10th October 2013 Patient Congress meeting

Feedback on the ‘Fit 4 Future’ vision for Whitby and surrounding area

Hambleton Richmondshire and Whitby Clinical Commissioning Group (HRW CCG) is keen to involve patients and the public in its work and listen to what they have to say in relation to developing community services in Whitby and the surrounding areas. .

The following pages provide a summary of the questions asked and comments made at one of our Patient Congress event, held on 10th October 2013 We have provided the response given to each item raised at the time, as well as an update on any work which has taken place or associated actions which have been carried out since the meeting took place. We hope you find this both useful and informative.

The information in this document is being considered as part of an updated ‘Fit 4 the Future’ Vision document for Whitby and surrounding area. The updated Vision document will also include feedback from a professional stakeholder event which was facilitated on 8 October attended by representatives from local health organisations, social care, patient organisations and third sector.

There will be further chances to discuss the updated and revised Vision over the coming months, with public engagement events taking place in December 2013 - January 2014. Information about how to take part will be published shortly and the feedback from the Patient Congress will be fed back into the report produced at the end of the public engagement.

YOU DO WANT

This is what you said This is what we currently do/ have This is what we plan to do

Hospital Design

Community input into design of hospital

HRW CCG values the involvement of the public, patients and carers in everything we do and we will be launching a number of engagement sessions to ensure people have the chance to share their views around the hospital design. We will publish the plans for the public engagement by early December. HRW CCG will present a Public Engagement Plan to the HoSC and subject to approval we will then hold a series of public engagement events through December 2013 to January

2014. This will help us to develop the detail of the vision and ensure widespread support.

We will also undertake a formal consultation process on a short list of options based on earlier views, where the public and local stakeholders will have another opportunity to comment and input into the design of the hospital.

Improved building maintenance and cleaning

The current building was built around 1979 and has had few upgrades but doesn’t lend itself to current and future needs. It is very expensive to maintain old finishes, systems and engineering and also very hard to clean.

However, the providers have always ensured that the statutory requirements around safety and cleanliness are maintained.

The PEAT assessments have now been replaced with Patient Led Assessments of the Care Environment (PLACE).

The national average for cleanliness for the PLACE 2013 assessments was 95.74%, Whitby cleanliness score was 99.72%.Cleanliness monitoring is carried out by the domestic supervisors in line with frequencies as detailed in The National Specification for Cleanliness in the NHS (April 2007).

Scores:

June 96.85% July 97.16% August 96.58% Sept 96.75%

HRW CCG is aware that the current Whitby hospital is not fit for purpose and is very expensive and difficult to maintain and clean. HRW CCG recognises that a new facility is desirable and will need to be cost efficient and easier to maintain and clean. We will ensure that this to be one of the essential requirements of the building design that will be commissioned. This will be actioned by the Hospital Infrastructure Group. We will also ensure this group has a patient representative on it.

A helipad

The protocol for the air ambulance is to utilise any safe landing area for the helicopter as close as possible to the scene of the incident that is being responded to, including tarmac road, open fields and school grounds.

HRW CCG has no current plan to provide a helipad for the hospital and this is deemed outside of scope of this project. This would need to be a service development lead by Yorkshire Ambulance Services and is therefore outside of our remit

Eating facility available for visitors to the hospital

There is a restaurant at Whitby Hospital that is open to the visitors of the hospital.

HRW CCG will make sure the option of having an eating facility. We will look to provide some of these services in partnership with other agencies to provide value for money solutions and ensure they are well utilised.

Broadband links made available in the community (GPs?)

HRW CCG will produce an Integrated IT Strategy for the program which is critical to our integration agenda. This strategy which will look at not only the IT infrastructure required for the integration of services at the community level but also address how we plan to overcome the challenges of information governance, access and security of patient level information.

Staff

Better Continued Professional Development (CPD) for healthcare providers

All NHS provider organisations have a responsibility under their contractual arrangements to ensure a robust workforce plan is in place and that there is on-going monitoring of workforce plans. As part of the learning and organisation development is critical. These workforce plans can be found via the trust website and can be found in the York Hospitals NHS Foundation Trust Annual Plan for 2012/13.

