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Home / Case for change section 7: Delivering the Lancashire and South Cumbria Clinical Strategy
There are higher than expected levels of emergency admissions in the region, compared to the national average. Residents are 12% more likely to be admitted for all causes, 28% more likely for coronary heart disease and 27% more likely for Chronic Obstructive Pulmonary Disease (COPD). Mortality rates (for under 75s) is greater for 50% of counties in Lancashire and South Cumbria compared to the North West region average (388 per 100,000).
The integrated care system’s Clinical Strategy has set out three principle aims:
The Lancashire and South Cumbria Clinical Strategy (opens in a new window) outlines its priorities in response to the NHS Long Term Plan (opens in new window) and the future health needs of our population across six key programme areas shown in Figure 15.
Figure 15: Clinical strategy priorities (highest priority integrated pathways for improvement are indicated with **)
1. Health and wellbeing of our communities
• Prevention and health education
• Population health management
• Anticipatory care
2. Living well
• Self and personalised care
• Integrated place based care
• Intermediate care
• Mental health**
• Learning disability and autism**
• Maternity and children’s services**
3. Managing illness
• Collaboration, shared services and networks
• Planned and elective care **
• Specialist and acute care
4. Urgent and emergency care
• Emergency care **
• Urgent care **
• Mental health urgent assessment centres
5. End of life care, including frailty and dementia
• Care of the elderly
• Ending life well
• Palliative care
6. Maintain a healthy and happy workforce
• Compassionate leadership and systems development
• Positive employment experience
• Opportunities for all
• Building a sustainable workforce
The New Hospitals Programme will support the long term future development of our clinical priorities, including single shared services or specialty networks, which will be based on:
A single service approach across Lancashire and Cumbria, delivered from a specialised hub and with outreach across the network to provide care locally where possible
Or
Services provided from one central site as part of a single service offer for Lancashire and South Cumbria, in order to meet the volumes and co-location required to meet national standards
Or
Single service offers achieving standards across more than one site.
The Lancashire and South Cumbria Provider Collaborative is already transforming services and exploring the benefits to patients and staff of networks and greater collaboration. Our Major Trauma Network has facilitated significant improvements to access and sustainability of these services.
Further work is taking place to inform our long-term clinical services strategy. Some of these plans may require engagement and / or consultation.
“These are complex and ambitious plans and we need to look beyond individual organisations to consider the structure of services across the whole system.”
The Lancashire and South Cumbria Provider Collaborative is already transforming services and exploring the benefits to patients and staff of networks and greater collaboration. Our Major Trauma Network has facilitated significant improvements to access and sustainability of these services.
Further work is taking place to inform our long-term clinical services strategy. Some of these plans may require engagement and / or consultation.
Specialised services in Lancashire and South Cumbria
Vascular surgery
Neurosciences, including neurology, neurosurgery and neurorehabilitation
Major trauma
Adult critical care
Renal
Cardiology and cardiothoracic services
Hepatobiliary and pancreatic diseases (HPB)
Haematology – autologous bone marrow transplant
Specialised cancer surgery: Chemotherapy, radiotherapy, SABR (Stereotactic Ablative Body Radiotherapy)
• PET-CT (Positron emission tomograph – computed tomography)
• Critical care
• Cystic Fibrosis
• Specialised respiratory including Interstitial Lung Disease
• Specialised HIV (human immunodeficiency virus), Hepatitis C
• Neonatal care
• Perinatal mental health
• Inpatient mental health
• Sexual Assault and Referral Centre (SARC)
While some specialised services can only be delivered at a national or cross-Lancashire and South Cumbria level, some of our patients travel long distances to access care when:
(i) We could expand choice for patients by providing services closer to home, where there is the expertise, volumes and ability to deliver outcomes in line with national standards.
(ii) There could be opportunities for further specialist services to be provided in Lancashire and South Cumbria, where they have historically been provided elsewhere. Further work is required to understand this, but potentially some services in cardiac, neurosciences and haematology could be provided in Lancashire and South Cumbria. For example, in cardiology, there are out of area flows for Implantable Cardioverter Defibrillator (ICD) and Electrophysiology services.
Achieving this will require consideration of the models of care. Tier 1 specialised services account for around 7% (around £32m) of the total and typically could be delivered in region.
We cannot achieve this with our current infrastructure because we do not have:
The capacity for specialised and support services, including the associated workforce. We have previously outlined how specialised services have expanded at Royal Preston Hospital over time without the required physical space.
The flexible capacity to accommodate services that are changing with rapidly advancing technology.
Single room capacity to ensure the highest standards of infection control, in particular for cancer patients.
The required capability to accommodate advances in digital technology to support care closer to home and networked hospital solutions.
Patients wait longer for treatment than is acceptable because of the lack of capacity in and flexibility of our estate. We are below the national average position on several key performance standards:
70% of elective cancellations at LTHTr were due to a lack of bed capacity / equipment.
Bed occupancy rates are 95% and consistently above the National Institute for Health and Care Excellence (NICE) standards.
The standards of our facilities and lack of single room provision do not give our patients the privacy and dignity they deserve and create risk of infection.
Our poor hospital infrastructure is an important contributing factor to underperformance against key national access and quality standards. This means our patients wait longer for urgent treatment, routine surgery, diagnostics and cancer treatment than they should.
In their recent study of NHS hospital build programmes, the Nuffield Trust found significant evidence that better infrastructure and, in particular, access to a view led to quicker recovery time for the patient.
“More could have been done to incorporate well-evidenced lessons about how design can minimise noise, reduce stress, improve the staff working environment and improve outcomes and experience for patients.”
Figure 17: Reason for cancelled operations at LTHTr – 70% of cancellations are due to bed capacity or equipment
Bed occupancy rates are 95%; above the 85% rates recommended by NICE. This creates a critical safety issue at peak times and impacts on our flow.
The separation of planned and elective work is recognised best practice in achieving good flow and maximising patient experience. The current estate does not permit this. UHMBT and LTHTr are progressing plans to deliver Green Sites; however there is a shortfall of funding for Royal Lancaster Infirmary. The lack of separation of planned and non-elective work is a consistent theme across women’s services at the RLI and Furness General Hospital.
We cannot provide an acceptable standard of care for patients with acute mental illness. Across all our Emergency Departments there is insufficient space to provide adequate separation. This is a key issue with attendance from patients in mental health crisis continuing to rise.
Limited single room provision and toilet and shower facilities impact on patient experience and increase risk of infection. This is evident in our hospital-acquired infection rates compared to the national average. Our patient experience scores remain good, despite the inadequacy of our facilities. Standards of privacy and dignity have been underscored by women’s and children’s services.
New models of acute care will be needed to deliver the clinical vision for 2030 and the integrated care system clinical services strategy sets an expectation for closer working of providers across Lancashire and South Cumbria to achieve this. Development of new hospital infrastructure will be a key enabler in delivering our long term clinical strategy, improving outcomes and delivering care closer to home for our population.
As system wide plans progress, the expectation is that acute models of care delivery will change and a significant shift left will take place as the focus moves to preventative and out of hospital care. These developments will be vital considerations for the New Hospitals Programme.
Investment in world-class hospital infrastructure around a centre of excellence with leading technology and research facilities will address these shortfalls. Furthermore, and crucially, this will provoke a much needed step-change in Lancashire and South Cumbria as an attractive place to work for the best clinical and research teams in the world.
If we can accommodate the benefits of new digital technologies, we can create a network of care, providing more specialised services in our hospitals and delivering more care close to home as part of the wider ambitions of the Lancashire and South Cumbria Health and Care Partnership.
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