Looking at hospital services

If you have questions about the ICS rather than Working Together on Hospital Services you may find them answered here.

Working Together on Hospital Services is a large and complex piece of work, and we’re aware that there are many questions that people have about it. This section looks at the questions which we’ve received most often and provides clear answers to them.

Right from the beginning, there are some guiding principles for this work, which we will always stick to, and which underpin everything which we are doing here:

• There will continue to be a hospital in every Place (every borough within South Yorkshire and Bassetlaw): we are not closing any District General Hospitals (DGHs);
• Most patients will continue to receive most of their hospital-based care at their local DGH;
• We value the staff we have, and having a good supply of staff is one of our most pressing problems – so, we do not expect that Working Together on Hospital Services will lead to any redundancies, although some staff might have to work differently.

This is a piece of work about working with our existing NHS services and making sure that we can continue to deliver those NHS services, for all of the people of South Yorkshire and Bassetlaw, for the long term.

We’re also committed to working in a way which upholds the NHS Constitution, and its key principles and values.

What is Working Together on Hospital Services?

Working Together on Hospital Services began life as an independent review of five hospital services (the Hospital Services Review - HSR) in the hospitals of South Yorkshire and Bassetlaw as well as Chesterfield (who chose to be involved because of the way patients move between South Yorkshire and Chesterfield). The work explored how five services could be future-proofed to ensure local people have long-term sustainable access to safe, high quality care provided by the most appropriate NHS healthcare professional and in the best place. The services which were included are:

• Services for poorly children who need hospital care
• Services for pregnant women and mother-and-baby
• Stroke services
• Urgent and emergency care services
• Services dealing with, and investigating, stomach and intestine conditions

The independent review produced its final report in May 2018, and you can find that here. We then looked at the implications of that report, and all of our local NHS organisations agreed together how we take that work forwards (they considered a document called the Strategic Outline Case [SOC] which takes the review’s findings and makes recommendations for action). This decision was made in October 2018 and the agreed SOC was published. You can read the SOC here. The work will now move from being an independent review into being one of the main work streams of the South Yorkshire and Bassetlaw Health and Care Working Together Integrated Care partnership called 'Working Together on Hospital Services'.

Key to this work, all the way through, is the input of healthcare professionals, patients and the public in our region. A series of opportunities for staff and the public to engage and share their views have been held to date, and we commit to continuing with this throughout.

To see the breadth of engagement that has taken place to date and the outcomes, click below on 'all the documents'.

Who is involved?

This work has been initiated voluntarily by the organisations involved in the South Yorkshire and Bassetlaw Health and Care Working Together partnership (also referred to as the South Yorkshire and Bassetlaw Integrated Health System – SYB-ICS). It is a partnership of all of the health and care organisations in South Yorkshire and Bassetlaw.

It was felt by the hospitals that it was important for the initial review work to be led by an independent person so that the services are looked at independently and objectively, without bias to any one of the involved hospitals. Therefore the review was led by Professor Chris Welsh, who has been a vascular surgeon, senior medical manager in the NHS, including Medical Director for NHS Yorkshire and the Humber, and Director of Education and Quality at Health Education England. Currently he is Chair of the Yorkshire and Humber Clinical Senate.

As we move on and the work becomes part of the mainstream SYB-ICS work programme, we hope to retain senior independent advice throughout, as well as regularly consulting with our clinical teams across the region.

Working Together on Hospital Services is just one part of the SYB-ICS overall approach. At the same time as this work, we are continuing our work on developing more and more ways of treating and caring for people in their homes and local clinics, so that they don’t need to go to hospital. Details about all of the wider work of the ICS can be found on this website.

All the hospitals that provide acute medical and surgical services in South Yorkshire and Bassetlaw are included in the review. Also included are hospitals that have networked services and close links.

Mental health hospitals are not included. This is because mental health is a separate workstream within Health and Care Working Together with experts from across health and care working on how we can improve care and services.

The hospitals included are:

• Barnsley Hospital NHS Foundation Trust
• Chesterfield Royal Hospital NHS Foundation Trust
• Doncaster and Bassetlaw Teaching Hospitals NHS Foundation Trust
• Mid Yorkshire Hospitals NHS Trust*
• The Rotherham NHS Foundation Trust
• Sheffield Children's Hospital NHS Foundation Trust
• Sheffield Teaching Hospitals NHS Foundation Trust

* Mid Yorkshire Hospitals are included because there are some patients who live in Wakefield who access South Yorkshire hospitals and vice versa. The hospital is within a different NHS region which is also looking at how it can improve services by working differently. Some of the services which the review will be looking at have already been consulted on in Mid Yorkshire and we will not be making any recommendations that would change services already agreed.

What does Working Together on Hospital Services cover?

In terms of the geographical area, it covers the NHS areas that match the boundaries of the four Metropolitan Boroughs of South Yorkshire (Barnsley, Doncaster, Rotherham and Sheffield) and leaves in the services Bassetlaw District Council in north Nottinghamshire. This includes a population of circa 1.5 million people.

The work focuses upon acute hospital services, it therefore covers the hospitals within those areas: Barnsley Hospital NHS (FT) Foundation Trust, Doncaster and Bassetlaw Teaching Hospitals NHS FT (with sites at Doncaster Royal Infirmary, Bassetlaw District General Hospital and Mexborough Montagu Hospital), The Rotherham NHS FT, Sheffield Children’s NHS FT and Sheffield Teaching Hospitals NHS FT (with sites at the Royal Hallamshire campus, including Weston Park Hospital, Jessop Maternity Wing and Charles Clifford Dental Hospital, and at the Northern General Hospital). For NHS purposes, Bassetlaw is regarded as being within the Yorkshire and Humber region, even though it is politically a part of Nottinghamshire.

