TRANSFORMING CLINICAL SERVICES - Consultation 19 April - 12 July 2018 - HOW WE DEVELOPED OUR OPTIONS AND DECIDED ON OUR SHORTLIST TECHNICAL ...
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TRANSFORMING CLINICAL SERVICES
Consultation 19 April – 12 July 2018
HOW WE DEVELOPED OUR OPTIONS AND DECIDED ON OUR SHORTLIST
TECHNICAL DOCUMENT TO SUPPORT THE PUBLIC CONSULTATION
DOCUMENT
Contents About this document................................................................................................... 4 How we developed the options .................................................................................. 4 How we decided on our shortlist of options: Decision Points ..................................... 6 Our Options .............................................................................................................. 12 Option1..................................................................................................................... 13 Option 2.................................................................................................................... 14 Option 3.................................................................................................................... 20 Option 4.................................................................................................................... 22 Option 5.................................................................................................................... 24 Option 6.................................................................................................................... 25 Option 6a.................................................................................................................. 32 Option 7.................................................................................................................... 37 Option 8.................................................................................................................... 38 Option 9.................................................................................................................... 41 Option 10.................................................................................................................. 42 Option 10a................................................................................................................ 44 Option 10b................................................................................................................ 46 Option 11.................................................................................................................. 50 Option 12.................................................................................................................. 52 Option 12a................................................................................................................ 53 Option 12b................................................................................................................ 55 Option 13.................................................................................................................. 57 Option 14.................................................................................................................. 58 Option 15.................................................................................................................. 60 Option 16.................................................................................................................. 61 Option 17.................................................................................................................. 63 Option 18.................................................................................................................. 64 Option 19.................................................................................................................. 65 Option 20.................................................................................................................. 66 Option 21a................................................................................................................ 67 Option 21b................................................................................................................ 69 Option 21c ................................................................................................................ 74 Option 21d................................................................................................................ 76 Our proposed shortlist for Public Consultation ......................................................... 81
Appendix A: Options Development Action Group Membership ................................ 82 Appendix B: Workshop 1 attendance list ............................................................. 83 Appendix C: Workshop 2 attendance list.................................................................. 85 Appendix D: Options Challenge Events ................................................................... 89 Appendix E: SWOT Analyses and feedback on options ........................................... 91 Appendix F: Slide deck used at Executive Team Meeting on 14th February 2018 ... 91 Appendix G: Slide deck used at Executive Team Meeting on 28th February 2018 ... 91
About this document
This technical document has been produced to provide the background information to
explain how we have developed our options, and the decision-making process that led
to our final shortlist of options for public consultation. This document supports the
Hywel Dda University Health Board public consultation on the Transforming Clinical
Services Programme.
This document is meant as a reference guide. It does not provide exhaustive detail
but aims to answer any common questions that may arise from reading the main
consultation document. If you would like further detailed information, this can be
obtained by contacting hyweldda.engagement@wales.nhs.uk
This document should be read in conjunction with other documents that have been
prepared for the consultation, as they contain the financial, workforce, estates,
transport and population health information that is available to enable the service
changes that are being proposed.
How we developed the options
Our process for developing our options was driven by a core group of clinical staff
called the Options Development Action Group (ODAG). Membership of this group
can be seen at Appendix A. The initial set of options were developed at the Options
Development Action Group on 7th December 2017. This was the second meeting of
the ODAG, the first a week earlier being a scene setting session, which was run as a
workshop to generate an initial long list of options.
As a start point the group considered:
The Health Board’s challenges, including:
o Demography: People are living longer with more co-morbidities
o Finance: We have a major budget deficit
o Workforce: We find it very difficult to recruit to some posts and have an
over-reliance on costly agency/locum staff
o Sustainability: e.g. We have difficulty covering acute rotas on our four
main sites, our GP Out of Hours service is fragile
o Estate: Some of our buildings are very old and do not provide the
standard of facility we would wish to provide for our patients and staff,
we also have a significant backlog of maintenance issues
The group was then directed to consider all options that might serve to address the
challenges, bearing in mind:
What we heard in the Big Conversation engagement exercise about what
matters to people and what good would look like in terms of their healthcare
services. This was a fundamental element of the proceedings and was our
way of having the voice of the public in the discussion.
The vision and principles for the future that came from the Phase 1 clinically
led Programme Groups (Community Care, Urgent and Emergency Care and
Planned Care)
Examples of good practice and alternative models of care from around the
world that had been researched in the Phase 1 Programme Groups
The group was encouraged to think radically and at this point, nothing was to be
considered out of bounds. We wanted to generate an initial set of options that
considered a very wide range of configurations that we could test and develop with
stakeholders through the options development and challenge process. The output
from this meeting was 16 options (options 1,2,3,4,5,6,7,8,9,10,11,12,13,14,15 and
16) which included the status quo.
As part of the options development and challenge process we engaged with a wide
range of our staff, partner organisations and other stakeholders in:
2 large multi-stakeholder workshops (the attendance lists for the two
workshops can be seen at Appendix B and C)
15 Options Challenge Sessions (17 were planned but 2 were cancelled)
11 Staff Drop-In sessions
Details of the Options Challenge and Staff Drop-In sessions can be seen at
Appendix D.
We reviewed and considered the feed-back from these events at every OADG
meeting and as a result the options were modified and developed in an iterative
process, with some new options emerging as a result.
