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
2 Clinical Strategy
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 StrategyHumber 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 11Humber 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 StrategyNorthern 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 13Enabling 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 StrategyThe 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 15Our 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 StrategyOur 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 17Our 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 StrategyOur 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 19Our 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 StrategyOur 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 21Conclusion
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 StrategyClinical Strategy 23
Contact Us:
Telephone: 03033 303035
Email: nlg-tr.comms@nhs.net
Visit: www.nlg.nhs.uk
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