Strategic direction of health services in Wakefield and North Kirklees

Leaders of health services for Wakefield and North Kirklees are working together to determine the strategic direction of clinical services and The Mid Yorkshire Hospitals NHS Trust.

 

All NHS service providers have to become Foundation Trusts by 2014 or consider alternative solutions. Mid Yorkshire Hospitals has been reviewing the requirements for this, including a detailed analysis of its financial position. This has shown that the Trust will not be in a position to progress to Foundation Trust status in the foreseeable future.

 

The Trust and commissioners are working together to find the best way forward to maintain high quality healthcare services for the people of the Wakefield district and North Kirklees, which will include exploring the possibilities of working with other NHS providers. We expect to be able to tell people how things will be taken forward in the autumn.

 

A key part of this is continuing with the work already underway to tackle the financial and performance challenges and develop a sustainable model of services. These approaches have both been discussed in detail and agreed with the SHA and Department of Health.

 

Following extensive discussions with patients, clinicians and partners, the options that have been identified for longer term change are:

1.    Doing what needs to be done to improve services and ensure they continue to be clinically safe, which would involve consolidating children’s services and consultant-led maternity services in Wakefield, changes to urgent care at Pontefract and changing the way we organise urgent and complex surgery and planned surgery across the three hospitals.

2.    Radically reorganising services across our hospital sites to make the best use of resources as well as ensuring safety and service improvements. This would involve bringing all emergency and complex services into Pinderfields Hospital and increasing the level of planned and diagnostic services at Dewsbury and Pontefract hospitals.

 

Both options would take place alongside plans to deliver more care closer to home and reduce the need for people to be cared for in a hospital.

 

Stephen Eames, Interim Chief Executive of The Mid Yorkshire Hospitals NHS Trust, said: “The challenges faced by the Trust have been a matter of public concern for many years.

 

“We are working hard to meet national standards for how quickly people are seen when they need care and this work is starting to take effect. We are also tackling the financial problems head on with a savings plan for this year which we are delivering.

 

“In addition we are working with local people and their representatives to reorganise services so they are clinically and financially sustainable. The discussions we have had with people so far have brought us to the point where we feel we have two options to consider. The first looks at doing what we must do to make services clinically safe and sustainable, whilst the second goes further - radically reorganising services across our hospital sites to make the best use of resources.

 

“All of this work is essential to ensure people in these communities have really good healthcare, in the most appropriate place at the time when they need it.”

 

Chief executive of NHS Calderdale, Kirklees and Wakefield District, Mike Potts, said:

“We’ve worked together with the hospital Trust for some time to help them address the financial challenges. We’ve also worked together to ensure that we’re responding to changes in treatments and other things that improve patients’ chances of a good recovery from illness.

 

“Change is rarely easy for people to understand or accept, but the decision on foundation trust status has absolutely confirmed that staying the same is not an option. It has also reminded us that finance and quality of care are inextricably linked. 

 

“We are now working with the hospital Trust to find the best way forward for the future direction of the organisation. We are aiming to do this as quickly as possible to minimise uncertainty and we are committed to making sure that local people, patients, elected representatives, staff and all other interested individuals have the opportunity to give us their views.”

 

Dr Phil Earnshaw, Chair of Wakefield Clinical Commissioning Group, said: “The NHS provides excellent care for local people, and the outcomes for patients are continually improving.  We want that to carry on and if it means taking difficult decisions about finance and reorganisation, then that’s what we must do but we will not do it in isolation. We want to help people understand why things need to change, and we want to be sure the NHS takes account of what patients are saying.”

 

Dr David Kelly, Chair of North Kirklees Clinical Commissioning Group, said: “It is clear we need to make some difficult decisions if we are to ensure that local people can continue to receive high quality healthcare, not just in the future but now. We are committed to working with colleagues across the area to make sure we achieve the best and most long-lasting changes, and that these are based on meeting the real needs of people in our community.”

 

The financial position of the Mid Yorkshire Hospitals NHS Trust

The Trust ended the last financial year (2011/12) with a £19.2 million deficit. It’s current ‘in year’ financial position (accurate to the end of May 2012) is showing it is £4.42 million in deficit. This position is updated at the Trust’s monthly board meeting.

 

The Trust is implementing a savings plan for this financial year (2012/13) which is expected to yield £24 million worth of savings. Even if that is achieved, it is still forecast that the Trust will end this financial year with a deficit of £26 million. This is 6% of budgeted income.

 

The Trust is in effect losing £100,000 a day – all its hospital sites are contributing to this loss through inefficiency. This deficit will continue to grow unless radical steps that are being proposed are taken forward.

 

Clinical Services Strategy

Work is already underway to develop a sustainable model of clinical services across Wakefield and North Kirklees. This work is being led by the Trust and local commissioners including the recently-formed Clinical Commissioning Groups.

 

Following extensive discussions with patients, clinicians and partners, two options have been identified for longer term change for hospital services. Both options will be supported by enhanced primary care and community based services to reduce the need for people to receive care in a hospital. It is important to note that we are at the beginning of a period of local engagement on these options and we are still working through the finer detail. No final decisions have been made. Any final proposals will be subject to formal consultation scheduled to start in January 2013.