How we decided on our shortlist of options: Decision Points
This section details the various meetings, events and review sessions at which
decisions were made regarding the options. It does not include details of every
engagement session or event but rather the points at which options were developed,
modified and either kept in or ruled out of the long list. As various groups reviewed
the options they were asked to consider whether the option:
Would be an improvement on what we have now
Responds to what we heard in “The Big Conversation”
Aligns to the vision and principles set out by the Phase 1 Programme Groups
Responds to the Health Board’s challenges around, sustainability, workforce,
finance
The summary of the rationale for these decisions is shown for each option in the
“Our Options” section beginning on page 8. It is not possible to include full details of
all the feed-back received, in this document, but the further detail can be viewed at
Appendix E.
Workshop 1: 18th December 2017
This full day workshop was attended by 57 clinical staff, managers and other
stakeholders. The attendance list can be seen at Appendix B. The opening
presentations covered an overview of the Transforming Clinical Services Programme
to date and a review of Population Health, the Legislative framework, the outputs
from the Phase 1 TCS Programme groups and what we heard in the “Big
Conversation” engagement process. The major part of the workshop was around
reviewing and challenging the initial set of 16 options by completing a SWOT
(Strengths, Weaknesses, Opportunities, Threats) analysis for each option. These
SWOT analyses can be seen at Appendix E. Attendees did the SWOT analysis
exercise in their professional groups, e.g. medical, nursing, therapies and other
clinical and non-clinical stakeholders. We wanted the groups to appraise the options
through their particular “lens” so that we ended up with a fully rounded view of each
option.
If the groups felt a particular option was not viable they could recommend elimination
from the long list with their rationale for doing so. The various groups suggested a
total of 13 options were not viable and should be eliminated (These were options 1,
2,3,4,5,7,8,9,11,13,14,15 and 16).
At the end of the session the groups were invited to propose new options if they
wished, and as a result 4our new options were put forward.
Options Development Action Group: 21st December 2017
At this session, the group were asked to review the SWOT analyses from Workshop
1 and to complete their own SWOT analyses. In particular, they were asked to
decide whether they agreed:
that 13 options recommended for elimination should be removed or if they felt
they should be considered further, as insufficient rationale was available, or
that further work was required on the particular option.
that the 4 new options proposed at Workshop 1 should be added to the long
list for further consideration.
The outcome of this session was that 4 of the options recommended for elimination
were reprieved (Options 2,8,14 and 16). It was felt that the rationale given by the
Workshop groups was not sufficiently robust to eliminate them at this very early
stage and that further work and consideration was necessary.
The group agreed that the 4 new options should be added to the long list and these
became Options 17,18,19 and 20.
Transformation Director and Medical Director Review: 2nd January 2018
Libby Ryan-Davies (Transformation Director) and Dr Phil Kloer (Medical Director)
reviewed the options, feedback and decisions made thus far with some members of
the TCS Programme Management Office. They agreed that the decisions around
elimination and new options should stand.
They also noted some feedback from ODAG that had pointed out that some of the
options were very similar and should, perhaps be merged. The outcome of this
review was that 6 of the options (14, 16,17,18,19,20) were merged to create 4 new options (21a, 21b,21c,21d). Options Development Action Group: 4th January 2018 The ODAG reviewed the remaining options and eliminated Option 21a as they felt it was not viable, mainly due to having 5 sites to staff and no Bronglais Hospital providing cover for Mid-Wales Review following feedback from Withybush Medical Staffing Committee Challenge Event and Staff Drop In: 12th January 2018 There was very strong feedback from the Withybush Medical Staffing Committee and the South Pembrokeshire Staff drop-in session that there should be an option that considered Withybush as the site for the Urgent and Emergency Care Hospital, as there were no existing options that provided this opportunity. We considered this and felt that this was a valid suggestion. The outcome was that Options 10 and 12 which showed Glangwili General Hospital as the Urgent and Emergency Care Hospital both had an alternative option developed with Withybush as the UEC Hospital instead. These options became 10a,10b, 12a and 12b. Review of remaining options, taking account of feed-back from ODAG, Challenge Events and Staff Drop-Ins to date: 22nd January 2018 This was an in-depth review of feedback from ODAG, Challenge Sessions and Staff Drop-In Sessions by the Programme Management Office team. As a result, 4 options were eliminated due to cumulative feed-back giving rationale for elimination. These were Options 8, 10a, 12a and 12b. Option 6a was developed in response to feedback suggesting that Prince Philip Hospital should be considered as a Regional Centre for some specialities, at this point.
Review with Medical Director, Community GP Lead and Transformation Director: 30th January 2018 Phil Kloer (Medical Director), Sion James (Community GP Lead) and Libby Ryan- Davies (Transformation Director) reviewed decisions made thus far and the remaining options on the long list. No changes were proposed. Options Development Action Group and Design Steering Group review of options: 1st February 2018 The remaining 6 options were reviewed and although the groups noted some concerns about some of these options, in terms of still having multiple main sites to staff and travel distances for some people, it was agreed that these 6 should go forward to scoring. Details of the scoring criteria, process and the outcomes can be seen in the “How we developed our options criteria and the process we used to score our options technical document” http://bit.ly/2DOWmRm Executive Team review of initial scores (options scoring): 14th February 2018 Advice from the Consultation Institute, on best practice for public consultation, told us that 6 options are too many to consult on. To reduce this 6 down to a viable short-list for public consultation we used a set of criteria detailed in an exercise to score the options. Scoring took place from 7th to 14th February 2018. We held a workshop on 9th February 2018, which was attended by 63 multi- disciplinary staff and representatives from partner organisations. The workshop explained the criteria, the 6 options to be scored and the scoring process. Small groups then had the opportunity to do a practice scoring session. This enabled them to discuss their understanding of the criteria and rationale for scores. Participants were then invited to formally score the 6 options. There were several options for how participants could give their scores: By completing a paper score sheet at the workshop Via online tool – SurveyMonkey Via e-mail using an Excel based form Via e-mail using a Word based form
In addition to the workshop we emailed an information pack, scoring instructions and link to the scoring survey to a range of Hywel Dda UHB clinicians and staff inviting them to score the options. These included: Hospital Triumvirates (senior leadership team) Medical Staffing Committees University Partnership Board Staff Partnership Forum Health Professionals Forum Senior Nursing and Midwifery Team Primary Care Sub-Committee Therapies and Health Sciences Local Medical Council ABMU Clinicians They were also invited to share the information with their staff and colleagues. The full results of the scoring are shown in the slide deck we used to present the outcome to our Executive Team on 14th February 2018 at Appendix F. At this meeting we also presented a very high level affordability assessment of the options. This was based only on revenue and fixed infrastructure costs and used outputs from the activity modelling to build up high level costs. Clearly this is not a complete picture of costs as it is very high level and capital costs are not included. These caveats were made clear to the Executive Team and they were advised that this was an indicator of relative costs between the options but could not be used in isolation to make decisions. Using the weighted scores and the high-level cost for each option a cost per scoring unit was calculated. This measure is more usually used when full costing information is available as part of a business case. It gives an indication of “value for money” i.e. does a higher cost deliver more benefits? Again, we advised the Executive Team that this measure is not robust at this stage and should only be considered as part of the available information and not to base decisions on this alone.