Whilst Derbyshire has its own integrated working arrangements, and that the area falls with the NHS’s East Midlands region, there are very strong patient linkages between the Chesterfield,  North East Derbyshire and Bolsover areas of Derbyshire and South Yorkshire and Bassetlaw. Therefore, the Review currently includes within its scope Chesterfield Royal Hospital NHS FT.

The work covers certain hospital services within those hospitals named above:

• Services for poorly children who need hospital care
• Services for pregnant women and mother-and-baby
• Stroke services
• Urgent and emergency care services
• Services dealing with, and investigating, stomach and intestine conditions

Why did you decide on the five services that the review is focused on?

The report details how the five services were assessed and can be found here.

What did the review recommend?

The May 2018 independent report made a number of recommendations for each of the five services covered. The report considered two types of recommendations: those related to working together more closely, and those which might mean changing the ways in which services are delivered (for example the time or locations at which the service operates, this is known as reconfiguration). We will always try to do everything we can to work together before we change the configuration of our services, but in some cases (maternity, the care of acutely sick children,  and gastroenterology stomach and intestine health), the report does recommend that some reconfiguration might be necessary.

In terms of working together, the report established that there are risks to the current provision of all of the services which were reviewed, primarily around difficulties in staffing. By working more closely, we can align our approaches to recruitment and training, and work together to develop creative new job roles, which use the skills of our staff to the fullest extent.

But challenges also arise because different hospitals, albeit with the best intentions, do not always interpret national clinical guidance the same way and so can treat patients differently even if they present with exactly the same condition. This is known as Clinical Variation, and the report recommends working closely together to reduce this and to ensure that people right across our area receive equitable care (their outcomes will be the same, as good as possible, wherever they live and wherever they are treated).

There are also issues around the way in which we make the best use of innovative practice across our region. We have some excellent examples of innovation, but these are frequently confined to individual services or hospitals and we need to share these more widely.

Is the real issue that the NHS isn’t getting enough money from the government?

More money would not solve all the challenges we face, for example in finding  staff to recruit, or keeping up with advancing treatments and technology or ensuring that all of our clinicians are consistently using the same Best Practice guidelines all of the time to ensure we all have equal access to the best possible care. Working together differently (or, to put it another way, “integrating”) is a real opportunity for us to collectively improve the care and services our patients receive. We believe that we can do much more together than we could do individually.

How do the proposals within the HSR Report fit with current legislation and statutory organisational duties particularly around competition?

The Report’s recommendations have been put together as solutions that enable greater collaboration between organisations, for the benefit of patients. Organisations’ statutory duties remain and the recommendations are designed to support partners to meet these.

We have a strong and proud history of working together in South Yorkshire and Bassetlaw, and we’re recognising more and more that for example competing for the same staff, or duplicating equipment that we could share isn’t the best use of public money.

In our Memorandum of Understanding, which is our commitment to how we will work together, we are clear that we will support one another, not compete.

How do all of the recommendations work when there are geographical boundaries (such as Chesterfield in a different STP not SYBICS?)

There are currently barriers to patient flow between Trusts, as well as geographies. Our Clinical Working Groups identified that barriers in the current system include different patient transfer protocols, a lack of formal agreements between organisations around transferring patients between organisations, different availability of out of hospital services in different areas, and barriers to sharing patient information, all of which make it difficult for patients to move between different footprints and institutions.

The aim of the Integrated Care System (ICS), and of Working Together on Hospital Services, is to reduce barriers between the Trusts. We are aiming, for example, to use the Hosted Networks to agree standardised transfer protocols between Trusts so that patients can be transferred more easily, and to standardise care pathways, based on best practice, so that patients receive similar care whichever hospital they are in.

We recognise that whilst the ICS aims to make patient flow more straight-forward within South Yorkshire and Bassetlaw, we also have patients who cross our geographical boundary. We therefore work very closely with neighbouring organisations and partnerships (such as North Derbyshire to where some south Sheffield patients flow, and Mid Yorkshire Hospitals, to where some north Barnsley patients flow) to work towards the same improvements in patient flow across our borders as we are hoping to achieve within them.

Is the Review all about saving money?

No. The NHS (in our area, and right across the country) faces some significant challenges, such as rising demand, staffing shortages and meeting stringent quality standards, and this means that change is necessary to ensure the long-term future of our health services. It’s that long-term sustainability, ensuring that everyone across our region gets equitable access to those high quality services,  which is our reason for doing this.

We do need to ensure we make best use of the resources available, though, and so any proposed changes will need to fit within the budgets that the partner organisations have, and must not cost more to deliver than our current services. The Review was not set up to resolve the financial challenge although it was agreed that any recommendations from it would not make them worse.

By working together more collaboratively and planning services together, using our workforce in the best way and in many cases, reducing duplication for the patient, we hope to narrow this gap.

Is the HSR privatising NHS services?

No. We are committed to providing NHS care, with NHS providers, now and as far ahead as we can plan for.  The whole purpose of this work is to make those NHS services strong and sustainable, so that we can continue to deliver NHS care to the people of South Yorkshire and Bassetlaw long into the future. Our discussions are between NHS organisations, looking at how they can work together to make that happen

Why change? My local services are fine, so why are you trying to change them? Why can’t we just leave things how they are?

We have great health and care services in South Yorkshire and Bassetlaw, and many people have fantastic experiences of the care that they receive. However, we also know that we will be facing many challenges to our services in the future if we don’t do something to address some really major issues right now.              