 

Current service provision

 

Please note – the list below is an overview by broad category. It is not an exhaustive list of every specialty.

 

Current service provision

Dewsbury

Pontefract

Pinderfields

  • Emergency Department (Type 1*)
     
  • Critical Care 
     
  • Elective surgery
     
  • Day case surgery
     
  • Medical Wards
     
  • Rehabilitation (including stroke)
     
  • Children’s inpatients (excluding surgery) Consultant Led and Midwife Led Maternity Unit
     
  • Special Care Baby Unit
     
  • Outpatients
     
  • Diagnostic Centre
  • Emergency Department (Type 1*)
     
  • Clinical Decision Unit
     
  • Day case surgery
     
  • Short stay surgery
     
  • Rehabilitation (including stroke)
     
  • Midwife Led Maternity Unit
     
  • Outpatients
     
  • Diagnostic Centre
  • Emergency Department (Type 1*)
     
  • Critical Care
     
  • Trauma Centre
     
  • Acute Care facility - all specialties
     
  • Elective surgery
     
  • Day case surgery
     
  • Elective Medicine
     
  • Haematology and Medical Oncology
     
  • Specialist Centres - Spinal Injuries, Burns, Plastics
     
  • Children’s inpatients
     
  • Consultant Led Maternity Unit
     
  • Neonatal Unit (intensive care, high dependency care and special care)
     
  • Outpatients
     
  • Diagnostic Centre

 

 

Option one

Clinical Services Strategy proposal option one

Dewsbury

 

Pontefract

Pinderfields

  • Emergency Department with children’s assessment unit (Type 1*)
     
  • Critical Care 
     
  • Elective Surgery (apart from General and Colorectal Surgery)
     
  • Day case surgery
     
  • Medical Wards
     
  • Rehabilitation (including stroke)
     
  • Neuro Rehabilitation Unit**
     
  • Midwife Led Maternity Unit
     
  • Outpatients
     
  • Diagnostic Centre

 

 
  • Urgent Care Centre, providing urgent care services for minor injuries and minor illness (Type 3 facility*)
     
  • Day case surgery
     
  • Short stay surgery
     
  • Medical ward - Clinical Decision Unit and Medical Investigation Unit facility Rehabilitation (including stroke)
     
  • Midwife Led Maternity Unit
     
  • Outpatients
     
  • Diagnostic Centre
  • Emergency Department (Type 1*)
     
  • Critical Care
     
  • Trauma Centre
     
  • Acute Care facility - all specialties
     
  • Elective surgery
     
  • Day case surgery
     
  • Elective Medicine~
     
  • Haematology and Medical Oncology
     
  • Specialist Centres - Spinal Injuries, Burns, Plastics
     
  • Children’s inpatients
     
  • Consultant Led Maternity Unit
     
  • Neonatal Unit (intensive care, high dependency care and special care)
     
  • Outpatients
     
  • Diagnostic Centre

 

Option two

 

Clinical Services Strategy proposal option two

Dewsbury

Pontefract

Pinderfields

  • Urgent Care Centre, providing urgent care services for minor injuries and minor illness (Type 3 facility*)
     
  • Elective surgery (not requiring Critical Care)**
     
  • Day case surgery
     
  • Medical wards – Clinical Decision Unit, Medical Investigation Unit, Step up
     
  • Rehabilitation (including stroke)
     
  • Neuro Rehabilitation Unit**
     
  • Midwife Led Maternity Unit
     
  • Outpatients
     
  • Diagnostic Centre
  • Urgent Care Centre, providing urgent care services for minor injuries and minor illness (Type 3 facility*)
     
  • Day case surgery
     
  • Short stay surgery**
     
  • Medical ward - Clinical Decision Unit and Medical Investigation Unit facility
     
  • Rehabilitation (including stroke)
     
  • Midwife Led Maternity Unit
     
  • Outpatients
     
  • Diagnostic Centre
  • Emergency Department (Type 1*)
     
  • Critical Care
     
  • Trauma Centre
     
  • Acute Care facility - all specialties
     
  • Complex surgery
     
  • Day case surgery
     
  • Complex elective medicine
     
  • Haematology, Medical Oncology
     
  • Children’s inpatients
     
  • Consultant Led Maternity Unit
     
  • Neonatal Unit (intensive care, high dependency care and special care)
     
  • Specialist Centres - Spinal Injuries, Burns, Plastics
     
  • Outpatients
     
  • Diagnostic Centre

 

*What do we mean by Type 1 and Type 3?

  • Type 1: a consultant-led 24 hour service with full resuscitation facilities.
     
  • Type 2: a consultant -led single specialty accident and emergency service (e.g. ophthalmology, dental).
     
  • Type 3: other types of urgent care centre, such as minor injuries units or walk-in centres. A type 3 department may be doctor-led or nurse-led. It may be co-located with a major A&E or sited in the community. The range of diagnostic facilities (eg: x-ray, blood testing, fracture clinics) may vary.

     

Additional changes

The Trust is also proposing some changes to services that would be made ahead of the longer term options detailed above. These concern ophthalmology, orthopaedic and neuro-rehabilitation services and full details will be confirmed and consulted on shortly.