Clinical Services Review (CSR)
The Clinical Services Review (CSR) was led by NHS Dorset Clinical Commissioning Group (CCG). The CCG is the organisation responsible for commissioning – or planning and securing – healthcare in Dorset.
“Our vision is simple but effective: we want to change our healthcare system to provide services that meet the needs of local people and deliver better outcomes.”
In October 2014, the Clinical Services Review was launched to consider how health and care organisations in Dorset could work better in the face of a number of significant challenges.
Proposals – our original proposals
Integrated community services
“One way that we could help to join-up and improve health and care services in the community for local people is by creating what we are calling community hubs.”
“National clinical evidence shows that more lives are saved when people are treated in specialist centres with senior specialist staff available on-site 24 hours a day, seven days a week.”
Integrated community services means bringing together primary care, acute hospitals (secondary care), community and voluntary services and social care to provide services around the patients.
This involves teams including GPs, nurses, therapists, consultant doctors, social workers and community mental health nurses, working together across traditional organisational boundaries.
The original proposals included seven community hubs with beds and five community hubs without beds.
Dorset’s three major hospitals provide a lot of the same services, but facilities are stretched. Evidence shows more lives are saved when people are treated in specialist centres with distinct roles.
In the east of Dorset it was proposed that there should be one major emergency hospital (our preference is Royal Bournemouth Hospital) and one major hospital for planned care (our preference is Poole Hospital).
Dorset County Hospital would continue to provide both planned and emergency care in the west of Dorset.
Consultation – how the public were consulted
Since the review began in October 2014 we have shared our ongoing work and proposals with key stakeholders and the public. The feedback we received helped to shape the proposals which went to formal public consultation in December 2016.
The consultation asked for feedback on site specific options for Dorset County, Poole and Royal Bournemouth hospitals, the configuration of maternity and paediatrics, changes to community services and the redistribution of community beds across the county.
Between 1 December 2016 and 28 February 2017, 18,713 questionnaires were submitted along with 245 written submissions. In addition over 1900 people attended drop-in events, 14 focus groups took place and 1005 people took part in telephone surveys.
The results of the consultation were independently analysed by Opinion Research Services (ORS), specialist consultation analysts and were published in an independent report. The report looks at responses from more than 18,500 people who shared their views on the options for consultation either online, or by post. It also analyses feedback from thousands of other people that took part in focus groups, a telephone survey or made their views known through written submissions or petitions.
This report informed the final business case which was presented and considered by the Governing Body of NHS Dorset CCG in September 2017.
Consultation – what the public said about our proposals
Integrated Community Services (ICS)
The headlines from the consultation relating to Integrated Community Services confirmed:
- Little disagreement with the proposal to provide care closer to people’s homes in principle across all methodologies except the open questionnaire.
- There were, however, many questions and significant doubts that they could be achieved in practice (resourcing, affordability and overcoming current disconnect between different services).
- For the proposed locations, some areas were more controversial than others. Negative opinion was strongest where it proposed that beds or hospitals are closed.
This feedback, alongside the additional work led us to review and revise some of the proposals.
Acute care and hospitals
The headlines from the consultation relating to acute hospital services confirmed:
- Majority were in agreement with the vision of two specialist hospitals (one for emergency and one for planned care and an emergency and planned care hospital)
- 64% of NHS staff were in favour of the proposal to provide a major emergency hospital and a major planned hospital in the east of the county and 76% of NHS staff were in favour of the proposal to provide a major planned and emergency care hospital in the west of the county.
- Based on qualitative feedback Option B (Bournemouth as the major emergency hospital) was considered more favourable than Option A (Poole as the major emergency hospital)
- Preferences for Options A and B differed in the focus groups between groups and individuals, mainly based on geographical proximity to the proposed emergency hospital. People were pleased that Dorset County Hospital is to remain a district general hospital but some expressed concern that it may become a ‘poor relation’
- Overall there were concerns about travel, congestion, transport and transfers between Poole and Bournemouth hospitals and staff retention because of the changes.
Nearly 25,000 people signed a petition asking the CCG to keep Poole Hospital A&E and Maternity departments open, the petitions were considered as part of the deliberation phase. Careful consideration was given to the focus of the petitions, and not just the number of signatures received. This has informed the outcome of the recommendations and the details which sit behind them. These helped inform the final recommendations.
Maternity and paediatrics
We recognise that this was the most contentious proposal in the consultation and prior to public consultation we did not identify a preferred option for maternity and paediatrics services.
Based on feedback from consultation 63% of respondents supported Option A and 13% supported Option B, with 23% supporting another option. Based on the qualitative feedback it is fair to say that Option A was, in many senses, the least unpopular with members of the public. Many participants in the focus groups rejected both options, but if they had to choose, option A was considered to be the fairest/most reasonable.
People raised concerns about travel and transport, the clinical safety of mothers and babies and the effect on families. The CCG received two petitions against the closure of Kingfisher Children’s Ward at Dorset County Hospital which had a combined total of nearly 28,000 signatures.
Decisions – the outcomes of the consultation
During our deliberation phase we did change several of the proposals based on public feedback, however we concluded that there is no new evidence that would suggest a change to our preferred option for the roles of Poole and Royal Bournemouth hospitals.
After hundreds of hours of work and a public consultation which saw over 18,500 responses, earlier this month the Governing Body of NHS Dorset Clinical Commissioning Group agreed an investment of around £150m into local healthcare and made decisions that will see changes to how some services are delivered locally.
“The decisions we have made give us a once in a lifetime opportunity to invest in, and make changes to, services across the county, ensuring they are available for generations to come.”