These issues include:

• Demand for services is increasing, year on year
• People’s needs are changing. It’s fantastic that people are increasingly surviving illnesses which they wouldn’t have done in the past. But often this means that they have some ongoing health issues which they need help with.
• Our workforce is increasingly over-stretched. This is happening for various reasons, both related to increasing demand, and also to it being harder in some cases to recruit the staff we need. It can lead to a vicious circle where tired staff leave their jobs – we need to try and reverse that.

Although you may not have noticed that in care which you, your family or friends have experienced recently, these issues are likely to put increasing pressure on all of our services over time.

In addition to that, the NHS is largely unchanged, in its fundamental structure, from the way in which it was designed in the 1960s. But the types of healthcare we can offer, and the ways in which this can be provided, have been revolutionised since then. We need to make sure that our healthcare system is modernised to reflect the kinds of care that we can deliver now and in the future.

Is it all about cutting services or closing local hospitals?

One of the underpinning principles for the HSR is we are not closing any District General Hospitals - every borough across our area will keep its DGH. And whilst we’re not saying that services can remain exactly as they have been, we are also clear that the majority of patients will continue to receive most of their hospital-based care at their local DGH.

How safe are local services? 

The CQC assesses the safety of Trusts in South Yorkshire and Bassetlaw, and any immediate concerns are dealt with by individual Trusts. However, ensuring long-term sustainable and safe hospital services is one of the key aims of the Review.

How much does Working Together on Hospital Services take account of what is happening in local areas already?

Where work is already underway to make local improvements, or to address local issues, this is taken into account. We are not looking to undo or change any work but are looking where a region-wide solution might support locally faced challenges.

What are the implications of the CQC reports on services “requiring improvement”?  Will they be supported with resources to address local needs or will something else happen?

Individual Trusts are working with the CQC to address immediate issues raised in the CQC reports. The Review is focusing on the longer term sustainability of services.

Are you attempting to agree new standards of care for SYB? If so, what is wrong with national standards? 

We will follow national standards where these are prescribed. In areas of workforce, where there are guidelines rather than standards, the modelling so far has been based on individual Royal College guidelines.

However, Royal College guidelines have traditionally focused on a workforce that is largely based on traditional divisions between consultants, junior doctors and nurses. Some of the Royal Colleges are already beginning to look at how alternative roles (such as nurse endoscopists or Physicians’ Associates, for example) can support the traditional workforce. We will work with Health Education England, the Yorkshire and Humber Clinical Senate, and the relevant Royal Colleges to help develop work in this direction.

Does this mean my local hospital will close?

No. As our core principles state: No local hospitals will close. The Report recommends Barnsley, Bassetlaw, Rotherham, Sheffield, Chesterfield and Doncaster all continue to have District General Hospitals (DGHs), delivering high quality care for patients.

Although hospitals are under significant pressure, this is not about closing hospitals. There needs to be a hospital in every place, delivering a range of core services.

The overarching vision for services put forward by the Report is for all patients to have access to high quality services – with most people, most of the time, receiving the vast majority of their hospital-based care in their local hospital.

Don’t you already know what you want to do with the services?

No. Over the next six months, we will be looking at the five services identified in more detail to better understand the issues which they face in each town, as well as looking at any opportunities to work differently to be able to continue providing high quality care.

A really important part of this will involve conversations with all staff working within the services as well as asking for patients and members of the public to share their views and experiences. All  of this feedback will help to shape further, more detailed recommendations about the changes we should make to keep our NHS services providing high quality care for our whole population, for the long term.

Which organisations or hospitals will be affected?

The Report does not make any recommendations about any individual hospitals (or the organisations which run them, “Trusts”). The Report’s recommendations are not site specific but more general and it is now for all of the partners in the Integrated Care System to consider what happens next.  The detailed study along with the engagement work, which we will be undertaking (right throughout this work) with staff, patients and the wider public will have a significant influence on how we take this work forwards.

However, working more closely together is the key theme in the Report and, as our local hospitals continue to transform their services to meet future demand, the Report recommends that they work even more closely together in ‘Networks’ and this is across all of our hospitals.

Is this the start of merging all of our hospitals?

This Report is not a merger plan. Hospitals already work closely together across a range of services and the Report simply recommends finding ways for organisations to work together even more closely to provide better services for patients, where it makes sense to do so.

Does the Report make any recommendations that clinicians disagree with?

There are large numbers of clinicians in the region and some have different opinions about how services should develop. That’s why it’s important that we hear from as many of them as possible so that we can come to a conclusion about the majority of clinical opinion. The review has consulted extensively with clinicians and has collected the views of different members of staff, including medical, nursing and therapy staff (i.e. the clinicians), admin and management staff, Medical Directors (the hospitals’ most senior doctors) and wider hospital Board members, and NHS commissioners (the teams who decide how best we spend the NHS budget in each Place). This has included GPs and the ambulance services. We’ve also engaged extensively with patient and public groups. We’ll continue to engage with all of these people, and we’ll improve our engagement to ensure that everyone has the opportunity to have a say, all the way through this work.

The Report mentions a “District General Hospital’s unique service portfolio”. What does that mean?

It means that each of the hospitals in the region would provide a core set of services (which would include emergency services) as well as other services that are more specialist. This combination of services is likely to be a little different in each hospital.

How long will it take and when will I know?

Some of the recommendations could get underway quite quickly if all the partners agree with them; for example, recommendations such as the Hosted Networks of care and regional centres of excellence to support them. We think that these are about working together better, rather than really changing the shape of our services. Of course, as we take any work forward on these aspects, we will continue to engage thoroughly.