HRW CCG will ensure all providers have a workforce that has the confidence, skills, knowledge and adaptability to continuously improve health, well-being and enhance the patients’ experience’ and deliver high quality services. Currently Health Education England is supporting all providers in developing robust CPD programmes for their workforce and appendix 1 includes the key priorities.

Access to services

Single point of access

There currently isn’t co-location of skills and expertise from health, social care and third sector under one roof at the moment. There are individual access points locally for health and social care, where people are able to get information about health and social care services available locally and guidance on how to access these services.

HRW CCG recognises the need for an integrated single point of access to all services and is within the ‘Fit 4 Future’ vision to deliver care which focuses around patients and to enable the co-location of community and primary care, nursing, social work and voluntary sector personnel, working with visiting consultants and outreach service providers. This will facilitate the provision of locally accessible health and social care in and around Whitby. This will be a key focus of the work groups.

This is currently being reviewed across North Yorkshire to see what all agencies can collectively do to improve information and access to services and information about those services.

Reliable transport to centralised services (i.e. from the Esk Valley)

The new Hospital will require a Travel Plan to assist in promoting sustainable transport to and from the site for all staff, patients and visitors. A travel plan will be developed as part of the program to deal with impact the service changes will have on local people and transport and access to the site. We are keen to ensure good access for all and will seek detailed patients and carer feedback to ensure good and reliable transport arrangements are in place. We will also look to engage the third sector more going forward as their contribution will be invaluable and may be able to offer a more flexible solution for patients and carers

that better meets their needs.

.

Fast efficient transport. What will the travelling time be to each site? (South Tees/Scarborough/York)

As part of the service review we will look at all of the issues affecting Whitby and surrounding areas accessing healthcare services. We will therefore review what services can be delivered better locally and what needs to continue to be delivered in more specialist centres. As such we will ensure Yorkshire Ambulance Service are included in the development of the local travel plans and we are currently working closely with them to ensure all national targets are met and patient experience is improved.

Better education regarding which services are available and best point of contact

In addition to the NHS Choice there is also a directory of services accessible via NHS 111.

NHS Choice provides an overview of the most common services provided by the NHS in England, such as emergency and urgent care, general practitioners (GPs) or dental services. Also get advice on how to access each service.

It also has provides links to the services provided by Social care by directing users to the Local authority directory.

Please find the link below:

http://www.nhs.uk/NHSENGLAND/ABOUTNHSSERVICES/Pages/NHSservices.aspx

HRW CCG also understands issues around accessing services and is proposing as part of the redevelopment to develop a local wellbeing centre within the hospital which will be able to:

Improve local awareness services available

Promote improvements in self-care

Signpost patients and carers to appropriate services

Have a single point of access to services

Regular updates will be provided in the coming months on this initiative. We propose to provide this in conjunction with other public sector bodies and the third sector.

BEDS

More beds available! At least 30

We currently have 15 beds on Abbey Ward and 20 beds on the War Memorial Ward which also includes palliative care beds for Whitby and surrounding area. Currently the occupancy levels at 90% and the average length of stay is 20 days.

It is anticipated that the new facility will include inpatient beds which will include beds for intermediate and palliative care patients and outpatient services, a minor injuries unit, ambulatory services, therapy and diagnostic assessment services. The CCG does however need to develop the outline business case to validate these assumptions and confirm affordability. York Hospitals NHS Foundation Trust have complete commissioned a Health Planning Review which will look at what the future size of the hospital should be and will share this with all stakeholders. This will analyse current services and locations provided to people in the locality now and in the future. Through the health planning review will therefore:

Understanding current operational processes

Determine how these processes and models of delivery may be improved in the future

Develop planning solutions based on future patient pathways and workflow needs

Determine what the future bed requirement will be based on demographic trends etc.

This information will then be used to support

the basis of a Business Case for optimal investment by ensuring that space is utilised wisely and developed flexibly. We will look to report on the Health Planning Review in December and commission the next stage which will be an Options Appraisal for different uses for the site. This will provide stakeholders with more details on the future site use and range of options available for extra care housing, social housing and health and social care providers.

