change within our region which includes the Humber Acute Service Review and the potential changes and investment that may be made within Urgent and Emergency Care, Maternity and Paediatrics and Planned Care programmes, Out of Hospital transformation programmes and Capital Developments. https://www.longtermplan.nhs.uk Clinical Strategy 7
Partnership Working Across the Region We are working with partners on a wide ranging programme of change across the Humber to strengthen in and out of hospital delivery. The Humber Coast and Vale Health • Developing primary care – so • Securing a long-term, sustainable and Care Partnership is a collaboration that every neighbourhood has future for our hospital services – of health and care organisations who access to a single team of health so that our hospitals are working became an Integrated Care System and care professionals who can together to provide high quality in April 2020. This strengthens our meet a wide range of their needs care for our populations when collaboration with local councils and locally; they need to be in hospital. other health and care partners. • Joining up services outside of Our Clinical Strategy cannot be The principal aim of the partnership is hospital – so that care is designed created or delivered in isolation. to “improve the health and wellbeing around the needs of the person The changes taking place across of the population it serves through not the needs of the different the health and care system mean collective responsibility of managing organisations providing it; we must look to strengthen how resources to deliver health and care we work with partners including • Developing our unplanned care services” Primary Care Networks, voluntary services – so that appropriate sector, social care and all other As we strengthen the collaborative care, advice and support is health and social care partners. working across the health system, our available to citizens of Humber, priority is to improve patient access, Coast and Vale when they need it https://humbercoastandvale.org.uk/ reduce duplication, use technology and unexpectedly; partnership-long-term-plan strengthen our workforce through; 8 Clinical Strategy
Humber Acute Services Review A major element of the Clinical Strategy will be the implementation of the Humber Acute Services Review; The Humber Acute Services The review will have a focus on a We need to look at our approach to Review commenced in 2018 across number of challenges including: recruitment and work more closely Northern Lincolnshire and Goole with our local communities and • The low volume of patients for NHS Foundation Trust and Hull partners more effectively to “grow many services across this rural University Teaching Hospitals Trust. our own” whilst also recognising we and coastal geography leading need to enhance our approaches to The review is focused on ensuring to the difficulty of specialists building academic partnerships and that we improve access to deliver maintaining their skills international relationships. high quality care for patients. We • The inability to meet many core must improve access to services, Only through this approach will NHS standards and waiting times patient outcomes and experience we ensure we have a high quality whilst also harnessing new ways • Understand mortality rates and sustainable workforce for the future. of working if we are to deliver a address quality of care concerns Across the Humber we experience sustainable model of healthcare in where appropriate shortages of specialist staff within the future. • The limitations of our estate and a number of services. This impacts The review produced a Case for the lack of access to the latest our ability to meet national clinical Change in February 2020 detailing information technology and standards, to support effective the challenges and reasons to equipment training rotas and to deliver services review the acute services across the in a high quality manner, across The review will consider how we Humber. This was subject to a review multiple sites, on a 24 hour, 7 day can provide the best possible care by the Clinical Senate review and week basis. for local people who need to use published report in May 2020. acute hospital services within the The work we are undertaking will We are now moving at pace to resources (money, staffing and look at how we can ensure that we develop the potential options buildings) that are available to deliver safe pathways of care which for service change. These will be the local NHS. This may include meet national standards whilst also coproduced with commissioners, delivering some aspects of care out ensuring we meet local patient patients, carers, partners and of hospital in GP surgeries or other needs. staff during 2021, resulting in the community settings to better meet This is not an easy process and publication of a Pre-Consultation local people’s needs. one in which we must ensure we Business Case and statutory As a health and care system we continuously engage. We will ensure consultation during late 2021 early face significant challenges in our that we use multiple approaches to 2022. workforce. A critical element of the engage with you as the options for This will address the potential review is focused on ensuring we this important review are developed options for future service delivery recruit, retain, train and develop our during 2021. with a focus on models of care, staff. https://humbercoastandvale.org.uk/ workforce, infrastructure and wp-content/uploads/2020/02/HASR-Long- financial sustainability. Case-for-Change/Final-for-Publication.pdf http://www.yhsenate.nhs.uk/modules/ reports/protected/files/YH%20Senate%20 Report%20-%20HASR%20-%20Final%20 May%202020.pdf Clinical Strategy 9
