Five phases of local engagement and discussions
Our proposals for consultation were influenced very strongly by staff and local people. Between 1 March 2016 and the end of November 2017, there were five phases of engagement, which helped to shape both the decision-making process and the proposals for consultation.
Influences in this early phase led to a greater emphasis on mental health, developments in GP and community services and more emphasis on helping people to stay well. Doctors and nurses who were leading the development of proposals agreed a set of decision rules and criteria for proposed hospital service changes.
At this stage in May 2016, it was agreed to pursue the following objectives to:
- Designate a specialist emergency hospital
- Separate emergency and planned care
- Identify where some specialist services could benefit from a single service across three hospital sites.
Engagement activities in this phase included staff workshops, focus groups with service users and ongoing discussions with local authority scrutiny committees, Healthwatch bodies, health and wellbeing boards and others.
Insights from service users and staff informed the weighting of decision-making criteria and influenced the overall sustainability and transformation plan.
The independent East of England Clinical Senate, a group of clinical experts from outside our area, reviewed the developing proposals for hospital service changes. The Clinical Senate supported the overall direction of travel and suggested consideration of more radical options for emergency care, maternity and children’s services.
This phase included a programme of public workshops and staff briefings. Feedback identified priorities for change in health and care services and some potential implications for patients and families using hospital services in the future.
Service user feedback influenced the final sustainability and transformation plan, which was published in November 2016 with a public summary.
A second review by the independent East of England Clinical Senate commended our clear case for change, supported the proposed direction and advised on pace of change – “long term sustainable services should take priority over speed”
Discussions continued with staff and local people. We had by now reached over 100 meetings and events since March 2016.
Four panels (including service users) appraised five options for potential hospital reconfiguration. This options appraisal identified two preferred options with the three hospitals each providing different specialist services as well as the majority of routine hospital services for their local population. In both preferred options, identified in February 2017, Basildon was the preferred site for a specialist emergency hospital. However, the STP Programme Board decided that there should be a further round of engagement to gain insights from staff and local people.
Senior doctors and nurses across the three hospitals continued to develop detailed proposals. There were further discussions with staff, local groups and public representatives. This led to a modification of the previous preferred options. Modified proposals for services across the three hospitals were announced publicly on 20 July.
Based on this further modification, we finalised in September 2017, a draft pre-consultation business case for the overall STP plan and proposed hospital changes. NHS England assured the draft pre-consultation business case during October and November and the case was finally approved for public consultation by the Joint Committee of Clinical Commissioning Groups (CCG) in mid and south Essex.
The pre-consultation business case is now published along with a consultation document, feedback survey and other information on this website.
From local people – top 12 priorities for improvement
Throughout all of our discussions, we talked about current pressures and rising needs for health and care. Over two thirds of the people we listened to agreed that there was a need for change and gave us what they felt were the top priorities, which are listed below:
- Access to GPs
- Better access to community care
- Efficiency improvements
- Increase in Government funding
- Mental health
- Integrated health and social care
- Increase/improvement in social care
- Education for the public on services
- Discharge and care planning
- Better hospital experience
Narrowing down the potential options for hospital services
Over five phases of discussions with local people, we narrowed down the options for potential changes in services across our three hospitals in Southend, Chelmsford and Basildon. From over 100 possibilities we reached five main options for organising services across the three hospitals. By the end of phase four, the options appraisal phase, we had identified two options for more detailed development. Both of these options involved designating Basildon Hospital as a specialist emergency hospital, which would take all patients travelling by “blue light” ambulance.
Following the options appraisal process, there was a strong view from our Service Users Advisory Group and others that this theoretical approach should be sense checked to address local concerns. The result was a modification of the proposal, which would enable the majority of patients in need of emergency care to be treated initially at their local (or nearest) A&E and then, if needed, transferred to a specialist team, which may be in another hospital.
This changed the main principles upon which we have based our proposals for proposed hospital service changes.