Option Option Option Option Option Option
2 6 6a 10b 21b 21d
Total score 4,215 3,429 3,216 3,160 4,828 5,795
Total 4,259 3,454 3,291 3,188 4,885 5,822
weighted
score
*Cost per £194 k £239 k £246 k £260 k £164 k £139 k
scoring unit
The Executive Team decided to eliminate Option 6 and Option 10b at this stage.
Although Option 6a scored lower than Option 6, although Option 6b did not score
highly it looked to be more affordable than other options so deemed worthy of further
review and the Exec Team requested more information before eliminating it. They
requested some further modelling and a view from our workforce and estates
enabling groups to inform a final decision on the shortlist to be presented to them at
a meeting on 28th February.
Executive Team review of scores and additional analysis: 28 th February 2018
The Executive Team again reviewed the scoring outcomes and the next iteration of
the affordability analysis, enabling group feedback and modelling.
The presentation we gave at the Executive Team Meeting on 28 th February is shown
at Appendix G and this gives full details of the scoring and further information around
high level costs, estates and workforce considerations.The updated scoring summary is shown below.
Option Option Option Option
2 6a 21b 21d
Total weighted score 4,259 3,291 4,885 5,822
Affordability ‘saving £59.4 m £65.4 m £68.2 m £65.2 m
opportunity’
Cost per scoring unit £193 k £248 k £166 k £140 k
At this meeting the Executive Team agreed that Option 6a should be eliminated and
that Options 2, 21b and 21d were recommended to be taken forward to Public
Consultation, pending a decision by our Board in April.
Our Options
This section will describe each of the options and explain how they were developed
and the decision-making process that ruled them in or out of the final shortlist for
consultation. Further detail on the feed-back from Options Challenge Sessions and
Staff Drop-In Sessions can be seen at Appendix E. Details of feedback from specific
sessions can be made available on request, please contact
hyweldda.engagement@wales.nhs.ukOption1
This option is the status quo, or current service configuration, which includes:
4 main hospitals sites (Bronglais General Hospital, Glangwili General Hospital
Withybush General Hospital and Prince Philip Hospital).
7 Community Hospitals (Llandovery, Amman Valley, Aberaeron, South
Pembrokeshire, Cardigan and Tenby)
At Workshop 1 (18/12/17), this Option was recommended to be eliminated from the
long list by 5 of the 6 groups. The ODAG meeting on 21/12/17 agreed with this
recommendation and Option 1 was eliminated from the long list.
A summary of the rationale for elimination is:
Financially not viable
Estate not fit for purpose
Does not offer the best care for patients Not sustainable, due to covering rotas at 4 sites - high vacancy rates and
inability to recruit to some posts
Option 2
This option was one of the initial 16 developed by ODAG on 17th December 2017.
The original key features of this option are shown in the image above:
A new urgent care hospital – location to be decided according to need
Bronglais General Hospital remains
Glangwili General Hospital becomes a Planned Care Hospital
Withybush General Hospital ceases to operate in its current form
4 Community Hubs with beds
At Workshop 1 (18/12/17), this Option was recommended to be eliminated from the
long list by 2 of the 6 groups. A summary of the rationale for elimination is:
Not viable for staffing – 4 hospital sites and 4 community hubs
Too similar to the status quo which we know is not viable
Travel issuesHowever, The ODAG meeting on 21/12/17 did their own SWOT analysis and did not agree with the rationale for elimination and recommended that this option remains under consideration as at this stage there were too many unknowns. Following ODAG review on 4th January 2018 the option was clarified as per the image below. The main points of clarification being to state that Withybush General Hospital is assumed to close in this option and be replaced by the new facilities and services, and that depending on local health needs existing community hospital sites will either maintain beds, become an administrative base, or close. At this point a second image was added to the presentation of each of the options, see below, to illustrate the option and show the spread of facilities across the various levels of care. This was in response to feedback and discussions in ODAG. The rationale was that if we are proposing a change in the balance of care and more care being delivered closer to home it was important to be able to see where facilities in the proposals were located across the spectrum of care.
On 30th January 2018, this option was further refined in response to feedback from the Options Challenge sessions and Staff-Drop in sessions to include depicting existing and already planned community hospitals and hubs and provide some clarity on the level of service proposed at each hospital site and community site. The map image also shows Mental Health facilities planned as a result of the Transforming Mental Health Programme. Morriston Hospital is also shown recognising that changes within Hywel Dda UHB may impact on Abertawe Bro Morgannwg UHB and that for some people Morriston Hospital may be there nearest hospital. Please see the following 4 images.
