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.