Since Autumn 2015 NHS Hambleton, Richmondshire and Whitby Clinical Commissioning Group (CCG) and South Tees Hospitals NHS Foundation Trust (STHFT) have been working together to try to address the workforce challenges and provision of emergency services at the Friarage Hospital in Northallerton.
For two years we’ve worked as a system to try to find solutions for these issues including international recruitment, supporting GPs working in the hospital (GP hospitalists) and the development of the ambulatory care unit.
In the Summer of 2017 it became clear that we were going to have to do something radically different in order to stabilise and sustain services at the hospital. The Trust produced a Case for Change: ‘Building a Sustainable Future for the Friarage Hospital’, with input from partners which set out the challenge to sustain clinically safe, high quality services at the Friarage. It focused particularly on workforce sustainability.
Subsequent to this and after conversations with colleagues at NHS England, the Trust entered into phase one of the statutory service change process – the listening phase. This phase ran from 4 October 2017 to 20 December 2017 and involved:
- Launching patient and public engagement on the challenges
- Re-reviewing findings of relevant engagement since 2013
- Continuing to share messages with the public on findings and positive developments at the Friarage Hospital
Using the outputs and findings from this work, the Trust undertook an intensive period of clinical options development which lasted nine months and included consultation with healthcare delivery partners across the system.
During this time the Trust also consulted with the Royal College of Emergency Medicine and Royal College of Anaesthetics in order to ensure that best practice was adhered to and learning from other areas was also reviewed.
Reports by the Royal College of Emergency Medicine and Royal College of Anaesthetics, produced following site visits in November and December 2017, are available from the CCG on request.
Collectively we also invited the Yorkshire and Humber Clinical Senate panel to come to visit the Friarage Hospital, see the challenges that we were facing and informally advise us on the clinical options that we had developed at that time.
The Trust shared its clinical proposals with the CCG in September 2018 and we then undertook a further six month period of work together to develop the models and supporting material to the standard required for a pre consultation business case (PCBC). This period also involved:
Planning phase (10 September 2018 – 14 January 2019):
- CCG review of clinical proposals to consider wider system impacts ensuring they are financially viable and meet the needs of the population
- Revisiting existing staff, patient and public views based on pre-engagement feedback (including customer feedback, complaints, suggestions and previous surveys)
- Focussing pre-consultation engagement on key stakeholders, hard to reach groups and other particularly interested groups
- Building on the in-depth gathering of views and suggestions already collected from, clinicians, patients and carers
- Developing potential options to take forward to public consultation
- Formulating a timeline for public consultation
- Briefing NHS England, Clinical Senate and North Yorkshire Scrutiny of Health Committee on developments
- Drafting public consultation and summary documents
In February 2019 it became clear to the Trust that urgent temporary changes needed to be made to critical care and interdependent services at the Friarage Hospital on grounds of risk to patient safety. These changes came into effect on 27 March 2019.
As a system it was really important that we focussed on implementing and monitoring the urgent change to ensure that it was done completely safely and we did, and continue to do that now.
In May 2019, as is usual when planning a significant service change, we presented our clinical model to the Yorkshire and Humber Clinical Senate for its examination and assurance. We received its report and actioned the recommendations that it made in our pre-consultation business case.
On 27 June 2019 we presented the draft PCBC to the CCG Governing Body for its review, sign off and approval to proceed to Gateway 2 of the NHSE assurance process.
The reasons why the CCG is not consulting on an A&E model, as initially reference in the pre-consultation business case are set out, here (see page 5).
There's more information about the challenges faced by the Friarage and the urgent temporary changes, including the rationale for a 16-hour UTC, in an independent report published by Richmondshire MP, Rishi Sunak, here.
As is usual in the Gateway 2 process, NHSE advised us of best practice approaches regarding elements of the PCBC. Acting on this advice and because we want to be completely transparent to the public, we developed a number of additional appendices. They include:
- Equality and Health Impact Assessment Report
- Summary of the engagement process
- Patient stories
- Glossary of terms
In 13 September 2019 we updated the North Yorkshire Scrutiny of Health Committee to brief and assure elected members that we had done the work required to begin consultation.
The consultation commenced on 13 September and we have prepared a full suite of supporting documentation which can be accessed from the main consultation page here.
We know there’s a huge amount of information here but we want to be totally transparent about the complex journey that has brought us to this point.
If you wish to read only one document the Condensed Consultation Report is designed for this purpose.
It’s really important that we understand the views, concerns and experiences of the public so please do complete the Questionnaire and have your say.
At the end of the formal consultation period we’ll spend a further three months analysing the data we’ve collated in order to produce a post consultation report. This will be assured by NHSE through the checkpoint 3 element of the service change process and a final decision on the service change will be made by the CCG’s Governing Body. It is our hope that the whole process will be completed by March 2020.