The final revision of this option is shown below. This includes the addition of a Community Network Hub at Tenby Cottage Hospital. This decision was taken on the 1st February following discussion in the ODAG meeting. The rationale was that Tenby was the only community hospital facility proposed for closure and there was not sufficient analysis available at this point to warrant it being treated differently to the other sites.
In the Options Scoring exercise Option 2 scored third highest, of the 6 options scored, and the Executive Team (14/2/18 and 28/2/18) agreed that this option should go forward to public consultation subject to a decision by our Board in April 2018. In the consultation document this option is referred to as Proposal C.
Option 3
This option was one of the initial 16 developed by ODAG on 17th December 2017.
The key features of this option are:
A new urgent care hospital – location to be decided according to need
Bronglais General Hospital remains
Withybush General Hospital, Glangwili General Hospital and Prince Philip
Hospital become Planned Care Hospitals
4 Community Hospitals - location to be decided according to need
Minor Injuries Unit 24/7 – location to be decided
At Workshop 1 (18/12/17), this Option was recommended to be eliminated from the
long list by 4 of the 6 groups. A summary of the rationale for elimination is:
Very expensive, issues in covering rotas and recruitment
5 hospitals – too complex, hugely costly
Too close to the status quo which we know is not viableThe ODAG meeting on 21/12/17 agreed with this rational and recommendation and Option 3 was eliminated from the long list.
Option 4
This option was one of the initial 16 developed by ODAG on 17th December 2017.
The key features of this option are:
A new urgent care hospital – location to be decided according to need
Bronglais General Hospital: Medical take and MIU front of house)
4 Community Hubs with Beds
All elective activity is outsourced
At Workshop 1 (18/12/17), this Option was recommended to be consigned to
eliminated from the long list by 4 of the 6 groups. A summary of the rationale for
elimination is:
Transport issues
Paediatric services commissioned out – not acceptable
Downgrade of Bronglais Hospital not viable as it serves huge geographic
area.
Recruitment problems associated with Urgent Care only facility.
Not kind, equitable, accessible.
Postcode lottery of outsourcing planned care.The ODAG meeting on 21/12/17 agreed with this rational and recommendation and Option 4 was eliminated from the long list.
Option 5 This option was one of the initial 16 developed by ODAG on 17th December 2017. The key features of this option are: A new urgent care hospital – location to be decided according to need 4 Community Hubs with Beds Bronglais General Hospital becomes DGH with planned care At Workshop 1 (18/12/17), this Option was recommended to be eliminated from the long list by 2 of the 6 groups. A summary of the rationale for elimination is: Concerns around staffing Geographical issues Infrastructure not viable to support all planned acre at Bronglais Too far for large element of population to travel for planned care at Bronglais The ODAG meeting on 21/12/17 reviewed this option and did their own SWOT analysis. They agreed with the rationale for elimination and added that they felt this option would create an unsustainable flow to Morriston Hospital, so Option 5 was eliminated from the long list.
Option 6
This option was one of the initial 16 developed by ODAG on 17th December 2017.
The key features of this option are:
A new urgent care hospital – location to be decided according to need
4 Community Hubs with Beds – location to be decided according to need
Bronglais General Hospital becomes DGH with general medical take
Withybush General Hospital and Prince Philip Hospital become Planned Care
Hospitals
At Workshop 1 (18/12/17), none of the groups recommended to remove this option
from the long list and the ODAG meeting on 21/12/17 agreed that this option should
remain under consideration.Following ODAG review on 4th January 2018 the option was clarified as per the image below. The main points of clarification being to state that Glangwili General Hospital is assumed to close in this option and be replaced by the new facilities and services, and that depending on local health needs existing community hospital sites will either maintain beds, become an administrative base, or close.
At this point we also added a second image, see below, to illustrate the option and show the spread of facilities across the various levels of care. This was in response to feedback and discussions in ODAG. The rationale was that if we are proposing a change in the balance of care and more care being delivered closer to home it was important to be able to see where facilities in the proposals were located across the spectrum of care.
On 30th January 2018, this option was further refined in response to feedback from the Options Challenge sessions and Staff-Drop in sessions to include depicting existing and already planned community hospitals and hubs and provide some clarity on the level of service proposed at each hospital site and community site. The map image also shows Mental Health facilities planned as a result of the Transforming Mental Health Programme. Morriston Hospital is also shown recognising that changes within Hywel Dda UHB may impact on Abertawe Bro Morgannwg UHB and that for some people Morriston Hospital may be there nearest hospital. Please see the following 4 images.
The final revision of this option is shown below. This includes the following additions
which were agreed on 1st February following discussion in the ODAG meeting,
taking account of feedback from Staff Drop-In session in Pembrokeshire and Medical
Staffing Committee in Carmarthen :
A Community Network Hub at Tenby Cottage Hospital was added following
discussion in the ODAG meeting. The rationale was that Tenby was the only
community hospital facility proposed for closure and there was not sufficient
analysis available at this point to warrant it being treated differently to the
other sites.
An Enhanced Community Hub on the West Wales General Hospital
(Glangwili) site was added in response to feedback from several challenge
session stating clinical concerns around services currently provided within
Carmarthenshire, specifically renal dialysis and chemotherapy at Glangwili
General HospitalIn the Options Scoring exercise Option 6 was scored 4th out of the 6 options that were scored. The Executive Team (14/2/18) reviewed the scoring and agreed that this option should be eliminated from the shortlist.
Option 6a This Option was developed on 22nd January following the review of all feedback to date from ODAG, Options Challenge Sessions and Staff Drop-In sessions suggesting that Prince Philip Hospital should be considered as a Regional Centre for some specialities, see 2 images below.