Further work is recommended to look more in more depth at children’s and maternity services ,and at gastrointestinal bleeds. These areas could see some reconfiguration of their services, i.e. services might be delivered in different places and at different times to the ways in which they are delivered currently.

If the Report recommendations are accepted on reconfiguring these services, this would likely take some time, probably several months, to scope out even before any detailed options are put forward around changes to the existing units. If it was then decided that changes to existing units were recommended, there would be significant further work, including full public consultation, which would likely be in 2019.

It would then be likely to take a number of years before any changes would be implemented. Regular updates on what is happening will be posted on the Health and Care Working Together website.

Does this mean my local hospital will close?

No. As our core principles state: No local hospitals will close. The Report recommends Barnsley, Bassetlaw, Rotherham, Sheffield, Chesterfield and Doncaster all continue to have District General Hospitals (DGHs), delivering high quality care for patients.

Although hospitals are under significant pressure, this is not about closing hospitals. There needs to be a hospital in every place, delivering a range of core services.

The overarching vision for services put forward by the Report is for all patients to have access to high quality services – with most people, most of the time, receiving the vast majority of their hospital-based care in their local hospital.

Is my A&E going to close?

No. The Report includes a recommendation to keep all Emergency Departments (EDs, also known as A&E Departments) in Barnsley, Bassetlaw, Chesterfield, Doncaster, and Rotherham, plus both the Major Trauma Centre and ED at the Northern General Hospital in Sheffield and the ED at the Sheffield Children’s Hospital.

The independent review looked at how accident and emergency (A&E) and urgent care services are best delivered, and at the likely numbers of medical staff who we can expect to help us deliver them for the coming years, and it came to the conclusion that we can staff the current set of A&E departments / EDs for the foreseeable future.  We’d like our region’s A&Es to work together more closely, but none of them will be closing as a result of this work.

Is my maternity unit going to close?

For maternity services, the Report aligns its thinking with the national report “Better Births”. We know from Better Births that people want their maternity services delivered in a different way. Better Births promotes both safety and informed choice, with access to specialist care whenever it is needed.

To support Better Births, our Report calls for more choice for women and recommends that further work is carried out to consider the creation of more community maternity services and midwife-led units, and further development of home birth services. Further work will look at how maternity services are best provided to local people to ensure that the most appropriate care is delivered by the most appropriately skilled professionals in the most appropriate place, whilst taking women’s choice around their preferred environment for giving birth into account.

The review has identified that there are significant challenges in sustaining certain services in every DGH, in particular paediatrics and maternity services. The Report highlights working together to tackle this as our first option, and says that reconfiguration should only happen where closer working won’t be able to solve all the challenges. However, in the case of maternity, the Report recognises that we have a shortage of obstetricians (the doctors who specialise in maternity care), which is unlikely to improve significantly in the foreseeable future. This means we may have to think differently about the way in which doctor-led maternity care is provided.

This raises the question of whether a small number of towns (one or two) might best provide only midwife-led maternity care, thereby concentrating the number of doctor-led maternity services into a smaller number of hospitals. We recognise that this is complex, and the Report asks for further work to be done in maternity to examine these possibilities.

If the Report recommendations are accepted this is likely to take some time to scope out even before any options are put forward around changes to the existing units. If it was then decided that changes to existing units were recommended there would be significant further work, including very substantial engagement with staff and service users, leading to a full public consultation, which would likely be in 2019. It would then be likely to take a number of years before any changes would be implemented.

I thought there had already been recommendations and a public consultation on children’s services?

There was a consultation, in 2017, which looked only at Children’s Surgery and Anaesthesia. It asked how we could improve the care and experiences of all children needing an emergency operation out of hours in our region.

Following the consultation a decision was made that around one or two children per week (who need an emergency operation for a small number of conditions, at night or at a weekend)  are likely to no longer be treated in hospitals in Barnsley, Chesterfield and Rotherham and will instead have their surgery at Doncaster Royal Infirmary, Sheffield Children’s Hospital or Pinderfields Hospital (Wakefield).

However, this is a different piece of work to the one undertaken by the Hospital Services Review, which looked at children who have hospital medical needs (but who are unlikely to require an operation). This is a different group of patients, and the issues that affect that service are different. Nevertheless, the Review did take the previous work into account when it made recommendations for services for children who are acutely ill.

The Report recommends further work is carried out to consider a reduction in the number of inpatient paediatric units. Does this mean my hospital’s unit will close?

We know that there are, and will continue to be, significant challenges in sustaining our current ways of delivering inpatient care to sick children, based mainly upon the number of paediatricians (children’s doctors) who are likely to be available. At the same time, new ways of delivering care to sick children are being successfully rolled out in other parts of the UK and abroad, and these are less reliant upon children needing to spend time in hospital beds, away from their families. All of our data and feedback tells us that the large majority of children stay less than one day in hospital even now, and the number who come into hospital overnight is very small. In children’s services the Report recommends expanding services for children in the community (e.g. at home, supported by community nursing visits) and in “short stay units” (in hospital, but only for the shortest time possible, and not overnight). This would lead to shorter stays for children and would likely mean there would be less need for longer stay inpatient wards (wards where children stay overnight).

For those children still needing longer stays in hospital for more complex problems, it may be possible to provide this in fewer units and the Report recommends that further work be carried out to consider a small reduction in the number of inpatient paediatric units, by one or two units. By ensuring that our diagnostic and monitoring processes for all children are consistent across our region, and absolutely in line with national Best Practice, the small number of children who require a longer stay will be identified at the start of, or very early into, their hospital visit and brought to the nearest overnight inpatient unit for their specialist care.