Humber Acute Services Review – Principles There are a number of principles, agreed in 2018, which underpin how the Humber Acute Services Review will be co-designed and implemented. These principles will underpin how we engage with you not only during the review but also as we develop our Clinical Strategy within the Trust. Principles • Patient-focused, safe and sustainable services – meeting the needs of our population now and in the future • Clinically-led review of services • Evidence-based – taking into account best practice • Focus on hospital services – not hospital buildings and organisations • Take account of developments in out-of-hospital care – developing solutions that join up different types of care • A transparent, collaborative and inclusive approach – engaging with key stakeholders • Plans for future provision will be developed in accordance with the levels of human, physical and financial resource expected to be available • Plans for future provision will include Urgent and Emergency Care and Maternity Care in Hull, Grimsby and Scunthorpe • The review will follow an agreed programme plan that sets out objectives, processes, timescales and resources. 10 Clinical Strategy
Humber Acute Services Review – Programmes The review is made up of three major programmes of change consisting of: Programme 1 Programme 2 Programme 3 Interim Clinical Plan Core Service Change Strategic Capital • Urgent and Emergency Care • 11 Specialties within both • Strategic Capital • Maternity and Paediatrics organisations Investment • Planned Care Delivery 2021 Implementation 2022 Business Case 2023 Our strategy will reflect the outcomes that are delivered through the implementation of this important review. Programme 1: Interim Clinical Programme 2: Core Service Programme 3: Strategic Capital – Plan is focused on delivering Change is focused on delivering is focused on how we maximise our improved access, sustainability and long term change in our models ability to access significant capital performance within 11 specialties. of urgent and emergency care, funding – circa £750 million – to All of these have issues with maternity and paediatrics and build new hospital infrastructure numbers and skills of staff, patient planned care. We will co-produce in both Northern Lincolnshire and demand, access, waiting times and implement new models of care Goole Hospitals and Hull University and clinical outcomes. We will take which will address key performance Teaching Hospitals. actions to improve to integrate issues, reflect the need to deliver pathways of care, pool resources and new and evolving national standards improve access during 2021. of care, and allow us to address our workforce challenges. Clinical Strategy 11
Humber Acute Services Review – Capital Investment Strategic Capital Investment Our estate is not fit for purpose. We We will transform our current • Development of new inpatient, have significant issues with backlog hospital estate using leading diagnostic and treatment maintenance – circa £97.7 million edge design to provide new facilities at Hull Royal Infirmary across our sites. This impacts upon state-of-the-art health and care • Development of facilities on our ability to invest in new service campuses, as part of wider plans hospital sites at Grimsby, Goole models of care and limits our ability for the development of local areas, and Castle Hill to maximise our use of new and driving employment opportunities, emerging technologies. collaboration, learning and Developments are in progress with innovation across the region. new builds for additional diagnostic Given this is one of the main scanners, emergency departments challenges the Humber is facing, Our investment plans are: and acute assessment units within there is a commitment within our • Creation of a brand new hospital Grimsby and Scunthorpe. region to committing significant and healthcare facilities in capital investment to build a Scunthorpe healthier future for the Humber. We want to ensure our infrastructure can meet the ever-changing demands of 21st century healthcare and COVID-19 requirements such as isolation facilities, whilst also supporting an improved level of environmental sustainability, improved research and innovation and partnering along with being an attractive place to work to support improved recruitment and retention. Capital investment in our hospitals will act as a catalyst for the continued regeneration of the region, because of the opportunity a cash injection brings in terms of employment, education and mental and physical well-being for local people. It also provides an opportunity to build on the regions skills and expertise in green energy to develop a lower carbon future for our healthcare facilities and support the development of green jobs in the region. Healthcare facilities that are fit for the future will significantly improve patient care whilst also promoting research, innovation and greater employment prospects. https://humbercoastandvale.org.uk/wp-content/uploads/2020/05/HASR-Capital-Development.pdf 12 Clinical Strategy
