Barnet, Enfield and Haringey Clinical Strategy

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Barnet, Enfield and Haringey Clinical Strategy

• Update for
• Engagement Groups

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Background - 1

• This work builds on the Healthy Hospitals
  work led by Barnet and Chase Farm Trust
• The project is now led by the PCTs and covers
  the whole of Barnet, Enfield and Haringey, with
  input also from Southern Hertfordshire
• The project is focusing on how local primary and
  community health services will be developed in
  order to allow people to be treated closer to
  home in community settings. This reflects
  national policy set out in the Governments
  recent White Paper.
• The project will assess the potential impact of
  these changes on local hospital services,
  including the North Middlesex as well as Barnet
  and Chase Farm Hospitals
• The aim of the clinical strategy is to describe
  how and where local health services are proposed
  to be provided in the future

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Background - 2

• New Project Board and project structure
  established to manage the project (see later)
• Input is being sought from all those involved,
  including NHS organisations, local authorities,
  patient and public representatives, clinicians
  and other staff,
• Working towards formal public consultation in
  early January 2007 for three months
• A decision will then be taken in April, after
  which detailed implementation plans will be
  developed
• Important to understand that this will be a
  three to eight year strategy, with service
  changes planned over this period

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Why do we need to make changes?

• Clinicians are concerned about the sustainability
  of current services
• People want more care closer to home in improved
  community facilities (and Government policy
  supports this)
• Local hospital buildings are very poor in some
  cases (Chase Farm, North Middlesex)
• Despite recent increases in investment, local
  health services are financially overstretched and
  score poorly against national standards

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What we are asking of you

• This process only works with your active
  involvement
• Asking you to sign up to the process
• Attend a number of meetings
• Engage in the debate with an open mind

What you can expect from us

• Honesty and openness
• Support and information to help the process
• No hidden agenda- open mindedness about the
  outcome

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Project Structure
Patient/Public and Clinical Representatives
Barnet PCT Enfield PCT Haringey PCT Herts PCTs
London Ambulance Service
Barnet Chase Farm Trust North Middlesex
Trust Whittington Trust Royal Free Trust
London SHA
Barnet Local Authority Enfield Local
Authority Haringey Local Authority Broxbourne
Local Authority
Project Board
Patient and Public Engagement Group
Clinical Engagement Group
Project Executive
Public/patients/other local Stakeholders inc.
OSCs, MPs etc
Hospital, primary care and community clinical and
other staff
Project Team
Financial support
Estates support
Legal advisors
Public engagement support
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Proposed process for developing the strategy

• Patient Public and Clinical Engagement Groups
  first meetings soon to discuss and agree their
  involvement in helping to develop the strategy
• Second meeting of each Group in mid September to
  consider the ten potential scenarios and
  evaluate these (more later)
• The aim is to recommend to the Project Board the
  most viable four or five scenarios which should
  be worked up in more detail
• These four or five short listed scenarios will be
  examined in more detail in early November by the
  two Engagement Groups, working with a citizens
  jury, to recommend which of the potential
  scenarios are both clinically, practically and
  financially feasible and should be formally
  consulted on
• The agreed scenarios will then be worked up into
  fully developed options for public consultation
  in January

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Wider involvement

• There will be significant opportunities for
  input and involvement throughout the development
  of the consultation document and then during the
  formal consultation process
• As well as the two Engagement Groups and the
  formal citizens jury, there will be the
  opportunity for anyone to comment on the four or
  five short listed scenarios from mid September to
  early November via the project web site
• Briefings are also being arranged with local
  politicians, the media and others to make sure
  they are clear on the process and timetable
• Once the public consultation is launched in
  January, there will be a wide range of different
  ways that people can comment on and input to the
  proposals,
• These will include a web site, public events and
  information fairs as well as copies of the
  consultation document and a summary document
  which will be circulated to all households
  locally, inviting comments

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Context developing care outside of hospital