For the time being, children’s services will continue as they currently are, pending any further consideration. If the Report recommendations are accepted this is likely to take some time to scope out even before any options are put forward around changes to the existing units. If it was then decided that changes to existing units were recommended there would be significant further work, including very substantial engagement with staff and service users, leading to a full public consultation, which would likely be in 2019. It would then be likely to take a number of years before any changes would be implemented.

The Report recommends that networks and wider collaboration will provide the best opportunity to sustain local services at their current levels, and as with all of our other services under review, we will always consider the benefits of working more closely together as our first option, before we embark upon reconfiguration of services.  Nevertheless, in children’s services, knowing what we do about the likely challenges ahead, it is right that we begin to think early about the nature and impacts of a possible reconfiguration.

All the Emergency Departments in all of the hospitals which currently accept children (i.e. all of them except for the Northern General ED in Sheffield) will continue to accept them, with facilities to observe and care for them.

Are you planning to close any of our special care baby units?

We have no plans to close any of our special care baby units, or neonatal units. We know that there are many deep links (or ‘interdependencies’) between maternity, neonatal and acute children’s services, and will ensure any proposals to change the way we work take the whole service and care package into account.

Why are some parts of the stroke service not included in the Report? I thought there had already been recommendations and a public consultation on stroke services?

A separate business case relating just to Hyper-Acute stroke units (HASUs) was considered and approved in 2017. This was considered and accepted after a full public consultation. Hype Acute stroke services refers to the services where you are cared for in the first 72 hours after having a stroke, where you receive critical, specialist care. Hyper acute stroke services are just one part of a patient’s experience after having a stroke. The HASU business case recommends the concentration of HASU services onto three sites – Sheffield (Royal Hallamshire), Doncaster and Wakefield.

The Hospital Services Review did not duplicate this work, but we recognised that stroke services are a complicated and related group of services beginning at some outpatient clinics to hopefully prevent strokes from happening, right through to community rehabilitation for people who had their strokes several weeks or months ago. We felt that it was important to build upon the HASU work and ensure that the whole ‘pathway of care’ is fit for the future.

Which sites will be paired together for stroke?

A  major proposal in the Report  is that a pairing “approach” should be adopted which would see sites with HASUs share their consultant rotas with those that only have ASU wards (ASU means Acute Stroke Unit – the next step down, after 72 hours, where care does not need to be so intensive). The exact detail of the pairing would need to be worked through, subject to  acceptance of the Report recommendations; as with all the Report recommendations, this is the start of  a process of analysis and engagement before any final conclusions are reached.

Which hospitals will no longer provide overnight gastrointestinal (GI – stomach and intestine) bleed services?

At the moment, not all hospitals in our region provide overnight or out of hours services for urgent GI bleeds and we are not working in the most consistent way to support the staff providing the services for those who need it. 

The Report recommends that overnight and weekend services for emergency gastrointestinal bleeds are consolidated onto three or four sites. It does not specify where the consolidation would take place. This is intended to increase the safety of services for patients, to make sure that in an emergency, all patients have reliable and rapid access to the care they need.

The Report proposes that this will make these services safer for patients no matter what time of day, or day of the week they present. If the Report recommendations are accepted, it is likely to take some time to scope out how this would best be adopted. If it was then decided that significant changes to existing services were recommended there would be considerable further work, including very substantial engagement with staff and service users, leading to a full public consultation, which would likely be in 2019. It would then be likely to take a number of years before any changes would be implemented.

What if I have a gastrointestinal bleed in the night and my hospital doesn’t provide the service?

It will be some time before any proposed changes are implemented. However, if changes to services are eventually made, then these would include us ensuring that common ‘clinical  protocols’ are in place, between all of our hospitals and our local ambulance services,  for patients to be taken by ambulance directly to the nearest provider of this service out of hours. This is a common way of working, and there are already a number of conditions where the ambulance service will take a patient direct to the hospital where there is specialist care in place and where the patient can receive the best possible care. 

What do you do in the middle of the night if a patient is too ill to move?

In the rare situation where a patient is too ill to be moved, we anticipate that protocols would be in place for a consultant from the site providing the rota to come to the patient.

Does the Report’s recommended ‘further work into elective services’ mean you are going to stop providing other services in my local hospital?

No decisions have been made to stop providing services in any hospitals.

If the partners (all of our NHS organisations) propose to take the recommendation around elective services (E.G planned operations) forward, then more work would be done to understand the current links between services and hospitals (what we call “interdependencies”) as well as whether these services could be delivered in a better way for the patients and people accessing them. Staff, clinicians, patients and the public would all be engaged in the work before any further recommendations are made.

What analysis and forecasting underpin the assumptions in the Report that 12% of cases currently seen in hospital can be diverted to community healthcare?

Modelling for  12% of cases being diverted to primary or community care is based on assumptions made in the South Yorkshire and Bassetlaw Sustainability and Transformation Plan in 2016. This, in turn, was based on a strong evidence base from national and international studies, as well as advice from our clinicians and commissioners about what a realistic scenario for South Yorkshire and Bassetlaw could look like. These reports draw on a wide body of academic research which is in the public domain. Our assumptions are also confirmed by the most recent 2018 NHS Improvement guidance.