En-suite rooms. DIGNITY.

HRW CCG will ensure that everything to improve privacy and dignity of patients will be considered during the design phase of the project. There will probably be a mix of room types with both shared bays and private rooms and these will be allocated based on individual patient needs.

More provision for inpatient care at Whitby after leaving James Cook

Currently has rehabilitation step down beds and palliative care beds.

The new model of care will have rehabilitation and step down beds only, with no step up beds except for palliative care patients.

Better facilities for step up/down – beds should be available for the more complex cases

The new model of care will have rehabilitation and step down beds, and ensure there is good provision of beds for use of palliative care patients.

There will also be rapid access to remote specialist opinions to make decision making quicker and support more care to be delivered locally. The clinical model will be developed over the coming months and will involve a wide

range of clinical staff and patient representatives. This will ensure that we develop models that are able to provide the highest levels of patient safety and quality. It is envisaged the model will support the frail elderly who occupy the majority of beds and who have complex health needs and multiple co-morbidities.

Emergency and Urgent care

Good access to Accident & Emergency (A&E)

Currently patients have access locally to three hospitals for Accident and Emergency services if a patient is taking themselves to A&E. These are:

James Cook hospital in Middlesbrough- 30miles from Whitby Hospital

Scarborough General hospital, Scarborough – 19 miles from Whitby Hospital

York Hospital, York – 48 miles from Whitby Hospital

If Yorkshire Ambulance Service (YAS) are transporting patients in an emergency will always take the patient to the nearest hospital.

HRW CCG has no intentions to make any changes in this area

The ambulance services and patient transport services in the area have improved response times.

Minor Injuries Unit capable of treating heavy seasonal tourists influx, visa issues etc.

The GPs and the minor injuries unit in the locality have been able to flex current resources to handle seasonal demands and are capable of continuing to do so.

HRW CCG has no intentions to make changes to current service as it is able to meet current demand.

Option of having a minor injuries unit centrally in town

HRW CCG has no plans to move current services elsewhere within the town. This has not currently come out in any of the current engagement work. These is an important synergy/efficiency of co-locating services together such as MUI with the hospital and this also drives better value for money.

COMMUNICATION:

Joined up paperwork between health and social care services - systems that ‘talk to each other’

This is a big challenge for both health and social care. It is recognised that some investment will be required to fully integrate local systems. Currently each of the local services use different IT solutions. These are summarised below:

GP’s use EMIS IT system

Social service use Liquid logic

York Hospital trust use Core patient database

HRW CCG has been in discussion with other organisations around how we bridge gaps and improve integrated work across organisations and multi-disciplinary team approach.

There will be a work stream set up to review the IT Strategy as this is key to the integration agenda and currently being discussed with all of the senior leaders across North Yorkshire. Further updates will be provided as plans progress.

Improved liaison/communication between services – in hospital and on discharge

HRW CCG’s integration agenda will enable various organisations to work together to provide a smooth system that is easy to navigate and supports people in their own home. We recognise that we will need to ensure better plans are in place when transferring patients between different hospitals and when discharging patients to ensure GP/Community Services can provide continuity of care.

Staff from the community hospital, will co-ordinate a package of care that could involve

multiple agencies and address both health and social care needs of patients and carers, to facilitate early discharge home. This will form a care plan and over time will develop towards a personal health budgets.

There are initiatives like the Neighbourhood Care Team that will look to coordinate care in the community and support people in their own homes. This will be actioned by the Keeping Well at Home Sub Group.

CLINICS

More clinics in the following specialisms-

Diabetes

Pacemaker

Fracture

Heart

Paediatric/young people

Sexual Health

Gynaecology

Obesity

Drugs/smoking/alcohol

Keep the hearing clinic.

Re-instate the pain clinic

Improved chiropody

Consultant led clinics – particularly in oncology

The list of clinics currently provided from Whitby Hospital are summarised below and we will look to continue to provide all these services in the new hospital:

Adult Cardiology Service – Weekly Tuesday clinic

Adult General Ophthalmology – Weekly Thursday AM clinic

Nurse led Ophthalmology – weekly Thursday

Care of the Elderly – Weekly Tuesday clinic

Cataract Service – Weekly Thursday AM

Children’s General Ophthalmology – Weekly Thursday AM

Colorectal Surgery – Weekly Tuesday

HRW CCG has no intentions to make changes to any of the current outpatient services. We will review this in the ‘Keeping well at Home’ Work Group. One of the Group’s key areas of focus is on developing innovative solutions to provide better access to a range of follow up appointments locally with the use of technologies.