Northern Lincolnshire and Goole Hospitals Overview We operate across a wide complex geographical footprint; Northern Lincolnshire & Goole The Trust employs 6800 staff and Locally the Trust is part of the NHS Foundation Trust provides operates from three hospital sites Northern Lincolnshire health system services across the North and with two acute district general working with local commissioners, North East Lincolnshire area and hospitals; Diana, Princess of Wales primary care, community and the boundaries of East Riding of Hospital, Grimsby, Scunthorpe local authorities and providers of Yorkshire and Lincolnshire to a General Hospital and Goole District health care to continuously build population of 450,000. Hospital. upon improvements in health care provided to the local population. It is important to set our Clinical Diana, Princess of Wales Hospital, Strategy and plan to deliver within Grimsby and Scunthorpe General Our success will be dependent on the overarching health and care Hospital both provide acute hospital working together. landscape and in the context of care and a range of community the existing challenges and more services across North and North recently, the challenges that East Lincolnshire with Goole District COVID-19 brings to the organisation. Hospital predominantly providing outpatient, diagnostic, planned surgery and rehabilitation. Population of 450,000 3 Hospital sites, 860 beds 6800 Staff employed Clinical Strategy 13
Enabling Strategies Our Trusts Strategic Framework and Enabling Strategies The Trust has worked with patients, staff and stakeholders to develop and revise our Strategic Plan, Quality Strategy, People Strategy (workforce), Digital Strategy, and Estates Strategy. Quality These all underpin this Strategy Clinical Strategy and are significant enablers success. Finance to ensure its Strategic Strategy Plan Digital Clinical Risk Management Strategy Strategy Strategy People Estates Workforce Strategy Strategy Nursing Midwifery Allied Health Care Professionals Strategy 14 Clinical Strategy
The Trust Priorities Our Trust Strategic Framework developed in 2019 is shown below (this will be subject to review in 2021): The six Trust Priorities will be evolving through transformation over the next four years, formulating into the Clinical Strategy and driven by the Clinical Divisional plans. Clinical Strategy 15
Our Clinical Services The Trust operates through five Clinical Divisions. The Clinical Divisions provide a range of clinical services and are supported through a number of corporate functions as set out below: Surgery and Critical Family Services Clinical Support Community and Medicine Division Care Division Division Services Division Therapies Division • Emergency • Critical Care • Obstetrics • Radiology • Physiotherapy Department • Theatres • Gynaecology • Endoscopy • Occupational Therapy • Acute Medicine • Acute Surgery • Paediatrics • Pharmacy • Nutrition and Dietetics • Cardiology • Anaesthetics • Community • Pathology • Speech and Language • Stroke • General Surgery Paediatrics • Medical Physics • Community Dental • Respiratory • Trauma and • Breast Services • Audiology • Podiatry and orthotics • Diabetes and Orthopaedics • Neonatal Care • Medical Illustration • Neuro Rehabilitation Endocrinology • Colorectal Centre • Mortuary • Gastroenterology • Upper • Rehabilitation • Outpa tients • Clinical Haematology Gastroenterology • Nursing - Community • Cancer • Dermatology • Urology and Specialist • Medical Engineering • Rheumatology • Ophthalmology • Community Response • Palliative Care • ENT Team • Neurology • Maxillo Facial Surgery • Psychology • Elderly Medicine • Equipment Stores • Wheelchair Services Our Clinical Divisions are at the heart of delivering front line services to our patients to achieve our six Trust Priorities and each Division has a detailed operational plan. Divisional plans articulate the visions, challenges, aims and objectives which are built from the Trust Strategic Framework and priorities aligning to Care Quality Commission requirements and quality priorities. These plans underpin the delivery of the vision set out in this strategy. 16 Clinical Strategy
Our Plans and Milestones We cannot deliver this alone; we will need to work collaboratively across the Health and Care system, community and public; Our Clinical Strategy will be delivered through multiple approaches to the delivery of transformational change. This change will take place at three levels: Integrated Care System, Humber wide and locally-based population health strategies. These are summarised below: • Strategic Workforce Planning Integrated • Digital Solutions - System inter-operability Care System • Regional Diagnostics / Rapid Diagnostic Centres • Acute Collaborative • Outpatient Transformation • Primary Care Transformation • Mental Health Transformation • Interim Clinical Plan (Fragile and vulnerable services) (2020-22) Humber • Acute Services Review - Urgent & Emergency Care, Maternity & Paediatrics, Planned Care (2020-26) • Large scale capital investment in the Humber hospitals - Creating a healthier Humber (2020-31) • Humber Workforce Planning 0-2 years Local • Integrating care pathways across Primary, Community & Secondary Care • Urgent & Emergency Care - Acute Assessment Units • Diagnostics - Increase in MRI and CT scanners • Outpatients & Cancer Service Transformation 2-4 years • Reorganise our specialties and hospitals to address the challenges • Clinical Divisional plans (Trust priorities) • Enabling Strategies (i.e. People Plan, Digital, Estates, Finance) Clinical Strategy 17
