BOROUGH OF POOLE

Joint Health Scrutiny Committee on the NHS Transformation Programme

4 October 2011

PROPOSED CHANGES SPECIALISED IN-PATIENT HAEMATOLOGY SERVICES

Prepared by: Rachael Rowe

Date: September 2011

DECISIONS REQUESTED

The pan Dorset Health Scrutiny Committee is requested to consider the service change and inform the Primary Care Trust on how it would like to be consulted with further.

Committee members will be invited to discuss and input into the tendering questions and weightings at the meeting, specifically in the area of quality and governance (see Appendix 1).

PART ONE: Description of proposed service changes

  1. The Current Service

Haematology services care for people with disorders of the blood. This includes cancer as well as inherited disorders and some rarer diseases such as haemophilia.

Level 3 in-patient haematology services are specialised and include planned and unplanned treatment for people with complex haematological disorders and other inherited bleeding and cancer related disorders that require an in-patient stay. The service includesprovision of stem cell collection and autologus stem cell transplantation (using the patient’s own stem cells).

There are currently two level 3 inpatient haematology services in Dorset, both providing stem cell transplantation. These are Royal Bournemouth and Christchurch Hospitals NHS Foundation Trust and Poole Hospital NHS Foundation Trust. Dorset County Hospital NHS Foundation Trust has a level 2 centre which is an inpatient and outpatient facility for general haematology patients and no dedicated haematology ward.

  1. How many people does this impact?

Approximately 60 level three inpatients use this service per year.

Should the tender be awarded to a local provider the likely impact will be on approximately half of these patients who will be required to travel an additional eight miles to the designated site. If the tender is awarded out of county approximately 60 patients would be impacted by the change of location.

  1. What are the proposed service changes

A review undertaken in 2010, led by the local hospitals and the clinicians that provide this service, recommended that the serviceshould be centralised on one site. This together with the national Haematology Improving Outcomes Guidance (IOG) requirements and the need to provide evidence based cost effective services presents a case for this change.

Thisaim of centralising this serviceon one site is to enable the NHS to consistently achieve the best possible clinical outcomes for patients by ensuring access to uniform, high quality care.

Centres operating stem cell transplant units are expected to have been accredited by JACIE (Joint Accreditation Committee for the International Society for Cellular Therapy and the European Group for Blood and Bone Marrow Transplantation) and this is a requirement by South West Specialised Commissioning Services. The primary aim of JACIE accreditation is to promote high quality patient care and laboratory performance in stem cell collection, processing and transplantation centres by adopting a standardised system of accreditation officially recognised across Europe

Although this reconfiguration is concerned with inpatient level three services, there are opportunities for access to be improved with follow ups closer to home.

  1. Rationale

Centralisation of services for haematology has been supported by NICE Improving Outcomes Guidance, the new DH Strategy for Cancer and by the JACIE accreditation processes.

Centralised services should support population bases of 500,000 people as a minimum with plans to include more.This service would support a population base of 750,000.

Locally the provider-led acute services review recommended centralisation of haematology as a way of releasing resources and the specialised commissioning teams were concerned aboutthe volume of bone marrow transplantation in the longer term at their inspection in 2010.

  1. Has this been part of a previous proposal?

No

  1. Can you provide an indication of the proportion of residents within Bournemouth, Dorset and Poole that are affected?

This will impact circa 0.008% of Dorset, Poole and Bournemouth’s population.

  1. Summary of involvement

Patient involvement, which is being managed by the Dorset Cancer Network, will be undertaken through questionnaires which will specifically ask patients to share their views onwhat is important to them in terms of their patient experience. The feedback will be used in the development of the specification of the service and input into the development of the tender evaluation criteria.

A number of patients, carers, member of the Dorset Cancer Network paneland LINk will be invited to attend the bidders’ presentations and asked to feedback to the PCT on specific criteria.

  1. Timescales

The current timetable is as follows:

Key Milestone / Start by / Completed by
Dialogue and involvement phase / July 2011 / End October 2011
Advertise requirements / November 2011 / November 2011
Invitation to tender / Early Jan 2012 / Mid Feb 2012
Evaluation and presentations / Feb 2012 / Mid April 2012
Award / May 2012 / June 2012
Mobilisation / June 2012
  1. Additional information

N/A

8.Does the NHS consider this proposal to be a substantial variation or development?Yes

NHS Dorset does consider this to be a substantial variation as the current services that are commissioned from two providers will be changed to a single site and provider. Please note that no services are being ceased or decreased.

PART TWO: Patients, carers and public representative views – summary of the potential impact of proposed service changes

List who has been asked to comment on or complete this section : / Vice Chair of the patient partnership panel
Benefits of the proposed service changes / Having one central area of expertise has to be of benefit to the patient. It ensures that all patients treated are offered the same standard of care and treatments. Highly qualified staff based in one dedicated area will ensure continuity of care.
Any negative consequences, including how you think these could be managed / Dorset has a wide catchment rural area which would impact greatly on patients/carers travel and expenses. Also long journeys whilst having these intensive treatments would be very distressing for the patients.
Good inhouse travel arrangements would need to be developed, with financial support
(especially with the cost of petrol and parking). Younger haematology patients with children would find it difficult to have their children visit fitting in with school times etc; This is important to consider from the psychological impact on the patient.
Any issues for patients/carers/families in accessing the new service particularly if a change of location has been suggested / As mentioned above travel and cost will be a major impact on patients and carers
Public transport is not good and takes time.
How do you think the proposed changes will affect the quality of the service / From the patients point of view they would be receiving a high level of expertise, with the same team throughout their treatment, which must be physically beneficial to them. However the issues around frequent hospital visits must be built into any changes of locations for the patient and families.
Impact of the proposed changes
on health inequalities / To centralise the proposed changes would hopefully ensure that inequalities would be avoided, the treatments being offered and given by the same team.
Any other comments / In the present climate of change, it does make sense to centralise such a complex speciality to ensure that adequate funds are available for a high level of care and treatments.
If you are a representative of an organisation, such as LINks, please indicate how you have drawn on the views of others from your group / Representative for the Dorset cancer network patients partnership panel

