We are working to ensure that children on the Isle of Wight are supported to get the best start in life that will lead to good health and wellbeing. This will provide the foundation to ensure they are able to achieve the best opportunities and keep as healthy and well as possible throughout their lives.
We want to ensure that families, individuals and communities are thriving and resilient with access to good jobs, affordable housing, leisure activities, lifelong training, education and learning, health and care services are are able to enjoy the place in which they live.
We want to ensure that people on the Isle of Wight are able to live independently in their own homes with appropriate care support. We want to make sure older residents are supported to play an active role in their communities and supported to maintain and develop their social and community networks.
We developed, with specialist data modelling support, over 280 different options. We were then able to narrow these down firstly by agreeing some fundamental principles. Most significantly was the agreement that we must continue to have an obstetric-led (specialist doctor led) maternity service on the Island, rather than a purely midwife-led service, recognising that this provided the best possible care for Island maternity patients and their babies.
We arrived at a final shortlist of five options that were then separately assessed by different representatives; clinical, workforce, finance, system-wide stakeholders (our steering group) who gave their expert opinion about each option against each of the following criteria:
- Quality of care (clinical effectiveness, patient and carer experience, safety)
- Access to care (distance and time to access services and specialists, operating hours)
- Affordability and value for money
- Workforce (recruitment and retention, skills and sustainability)
The different expert groups made their recommendations to a panel of stakeholders brought together by the Local Care Board in January 2018.
The five options were:
Option 1: No change.
Acute services remaining as they are (100% of current hospital acute activity retained on the Island, operational improvements only)
Early in the process it was agreed that Option 1 was unsustainable due to current and projected concerns in delivering appropriate quality and safety standards in several specialties. In these areas, workforce challenges are often compounded by low activity levels and challenges in meeting appropriate quality standards. It was also agreed that even assuming the delivery of challenging year-on-year system efficiencies, the current configuration of acute services is unaffordable against projected income and expenditure forecasts.
Option 2: Flexible workforce.
Acute services remaining as they are but working in a more flexible way with our workforce (100% of current acute hospital activity retained on the Island but with significant workforce changes resulting from joint working with Solent Acute Alliance i.e. Southampton and Portsmouth hospital trusts)
It was agreed that Option 2 would not, on its own, sufficiently address the challenges some services face in meeting national standards and delivering effective clinical results, however a flexible workforce approach would be needed in any future option proposed.
Option 3: Emergency and Elective Care Centre (4% of activity transferred)
Running St Mary’s as an ‘Emergency and Elective Centre’ with enhanced emergency surgical and critical care support from the mainland (under this option 96% of current acute hospital activity would be retained/with a small amount of hospital activity transferring to mainland providers)
It was agreed that Option 3 would not sufficiently address the challenges some services face in meeting national standards and delivering effective clinical results. It would also not go far enough in addressing the challenges of sustainability across a sufficiently broad enough range of services which are facing issues of low levels of activity, workforce issues and concerns about their ability to consistently achieve acceptable quality standards.
Option 4: Emergency and Elective Care Centre (up to 11% of activity transferred)
Running St Mary’s as an ‘Emergency and Elective Centre’ with enhanced emergency and elective surgical, critical care and paediatric support from the mainland (under this option 89% of current acute hospital activity would be retained/with 11% of activity transferring to mainland providers)
It was agreed that Option 4 could sufficiently address the challenges some services face in meeting national standards and delivering effective clinical results, provided risks were addressed by the development of a credible and seamless means of transferring and retrieving patients from/to the Island. It was also agreed that this would provide a clear opportunity to bring back more routine activity (for example hip and knee procedures) from the mainland to the Island so that in overall terms there would be a reduction in patient journeys. Option 4 was also assessed as providing the best value for money (estimated £80.6m improvement over 30 years) although it was noted that none of the options fully address the financial gaps.
Option 5: Enhanced Urgent Care Centre
Running St Mary’s as an ‘Enhanced Urgent Care Centre’ with extended support from the mainland (under this option 46% of current acute hospital activity would be retained/ with over half of activity transferring to mainland providers – note this includes the flexible workforce changes i.e. Option 2)
Whilst it was agreed that Option 5 might improve the clinical results of the higher volume of activity that would be transferred to mainland providers, it was agreed that it should be rejected because these benefits would be compromised by the higher numbers of very ill people being transferred off-Island. It would also require a significant increase in transport infrastructure to transfer higher volumes of patients and a significant increase in the costs associated with funding these transfers for both the NHS and for patients. It was also highly likely to be unacceptable to Island residents based on feedback to date.
The Local Care Board made a recommendation, which was endorsed by the IW Clinical Commissioning Group Governing Body, to pursue Option 4 as the preferred option for improving acute services, subject to further work to refine and improve this model in parallel with the work to redesign community services. However, it made its recommendation only on the condition that certain conditions had to be met. These included:
- Making sure more work was done to look at those key acute specialty services where change is most needed to ensure a properly integrated workforce
- Ensuring that any changes to capacity at St Mary's Hospital and how it provides critical care to patients, is only undertaken when that capacity can be met elsewhere
- Making sure a credible and seamless method of transferring patients to and from the Island is in place before any changes are made.
You can read the full papers for the IWCCG Governing Body here
The NHS is turning 70 on 5 July 2018. The following activities and events are taking place on the Island to celebrate this important milestone: