News from Sutton LINk

Quality and safety first: unanimous view of ...
05 March 2012

Doctors, nurses, other health professionals, patient representatives and stakeholders in south west London have made safe, high quality services their top priority as Better Services Better Value sets out final recommendations for the future of local health services. Five of the six clinical reports from the Better Services Better Value review – issued in draft in December – have been published.

The emphasis on clinical quality and safety reflects the results of a recent survey and discussion events in January with patients, public and local stakeholders, both of which found that local people saw this as their top priority.

Recommendations for the shape of future health services in south west London include centralising essential and lifesaving services in order to improve quality and safety and so that high quality care can be provided seven days a week. To deliver the models set out in the reports, doctors, nurses and other health professionals leading the Better Services Better Value review are recommending:

Three emergency departments in south west London rather than the current four, each with an integrated urgent care centre. A fourth stand-alone urgent care centre which could treat up to 70% of patients currently seen at A&E, is also proposed.

Three obstetric units in south west London rather than the current four, though clinicians do not rule out the possibility of a stand-alone midwife-led unit. The three units would be co-located with emergency departments.

A world class, state-of-the-art planned care centre for elective surgery, kept separate from emergency care, so that emergencies do not disrupt planned operations.

Increasing services in the community – more services delivered in GP surgeries, community settings and people's homes, including support for people with long term conditions

Dr David Finch, local GP and Joint Medical Director for Better Services Better Value, said:

"These are clinical recommendations only. No decisions have been made and our recommendations will be subject to full public consultation.

"Our recommendations should mean that everyone in south west London can be sure that they will receive the highest quality of care when they need it most, even at the weekends. I know that in a life-threatening situation I would want my family to travel that little bit further by ambulance to be treated by the best possible, specialist doctors and nurses for their condition. I think everyone in south west London deserves the highest quality of care and I believe these recommendations could greatly improve the local NHS and save lives.

"By centralising the most specialist services, we know we can improve their quality and safety. A doctor performing a certain operation five times a week is going to be more prepared than a doctor who performs it just five times a year. By centralising maternity services we can help ensure every mother has one to one midwife care and a senior doctor on hand in case of emergencies. By centralising highly trained and specialist doctors and nurses we can treat more patients in bigger units and separate planned care from emergencies, making sure safety and quality is the best it can be for everyone.

"Proposals for changing services will be subject to full formal consultation and local GPs, hospital doctors and nurses involved in the review will be talking to local people about how these changes could transform the quality of the NHS locally. If any of the proposals then go ahead, they would be implemented over the next five years.”

Dr Howard Freeman, local GP and Joint Medical Director for Better Services Better Value, said:

"We agree with the public that the top priority is safe, high quality services. These final clinical reports reflect that view. They set out in detail the challenges facing local health services, and recommend how services could be delivered in the future to overcome these challenges. They have been influenced by local people, patient groups and stakeholders, who have been involved in the review from the beginning and of course commented on the draft reports.

"We need to get the best results for patients. Many people who attend A&E could be treated elsewhere, such as in an urgent care centre attached to A&E or by their GP. A recent study into acute medicine and emergency surgery showed that over 500 hospital deaths could be avoided* if the death rate for patients admitted at the weekend was the same as the death rate for patients admitted during the week. Reduced senior doctor presence at weekends is associated with more people dying**. The change to stroke services in London prevented the death of over 200 Londoners in 2010 and we firmly believe that our recommendations will save further lives.

"Better Services Better Value is not about cutting services, but redesigning them. No-one is going to be denied treatment. It's about making sure people are treated by the right clinician, at the right time in the right place. The point is that the population is changing. Increasingly people are living past the age of 85 but they are usually much sicker as they have long term illnesses like diabetes or breathing problems. These patients use health services the most, accounting for over half of GP visits, and one in three hospital beds. Our current NHS is not designed in the right way to treat people with long term illnesses in their homes and in the community to keep them well and out of hospital.”

Mr Mike Bailey, Consultant Urologist at St George's Hospital and Acute Medical Director for BSBV, said:

"We have been delighted with the way in which local people, organisations and clinicians have got involved in this review. All of the feedback received throughout the review is published in the final clinical reports, together with our response to each item. Sometimes this has involved adding further evidence and information to the reports, sometimes it has meant looking again at our recommendations. Each clinical working group is able to point to ways in which their final reports have been improved by the extensive comments and feedback received.

"We are facing very difficult challenges, but our prime concern has to be that we have enough senior and specialist doctors in every unit to ensure that we deliver safe services in the future.

"Options for the future shape of services will now be scored by a panel of 60 people this May, including members of the public, local authorities, doctors and nurses, directors of public health and the voluntary sector. We are taking this approach because feedback at a series of events we held in January suggested that local people would prefer an inclusive panel with a wide range of representatives. Once the panel has agreed a ranked shortlist of options and these have also been tested for affordability, the options will be put to local people in a full three-month consultation starting this summer.”

Each clinical working group has made changes to its report as a result of feedback and comments. These changes include:

For maternity services, clinicians had considered that an alternative to reducing the number of maternity units might be to provide different levels of service at different units. As clinicians and the public prioritised clinical quality and safety, reflecting the view that all women in south west London should have access to the best possible care, this option was not recommended.

Some women expressed concern that the recommendation for three maternity units would lead to increased travel times for women in labour. Clinicians and women shared experiences of being sent home in early labour and only ‘allowed' back when birth is imminent. So clinicians have recommended early labour space within maternity units, enabling mothers in earlier labour to stay in the hospital rather than returning home.

For end of life care, there is now added emphasis that the health service needs to be flexible to take account of the change in patients' wishes over the course of their illness, meaning that sometimes patients may prefer to die in hospital rather than at home. The importance of meeting patients' needs in relation to cultural background and religious beliefs was also given added emphasis.

In response to feedback that major operations and day surgery should be available seven days a week with flexible hours, the planned care clinical working group emphasised that they anticipate extending the usual hours of working in theatres to 12 hours a day, six days a week. This is a 44% increase.

Feedback on the model of care for long term conditions suggested that education for patients on their condition and where to get help when, along with regular communication with their GP, were critical. All of these points have been emphasised in the final report.

Criteria for shortlisting options for public consultation were agreed following extensive feedback from clinicians, local patients, public and stakeholders, including a month long survey and three discussion events in January.

Based on the feedback, a joint meeting of our Patient and Public Advisory Group and the clinicians leading the review agreed the criteria and the weighting they will be given when deciding the shortlist of options as follows:

• Clinical Outcomes and Safety 32%
• Patient Experience 22%
• Workforce Development 19%
• Access to Services 11%
• Deliverability 8 %
• Travel and Transport 8%

For more information on Better Services Better Value, and to read the clinical reports, full report on the deliberative events and the feedback the review has received, go to www.southwestlondon.nhs.uk