Diabetes Service – Monthly 1 x Friday AM

Oncology Service – Monthly 1 x Friday

Endocrinology Service – Monthly 1 x Friday AM

Gallstone Disease Service – Weekly Tuesday PM

Gastroenterology Service – Weekly Monday PM

General Dermatology – Twice a month Wed PM

General Gynaecology Service – 3 times per month Tuesday PM

General Orthopaedics Service – Weekly Wednesday PM (4 rotating consultants with different specialities)

General Paediatrics – Weekly Monday, Tuesday or Thursday AM dependent on consultant

General Surgery – Weekly Tuesday AM

General Medicine – Monthly Monday PM

Neurology Service – Monthly Tuesday PM

Respiratory Service – Bi weekly Monday PM

Urology Service – Weekly Wednesday PM

Ear, nose and throat – Weekly Monday

Respiratory – Twice monthly Monday PM

Rheumatology – Monthly Tuesday AM

Antenatal – 2 times per month on Wednesday PM

Orthoptist – Thursday three times per month

There are some general points to note about some of the suggestions for local clinics in Whitby Hospital

Diabetes Care in Whitby and surrounding area is managed mainly in a primary care setting and are referred to specialist if need arises

Pacemaker monitoring is a specialist service and cannot be provided safely in a community hospital

Obesity clinics not provided at Whitby Hospital currently but we will look to provide weight management and exercise on referral programmes through the wellbeing centre

Pain clinics not provided at Whitby Hospital and we are currently reviewing how these are provided across the CCG

We will look to improve access to Chiropody Services

Consultant led clinics in oncology is currently being provided at Whitby

24 HOUR CARE:

Access to 24hr service for Minor Injuries Unit, District Nursing (home support), Emergency Care

HRW CCG has no plans to extend Minor Injuries Services to 24/7 as there is not the demand to support. HRW CCG is however currently reviewing plans to extend community district nursing cover to 24/7.

HRW CCG will work in partnership with

neighbouring CCG and social care services to deliver this service for Whitby and surrounding area. An update will be provided when decisions are made.

Emergency asthma care

Emergency Asthma care is currently provided in primary care and by Out of Hours GPs and if the need arises they are sent to an acute hospital.

Most acute patients have management plans in place to prevent an acute exacerbation , but if they do, there is support from GPs, NHS 111 or they can be taken to the nearest A&E.

HRW CCG has no intentions to make changes to current service. This will however be reviewed as part of the patient feedback.

MENTAL HEALTH:

More mental health services needed in the community - particularly at the hospital

Mental health services are currently provided in the main by Tees, Esk and Wear Valley NHS Foundation Trust and are being provided from two local sites

Anchorage in Whitby

Cross Lane Hospital in Scarborough

TEWV moved their mental health services into purpose built facilities some years ago.

IAPT services are currently provided by Leeds and York Partnerships Foundation Trust and are provided from the Whitby hospital site.

HRW CCG will work with services users to review whether a hospital site is the ideal location to provide some services from, such as IAPT and will explore innovative models of delivery. HRW CCG wishes to see more integration between mental health and community services and will look to work with providers on innovative solutions for service users and their carers. HRW CCG are working closely with providers and NYCC to jointly develop a Mental Health Strategy for North Yorkshire and we will ensure the work of both groups (the Mental Health Strategy Group and the Keeping Well at Home Group) are aligned to drive improvements in care for mental health patients locally.

A key theme which came out of the Stakeholder Event on the 8th October was the need to strengthen the involvement of our mental health

providers in the visioning document. They are currently reviewing this and we expect to further develop the input from them.

