This project was undertaken by a large multi-site acute Foundation Trust, which provides high-quality health care for a population of approximately 570,000 people in the South East of England.
The Trust had participated in a major review of county wide acute service reconfiguration options (the TCS review). The review recommended further work was completed to assess the feasibility of centralising essential services on one of the Trust’s three hospital sites, using existing buildings (Option 6).
Further feasibility work completed by the Trust had indicated that this option was not viable, but it proved difficult for the Trust, commissioners, local partner organisations and regulators at NHSI/E to agree the best way forward in terms of clinical strategy and service configuration, resulting in deadlock.
4OC were invited to come and work with the Trust and their partners to develop a viable clinical strategy, with stakeholder support, which:
- Responded to the questions raised by the TCS review
- Updated the ‘case for change’ included in the review, including activity and performance assumptions
- Set out the Trust’s clinical strategy for the next three years, developed through discussion and collaboration with partners
£10 million of savings identified and delivered
We put a small team in place, each of whom had Board level experience of managing acute trust finances, strategy and operations, together with ‘hands on’ experience of leading service reconfiguration projects.
A series of one-to-one discussions and small group meetings was held with CCG Commissioners, STP leads, NHSI, NHSE, Hampshire County Council colleagues, neighbouring Trusts and General Practitioners. The engagement process included Trust clinical leads and the Executive Team, and covered the following questions:
- Current Trust strengths and areas for development
- How the Trust’s services might best be configured to ensure the provision of high quality and sustainable clinical care
- The activity, income, workforce, estates and quality assumptions included in the case for change, and whether these now required revision
The findings from the engagement process were used to review and update the Case for Change and to develop a clinical strategy for the Trust.
In summary, we delivered a comprehensive, focussed Clinical Strategy which included:
- A summary of the strategic context and drivers for change
- A review of the case for change
- A summary of stakeholder views
- A description of the Trust’s four clinical strategy objectives, together with year one action plans for delivery
The Strategy struck a balance between the strategic objectives and action plans required to ensure continued provision of safe, high quality care and the actions required to start the reconfiguration of services across the Trust’s three sites.
Critically, the thorough stakeholder engagement process allowed for commissioner and partner concerns about clinical service delivery and future configuration to be identified and responded to by the Trust. The Trust recognised that the current service configuration was unsustainable. This was reflected in the clinical strategy document.
The recommendations were accepted by both the Trust Board and the wider health economy, and a shared whole system business case for capital development to support the delivery of this option is currently in development. This partnership working is a significant move forwards for a system that was previously in ‘deadlock’.