• Our vision in Barnet, Enfield and Haringey is
  that
• People should be helped to remain healthy and
  independent
• People should have real choices and greater
  access in both health and social care
• Far more services should be delivered safely
  and effectively in the community or at home
• Services should be integrated, built round the
  needs of individuals and not service providers,
  promoting independence and choice
• Hospitals should continue to provide specialised
  services where they cannot be delivered in
  community settings
• Long-standing inequalities in access and care
  should be tackled
•  
• This vision will guide our work it will inform
  our plans and determine
• how we spend NHS funding locally

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Care outside of hospital Making the vision a
reality

• To make our vision a reality, we will
• Put more emphasis on people keeping healthy
• Improve support for people who have long term
  conditions
• Redesign care pathways so that they are more
  convenient for patients, with more care provided
  at or close to home and with visits to hospital
  kept to a minimum
• Develop more community based unscheduled care
  services, so that only people with the most
  serious needs have to go to hospital for urgent
  treatment
• Recruit more clinicians to work in community
  settings, and support these professionals in
  developing new skills and new ways of working
• Develop new buildings to deliver care close to
  where people live

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Outline of potential scenarios

• Ten potential scenarios to be considered in
  detail at second meeting of the Engagement
  Groups. In summary these are
• 1 No change, all services remain as at present,
  in existing buildings
• 2 Redevelopment with no clinical changes, all
  services remain as at present, in new /
  refurbished facilities at Chase Farm and North
  Middlesex
• 3 All three hospitals continue as at present,
  but with centralisation of women childrens
  services from Chase Farm to Barnet and north
  Middlesex (this would also occur in scenarios
  4,6,7,8 10)
• 4 Planned / emergency split with Barnet and
  North Middlesex as emergency centres and Chase
  Farm as planned surgery centre
• 5 - Planned / emergency split with Chase Farm and
  North Middlesex as emergency centres and Barnet
  as planned surgery centre

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Potential scenarios cont.

• 6 Medical / surgical split with Chase Farm
  focusing on emergency medicine, Barnet focusing
  on emergency surgery and women and children's
  services and North Middlesex providing both
• 7 Chase Farm becomes a community hospital (like
  Edgware), Barnet and North Middlesex provide all
  other acute hospital services
• 8 Chase Farm closes as an acute hospital, but
  gains a new primary care centre on the site
  (mental health and community services would
  remain as now), with all acute hospital services
  provided at Barnet and the North Middlesex
• 9 North Middlesex becomes a community hospital
  with all acute hospital services provided at
  Chase Farm and Barnet Hospitals
• 10 Do minimum, acute services reconfigured as
  per one of other options, but done in a way that
  minimises investment in new hospital facilities

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Evaluation criteria

• Proposed evaluation criteria for assessing the
  ten scenarios
• Clinical viability and safety
• Ability to provide safe, effective, patient
  centred services which are fit for the 21st
  Century and are based on the most up to date
  clinical evidence
• Clinical support both from primary and secondary
  care
• Ability to attract and retain a skilled workforce
  with appropriate specialisation
• Ability to operate safe clinical rotas
• 2. Accessibility
• Emergency services are accessible at all times to
  patients with appropriate travel times
• Non emergency services are accessible to
  patients, their families and other visitors
• Services are available equitably, are accessible
  to the poorest populations and reflect the health
  needs of the local population

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Evaluation criteria cont.

• 3. Affordability / best use of resources
• Proposals are efficient and make best use of the
  finite NHS resources available in Barnet, Enfield
  and Haringey
• Proposals are affordable to the whole health and
  social care system
• Proposals which make best use of the existing
  hospital, community and primary care facilities
  available
• Proposals which are affordable in terms of the
  need for new facilities and provide the most cost
  effective and value for money use of NHS capital
• 4. Sustainability
• Ability to cope with future projected increases
  in local population
• Ability to cope with future changes in NHS policy
• Ability to cope with future developments in
  clinical care and new technologies
• Fit with broader healthcare strategy in North
  London / Hertfordshire
• Address poor quality estate and facilities

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Evaluation criteria cont.

• 5. Deliverability
• Proposals that are realistically deliverable
  within a clear timetable
• Proposals that minimise the risk to service
  provision in the interim (i.e. before the full
  changes are made)
• Proposals that make sense in having any required
  early developments in place before changes are
  made
• Ability to demonstrate sufficient capacity in the
  proposed new healthcare system