Emphasis on ‘talking therapies’ and a more holistic approach – particularly for mental health to avoid admissions

This service is currently being provided at the hospital HRW CCG recognises there are unacceptable waiting times for IAPT services. HRW CCG has met with the provider to ensure improvements are made. The current improvements are summarised below:

Create a Single Point of Access and Referral (SPAR)

Streamline the referral and triage process

Undertake a telephone assessment on everyone currently waiting on the IAPT Step 2 and Step 3 waiting list

Implement new telephone assessment protocol on all new referrals into IAPT

Increase the use of technology to support appointment attendance

Introduce a Group Work programme for patients experiencing anxiety

Strengthen the use of Computerised Cognitive Behavioural Therapy (CCBT)

Increase Step 3 interventions by introducing and evaluating EMDR as an additional treatment to complement CBT.

Improve the IAPT IT infrastructure

Increase the use of IAPT’s reporting function to provide more detailed commissioner reports

Ensure all therapy staff are registered or moving towards registration with the BABCP

Improve service wide communication

TELEHEALTH:

Heart monitoring facilities available at home – remote diagnostics.

Currently 24 hour ECG monitoring is provided by secondary care, monitoring of suitable patients with heart failure is done within in their own homes via Tunstall Telehealth.

HRW CCG is currently developing an ‘Improving Quality Through the Use of Technology work stream to consider all alternatives to Telehealth. Some work has begun with Whitby and District Practices to roll out a “simple” Telehealth system we have started with only hypertension being considered and will extend further.

Carotid artery checks, Doppler cameras

These services are currently provided at the hospital. HRW CCG are keen to progress the implementation of Telemedicine across the locality to allow primary, secondary and community services to work closer together whilst avoiding unnecessary trips to secondary care for patients. This work is very much in its infancy at present but is progressing

Tele diagnostic/consultation facility (TeleMedicine)

HRW CCG has provided telemedicine equipment to the trust and we are currently discussing how we deploy this equipment.

HRW CCG are keen to progress the implementation of Telemedicine across the locality to allow primary, secondary and community services to work closer together whilst avoiding unnecessary trips to secondary care for patients. This programme will be developed by the Keeping Well at Home Group.

Mobile phone monitoring or reminder apps

A pilot for Whitby and surrounding area has been launched recently where NHS approved mental wellbeing web-based application links have been shared with the Whitby and surrounding area Practices for use with patients where appropriate. Success and outcomes are yet to be evaluated which will lead to

HRW CCG ‘Improving Quality Through the Use of Technology’ strategy outlines working with providers and developers of such services. We plan in the first instance to promote further use of NHS approved applications with a view to developing appropriate tailor made applications

further work in this area. for our population.

Rehabilitation

Extensive and better rehabilitation services – for stroke, heart attack, mental health….

HRW CCG intends to develop better integration between health and social care will open the door to partnerships being formed with the local community in providing a range of health-related community activities in the daytime and at evenings and weekends.

Locality rehabilitation services will be key in supporting patients to recover from ill health and regain independence.

Physical activity classes, complementary therapy sessions and supportive activities for mental health service users are possible examples we want to explore through the consultation process.

The scope for this ranges from minor ailments to long term conditions such as COPD, heart failure and diabetes. Whitby Hospital would provide resources, advice and teams of staff that people and patients need to support their self-care

MATERNITY:

Pre and post natal services – maternity services reinstated. Midwife led services.

Provide antenatal and postnatal clinics at the Hospital. The HRW CCG has no intentions to make changes to current service.

END OF LIFE:

Palliative beds – flexible bed base. End of life care – more home care available (‘Hospice at home’)

The beds are flexibly used at the hospital for rehabilitation, intermediate care and palliative care.

HRW CCG recognises that there is an educational issue around choice and end of life care plans which gives people with terminal illness the opportunity to state were they wish to be cared for at the end of their life.

This requires professionals and care homes to encourage end of life care planning, which involves relatives, so as the person does not end up getting admitted to a hospital when they would wish to be cared for at home.

HRW CCG via the Project Working Group will review and develop care pathways that involve end of life care and build capacity in the community to be able support people at home or in the hospital as per patient choice and situation.

