ORPINGTON HEALTH SERVICES PROJECT

• The essential drivers for better clinical care described, agreed and delivered from A Picture of Health have led to clinical service changes at Orpington hospital.

• South London Healthcare NHS Trust has given notice that the Trust will be withdrawing its services in their current form from Orpington Hospital.

• A full understanding of the health needs of the area is being prepared and being put alongside the Bromley Clinical Commissioning integrated community ambitions and must inform our final recommendations

• If the recommendations indicate there will be any substantial changes then we would need to formally consult with the public for 3 months

• The 4 tests will need to be applied for any major change (Clinical evidence, GP support, Impact on choice, Public/LA/Patients engagement).

Context to changing position in Orpington

Bromley Clinical commissioning focus Better value, Better care, Better health

• To improve ease of access, address inequalities and achieve the best in health outcomes for patients through pathway redesign initiatives

• Earlier identification and management of longer term conditions in the community

• Integrated care at home to avoid unnecessary admissions

The direction of travel of health services in Bromley

• Need to do less in hospital• When we do need to use the hospital it will be

for specialist work requiring state of art equipment and skills

• Need to further improve Primary care facilities, capacity, diagnostic support and skills

Orpington Project TeamThe purpose of the project is to design clinically and

financially sustainable services to serve Orpington residents

Commissioning - voting Governance role• Managing Director• Project Director BSU• Public Health Consultant BSU• 1 GP Clinical Commissioning lead for Orpington • Joint Commissioner (LBB and LCCC): Older

People and Long term conditions • Project Consultant clinical lead SLHT• Head of Finance BSU

For SLHT estates related items - voting Governance role

• Project Director SLHT• Director of Estates SLHT

Engagement • GP from Orpington area• Bromley LINks (to identify 4 participants)• Friends of Orpington Hospital chair• SLHT trade union representative• Communications lead (SEL cluster) • Engagement lead Bromley BSU• Director of Communications SLHT• Operations Director/Quality BHC Project delivery• PMO manager lead SLHT• Orpington commissioning manager BSU

Bromley PCT Board (meeting as the Joint Boards of PCTs in SE

London and Bexley Care Trust)

SLHT Board

Orpington Project Team

Communications&

Engagement

Bromley’s Clinical Commissioning

Strategy

Orpington relate

d eleme

nts

Bromley Local Clinical Commissioning Committee

Technical GroupBusiness Case

&Estates

SLHT Executive

Feed into program at all recommendation points

Denotes formal decision making forum

Formal delegation in September Board to LCCG of decision to go out to public consultation and associated documentation.

Any final agreement on service changes to return to Bromley PCT board (meeting as the Joint Boards of PCTs in SE London and Bexley Care Trust) post public consultation

PROGRAMME STRUCTURE FOR ORPINGTON HEALTH SERVICES PROJECT

Project establishment

The project will have six phases• Gathering information• Service review and recommendations• Public consultation – if necessary• Feedback from any consultation• Final agreement on service changes• Implementation

Development of Options Need to test Strategic fit, Options appraisal, Commercial aspects, Affordability and Achievability

Emerging Options for DiscussionDo NothingRebuild of services in a portion of Orpington hospital site,Utilisation of a portion of the current building Renting somewhere else in the Orpington area Buying/building somewhere else in the Orpington area,Move services in Orpington to other NHS sites.

These above options could apply to all services or some of them.

Considerations Walking distance to services, nearest public transport and car parkingBus routesCar Parking

A Health Inequalities and Equality Impact Assessment will be used to ensure that any service changes have a positive impact on reducing inequalities.

Raising awareness and Listening to the views of patients and the public

o presentations to patients groups, partner agencies and the Health Overview and Scrutiny Committee. (Suggestions are most welcome of interested groups).

o leaflets with contact details of how patients and the public can in put their comments disseminated to health centres, GP practices, libraries, community centres and local businesses and stakeholders

o Dedicated email address for members of the public to send comments (bro-pct.orpingtonquestions@nhs.net)

o NHS South East London and partner agencies website regularly updated with relevant information about the project

o Adverts in the media and information in newsletters of voluntary organisations such as LINKs. Public meeting organised jointly with Bromley Links and focus group discussions to seek feedback on the outcome of the needs assessment and input to the development of options and criteria for assessing options

Staff engagementThe process of Staff engagement is underway. The opinion of clinicians

currently delivering services will inform the services review. Other means of engagement as below

• Meetings with staff have already taken place to inform them of the launch of this project

• Orpington staff are directly represented on the Project Team by a representative of the Trust's Staff side union forum.

• There are the usual channels of SLHT's communication processes including SLHT newsletters, CEO bulletins, staff meetings and team briefing cascade.

• In addition to this, a series of special Orpington engagement meetings have been scheduled

• A leaflet is being prepared for all Orpington staff with further details of the process and likely options, this leaflet will include a feedback mechanism so that staff can feed into the engagement process.

September 2011

Map of Zones of Interest with IMD Scores

0.1%

3.5%

7.9%

2.1%

5.8%

13.2%

23.4%

10.3%

0.0%

5.0%

10.0%

15.0%

20.0%

25.0%

Zone 1 Zone 2 Zone 3 Bromley

% Population Change by Zone for Age 75 years and over (2011 - 2021)

2016 2021

1.5%

-0.7%

5.1%

2.1%

3.0%

-0.3%

10.0%

4.2%

-2.0%

0.0%

2.0%

4.0%

6.0%

8.0%

10.0%

12.0%

Zone 1 Zone 2 Zone 3 Bromley

% c

hang

e in

pop

ulati

on

% Population Change by Zone for Age under 19 (2011 - 2021)

2016

2021

Zone 1 Zone 2 Zone 3

Highest level of deprivation Lowest level of deprivationexpectancy

Highest proportion of children/young people

Highest proportion of over 65s and over 75s

Highest projected population growth

Gypsy Traveller community

Lowest life expectancy Highest life expectancy

Highest circulatory disease and cancer mortality rates

Higher than Bromley average prevalence of chronic kidney disease, dementia, hypertension, serious mental illness

Lowest uptake of cancer screening Highest proportion of intermediate care admissions

Lowest immunisation uptake

Highest rate of teenage pregnancy

Higher than Bromley average prevalence of chronic diseases

Higher than Bromley average prevalence of many chronic diseases

Higher than Bromley average outpatient referral rates for most specialties

Higher than Bromley average outpatient referral rates

Highest rates of outpatient referrals for many specialties

High emergency admission rates overall

Highest emergency admission rates for cancer and general surgery

Higher than Bromley average emergency admission rates for many specialties

Historically, Bromley has had a high level of 1st outpatient referrals ranking 9th highest in London with respect to first outpatient referral rates.

Specialty No of Attendees from Orpington Zones

Dermatology 8794

Physiotherapy 5639

Radiology 4322

Oral Surgery 3671

Diabetes 2806

Rheumatology 2755

Trauma & Orthopaedics 2498

General Surgery 2019

Podiatry 1455

Geriatric Medicine 1093

Also phlebotomy has over 62,000 attendances per annum

OLDER PEOPLEUNDER 19S

PREVENTIONPUBLIC HEALTHSERVICES

Timing• Phase 1 and 2 Engagement phases

– Needs assessment; Mid September– Clinical Commissioner Priorities – Service review– Option appraisal– Agree final shape of services; October

• Public consultation (if necessary); Nov – Jan• Approval to Implement changes; March 2012

Questions and discussion