The West, North and East Cumbria Success Regime has today unveiled its emerging vision for Health Care in North Cumbria.
Its ambition it that Cumbria becomes known as a international centre of excellence for rural integrated health and social care provision in rural, remote and dispersed communities.
However there are, as Sir Neil McKay describes, some tough decisions. What follows is a summary of the key emerging options and proposals:
- Community Hospitals
There are currently 9 community hospitals in North, West and East Cumbria, each with a small number of beds. Emerging ideas are to:
- Concentrate inpatient beds on fewer sites and offer a wider range of health and care services – including outpatient appointments – at the other community hospitals which would have no inpatient beds.
- No inpatient beds in any of the community hospitals. – These would all become health and care hubs from which more extensive care would be provided in the community.
- Urgent Care, Emergency Care and Acute Medicine
Acute medicine at the West Cumberland Hospital is fragile due to high levels of consultants and doctor vacancies resulting in a larger reliance on locum staff. This is especially a concern overnight when senior clinical decisions are made. Emerging ideas are:
- Fewer patients being treated at nights and weekends in West Cumberland Hospital to help reduce safety risks.
- A Hyper-Acute Stroke Unit at Cumberland Infirmary Carlisle – this would be put in place alongside acute stroke services at both sites and enhanced stroke rehabilitation services.
- Potential changes to which hospital patients are taken to, dependent on postcodes, to manage the number of patients at WCH more safely.
- More health and care services delivered in the community and in hosptials in the daytime meaning fewer beds needed at hospitals.
- Maternity Services.
There are a number of maternity ideas currently being considered to ensure a sustainable and safe model of care. The North, East and West Cumbria area has a relatively small number of births annually. Emerging ideas are:
- Consultants on call overnight at the West Cumberland Hospital and continued use of registrars on site overnight.
- A new consultant led and 24 hour resident consultant on-call at the West Cumberland Hospital.
- Higher risk births identified and booked at Cumberland Infirmary which has more robust clinical support.
- A midwife led unit at West Cumberland Hospital and all other births booked at Cumberland Infirmary
- Children’s Services
Working towards a whole system plan of an integrated model of care involving care closer to and at home. Emerging ideas are
- A single joined up child health team involving Cumbria County Council children’s services and NHS children’s services working across West, North and East Cumbria.
- 14 hour short stay Children’s assessment unit at both hospitals with inpatient beds at the Cumberland Infirmary Carlisle and 24 hour/7 days a week beds for children who are less seriously ill at West Cumberland Hospital.
- 14 hour short stay children’s assessment unit at the West Cumberland Hospital with no overnight inpatient beds.
- Planned Operations, Procedures and Outpatients
Emerging thinking is towards utilising the better facilities at the West Cumberland Hospital for more elective surgery: Emerging ideas are:
- More day case operations/procedures with less overnight stays at both the West Cumberland Hospital and Cumberland Infirmary Carlisle.
- Changes to outpatient services – using technology such as electronic referrals and tele-consultations.
- Outpatients clinics closer to home/in the community rather than at Cumberland Infirmary.
- Specialised Services
Most of West, North and East Cumbria is an hour away from specialised centres for certain cancers and circulatory diseases – the 2 main causes of mortality in Cumbria. An emerging idea is:
- Agreement with Newcastle NHS Foundation Trust to develop enhanced and new links to increase benefits for patients and staff in initially three specialised services – cancer, children’s services and trauma.
- Mental Health Services
There are plans to deliver Mental Health Services through a multi-agency community team and focus on urgent Mental Health Services delivered appropriately in hospital. Emerging ideas are:
- A multi-agency crisis assessment centre at Cumberland Infirmary Carlisle providing urgent care for Mental Health patients who don’t need to go to Accident and Emergency.
- A Mental Health Services Triage phone line allowing professionals to get important information about patients with mental health issues quickly.
- Consolidate mental health beds to fewer sites
- GP’s – Your local Doctor
Emerging thinking is to use current investment to set up a local improvement scheme for 2016-18. This would focus on interventions at GP level to make a difference to patient outcomes.
- Offer bursaries to attract more GP’s to train in Cumbria.
- Consider supporting GP practices to work together more effectively in the community through Integrated Care Communities.
- Consider using GP premises more effectively.
- A minor ailments service to be made more available across West, North and East Cumbria for self-care and management of conditions in order to relieve capacity pressure on GP’s and wider health economy.
- Workforce and Leadership
There is a need for the development of the current and a new workforce for Cumbria against a challenging recruitment and retention issues in the NHS. Emerging ideas are:A new workforce strategy and investment plan for the next three years to compliment the proposed draft clinical strategy.
- Idea of a Clinical Task Force to be piloted in Cumbria called P.O.S.T. (Post Operational Support Team). This would address short term recruitment challenges.
- A new education, training and development plan with aspirations to be the first “Associated University Teaching System” in the country supported by new centres of excellence for staff and a new rural clinical school at University of Central Lancashire.
- Consider a rebalance of the workforce by employing more staff in the community as services move into community settings and have fewer staff in hospitals.
There is public concern involving Ambulance response times across North, West and East Cumbria. Emerging ideas are:
- An expanded Helicopter service based at West Cumbria providing increased rapid access to emergency medicine and treatment.
- Treating more people at home by reiniforcing current paramedic capacity to increasing “see and treat” services in order to lessen hospital admissions.
- The possibility of using telemedicine more – such as consultations over the telephone or via video links.
- Organisational Form
It is critical that North Cumbria University Hospital Trust demonstrates improved leadership and strong organisational form. However, due to the risks associated with the financial deficit in NCUHT, the takeover by Northumbria Healthcare Foundation Trust is no longer an option. Other organisation plans are:
- A legal agreement between NCUHT and Northumbria Healthcare Foundation Trust to make the current “buddying” relationship clearer.
- Northumbria Healthcare Foundation Trust to provide specific clinical services and also manage some services and work on joint clinical appointments
- New organisational form in line with the proposed new integrated service models.