To consider a report outlining the Peninsula Acute Sustainability Programme draft Case for Change and provide feedback.

(Note: to be presented by Liz Davenport, Chief Executive, Torbay and South Devon NHS Foundation Trust and Kate Lissett, Chief Medical Officer, Torbay and South Devon NHS Foundation Trust).

The Chief Executive, South Devon NHS Foundation Trust and the Chief Medical Officer, South Devon NHS Foundation Trust presented an outline of the Peninsula Acute Sustainability Programme (PASP) Draft Case for Change.

Members were informed that the Case for Change was a technical document that used data to evidence the need to change and was currently being developed.  A summary of the document would also be produced to support local populations and stakeholders to understand the challenges.

The purpose of the Peninsula Acute Sustainability Programme (PASP) was to ensure clinical, workforce and financial sustainability of services at the five acute hospitals in Devon, Cornwall and the Isles of Scilly.  The primary role was to support service sustainability in the long-term creating a sustainable platform for strategic service improvement and the recovery of fragile services in the medium term.  However, this needed to be aligned with short-term tactical improvements to ensure support for recovery of elective, cancer and diagnostic services for example.

It was recognised that the pandemic had exacerbated the challenges and that acute service transformation was required to address services that were struggling to meet the increasing demand and needs of patients.  In addition, there was a need to support staff to deliver safe and high quality care whilst ensuring that services conformed to national and professional standards.  It was important to provide safe and high quality services across the whole geography to meet demand now and into the future whilst making best use of limited resources.  It was acknowledged that medicine was getting more specialist and that currently it was necessary for some patients to travel outside the locality to receive the specialist care they needed.  With innovative thinking, the aim was to provide the same specialist care locally.

Members welcomed the fact that preliminary progress had already been made.  For example, the One Devon Elective Pilot enabled use of the Nightingale Hospital as a specialist centre for orthopaedic, ophthalmology and spinal surgery services.  Staff and clinical networks enabled hospitals across the peninsula to work together in a networked way to provide care (for example, neonatal networks and an interventional radiology rota) and the use of technology such as Shared Picture Archive System enabled radiologists to share images across all Peninsula Trusts.

The starting point for the acute services model was to recognise different approaches to delivering the non-core services and that would start to address some of the significant workforce challenges facing the Peninsula.

Phase Two of the PASP would now be undertaken and would include developing a detailed formal case for change in partnership with staff and local people together with undertaking some detailed modelling in conjunction with staff and patients to further explore possible ways to tackle the challenges.

Members asked questions around how people would be encouraged to support the proposed changes and document; whether the nurse/staff ratio could be increased alongside staff retention;  whether the initial survey included social media feedback and if this was sought solely from patients and why was there only a small number in terms of feedback; how would access to other services be achieved; whether accessible and layman terminology would be used in the summary document and survey; how would effective engagement with people be achieved; whether there were comparisons with other Local Authorities and how those who remained in hospital but did not require acute care (particularly the elderly) could be assisted so that they could return home.

In response, Members were informed that change was always challenging but that there was a desire to improve and that meant working differently.  A recent example involved developing a joined-up rota which resulted in shorter waiting lists which demonstrated positive results for both staff and patients.  The current delays and frustration in respect of front door care meant that people were generally open to considering change with a view to improvement.  Pressure on staff was acknowledged and it was felt that if funding was used well, there was a join up in services, coupled with only admitting people to hospital where really needed, that pressure could be alleviated.  Growth and development opportunities were key to staff retention as well as jobs that people wanted to do.  Nursing staff were becoming more and more specialist. 

The design work was predominately focussed on acute hospital care but improvements in acute care were dependent upon what happened outside the hospital, for example, integrated care in the community.  Digital access to health records would give people access to healthcare across the wider Devon area with clinicians in any area being able to view records.  In relation to the initial feedback from patients and staff, this was just a start in trying to understand the problem at a very early stage.  In relation to the Summary Document it was vital that it was readable and honest to gain real and honest responses.  The safest care was getting more complex and it was seen as important to be honest with service users so that challenges could be fully understood through effective engagement. 

People needed to be informed where it had gone wrong and what could be done differently to put it right.  It was imperative to get the engagement with people right.  Initial enquiries focussed around talking to patients and families with some focus groups and written feedback.  It was not a full programme of consultation but a measure of the reflection of challenges and whether those had been understood correctly.  There had not been a comparison with other Local Authorities but previously best practice examples had been looked at.  The local voice was really important as there were some unique things about local communities in terms of needs.  The quality and level of delivery of acute care was dependent on community and social care working well.  In relation to those patients who did not have an acute need but remained in hospital, it was hoped that digital innovations could assist with the process in enabling a return home.

Resolved (unanimously):

That the Adult Social Care and Health Overview and Scrutiny Sub-Board notes the report provided by Torbay and South Devon NHS Trust in relation to the Peninsula Acute Sustainability Programme Draft Case for Change and that the Integrated Care Organisation be requested to ensure:

1.         that the Summary Document and Survey contain accessible language        to encourage effective engagement;

2.         engagement with the Voluntary Sector to encourage survey responses       from individuals who may not otherwise be confident in participating,    articulating or responding directly to the survey;

3.         further consultation includes the use of both social media and surveys;

4.         further consultation includes engagement with patients, families and            local charities; and

5.         further consultation includes engagement within a clinical setting (for           example, hospital and GP waiting rooms).