Agenda item

RUH Programme managers Simon Cook and Geoff Underwood will brief the committee on the health and care vison/support model being developed and how this will shape any potential business case bids to invest in the RUH infrastructure.

The committee is invited to comment on the proposals and consider how it may wish to scrutinise going forward.

RUH Programme Managers Simon Cook and Geoff Underwood gave a very detailed presentation about the health and care support model being developed across the BANES, Swindon and Wiltshire (BSW) System and how they felt this would shape any potential business case bids to invest in the RUH infrastructure.

The managers highlighted long term pressures facing health and care, such as an aging population and spoke about technological innovations changing the way that services are delivered. Against this background they developed seven priority areas had been identified, based on the RUH’s plans for the future of the hospital as well as principles put forward by the BSW group:

1. Provide holistic and flexible care seamlessly as one system with embedded innovation and continual improvement.

2. Care is preventative, proactive and anticipatory, focuses on wellbeing and addresses health inequalities through the lens of wider determinants of health.

3. Provide person centred care and empowerment to put the person in control of their health and well being, and ensuring that each interaction adds value to the person.

4. Provide care at home or in the community wherever appropriate, coordinated through strong primary care networks and multidisciplinary teams, and supported by sufficient emergency and specialist capacity in hospitals.

5. Lead with digital and data to support seamless care for our patients and drive more effective decision making.

6. Support an agile workforce, champion innovative roles and provide opportunities for training, research and development.

7. Deliver an efficient way of working to ensure financial sustainability of the system and value for money of services.

A potential model for the future was outlined, comprising a coordinated system making it easy to access health care services. There would be an emphasis on prevention to reduce demand for health care. The managers emphasised that the hospital itself was only a single part of the patient pathway, indeed, it was hoped to provide more care in the community to allow hospitals to focus on care that could only be delivered in a hospital setting.

When summing up, the managers spoke about the importance of involving the public in developing the care model. Similar models were being developed by the Wiltshire Integrated Care Alliance and their equivalent in Swindon, so it was planned to coordinate all three plans to cover the whole of BSW. Whilst the focus of their presentation had been on BANES and West Wiltshire, the catchment area of the RUH, they stated that a version covering the whole of BSW would be bought to a consultation event on 7 October. Further consultation events would then be held up until the end of November 2021.

During the discussion the following points were made:

• Engagement would be undertaken with all doctors including GPs and those in mental health teams.

• It was felt that a lack of community doctors, particularly in less urban areas, would drive people to hospital when it may have been more efficient to treat them elsewhere.

• Questions were raised about how diagnosis of serious illnesses, such as cancer, would be improved under the new care model. It was noted that this was a nationally recognised issue, as patients had been reluctant to come forward during the pandemic. A BSW diagnostics strategy was under development and a plan was in place to create community diagnostic hubs on separate sites from hospitals, with a view to boosting capacity and allowing hospitals to concentrate on other core services. The managers offered to liaise with colleagues about bringing the paper on diagnostics in BSW to a future meeting.

• Assurances were sought about the continued involvement of local councils and the voluntary sector. Although the focus thus far had been on engagement with BANES, the managers stated that they would be very happy to engage at local events throughout the whole of BSW, including with the voluntary sector. They also emphasised that there would be a consistent model of care across the whole of BSW, although one tailored to local needs.

• It was also noted that it might be useful for an update to be bought to the Committee once the consultations had been undertaken and with a specific focus on the feedback from Wiltshire.

• It was asked what success would look like for the new health and care model and how this could be measured. The managers stated that they did not yet have any metrics identified specific to the new model. However, they did have a number of objectives about what they are trying to achieve in terms of patient outcomes, not just in terms of health, but also in terms of patient experience. They emphasised that the results would be borne out over many years, as they had been with a similar system developed in Israel. It was also explained that they were quantifying data about where care was currently delivered in order to inform the size of infrastructure required.

• Members felt that including headline objectives would make the report accessible for the public and give an insight into the challenges faced.

• Questions were also received about how dentistry and optometry were being integrated into the model. The managers noted that the model focussed on an overall strategy rather than individual services but felt that each service could benefit from the strategy and offered to hold discussions about how those services may benefit.

• Lucy Townsend, Corporate Director People, welcomed the overall strategy but did raise practical concerns about the input of the Wiltshire Alliance being at a stage when the project was already well developed. The director stated that she would look forward to further collaboration on social care and welcomed the project being both community and hospital led. Finally, assurance was sought that the project covered both adults and children.

• Managers reiterated that the model was for both adults and children. They explained that they welcomed the feedback, noting that a workshop had been held prior to the current project to explore what the model should look like across the whole of BSW.  

Resolved:

1.    To thank the programme managers for the update and request that they take into account the comments of the Committee.

2.    To request continued engagement with Wiltshire Council, the voluntary sector and other partners in Wiltshire as the model is developed.