Our Plans and Milestones Where We Are Going To Be; We have a number of really great health and care services in our area and many people have excellent experiences of the care they receive. However, our current services are under increasing pressure due to rising demand and in many cases are finding it extremely challenging to adequately staff and resource all the services that are provided in their current form. Our Clinical Strategy is set within the context of achieving the six Trust Priorities to deliver the following outcomes; Outcomes Trust Priorities Improved Improved Reduced Equity of Safe Sustainable What Will be Different Patient Clinical Waiting Access for Services Services Experience Outcomes Times Patients Reduced attendance, waiting times, 1. out of hospital care, decreased Integrated Urgent and Emergency Care ambulance conveyance, improved environment and reduced length of stays in hospital Reduced waiting times. Virtual and 2. telephone consultations. Primary Transformed Outpatient Services Care partnerships and increased provision of services out of hospital 3. Redesigned clinical pathways – more Working in locally based services and one stop Partnership with Primary Care shops. Community provision and Networks seamless working 4. Consolidation of speciality services Reconfigure to provide 7 day continuous Specialities to One Site Where care. Reduced waiting times and Appropriate improved outcomes 5. Improved times to diagnosis and Restructure Cancer Services treatment. Quicker access 6. Utilisation of space and increased Create Sustainable Services at Goole services across the region. Decreased length of stay in hospital Along with the six Trust priorities,the Clinical Strategy will align to improving quality standards Improved performance standards/ Improve Quality Standards waiting times and length of stay in hospital 18 Clinical Strategy
Our Plans and Milestones We will ensure that we have robust governance to deliver our changes; As we move forward new models of care will emerge. Clinical pathways may change the way we deliver care and it will be essential that change is planned, reviewed and impact assessed. Any proposed changes will be carried out following full engagement with colleagues, patients and the wider public. We will ensure that our decisions are clinically led and engage the right stakeholders at the right time making sure service changes align to the system plans. Our programmes of change will be assured and managed both internally and externally. The external assurance will be provided though the Integrated Care System, Humber Acute Services and NHS England and Improvement assurance process set out below; Discussion Joint Strategic Needs Joint Health and Proposal Assessment Wellbeing Strategy Ongoing Assurance and continuous patient and public Consultation* engagement CCG, local authorities, Decision Service re-design STPs and FYFV Implementation * Public consultation may not be required in every case. A decision about whether public consultation is required should be made taking into account the views of the local authority. Our Trust governance and assurance structure set out below will ensure that any proposed changes are subject to assurance reviews, that implementation is reviewed and that post implementation outcomes are scrutinised to ensure we not only learn from experience but that we have delivered the outcomes we proposed. Humber Coast & Vale Health Care Partnership Trust Board (TB) Council of Governors Humber Acute Services Executive Oversight Group Trust Management Board (TMB) Commission Governing Bodies Divisional Board Overview Scrutiny Committees (OSCs) Delivery Group Citizens Panels (where appropriate) Formal Reporting Clinical Strategy 19
Our Plans and Milestones Whilst we develop and progress our Clinical Strategy within the Region and the Humber, we will continue to progress with the following local transformation; • Increase rapid access to assessment with prompt review, diagnosis and treatment • Partnership working • Same Day Emergency Care • Focus on preventing • Ambulatory Care Integrating admissions to hospital • Improve support in flow in hospital Care • Pathways • Improving discharge to out of and out of hospital Integrating across hospital • Purpose build new Emergency Departments and Acute Assessment Units Urgent and Primary and • Redesign of planned care • Developing Frailty models across Emergency Care Secondary Care pathways the system • Incorporating additional MRI and CT scanners to support demand for both Increasing acute Outpatient • Increase used of non face-to-face appointments and planned care Diagnostic and Cancer • Additional CT scanners at both • Improve waiting times DPoW & SGH (2021) scanning Transformation • Improve timeliness of cancer • Additional MRI scanner and new suite capacity diagnosis and treatment build in DPoW (2021) • Clinical service redesign with • Additional MRI scanner and extension system partners in SGH (2022) 20 Clinical Strategy