There is strong evidence that at any given time a significant proportion of the patients in a hospital could receive care in another setting:

• https://www.nao.org.uk/wp-content/uploads/2015/12/Discharging-older-patients-from-hospital-Summary.pdf
• https://improvement.nhs.uk/documents/2898/Guide_to_reducing_long_hospital_stays_FINAL_v2.pdf

 

There is also strong evidence that for many patients that receiving care in a setting other than hospital – for example, in a dedicated rehabilitation setting, or being back in their own home with the appropriate support - would be more appropriate and would improve health outcomes:

• https://www.nao.org.uk/wp-content/uploads/2015/12/Discharging-older-patients-from-hospital-Summary.pdf
• NHS Improvement guidance states that 35% of 70-year-old patients experience functional decline during hospital admission in comparison with their pre-illness baseline; for people over 90 this increases to 65%: https://improvement.nhs.uk/documents/2898/Guide_to_reducing_long_hospital_stays_FINAL_v2.pdf

This evidence around alternative places to deliver care doesn’t only apply to older people. In maternity services, for example, some patients don’t need to be in hospital at all and can choose to give birth at home. In paediatrics, some treatments that would once have required a child to attend  hospital (such as receiving intravenous antibiotics) can now be delivered at home. For working age adults, similarly, treatments such as dialysis and some kinds of chemotherapy can now be delivered by neighbourhood teams closer to – or in – patients’ own homes.

Based on all of this evidence, we believe that there is a significant opportunity to provide care for patients outside hospital. The figure of 12% was agreed by clinicians and commissioners in our area at the time of writing the STP as being a reasonable and realistic assumption to make. They felt that this was well within the level of opportunity identified in national and international evidence.

Each of the Places within South Yorkshire and Bassetlaw (Barnsley, Sheffield, Rotherham, Bassetlaw and Doncaster) is in the process of developing the capacity and capability of its primary care and community care services (through partnerships between the different health and social care services in each Place). Each Place has produced a “Place Plan”, and these are published online. They lay out the current proposals in each Place that are intended to begin to deliver the shift of activity out of hospital. Primary and community care will continue to work together and with other partners to ensure that patients are receiving care as close to home as is appropriate for them.

Doubling this level of shifting activity out of hospital (from the 12% assumed to 24%) was an illustrative scenario to indicate the possible impact of increasing the STP assumptions. It’s a challenging proposition – however it is still well within the limits identified in the NHS Improvement guidance 2018, which identifies of 50% of bed days as not needing to be in an ‘acute’ hospital bed,  because those patients’ medical needs could be met at a more appropriate, usually lower, level of care.

If I am a current patient in one of the five services that the Review is focusing on, does that mean I am not getting a quality, safe service now?

No it does not mean that. Each of the services that were reviewed currently provide safe services across all our hospitals. However, like many across the country, all of the services we’re reviewing are under pressure to meet rising demand and challenges particularly around workforce. We want to ensure that these services stay safe, and that they provide consistent and equitable care to people right across our region, and so we believe we need to tackle those challenges now.  The Report’s recommendations suggest how best this can be done.

Will I have to travel for my care?

At the moment nothing will change. If any of the Report recommendations are taken forward and if there were any changes to how people receive their services, business cases would need to be developed, followed by public engagement. The Report is clear that transforming the way things are done by working together more closely  is the preferred way of making improvements and reconfiguring services should only be done where that isn’t possible. But, if we do ultimately reconfigure our services, then relatively small numbers of patients may need to travel for elements of their care: we wish to keep the numbers of people needing to travel, and the distances which they would have to travel, to a minimum

The Report also makes the recommendation that a Travel and Transport group is developed. This would look at the impact that changing services could have on travel times, and would include consideration of, for example, public transport, car ownership,  etc., as well as the views of our ambulance services. Patients and the public are invited to be a part of these discussions along with colleagues from the ambulance services.

Does the Report make any recommendations that mean staff will lose their jobs?

No, they won’t. This is one of our core commitments, and we will stick to it.

Staff are needed now more than ever and if the recommendations went ahead, we would aim to ensure that the hospitals in the region would be among the most attractive places to work in the English NHS and providing some of the very best care in the world.  They would have fantastic opportunities to develop and learn and to shape the way they work. There are national workforce shortages, and a key aim of this Report is to recommend ways that our region’s services can be even more successful in recruiting, retaining and developing staff.

Why are people not choosing to work in healthcare? How will you make care better without any extra staff?

There may be many reasons why people may not be choosing to work in healthcare, we know that healthcare roles are often demanding jobs. However, locally we are committed to creating more career opportunities within our services and will support and develop our highly skilled and dedicated staff to provide the best possible care in the jobs that they love.

Over the coming months we will be developing a Workforce Hub to look at this and will create a South Yorkshire Regional Excellence Centre as part of these plans. Further information can be found elsewhere on our website.

Whilst we want to recruit and retain more staff, and the Workforce Hub is a major answer to that, another way in which we will bring people in is by encouraging our services to work more closely together seeing how they can support each other day to day, and removing some of the pressure which affects our staff. A lot of the proposals in the Report relate to shared working.

If you had enough staff would you still want to make changes?

Since its creation in 1948 the NHS has constantly adapted and it must continue to do so as the world and our health needs change. There have been some big improvements in healthcare over recent years. For example, people with cancer and heart conditions are experiencing better care and living longer. People’s needs have changed along with this.

People want their health and care services in a place and at a time that is right for them. For many, this means care that is provided at home, or in local healthcare centres – not in a hospital. At the same time, many of our tough financial pressures are down to increased demand on services as people survive conditions which previously they would not have done. It’s a good thing that so many people are living longer but it means the way we work needs to evolve to meet the needs of that changing population, so they can live well.

As the organisations that plan, fund and deliver services, we also need to change to keep pace. By making changes now, we can be sure that the services we rely on today will be able to meet the future needs of our population.

Would investing to solve understaffing not be the obvious way forward in terms of patient safety and future-proofing?