The key features of this option are:
A new urgent care hospital – location to be decided according to need
4 Community Hubs with Beds – location to be decided according to need
Bronglais General Hospital becomes DGH in line with the ambition set out by
the Mid-Wales Collaborative
Withybush General Hospital and Prince Philip Hospital cease to operate in
their current form and are replaced by new services and facilities.
On 30th January 2018, this option was further refined in response to feedback from
the Options Challenge sessions and Staff-Drop in sessions to include depicting
existing and already planned community hospitals and hubs and provide some clarity
on the level of service proposed at each hospital site and community site. The map
image also shows Mental Health facilities planned as a result of the Transforming
Mental Health Programme. Morriston Hospital is also shown recognising that
changes within Hywel Dda UHB may impact on Abertawe Bro Morgannwg UHB and
that for some people Morriston Hospital may be there nearest hospital. Please seethe following 4 images. This iteration also confirms that Withybush General Hospital is repurposed to become an Enhanced Community Hub.
The final revision of this option is shown below. This includes the following additions which were agreed on 1st February following discussion in the ODAG meeting: Amendments made to a Community Network Hub at Tenby Cottage Hospital following discussion in the ODAG meeting. The rationale was that Tenby was the
only community hospital facility proposed for closure and there was not sufficient analysis available at this point to warrant it being treated differently to the other sites. An Enhanced Community Hub on the Glangwili General Hospital (West Wales General Hospital) site was added in response to feedback from several challenge session stating clinical concerns around services currently provided within Carmarthenshire, specifically renal dialysis and chemotherapy at Glangwili General Hospital In the Options Scoring exercise Option 6a was scored 5th out of the 6 options that were scored. The Executive Team (14/2/18) reviewed the scoring and the high level affordability test. In the high level affordability test this option was seen to one of the more affordable options. Whilst they agreed that the affordability test was of limited value at this stage, being based on activity revenue costs only, they felt that they would like to see some further analysis before making a final decision. At the Executive Team meeting on 28th February 2018 they reviewed the next iteration of affordability modelling, activity modelling and feedback from the enabling groups, and again reviewed the scoring and agreed that this option should be eliminated from the shortlist.
Option 7
This option was one of the initial 16 developed by ODAG on 17th December 2017.
The key features of this option are:
A new Major Urgent and Planned Care hospital – location to be decided
according to need
4 Community Hubs with Beds – location to be decided according to need
Planned care to be delivered in the Community Hubs
At Workshop 1 (18/12/17), this Option was recommended to be removed from the
long list of options by 1 of the 6 groups. The ODAG meeting on 21/12/17 carried out
a SWOT analysis and agreed with this recommendation. Therefore, Option 7 was
eliminated from the long list.
A summary of the rationale for elimination is:
Eliminating Bronglais General Hospital leaves Mid-Wales with no urgent care
provision and is at odd with the view of the Mid-Wales Collaborative.Option 8 This option was one of the initial 16 developed by ODAG on 17th December 2017. The key features of this option are: A new Tertiary Specialist Centre – location to be decided according to need 7 Community Hubs with Beds – location to be decided according to need Bronglais General Hospital continues as a District General Hospital. At Workshop 1 (18/12/17), this Option was recommended to be eliminated from the long list by 1 of the 6 groups. The rationale stated by this group was: Not clinically safe No viable journey Staffing The ODAG meeting on 21/12/17 reviewed this rationale and carried out a SWOT analysis. They felt that the rational put forward at the workshop was not sufficiently robust to eliminate Option 8 at this early stage and agreed that it should remain on the long list for further consideration.
Following the ODAG review on 4th January 2018 the option was clarified as per the image below. The main points of clarification being to state that Withybush General Hospital, Glangwili General Hospital and Prince Philip Hospital are assumed to close in this option and be replaced by the new facilities and services, and that depending on local health needs existing community hospital sites will either maintain beds, provide a range of day time services, become an administrative base, or close. At this point we also added a second image, see below, to illustrate the option and show the spread of facilities across the various levels of care. This was in response to feedback and discussions in ODAG. The rationale was that if we are proposing a change in the balance of care and more care being delivered closer to home it was important to be able to see where facilities in the proposals were located across the spectrum of care.
On the 22nd January 2018 at the review of all feedback to date from ODAG,
Challenge Events and Staff Drop-Ins the decision was made to eliminate this option
from the long list. The rationale for this decision was:
The Tertiary Centre is ambitious but unrealistic
The population of Hywel Dda UHB is too small for a separate Tertiary Centre
There are no plans for Morriston to downsize and a competing Tertiary Centre
would have an impact on the commissioning of servicesOption 9
This option was one of the initial 16 developed by ODAG on 17th December 2017.
The main features of this option are:
7 Community Hubs with beds
Bronglais General Hospital remains as a general hospital with general
medical take
Prince Philip Hospital becomes Urgent Care Hospital
Withybush General Hospital becomes Planned Care Hospital
Glangwili General Hospital becomes a Rehabilitation Centre
At Workshop 1 (18/12/17), this Option was recommended to be eliminated from the
long list by 2 of the 6 groups. A summary of the rationale for elimination is:
Does not meet population health needs
Prince Philip site issue
Rehab at Prince Philip would make more sense
Urgent Care at Prince Philip - geographically too close to Morriston
The ODAG meeting on 21/12/17 agreed with this rational and recommendation and
Option 9 was eliminated from the long list.Option 10
This option was one of the initial 16 developed by ODAG on 17th December 2017.
