Two STPs launch joint acute services review

The sustainability and transformation partnerships in Cornwall and the Isle of Scilly, and Devon have agreed to create a new clinical service strategy for the south west peninsula, which will form part of the area’s response to the NHS long-term plan.

Both health economies have had finance and quality problems in the last few years. Most of Devon has been in the “success regime” for several years, while Kernow Clinical Commissioning Group had legal directions imposed and Royal Cornwall Hospitals Trust remains in special measures.

Rob Dyer, medical director for the Devon STP, told HSJ some services are not entirely resilient in every organisation across the two STPs, which means chiefs must “think about how we share and support one another to make sure care is provided in each area in a roughly equivalent way so that access is maintained”.

The peninsula’s five acute hospital trusts will all retain their emergency and maternity departments, but a number of specialties currently provided at most of the trusts will be prioritised for review. These are:

• Medical and clinical oncology;
• Paediatrics, neonatology and paediatric surgery;
• Spinal/neurosurgery;
• Cardiac surgery and cardiology;
• Planned orthopaedics;
• Diagnostics; and
• Specialised commissioning.

“In theory, with time, the strategy could cover almost any specialty, but what we’ve chosen to do is focus on those where we think the risk is highest,” Dr Dyer said.

Hot and cold sites

This risk-based approach excludes orthopaedics, which has been selected because two trusts (RCHT and University Hospitals Plymouth Trust) on the peninsula have separated their orthopaedic work into so-called “hot and cold sites”, with the remaining trusts in Devon keen to follow suit.

“We have a number of options in the south, east and north of Devon,” he said.

“We could focus elective orthopaedics in one of the provider organisations but that doesn’t necessarily give you the benefit of separating the elective from the urgent care which is probably crucial, so there are options for developing on separate sites and/or in conjunction with the independent sector.”

Kate Shields, chief executive of RCHT, told HSJ a peninsula-wide review made sense because liaising between organisations over a large geographical footprint such as Devon and Cornwall “needs to be planned”.

“If we do have wobbles in service sustainability and workforce issues then we know we already have a plan and the relationships in place,” she said.

There is already peninsula-wide work ongoing to establish “clinical services delivery networks” within stroke, haematology, neurology, dermatology, pathology and local maternity services.

Devon’s providers have also used a “mutual support” scheme where staff have been transferred to trusts in urgent need – a collaboration which has been praised by NHS England.

The programme also extends to Cornwall, which last year agreed on a memorandum of understanding for mutual support with Plymouth.

“We’re looking a lot at novel workforce solutions such as networked models so that we’ve got the workforce in the right place and that job plans look interesting to people across large geographies,” Ms Shields said.

Geographies

Asked if centralisation of services was a likely outcome, Dr Dyer indicated, because of the geography, “the sharing of some services” was more probable at the trusts east of UHP (Northern Devon Healthcare Trust, Royal Devon and Exeter Foundation Trust, and Torbay and South Devon FT).

“This is where the two counties are a bit different as the acute trust in Cornwall is quite a distance away from Plymouth,” he said.

“But there are already quite a lot of shared services between Royal Devon and Exeter FT and Northern Devon Healthcare Trust, and – to a lesser extent – between RD&E and Torbay and South Devon FT, and I think there is definite potential for more of that.

“For example, in cardiology in south Devon, we’ve got an excess of cath lab capacity. But in Exeter they are really short, so we’re working together to share that and share good practice across our pathways.”

He said the mutual support scheme, which is most used by NDHT, is meant to be temporary and that “the plan is to develop shared services between NDHT and RD&E”. One example would be in maternity and obstetrics where clinical staff, including consultants, are shared between the two trusts.

“It’s partly about a small hospital finding it difficult to maintain skills, but it’s also about making posts more attractive so that we can be sure we can recruit,” he said.

Ms Shields added the review would also explore how technology can be used to deliver services differently.

The pair hope the review will be completed in the next six months. Leadership teams have been set up for each of the clinical areas affected which will include input from clinicians and primary care.

“This will be done with clinical workshops, getting clinical representatives together in a room on a number of occasions to consider and look at potential options for changing the model,” Dr Dyer said.

According to a report for Devon CCG, the review will take account of the contribution of – and impact on – mental health, primary care and community services “where there are critical clinical interdependencies”.

Ms Shields said she believed mental health collaboration across the two counties is “in some respects in front of us”, due to services such as specialised services, eating disorders, and child and adolescent mental health services all being “done on a peninsula footprint”.

“That co-dependency between providers across the peninsula is starting to become just the way we do business,” she said.