Liz Davenport (SRO: PASP, NHS Devon), Jenny Turner (Programme Director: PASP, NHS Devon) and Paul McArdle (University Hospitals Plymouth) delivered the Peninsula Acute Sustainability Programme (PASP): Developing the Draft Case for Change, and discussed:

 

a)    The ambition of the PASP was to develop sustainable care for local people and deliver high quality equitable services;

 

b)    It was important that care was delivered in the most appropriate setting for each individual and that care was accessible for all;

 

c)    Engagement had been undertaken with patients and staff over several years, and feedback had centred around:

 

i.      Long waiting times for access to services;

ii.     Complex processes to gain access to services;

iii.    A need to ensure equity of access to services, particularly for deprived groups and rural areas;

iv.    A need to ensure services were ‘joined-up’ and integrated;

v.     The lack of an electronic patient record, and need for digital ‘enablers’ for delivering integrated care across the Devon system;

vi.    Patients were not always seen in the right place at the first point of entry;

vii.   A need to improve productivity and efficiency.

 

d)    Healthcare was facing considerable challenges, particularly across Devon and Plymouth. Factors included a growing population and an elderly population with increasingly complex comorbidities;

 

e)    There was a need to re-evaluate approaches to healthcare to ensure longer and healthier lives, as well as reducing the impact on health services;

 

f)     Under new leadership UHP had adopted a ‘One Method’ approach, focussing on avoiding admissions, managing patient arrivals in a considerate, kind and effective manner, and ensuring successful discharges. This had resulted in an 18% improvement;

 

g)    Working as isolated hospitals across the region was no longer sustainable and a collaborate approach was proposed to best optimise resources and demand across the region;

 

h)    Future system challenges would include meeting the demand of an increasingly elderly population, as well as addressing inequalities;

 

i)     The PASP was designed as a response to current financial and demand challenges, with the ambitions of developing sustainability for services, workforce and finances;

 

j)     Each of the acute providers in Devon and the Integrated Care System (ICS) were in NOF4, the highest level of regulation, due to failings in performance and financial spend;

 

k)    Across the peninsula there were enough staff to operate four hospitals however, there were five hospitals in operation. The hypothesis for building a sustainable acute service model was to improve diagnostic and assessment functions at the ‘front door’ of the hospitals to enable the redesign of ‘non-core’ elements and combat workforce challenges;

 

l)     Having engaged with clinicians, Healthwatch, patients and staff to understand the challenges, a shared view had been identified;

 

m)  The Case for Change was a technical document which set out the fundamental challenges faced, along with a vision for the future. The document would not include ‘solutions’ at this stage, but would help facilitate engagement and the development of modelling for solutions later on. The challenges identified were:

 

n)    People & Health Needs:

                      i.    There were approximately 1.3 million people living across Devon, Cornwall and the Isles of Scilly, with over half of the population above 50 years old and nearly a quarter over 65. This was expected to significantly rise over the next 20 years;

                     ii.    The gap between ‘life expectancy’ and ‘health life expectancy’ was growing. In Plymouth, the gap was 18 years for men, and 23 years for women;

 

o)    Performance:

                      i.    None of hospitals within the region were meeting the four hour wait target in A&E. As of January 2024, over 1,000 people were waiting over 18 months for an operation, and 6,000 people were waiting more than 15 months. Around 4,000 planned operations were cancelled last year;

 

p)    Estates and Infrastructure:

                         i.     There was an estimated £4 million of estates improvements and repairs required;

                        ii.    It was also important to boost staff recruitment and retention;

 

q)     Finances:

                         i.     There was an estimated overspend of £85 million in Devon for 2024/25. There was an expectation nationally that this would not continue;

 

r)    The vision of the plan was: To work together to deliver safe, high quality, sustainable and affordable services as locally as possible;

 

s)     The next stage would be to engage with the public to understand if all of the challenges had been accurately identified, what the impact of challenges was to the public, what ‘good access’ looked like, how the challenges could be best addressed, and what the best forms of engagement were.

 

In response to questions, the Panel discussed:

 

t)     The role of the Nightingale Hospitals in alleviating pressures on local services and reducing waiting times;

 

u)    Concerns around accessibility of services and the requirement to travel for care, which could inequitably affect disabled, elderly and deprived communities. It was stated that requirements for travel would be kept to an absolute minimum, and only used to enhance accessibility of services;

 

v)    The importance of equity of access and outcomes;

 

w)   Services would be designed around patient safety, effectiveness and wrap around patient care;

 

x)    A commitment to engage, listen and incorporate patient feedback during development of the PASP;

 

y)    The importance of developing a prevention and intervention strategy to mitigate long-term demand, beginning with children and young people;

 

z)    Concerns that transferring patients from acute setting to the community would transfer financial pressures to Local Authorities;

 

aa)  The target for completion of the Case for Change was November 2024, which would then be followed by a formal consultation period;

 

bb)An electronic patient record system was being developed, which was critical for transformation and efficiency;

 

cc)  Funding through the New Hospitals Programme, and the importance of ensuring appropriate investment was made, considering long term future needs;

 

dd)The public engagement campaign would include an ‘easy read version’ and a translated version (upon request). The campaign would use surveys and meetings to engage with the public, utilising existing networks and targeting vulnerable groups and service users.

 

The Panel agreed to-

 

1.    Provide feedback on the Peninsula Acute Sustainability Programme to NHS Devon, summarising this meetings discussions;

 

2.    Note the report.