The main features of this option are:
7 Community Hubs with beds
Bronglais General Hospital remains as a general hospital with general
medical take and MIU
Prince Philip Hospital remains and has a Rehab Centre, medical take and
MIU
Withybush General Hospital becomes Planned Care Hospital
Glangwili General Hospital becomes an Urgent Care Hospital
At Workshop 1 (18/12/17), this option was not recommended to be eliminated from
the long list by any of the 6 groups.
The ODAG meeting on 21/12/17 carried out a SWOT analysis and agreed that this
option should remain under consideration.
In response to feedback from Withybush Medical Staffing Committee (8th January
2011) Options Challenge session and Withybush Staff Drop-In session (11th January
2018) Option 10b was developed and Option 10 was renamed as 10a. The feedbackthat led to this change was that none of the options were showing Withybush as the Urgent Care Hospital and it was felt that this should be given due consideration. Please see the revised Option 10a below.
Option 10a This Option was formerly known as Option 10 (see above) and was renamed as 10a when Option 10b was added on 12nd January 2018. On the 22nd January 2018 at the review of all feedback to date from ODAG, Challenge Events and Staff Drop-Ins the decision was made to eliminate this option from the long list. The rationale for this decision was:
The distance to access urgent and emergency care for Pembrokeshire
residents is too great
Not an equitable model in terms of access to urgent and emergency careOption 10b This option was developed as a variant of Option 10, in response to feedback from Withybush Medical Staffing Committee (8th January 2011) Options Challenge session and Withybush Staff Drop-In session (11th January 2018). The feedback that led to this change was that none of the options were showing Withybush as the Urgent Care Hospital and it was felt that this should be given due consideration.
The main features of this option are:
7 Community Hubs with beds
Bronglais General Hospital remains as a general hospital
Specialist Rehab Centre in Llanelli with medical take and MIU
Withybush General Hospital becomes an Urgent and Emergency Care
Hospital
Glangwili General Hospital becomes a Planned Care Hospital
On the 22nd January 2018 at the ODAG session to review of all feedback to date
from Challenge Events and Staff Drop-Ins it was agreed that this option should
remain under consideration. It was noted that this option provides more equitable
provision for all residents due to the location of Urgent and Emergency Hospital
(UEC) in Pembrokeshire and the development of community hubs can ensure further
equity of access to a range of services.
The key strengths of this option were considered to be:
7 community hubs
More care available in the community, closer to home
Acute care maintained in all counties
Weaknesses of this option were noted as:
Locating UEC Hospital so far West may pose a clinical safety risk for
residents in the East
Still servicing 4 hospital sites – is this viable/sustainable?
Increased travel for some people
Increased flows to Morriston Hospital
0n 30th January 2018, this option was further refined in response to feedback from
the Options Challenge sessions and Staff-Drop in sessions to include depicting
existing and already planned community hospitals and hubs and provide some clarity
on the level of service proposed at each hospital site and community site. The map
image also shows Mental Health facilities planned as a result of the Transforming
Mental Health Programme. Morriston Hospital is also shown recognising that
changes within Hywel Dda UHB may impact on Abertawe Bro Morgannwg UHB andthat for some people Morriston Hospital may be there nearest hospital. Please see the following 4 images.
In the Options Scoring exercise Option 10b was scored lowest out of the 6 options that were scored. The Executive Team (14/2/18) reviewed the scoring and the high level affordability test and agreed that this option should be eliminated from the shortlist.
Option 11
This option was one of the initial 16 developed by ODAG on 17th December 2017.
The main features of this option are:
Urgent and Emergency Care Hospital – location to be decided according to
need
Bronglais General Hospital is a general hospital with general medical take and
MIU
Prince Philip Hospital becomes a Planned Care facility with MIU
Withybush General Hospital becomes a Rehabilitation and Intermediate Care
facility
Glangwili General Hospital becomes a Community Hub with beds.
At Workshop 1 (18/12/17), this Option was recommended to be eliminated from the
long list by 2 of the 6 groups. A summary of the rationale for elimination is:
Not viable
Rehab should be delivered closer to home
Planned care at Prince Philip is too far for some people to travelThe ODAG meeting on 21/12/17 agreed with this rational and recommendation and Option 11 was eliminated from the long list.
Option 12
This option was one of the initial 16 developed by ODAG on 17th December 2017.
The main features of this option are:
Planned Care Hospital – location to be decided according to need
7 Community Hubs
Bronglais General Hospital is a general hospital with general medical take and
MIU
Glangwili General Hospital becomes an Urgent and Emergency Care Hospital
At Workshop 1 (18/12/17), this Option was not recommended to be eliminated from
the long list by any of the 6 groups.
The ODAG meeting on 21/12/17 agreed that this option should remain under
consideration.
In response to feedback from Withybush Medical Staffing Committee (8 th January
2011) Options Challenge session and Withybush Staff Drop-In session (11th January
2018) Option 12b was developed and Option 12 was renamed as 12a. The feedback
that led to this change was that none of the options were showing Withybush as the
Urgent Care Hospital and it was felt that this should be given due consideration.
Please now see Option 12a below.Option 12a This Option was formerly known as Option 12 (see above) and was renamed as 12a when Option 12b was added on 12nd January 2018. The revised images below make clear the assumptions that in this option Withybush General Hospital and Prince Philip Hospital will close and be replaced by new services and facilities and that depending on local health needs existing community hospital sites will either maintain beds, provide a range of day time services, become an administrative base or close.
On the 22nd January 2018 at the review of all feedback to date from ODAG,
Challenge Events and Staff Drop-Ins the decision was made to eliminate this option
from the long list. The rationale for this decision was:
The distance to access urgent and emergency care for Pembrokeshire
residents is too great
Not an equitable model in terms of access to urgent and emergency careOption 12b This option was developed as a variant of Option 12, in response to feedback from Withybush Medical Staffing Committee (8th January 2011) Options Challenge session and Withybush Staff Drop-In session (11th January 2018). The feedback that led to this was that none of the options were showing Withybush as the Urgent Care Hospital and it was felt that this should be given due consideration.