We have to be realistic around our ability to recruit staff

Even if we had significant funds to invest, the problem is in the supply of workforce. For example, we know that all the projections around our paediatrician (children’s doctor) workforce, locally and nationally, suggest that there simply won’t be sufficient trainees coming through in the foreseeable future to run the number of rotas which are currently in place. This type of situation, based upon data provided by the relevant Royal Colleges (the ‘trade organisations’ for those services) exists in all of the services which we’ve studied. Where the data suggests that, despite pressures, we think we’ll have sufficient staff to avoid reconfiguring services, for example in A&E, then we’ve been very happy to go along with this. But the reality in many areas is that we think we need to do things differently, and we would have to do that even if we had unlimited money.

One of the main aims of the proposals in the Hospital Services Review is to enable our region to attract and retain more staff. One of our problems is that the tough working environment (due to increased demand and already stretched rosters because of difficulty in recruiting), leads to more staff leaving the service, so it’s a really important aim for us to reverse that trend. Our proposals include the development of “Hosted Networks” and a Health and Care Institute, which aim, through our hospitals working in closer collaboration, to develop shared approaches to recruitment, promote training and development, and work together to attract new staff through avenues such as apprenticeship schemes.

How are you working with trade unions on this?

We know that it’s really important to work with Staff Side, including trade unions, throughout this piece of work. The SYB-ICS holds a monthly Staff Partnership Forum, which includes trade unions as members, where we discuss this work and other SYB-ICS business. As our proposals become better.

Is Working Together on Hospital Services expecting all staff to work across different sites?

No. The Report recommends that working more closely together in “Hosted Networks” would enable ways in which staff could work more flexibly across sites if they wanted to.  For example, this could be  through undertaking a secondment to another site to gain experience of working in a different unit, or in different settings such as spending time working in a community setting. It’s really important to us that our staff are fulfilled in their jobs, and that they get access to the best training and experience. We hope that working in networks will open lots of these experiences up to our staff, if they want to take advantage of them.

If any Report recommendations are taken forward which suggest significant changes to the time or place at which a service operates, then formal consultation with our staff is as important as consultation with our public: they are both legal duties for us, and they’re both very important to know that our proposals make sense.

Detailed recommendations on shared working across the system

The first recommendations from the HSR which need to be carried out relate to working more closely together, right across our NHS ‘system’. Before we do any reconfiguration work, we are committed to ensuring that we have got the maximum benefit possible from working together.  The Report’s proposals around working together involve the creation of ‘Hosted Networks’ (HNs).

The exact nature of HNs is still under discussion, and we are engaging with staff on this. However, in basic terms these would be circumstances where all of our organisations ‘sign up’ to work together for our region’s good, to ensure that NHS services remain safe and sustainable, and to adopt common ways of working (clinical protocols, job roles, and so forth). The term ‘hosted’ refers to the administration for the network being based in one of our local hospitals (they ‘host’ it for office accommodation, IT, possibly some of the administrative and management staff). However, we should be clear that all of our Trusts are full members of the network, the network rules would apply to them all, and being a host doesn’t mean that services would be centralised or concentrated at the host hospital).

How will Hosted Networks be different from the existing Managed Clinical Networks (MCN)?

The Hosted Networks will build upon work that the MCNs have done. However they will have more operational impacts than the MCNs have: they will be backed by formal agreements between the Trusts around applying particular ways of working. They would also be held to account for implementing proposals once they have been agreed, in a way that they are not in most clinical networks at the moment.

Under the proposed network arrangements, who would the staff be managed by? The lead for the network or the hospital they’re providing the service in?

The Report outlines three different approaches (or ‘levels’) to Hosted Networks (HNs). The detail will need to be worked through with staff in each specialty, but on the basic model, and the ‘co-ordinated delivery network’ which is the middle model, we currently expect that staff would continue to be employed and managed by their own trust.

We would expect any work on HNs to start at the most basic level, and for us to get that working right before me took it to a more advanced stage. And if we did move things onto the higher ‘levels’, then we would engage our staff and public as part of that process, just as we would with any significant change.

If a HN eventually became a ‘single service model’ (working much more closely as one single service across our whole region, in ways that already exist in some parts of the country), then there are a number of options: in some places where such models are in place, staff continue to be employed and managed through the trust where they are based, while in others they are employed and managed by the trust managing the service. If these recommendations went ahead, we would explore the options and listen to the views of staff before deciding which option would be best.

How will you decide which trust leads each Hosted Network?

Ideally, we would like each of our local acute hospital Trusts to be responsible for managing one of the five proposed Hosted Networks. We are working with all of our hospitals, and NHS commissioners, to determine the best way of appointing hosts. This will include answering questions such as whether a Host needs to have particularly strong skills or performance in the service being hosted.

Does this mean Sheffield will be running our services?

No. The Report doesn’t recommend this. Each hospital would be responsible for running its own services under the basic HN models, and ideally each hospital would lead on one of the proposed networks.

What do Hosted Networks mean for partnership work and staffing?

The networks offer a real opportunity to work even more closely together while supporting and building staffing capacity. They would enable a shared approach to recruitment and increase the attractiveness of our region for staff to join teams and build their careers.

What does ‘reducing unwarranted variation’ mean?

When different organisations treat the same types of patients differently from one another without a clear clinical reason or without an obvious benefit for doing so, then this is classed as “unwarranted variation”.

By reducing this, we ensure all patients get the right care, consistently across our region and make things fairer for patients as well as easier for staff and clinicians to work in a ‘networked’ way.

How can Staff and clinicians be engaged in the design of Hosted Networks?

Should the partners decide to take any of the recommendations forward, then full engagement plans will be developed with clinicians and staff who will be given the opportunity to shape future services and ways of working.

What are the Health and Care Institute and Innovation Hub going to do?