PART THREE: Impacts at a glance

Impacts

/
NHS View
/ Patient/carer/public representatives’ view
Impact on patients / G: higher quality services / G
Impact on carers / A: potentially some additional travel / A
Impact on health inequalities / G: / G
Impact on local health community / G: specialised service maximising clinical effectiveness for the local population / G

R = (red)significant negative impact

A = (amber) negative impact for some

G = (green) positive impact

Appendix 1: Proposed Tender Evaluation Questions

1.0Service/Scheme Delivery

Please confirm if you are proposing any variation from the service specification
Provider response:
If variations are proposed, please provide details of suggested variations cross referenced with the specification section/paragraph.
Please provide a statement of the operational issues relating to the provision of the services
Provider response:
In your response you may wish to consider: -
Location of services
Facilities available at the location
Capacity projections and availability
Working to agreed care pathways
Acting within clinical effectiveness
Interaction and relationships with other services identified in the specification
Management of the multi-site responsibilities
Utilisation of resources
Integration with current services
Working within a multi-disciplinary team
Management of the transition of patients
What do you believe would be the main benefits to the local health community by your organisation providing this service
Provider response:
Please advise if you believe there are opportunities for development of these services.
Provider response:
In your response you may wish to consider: -
Areas which could be developed or repatriated
How such a transformation could be managed
Potential capacity requirements of enhanced service
Please indicate which IT system will be utilised for the service and highlight the key benefits of the proposed system to meet the service requirements
Provider response:
How do you propose to treat patients out of hours
Provider Response:
Consider:
West Dorset Patients
Patients who present in the ED
Weekend
Transport
On-Call Arrangements
Links and interdependencies with Haematopathology services
Provider Response
Links with older peoples services
Provider response

2.0Quality and Governance

Please can you confirm that your current CQC registration status covers the provision of these services?
Provider Response
Please advise the impact the provision of these services will have on your CNST or insurance arrangements.
Provider Response
How does your Board ensure the services provided are of a high quality? Do you envisage any changes in governance structures or policies should you be selected to provide the Level 3 Haematology Services
Provider Response
In your response you may wish to consider: -
Collection and collation of patient safety/quality indicators, their analysis and how reported to board/NED visits/board of governors
Policies and procedures that are in place covering patient safety, clinical effectiveness and patient experience.
Specific information relating to management of adverse/serious incidents, complaints/concerns, staff training and registration, infection control, medicines management, implementation of relevant NICE & National guidance, safety alerts, mortality/morbidity rate measurement.
This should include how all of these are reported to the Board.
Please advise how you will comply with the monitoring arrangements/quality indicators required for this service.
Provider response:
In your response you may wish to consider: -
How will you capture information/data and provide a monthly report to commissioners to evidence performance of all of the areas of quality and governance-
The format will the report be in and are systems in place to enable this
How would you organise delivery of care to improve service outcomes and patient experience?
Provider response:
Consideration should be given as to how care can be delivered in innovative ways to support best practice and service outcomes. Can you provide us with key examples of how you would develop the service to be innovative and support best practice?
Provider response:
The transition of any service does have implications for quality and safety, how can you demonstrate that the mechanisms you will put in place ensures that quality and safety are central to patient care?
Provider response:
Who do you think are the key strategic partners in delivering Level 3 Haematology services and how would you develop effective partnerships?
Provider response:
Please identify how you will ensure effective clinical engagement
Provider response:
Demonstrate how you would ensure feedback from patients improves services
Provider response:

3.0Workforce, Management and Leadership

Please provide a profile of your organisation
Provider response:
In your response you may wish to consider: -
Organisation status and structure
Vision and strategic aims
Profile of current business
Please provide details of your proposed management arrangements for this service within your organisation.
Provider response:
In your response you may wish to consider: -
Direct management arrangements
Fit within the organisational structure
Clinical supervision
Please describe your approach to fostering relationships with other organisations and departments who are linked with these services.
Provider response:
In your response you may wish to consider: -
Key departments
Professional links
MDTs
Improving patient flows
Discharge arrangements
Please describe how you have effectively implemented workforce development strategies across your own organisation and with other organisations.
Provider Response:

Mobilisation and Transition

Please describe your approach to the mobilisation of the service and include an example of a mobilisation plan.
  • Illustrations and flow charts may be included to aid your description.

Provider response:
In your response you may wish to consider: -
Please include timescales for completion by DATE and additional timescales for a more measured transition period.
TUPE – measures envisaged and staff consultation with current provider
Identify workstreams and key tasks required for mobilisation
Consideration of existing services with the introduction of these new services
Timescales

1