The main features of this option are:
7 Community Hubs some with beds
Bronglais General Hospital remains as a general hospital
Withybush General Hospital becomes an Urgent and Emergency Care
Hospital
Glangwili General Hospital and Prince Philip Hospital will close and be
replaced by new services and facilities
On the 22nd January 2018 at the ODAG session to review of all feedback to date
from Challenge Events and Staff Drop-Ins the decision was made to eliminate this
option from the long list. The rationale for this decision was:
The distance to access urgent and emergency care for Carmarthenshire
residents is too great
Not an equitable model in terms of access to urgent and emergency careOption 13 This option was one of the initial 16 developed by ODAG on 17th December 2017. The main features of this option are: 7 Community Hubs with beds Multiple hub centres (TBC) Significant EMRTS resourcing required All Level 3 services commissioned out At Workshop 1 (18/12/17), this Option was recommended to be eliminated from the long list by all 6 of groups. A summary of the rationale for elimination is: Not safe for the population No care closer to home Not kind, not sustainable, not accessible This model would destroy the whole system Huge reliance on other health boards and transport The ODAG meeting on 21/12/17 agreed with this rational and recommendation and Option 13 was eliminated from the long list.
Option 14
This option was one of the initial 16 developed by ODAG on 17th December 2017.
The main features of this option are:
New Super Hospital with Planned and Urgent and Emergency Care – location
to be decided according to need
Withybush General Hospital, Prince Philip Hospital, Glangwili General
Hospital and Bronglais Hospital become Community Super Hubs (Level 2 and
2+ Services)
At Workshop 1 (18/12/17), this Option was recommended to eliminated from the long
list by 1 of 6 of groups. The rationale they gave was simply that they did not feel
this model was viable.
The ODAG meeting on 21/12/17 felt that the rationale for elimination was not robust
and that this option was similar to others still being considered and so agreed that
this option should remain on the long list.
On 2nd January Phil Kloer (Medical Director) and Libby Ryan-Davies (Transformation
Director) reviewed the options and feed-back to date with some of the TCS
Programme Management Office team. They felt that a number of the options were
sufficiently similar to be considered as variant of one option rather than separateoptions, These were Options 14, 16, 17,18, 19 and 20. Following this review Option 14 was revised and merged with Option 16 to become Option 21a. Please now see Option 21a.
Option 15 This option was one of the initial 16 developed by ODAG on 17th December 2017. The main features of this option are: Outsourcing of all activity Privatisation of all services At Workshop 1 (18/12/17), this Option was recommended to be eliminated from the long list by 4 of the 6 of groups. A summary of the rationale for elimination is: Impact on economy Mass redundancies Not safe, will lack own governance Patient voice won’t be heard Not compatible with NHS Wales ethos The ODAG meeting on 21/12/17 agreed with this rational and recommendation and Option 11 was eliminated from the long list.
Option 16
This option was one of the initial 16 developed by ODAG on 17th December 2017.
The main features of this option are:
Major Urgent and Planned Care Hospital – location to be decided according to
need
4 Community Hubs, 1 or 2 of which will have frailty/dementia units
Level 2 and 2+ Services provided within the hubs
At Workshop 1 (18/12/17), this Option was recommended to be eliminated from the
long list by 3 of 6 of groups. A summary of their rational for elimination is:
No Bronglais exposes the whole of mid-Wales
Narrow scope of what will be delivered locally
Staffing issues
Local infrastructure networks
The ODAG meeting on 21/12/17 felt that the rationale for elimination was not
sufficiently robust and that as this option was similar to others still being considered
and so agreed that this option remain on the long list.On 2nd January Phil Kloer (Medical Director) and Libby Ryan-Davies (Transformation Director) reviewed the options and feed-back to date with some of the TCS Programme Management Office team. They felt that a number of the options were sufficiently similar to be considered as variant of one option rather than separate options, These were Options 14, 16, 17,18, 19 and 20. Following this review Option 16 was revised and merged with Option 14 to become Option 21a. Please now see Option 21a.
Option 17
This option was developed by one of the groups at Workshop 1 (18/12/17).
The main features of this option are:
7 Health and Wellbeing Centres aligned to localities, some of these will have
48hr observation beds. Other community beds to be commissioned
Bronglais General Hospital – MIU front of house, medical take, ITU
New major Urgent and Planned Care Hospital – location to be decided
according to need (between Haverfordwest and Carmarthen)
Glangwili General Hospital will close
On 21st December 2017, ODAG reviewed this newly proposed option and agreed
that it should remain under consideration.
On 2nd January Phil Kloer (Medical Director) and Libby Ryan-Davies (Transformation
Director) reviewed the options and feed-back to date with some of the TCS
Programme Management Office team. They felt that a number of the options were
sufficiently similar to be considered as variant of one option rather than separate
options, These were Options 14, 16, 17,18, 19 and 20. Following this review Option
17 was revised and merged with Options 18 and 19 to become Option 21b.
Please now see Option 21b.Option 18
This option was developed by one of the groups at Workshop 1 (18/12/17).
