We know in parts of our hospital services there are issues of quality, performance and/or sustainability that present major improvement challenges.
Our services also face significant operational and financial pressures, with particular difficulties associated with the recruitment and retention of medical and nursing staff, and consequent heavy reliance on locum and agency staff. This in turn impacts on continuity of care and whole system working, clinical leadership and the ability to improve services.
In addition our current system too often causes people, who reach a health and/or care crisis, to not always be responded to with the right care in the right place at the right time, first time.
What are we doing?
Emergency & Acute Care
We are further developing and embedding a single-service model across the Cumberland Infirmary Carlisle (CIC) and West Cumberland Hospital (WCH) with the aim of improving outcomes for patients.
There is work to offer more specialised services from a single site ie, developing a Hyper Acute Stroke Unit in Carlisle and we plan to provide improved access for minor trauma and minor emergency general surgery at WCH, where this can be provided safely and effectively.
We plan to create an innovative and integrated ‘front of house’ workforce, strengthen daytime ambulatory and ‘anticipatory care’ services. This will closely link with Integrated Care Communities (ICCs) to ensure that patients and professionals can swiftly access specialist opinion and diagnostics to prevent unnecessary admission to hospital and/or deterioration in condition that would result in eventual emergency admission.
Local Specialised Services
To support our population’s access to specialist services locally we plan to develop stronger clinical networks with regional centres and other providers with expertise that augments our local services. Importantly we have started this process of formal partnering with Newcastle Hospitals NHS Foundation Trust and Northumbria Healthcare Foundation Trust to provide clinical network support in key areas such as radiotherapy/oncology and specialist children’s services.
We are also focusing on the specialist radiotherapy infrastructure at the Cumberland Infirmary with NHS England Specialist Commissioners and a tertiary services provider
Some services have already moved from Carlisle to Whitehaven and more will follow as we make use of the new surgical facilities at the West Cumberland Hospital (WCH).
The system is committed to meeting the constitutional standards in elective care:
- the referral to treatment 18-week performance metric;
- the six-week diagnostic metric
- the 62-day wait cancer target
We are also looking closely at the full system for outpatient activities so that we provide a more balanced and localised overall approach to elective care. Other work includes:
- Redesign of MSK pathways including rheumatology (hip & knee, spine, foot & ankle, upper limb, paediatrics) to form an integrated service with community/primary care.
- Redesign of ophthalmology pathways (cataracts, glaucoma, AMD, Minor Eye Conditions, and Paediatrics) to form an integrated service with community/primary care.
- Introduction of integrated models for chronic pain and for surgical pre-assessment
- Repatriation of elective work currently undertaken outside the county.
- General surgery quality improvements that will ensure that the right person sees the right patient at the right time.
Women’s & Children’s – Integrated Children’s Services
We aim to create an evidence-based, sustainable, one-team model integrating services across all professions and sectors with the aim of improving health outcomes and experience for children, young people and their families.
Our proposals include:
- Support for children and young people to be healthy and safe.
- Focus on quality and better health outcomes.
- Developing the relationship between acute, community, ICCs and networks.
- Provision of short stay paediatric assessment Units (SSPAU) at both sites.
- Changes to inpatient care with low acuity beds at WCH.
- The development of an integrated and coordinated children’s nursing service that will deliver multi-disciplinary care including working with Jigsaw children’s hospice as part of the
integrated nursing team.
- Working collaboratively at a regional level to deliver more specialist services and improving the sustainability of services locally.
- Developing a whole-system approach to promoting emotional resilience and good mental health.
It is important to recognise that any future models for paediatric services will need to be considered alongside the future model of maternity services.
Improving Maternity Services
We have two of the smallest consultant-led maternity units in the country and there are real challenges with sustainability given the inter-dependencies with paediatrics and anaesthetics services.
Following the Healthcare For The Future public consultation much time and energy has been spent developing co-production to help secure maternity services.
It is important to recognise that any future model for maternity services need to be aligned to the future model of paediatric services.