Our Plans and Milestones Milestones: Our timescales and the improvements that will be achieved through delivering our Clinical Strategy, set within the context of achieving our six Trust Priorities, our Quality Priorities and the progression of the Humber Acute Service Review, are summarised below; Timescales Priorities 2021-2022 2022-2023 2023-2025 • Implement an Urgent Care Hub • A new dedicated Acute • Continue to work in Integrated Urgent Assessment Unit and Emergency partnership to improve • Increase access to Same Day Emergency and Emergency Care and Ambulatory Care Department at both DPoW and performance levels SGH Care (U&EC) • Reduce the length of stay in hospital • Implement Humber Acute Service • Implement Talk before you Walk, Frailty Review models of care model and Community Response Team • Expand the use of non face-to-face • Developed digital devices and • Increased virtual and Transformed appointments systems to support patient record community clinics Outpatient • Reduce the back log of follow up sharing • Reduced 30% of face-to-face Services appointments • Implemented joint pathways with appointments • Reduced waiting times and progressed Primary care • Eliminated overdue follow ups recovery from COVID • Patient initiated follow ups and • Increased digital technology to manage patients apps patient pathways Worked in • Implement Cardiology clinics within the • Develop shared training, • Formation of teams within community recruitment and retention each location, sharing skills Partnerships with approaches across the system Primary Care Networks • Deliver the HASR Interim Clinical Plan • Implement Humber Acute Service • Continue to work in Reconfigured Review models of care partnership across the • HASR Core service change: Specialities to Humber to improve the • Completed pre-consultation delivery of patient care one site where engagement appropriate • Submission of pre-consultation business case • Explore and develop new models of • Implement additional MRI • Full deployment of digital Restructured care to ensure faster diagnosis and scanner in SGH pathology and digital Cancer Services treatments • Alignment of histopathology outsourcing • Implement additional CT and MRI service to support faster diagnosis scanners in DPoW • Implement all stratified pathways Created a • Ensure full utilisation of our theatres and • Reshape the workforce working • Continue to work in clinics to meet demand in different ways to effectively use partnership with local and Sustainable specialist skills of staff regional partners Hospital at Goole • Improved quality and timeliness of • Eliminate 40 week waiting lists • Maintained better support Quality Priorities patient discharges to appropriate safe for patients at end of life • Reduce 26 week waiting lists environments and maintained reduced • Reduce overall referral to admissions to hospital • Better support patients at end of life treatments and reduce admissions to hospital where avoidable through where this could be avoidable through • Continued reduction of the strengthened planning in improved care planning in collaboration number of patients at the end collaboration with primary with primary care networks to improve of life phase having emergency care networks effectiveness of care admissions in the final 3 months • Maintained the Summary of life Hospital level Mortality • Reduction in the out of hospital Summary Hospital Level Mortality • Continued reduction in the out of Indicator (SHMI) Indicator (SHMI) hospital Summary Hospital level Mortality Indicator (SHMI) • Increase of patient observations recorded on time in line with policy • Increase of clinically indicated patients to have a sepsis six screening • Improved administration of insulin within the required time and a reduction in medication omissions Clinical Strategy 21
Conclusion The challenges we face are multiple and the solutions for improvement will require not only us but our partners to work in new ways, to pool resources and to implement new models of care. We are actively working with We are also focused on us to address our issues of backlog our partners in the Integrated implementing new in-hospital estate maintenance and digital Care System and have a leading pathways, which make use of new infrastructure whilst also seeking to role within the design and ways of working and deliver not only gain national support for strategic implementation of the Humber an improved patient experience, capital investment in our major Acute Services Review. but also shorter lengths of stay and hospitals. improved outcomes. We are actively engaged in the In doing so we will be working development of local Place Based We recognise that this cannot be with our local authority and services with our partners in Primary, achieved in isolation and that we academic partners to ensure we Community and Social care. must look further to recruit, retain align our strategies for economic and develop our workforce. development, local sustainability We are focused on ensuring that and local regulation. we implement new models of care We will accelerate working with which improve access ensuring that local partnerships to recruit and The environment within which we you get access to services in a timely develop our local workforce whilst operate is dynamic and requirements manner and that those services can also ensuring that we provide are changing regularly. This strategy be delivered either closer to home an attractive environment for will be subject to ongoing review or at home where appropriate. specialist staff recruitment aligned and challenge with updates being to enhanced training, development undertaken every six months. We are focused on ensuring that and research and teaching we maximise our use of technology Only through this approach will we opportunities. to deliver improved self-care, early ensure that we deliver our aspirations intervention and monitoring. Our infrastructure is not fit for and that we implement the changes purpose and we will work to that we are committed to. secure national funding to allow 22 Clinical Strategy
Clinical Strategy 23
Contact Us: Telephone: 03033 303035 Email: nlg-tr.comms@nhs.net Visit: www.nlg.nhs.uk NHSNLaG NHSNLaG
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