We are looking at innovative ways of providing more flexible beds in the future. We are looking sharing bed base with health and social care and provide rehabilitation, intermediate care and palliative care beds. We do however want to support patients to stay and be supported in their own home as this was one of the strongest messages which came out of the ‘fit 4 the future’ events earlier in the year.

A Hospital bed should not be the default position and we will look to radically change the model of care through strengthening community nursing resources so patients can receive the care they want in their home. We will look to

also enhance the range of community services offered such as community IV Antibiotics which has been requested through the ‘fit 4 the future’ events.

CARERS:

Respite care – for elderly and for carers

As part of the vision, we will review the bed requirements for respite care and determine how this could be best provided by engaging other organisations like the third sector, who have a working model already set up to deliver such service to the local population.

Support and training for carers

North Yorkshire County Council in partnership with HRW CCG are working on a Joint Carers Strategy which will be underpinned by a Joint Carers’ Implementation Plan .The aim of the Strategy will be to continue to improve the range and quality of services provided to the county’s carers. One of the proposals put forward is training for carers to look for early signs of issues i.e. tissue viability, continence, moving and handling.

MORE SERVICES NEEDED:

Pre-operative assessments available at Whitby

HRW CCG would like to explore opportunities to increase the amount of pre-operative assessment undertaken locally. This prevents patients who require operations having to travel to acute hospitals unnecessarily for appointments prior to an operation.

We are currently working with provider trusts to develop this model in more detail.

Investigative procedures available at Whitby X– ray, ultrasound, audiology, blood test lab

The hospital provides X–ray, ultrasound, audiology services currently

HRW CCG has no intentions to make changes to current range of diagnostics provided but however will review as part of the work program being developed to see how better services can be provided more locally using telehealth/ telemedicine thereby reducing dependency on Acute hospital for such services and reduce travel time for the local population.

More support groups available

We are really keen to promote a self-care and self-management agenda so patients and carers can access local groups which will support their overall wellbeing. We will use the proposed health and wellbeing centre to provide more support groups these are likely to include weight management, exercise, stress control and pain management but we will develop the proposals in more detail through public consultation.

Improved support for long-term conditions

HRW CCG is reviewing and the approach is to build teams of integrated health and social care professionals able to work with groups of GP practices to offer on-going support to those at risk and those suffering from long term-conditions (LTC). We would like to review the way community services for those with LTC has developed. We have a specialist heart failure nurse, respiratory nurse etc. and we are believe that the nursing staff will need to be focussed on treating patients with complex co-morbidities e.g. more than one long term condition so you treat the patient, not just one element of their

condition. We will also look to provide support on a 24/7 basis going forward and will look to implement these plans within the next year prior to the hospital redevelopment.

Preserve GP specialism and also include more services such as counselling, health and wellbeing advice.

The vision embraces space for a wellbeing centre which will offer services to support better self-care and self-management of risk factors such as weight, alcohol consumption, smoking etc. and thereby support better health outcomes for the local population

YOU DON’T WANT

This is what you said This is what we currently do/have This is what we plan to do

Acute hospital beds being blocked

York Teaching Hospitals NHS Foundation Trust provides intermediate care and Fast Response services for the CCG. Intermediate Care is therapy-led (physiotherapy and occupational therapy) and proactively rehabilitates patients in their own homes or in Community hospitals, including for those patients identified as at-risk of falls. Fast Response Services are provided by a multi-disciplinary team over a 24/7 basis and provide multiple Intensive interventions for generally up to three to five days.

Community Services for Whitby and the surrounding area are currently being reviewed to understand what they currently do and what they could do in the future which could support patients better at home. We are also reviewing Fast Response Team’s current operating hours as they are not currently 24/7. We think through redesigning some elements of the services we could provide better care in the home. We would also like to complement community services with more services from the third sector which may support earlier discharge and admission avoidance.

The CCG is also undertaking a lot of work with South Tees NHS Foundation Trust to ensure acute beds are not blocked by

an effective discharge planning strategy in place through the employment of case managers and have seen lengths of stay reduce on average from 15 days to 7 days for an acute stay

a robust winter planning strategy in place and this includes a plan to flex the bed base

working closely with Yorkshire Ambulance Staff to enable patients to be taken to their local GP Practice where appropriate to receive treatment

Loss of oncology services – can chemotherapy be available locally?

