Clinical service reconfiguration for an NHS Trust undergoing merger

Background to the review

The Mid & South Essex University Hospitals (MSE) Group is a partnership of three NHS Trusts in mid and south Essex, operating as an NHS provider group:

  • Mid Essex Hospital Services NHS Trust – based in Chelmsford.
  • Southend University Hospital NHS Foundation Trust – based in Southend.
  • Basildon and Thurrock University Hospitals NHS Foundation Trust – based in Basildon.

The three NHS Trusts provide services to a total population of approximately 1.2 million, and have been discussing service reconfiguration for several years as a way of tackling the challenges of a growing population with increasing demand for healthcare, sustaining a specialised workforce to support local specialised services, and securing sustainability of local hospital care. The trusts were recently part of the NHS Success Regime, and now form the primary acute provider in the Mid and South Essex Sustainability & Transformation Partnership. They are due to merge in April 2020.

Your Care in the Best Place

MSE Group recognised when they came together as a partnership in 2016 that, while there were many examples of excellent care in the region, there was still room for improvement. The group’s clinical strategy centres on the provision of excellence in care and the experience of care, no matter where patients live in Essex. The strategy depends on a hub and spoke model, where specialist centres can provide complex treatment and deliver the best possible outcomes, and local hospital care is strengthened and more responsive to the needs of local populations.

The ‘Your Care in the Best Place’ strategy, developed by the CCG Joint Committee in Mid and South Essex in 2017, aimed to enable more sustainable services, by addressing local workforce and quality challenges. Plans articulated improvements in local health and care across home, primary and community settings, as well as numerous proposals for redesign of hospital services, including in specialist areas. These proposals were also reviewed and challenged extensively on three occasions for their likely clinical impact and feasibility by the East of England Clinical Senate.

Following public consultation, 19 recommendations were accepted for this system redesign in July 2018 by the CCG Joint Committee, and included:

  • Making improvements in A&E at all three hospitals in Southend, Basildon and Chelmsford, with the development of new assessment and treatment centres alongside each A&E.
  • Bringing together into fewer sites some specialist inpatient care where there is existing expertise and to allow for extended hours, with seven days a week consultant and specialist cover for these services – this includes vascular surgery.
  • Separating some planned operations from emergency cases. This will help reduce the rate of cancelled operations and reduce infection risks by separating this type of care from emergency care.

All recommendations are available here

Vascular services reconfiguration – the need for a review of the operational plan

Following clinical review and public consultation in 2017 and 2018,  NHS England and local commissioners decided that vascular services in Mid and South Essex would be reconfigured, with the majority of specialist services provided from the Basildon Hospital site as the ‘arterial centre’, and Mid Essex and Southend as the ‘non arterial sites’, effectively a hub and spoke model. The spoke sites would provide day case and short stay elective services, with a treat and transfer model in place. Details about this are available in the decision making business case here

MSE Group wanted the support and advice of an expert critical friend to review the plans for operationalising the clinical strategy for vascular services, and to make sure plans for investment and service design were aligned to the best practice evidence, and to consider linkages with interventional radiology services. They approached HQIP in April 2019.

HQIP received the support of the two clinical leads of the National Vascular Registry (NVR) annual report to lead on reviewing and commenting on the business case for the operational implementation of the vascular reconfiguration, and key supporting documents.

The HQIP team then synthesised their comments into a report, triangulated the Trusts against National Clinical Audit Benchmarking data to establish relative performance, and provided key metrics and recommendations for the operational model going forwards.

What the review found

The key finding of the review was that the proposal for reconfiguration conformed with the latest provision of services for patients with vascular disease (POVS 2018) guidance and the direction of travel could be implemented with the required investment.

A number of supporting recommendations were made with a view to validating existing planning assumptions for beds and workforce, e.g. in relation to ensuring appropriate bed numbers from the outset, and models of working for specialist vascular surgeons and trainees to be in place for the final phase of reconfiguration. Additionally, MSE Group was advised to ensure that some key co-dependencies with interventional radiology services be considered in greater detail and suggestions for this were proposed.

Impact of the review

The findings and recommendations of the review were invaluable for the vascular clinical team at MSE Group in providing evidence for supporting the business case for implementing the reconfigured service model and gaining the confidence of the wider clinical and executive team in the proposed approach.

HQIP’s report was used as the primary appendix to the business case, and the articulation of the benefits from the proposed service model could be made more strongly because of it. In addition, the report identified which were the priority metrics for the reconfiguring services to focus on, and allowed MSE Group to benchmark their vascular services against similar services nationally.

Charlotte Williams, Group Director of Strategy and New Care Models commented on this partnership:

“Making sure we are scrutinising our planning at each stage, and remaining open to learning from the evidence, benchmarking findings and new data is vital for us in making sure services are offering best value and outcomes for our patients. Working with HQIP in this example for vascular surgery has been a really useful learning exercise for MSE about how we can access expertise externally to enrich our own approach, and we will certainly seek to do similarly as we change services for the better.”

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