The main features of this option are:
7 Community Hubs, some of these will be 24hr)
Community Hubs will have frailty acute beds and MIU
Bronglais General Hospital – full front of house, medical take, ITU
New major Urgent and Planned Care Hospital (separation of urgent and
planned care but on same site) – location to be decided according to need
Hotel/live-in facility supported by health/LA/3rd Sector (extra care enabling
approach)
On 21st December 2017, ODAG reviewed this newly proposed option and agreed
that it should remain under consideration.On 2nd January Phil Kloer (Medical
Director) and Libby Ryan-Davies (Transformation Director) reviewed the options and
feed-back to date with some of the TCS Programme Management Office team. They
felt that a number of the options were sufficiently similar to be considered as variant
of one option rather than separate options, These were Options 14, 16, 17,18, 19
and 20. Following this review Option 18 was revised and merged with Options 17
and 19 to become Option 21b. Please now see Option 21b.Option 19
This option was developed by one of the groups at Workshop 1 (18/12/17).
The main features of this option are:
Bronglais General Hospital – MIU front of house, planned care
New major Urgent and Planned Care Hospital – location to be decided
4 Community Hubs with beds co-located with hospitals in Llanelli,
Carmarthen. Haverfordwest and Bronglais
Additional hubs (number and location to be determined) with mental health,
frailty and rehab services
On 21st December 2017, ODAG reviewed this newly proposed option and agreed
that it should remain under consideration.
On 2nd January Phil Kloer (Medical Director) and Libby Ryan-Davies (Transformation
Director) reviewed the options and feed-back to date with some of the TCS
Programme Management Office team. They felt that a number of the options were
sufficiently similar to be considered as variant of one option rather than separate
options, These were Options 14, 16, 17,18, 19 and 20. Following this review Option
19 was revised and merged with Options 17 and 18 to become Option 21b.
Please now see Option 21b.Option 20
This option was developed by one of the groups at Workshop 1 (18/12/17).
The main features of this option are:
Bronglais General Hospital remains as DGH
New major Urgent and Planned Care Hospital – location to be decided
according to need
Prince Philip Hospital becomes acute medicine only with MIU (no planned
care)
2 Community Hubs providing any services that don’t require an overnight
medical rota
On 21st December 2017, ODAG reviewed this newly proposed option and agreed
that it should remain under consideration but noted that it was similar to Options 14
and 16.
On 2nd January Phil Kloer (Medical Director) and Libby Ryan-Davies (Transformation
Director) reviewed the options and feed-back to date with some of the TCS
Programme Management Office team. They felt that a number of the options were
sufficiently similar to be considered as variant of one option rather than separate
options, these were Options 14, 16, 17,18, 19 and 20. Following this review Option
20 was revised and became Option 21c. Please now see Option 21c.Option 21a
On 2nd January Phil Kloer (Medical Director) and Libby Ryan-Davies (Transformation
Director) reviewed the options and feed-back to date with some of the TCS
Programme Management Office team. They felt that a number of the options were
sufficiently similar to be considered as variant of one option rather than separate
options, these were Options 14, 16, 17,18, 19 and 20. Following this review Options
14 and 16 were merged and became Option 21a.
The main features of this option are:
New major Urgent and Planned Care Hospital – location to be decided
according to need
Prince Philip Hospital, Bronglais General Hospital, Withybush General
Hospital and Glangwili General Hospital become Community Super Hubs
Level 2 and 2+ services provided in the Super Hubs
Frailty and Dementia services provided in the Super Hubs
This option assumes that depending on local health needs existing community
hospital sites will either maintain beds, become an administrative base, or
close.In the ODAG review on 4th January 2018, the group reviewed this option and
agreed that is should be eliminated from the long list. Their rationale for
elimination is summarised as:
Requires major cultural shift
5 sites to cover
No Bronglais and provision for Mid-Wales
Community focus will be difficult to achieve if using existing hospital sites
as community hubs and wholly dependent on achieving cultural shift at
paceOption 21b
On 2nd January Phil Kloer (Medical Director) and Libby Ryan-Davies (Transformation
Director) reviewed the options and feed-back to date with some of the TCS
Programme Management Office team. They felt that a number of the options were
sufficiently similar to be considered as variant of one option rather than separate
options, these were Options 14, 16, 17,18, 19 and 20. Following this review Options
17,18 and 19 were merged to become Option 21b.
The main features of this option are:
New major Urgent and Planned Care Hospital (separation of planned and
urgent care but on same site) – location to be decided according to need
Prince Philip Hospital, Withybush General Hospital and Glangwili General
Hospital close and are replaced by new services and facilities
Bronglais General Hospital is a DGH with MIU, medical take, ITU and a
separate planned care facility
7 Community Hubs aligned to localities, some to have 48hr observation beds
Frailty and dementia services provided in the Community Hubs
Depending on local health needs existing community hospital sites will either
maintain beds, become an administrative base, or close.On 22nd January all remaining options were reviewed taking account of feed-back
to date from Options Challenge sessions and Staff Drop-In sessions, and it was
agreed that this option should remain under consideration. The view was that the
strengths of this option are:
A centrally located new Urgent and Planned Care Hospital supported by 7
Community Hubs
Separation of planned and urgent care but on the same site has
advantages for staffing and support services
New build is considered attractive for recruitment and retention
Reduction to 2 hospital sites is more sustainable
7 Community Hubs align to existing locality structures
Some weaknesses were noted as:
Location of the new build may cause clinical safety issues due to travel times
and may increase flows to Morriston
Increased travel times for some patients and staff
Timescale to deliver major new build
Capital cost of new build
On 30th January 2018, this option was further refined in response to feedback from
the Options Challenge sessions and Staff-Drop in sessions to include details of
existing and already planned community hospitals and hubs, and provide some
clarity on the level of service proposed at each hospital site and community site. The
map image also shows Mental Health facilities planned as a result of the
Transforming Mental Health Programme. Morriston Hospital is also shown
recognising that changes within Hywel Dda UHB may impact on Abertawe Bro
Morgannwg UHB and that for some people Morriston Hospital may be there nearest
hospital. Please see the following 4 images.You can also read