Whilst each service will be expected to work more closely through a Hosted Network, the Report also proposes some new ways of working which cover all of our services. Among the proposals are two new regional centres of excellence to support the Networks.

A Health and Care Institute would link the region’s universities, colleges and schools with the NHS and local authorities to focus on region wide workforce solutions. As well as recruiting and nurturing the workforce of the future, it would include a single joint approach to developing and putting shared ways of working in place.

The creation of an Innovation Hub, in partnership with the Yorkshire and Humber Academic Health Science Network, would develop, spot and quickly roll out innovation schemes across the region, such as new technologies.

Are there any opportunities for any different kinds of training, e.g. opportunities that aren’t just academic?

Our Health and Care Institute is about making us attractive to as wide a group of potential employees as possible.

To aid in this, we are developing a 'framework' to help us understand how we can better support and develop the staff we have, attract new workers and make our health and care services an attractive career option for our young people and students. A part of this work is to look into what apprenticeships are currently available and how we may be able to expand on these, whilst also providing training to existing staff to develop into new and different roles.

How much involvement did patients and the public have in the outcome of the independent Review?

There has been extensive patient and public involvement in the Review. The reports which detail the engagement, the feedback and how that feedback has been used to inform the Report are available below under 'all the documents'

How much say will staff have on the outcome of  Working Together for Hospital Services?

All staff – those working in the five services , but also wider NHS staff groups – have had opportunities to share their views and experiences so far and will continue to do so, so that any recommendations which we take forward are based on what the people who actually provide healthcare believe would make their services better. In exactly the same way as for patients and the public, we recognise that any meaningful and appropriate changes to our services must be designed in very close co-operation with our staff. 

Staff have been invited to contribute to online and paper-based surveys, with this being positively encouraged and promoted by all of the employer organisations. Staff have also hadthe opportunity to share their views with the Review Engagement team at drop-in sessions at each Trust; we anticipate that this will continue.

Most importantly, we have held, and will continue to hold, a series of ‘Clinical Working Groups’, where staff working in the services under review have had a chance to discuss the issues which they are facing and to consider the ways in which we might approach those issues. The representatives attending the Clinical Working Groups had a commitment to reflect discussions back within their organisations with the staff in the review service areas, and to ensure their input into the Clinical Working Groups represents not only their own views but the views of their colleagues. A programme of Clinical Working Groups is being established over the remainder of 2018 and into 2019.

Do the unions know you’re changing how services are staffed?

There’s a lot of work to do before the recommendations are taken forward. Engagement is vital with that, including staff engagement and as part of that, we will absolutely continue to engage with unions / staff side.

As part of the work of the ICS, a Staff Partnership Forum has been set up with key union representatives involved. This group meets regularly and is kept up to date with all developments. The group will continue to meet and will be involved in further work should any of the recommendations be taken forward.

How will you ensure involvement of Local Authorities? 

All the Local Authorities (LAs) in South Yorkshire and Bassetlaw, and North Derbyshire, are members of the ICS’s Collaborative Partnership Board. We will continue to engage with them and encourage their involvement.

We are also engaging with the Joint Health Overview and Scrutiny Committee, which has agreed to be the group which oversees Working Together on Hospital Services. LAs are able to exercise their powers of oversight through the JHOSC, as they are currently doing, and we welcome this.

Are social care involved in Working Together for Hospital Services?

All of our Local Authority partners (who deliver social care) are involved in this work and have been providing input throughout the process. Although we have identified five individual services as the primary focus for this work we know they can’t be looked at in isolation as there are so many interdependencies between these services and wider health and care services.

We will therefore be continuing to work with and involved our social care, NHS community services and primary care colleagues.

How much involvement will patients and the public have into the outcomes of this work?

We have undertaken substantial engagement with patients and the public from the outset of this work, and we are committed to continuing this. The independent review findings were influenced by an engagement report which can be found here.

We recognise that we cannot design services which are right for the people of our area without designing them in close co-operation with those people, and understanding what is important to those people as well as considering what the data tells us about their health needs.

How many patients contributed to the review?

Many hundreds of patients and members of the public have been involved in the Review. This is really fundamental for us, and we will continue to engage widely.

Why have I only just heard about this?

The intention to independently review hospital services was first mentioned in the South Yorkshire and Bassetlaw Plan, published in November (2016). After several months of looking at information across many hospital services and talking with the public about how we decide which ones to review, the Independent Review was launched in October 2017.

The launch was covered in local media, on social media, and via all of the partners’ (our hospitals’ and our NHS Clinical Commissioning Groups’) communications channels (their websites, newsletters, social media feeds, etc.).

Staff working in the services and patients and the public who use them have had a number of chances to give their views, including public events, online surveys, focus groups and a telesurvey. Updates on the Review have been discussed at partner boards and governing bodies, which are held in public.

If you think that there are further, practical ways in which we can engage better, then we’d be delighted to hear from you at: helloworkingtogether@nhs.net

How can I get involved?

We are asking for your views to inform an independent review of hospital services in South Yorkshire, Bassetlaw and North Derbyshire.

The review is looking into five of our regions’ services – gastroenterology (for stomach or intestine conditions), urgent and emergency care, maternity services, stroke services (early supported discharge and rehabilitation) and services for children who are particularly ill.

We want to improve these services so that everyone in the region has access to high-quality, safe care – now and in the future.

We are not closing any local hospitals. We want you to help us future-proof local services.

There are lots of ways you can get involved. This page will provide you with email and telephone contact links. We continue to welcome feedback and questions.

We will be holding a continuing process of engagement events and activities. These will be publicised via the website, but we will of course proactively be contacting prospective attendees to publicise these directly.

 

Download the full report