HRW CCG will review with providers to see if this can be available locally.

Loss of parking spaces at James Cook and Scarborough

In discussions with the provider it has been highlighted that there is no intension to reduce any parking spaces by both York Hospitals NHS Foundation Trust and South Tees NHS Foundation Trust.

Both organisations are reviewing current provision and looking at providing better and possibly more parking spaces onsite to

improve patient access and experience.

Community care to fail or lose funding

HRW CCG has no plans or intensions to reduce spend on community services. However the overall budget for both the hospital and community services will need to be used more efficiently and differently to drive better health outcomes.

Dentistry or Sexual Health taking up space when the specialised Dentists/GPs could deal with this?

HRW CCG has no intension to reduce or stop providing this service for the people of Whitby and surrounding area.

Major operating theatres

HRW CCG has no plans to re-instate this service

Such a large costly building

The current hospital building is very expensive to run and the providers only occupy 25% of the site and the reminder has been mothballed. We need to develop a new facility which is more sustainable and will meet the future needs of the local population.

HRW CCG recognises that cost neutral development is essential and as a result the hospital may occupy a much smaller footprint and therefore the wider site may be developed with partner organisations. Clearly this will all be subject to planning approval and the development of a commercially sound business case.

To die due to difficulties with rurality – i.e. long ambulance journeys to acute hospitals

We acknowledge that longer travel times for ambulance journeys are more likely due to our rurality and geography when compared to more urban./city areas of the county. With this in mind the HRW CCG in collaborations with Yorkshire Ambulance services aims to;

Protect ambulance resources locally in the area as much as possible by providing alternative pathways (to Accident &Emergency) for Yorkshire

HRW CCG is committed to endlessly look at innovative ways to improve services for the local population and ensure get rapid access to hospital services in acute and emergency situations.

Ambulance Service crews from scene.

Provide additional more highly trained paramedics with additional clinical skills (paramedic practitioners) to increase the number of conditions, injuries and illnesses treated in the local community and thereby reduce the need to transport to acute hospital A&E departments.

HRW CCG has reviewed ambulance response times for the locality and implemented several initiatives that have improved ambulance response times to Red 1 calls (the most clinically urgent 999 calls) for the locality. Some of them are:

GP in-hours Triage- implemented 1st July 2013 with YAS across all GP practices in the Hambleton, Richmondshire & Whitby locality

GP urgent pathway – implemented 8th Oct 2012 with YAS across all GP practices in North Yorkshire.

Paramedic Practitioners now integrated full time with the GP practices in Sleights/Sandsend and Harewood in Catterick.

There are also 2 air ambulances that are available to respond to emergency calls across HRW that can be dispatched at the same time as the ambulance ground crew is, thereby improving their response time to

scene and transfer time to hospital for the patient if required.

The Yorkshire Ambulance Service target for emergency response for the Red 1 category is 75%. And historically it has been 50%-55% across the locality. Since the implementation of the new initiatives we have now achieved 78%-79% each month since Aug 2013.

Appendix 1 – Out Health Education England key priorities: CPD programmes for their workforce England Priorities

Excellent education

Develop role models for education and training - ‘make being a trainer a badge of honour’ Education for life - ‘supporting and championing multi-professional CPD’

Competent and capable staff

Support a dementia aware workforce - ‘ensuring all staff are trained to rise to the challenge on dementia’

Widening participation

Making healthcare the career of choice - ‘use NHS Careers to reach out into schools for our future workforce; and open to all - encourage more part-time degrees’

Flexible workforce responsive to research and innovation

Making technology central to education - ‘introduce an app to allow students to access information and feedback on their experience’ Realise the potential of research and innovation - ‘invest in education and training in genomics’

Ensuring a workforce with the right numbers, skills and behaviours

Securing future supply and supporting stakeholders with current problems in ‘key areas such as emergency care workforce, primary care workforce, 24/7 services’

NHS values and behaviours

Roll out best practice so that healthcare workers are ‘recruited for values, trained for values, appraised for values and held to account for values’