>>Debbie Fanning: Well, good afternoon ladies and gentlemen. My name is Debbie Flemming
and I am Chief Executive of Poole Hospital. I'm here today with my colleagues to share
our plans for developing one NHS in Dorset. Dorset's traditionally been a high performing
health economy with four foundation trusts, there being a population of around 850 000
across the mixture of urban and rural communities. We've generally been seen as managing our
affairs rather well and we think we achieve good outcomes for patients and deliver high
standards of care. So why on earth do we need to be in the Vanguard?
Well to start with, we really do have some very significant heath challenges. For example,
we already serve the numbers of older people that many across the country are simply planning
for. There are pockets of deprivation and style differences across the patch between
our urban and our rural communities resulting in mount variations and outcomes. We have
very significant financial pressures. All three acute providers are forecasting deficits
this year at around 4% of turnover already and we will all three run out of cash around
the end of '16, '17.
As in many health systems it's difficult for us to work together. As foundation trusts
we've been brought up to compete and we've done so for many years. The tariff and current
service configuration have created many win/lose situations across Dorset. There are very real
differences between the west, which is mainly rural, and the east, which is more urban.
And if I'm honest, at times, we actually don't like each other very much.
So the real feature, though, of the Dorset health economy is that in our, in our patch
we have a prohibited merger between Poole and Bournemouth Hospitals, which now represents
a very real barrier to joint working.
In 2013, the two acutes in the east tried to come together but we were stopped by the
competition authorities on the grounds that it would result in the substantial lessening
of competition. This failure has seriously burned our fingers. It's not just that there's
now no appetite for mergers. We are actually precluded in law from bringing our services
together. So our sense may look great from the outside, in Dorset we're clear that we're
sitting on a time bomb.
>>Robert Talbot: I am Robert Talbot, Medical Director of Poole Hospital and I am surprised
that nobody has said how bowled over they are to be here today. 12 Months ago the Dorset
clinical commissioning group launched a clinical services review, which seeks to address some
of the significant health challenges and inequalities in Dorset.
This is clinically led and has involved more than 300 doctors, nurses and allied health
professionals from primary care, mental care, community services, secondary care and social
care. Through, first of all, the Big Ask which was led through the media and through a separate
patient/partnership forum, there has been considerable public and patient involvement
and through this we've designed a blueprint for integrated, seamless, high quality and
sustainable care for the patients and the children of Dorset.
The blueprint includes an out of hospital, integrated community care model. It includes
mental care, secondary care and by putting patients first over the needs of organisations.
If we focus now on the secondary care model, this will provide an acute emergency 24 hour,
seven day a week service to the people of Dorset supported by efficient high quality
elective services. Delivery of this blueprint will address the considerable workforce and
financial problems we sustain. As Debbie described, the acute trusts have barriers about working
together. We believe this cannot be delivered by individual organisations working in isolation.
>>Richard Renaut: So, Robert's just described that we've got a blueprint for Dorset built
up over time. So the Vanguard is perfect timing to be our delivery mechanism. I'm Richard
Renaut; I am the Chief Operating Officer at Bournemouth Hospital. Our plan is based around
a multi-specialty joint venture between the acutes for one Dorset NHS.
The first door of escape of what we're looking at is over £150 million of services, 2400
staff. So we're ambitious, we want to do this at pace and [Inaudible]. Those services include
frontline areas, like radiology as well as IT, and they're picked really from areas with
the hotspots from that clinical service review that Robert's described where we've got sustainability
issues but also where we've got some earlier [Inaudible] as well.
The joint venture allows us to keep sovereignty as FTs in the current system, helps us resolve
some of those competition issues, but we're very much looking for support in taking this
forward. And it's a great platform, we think we can expand this across partners in the
community and the community trust supports us, GPs and of course, more acute services
as well as our work with social services.
So how can the Vanguard help us? Six areas, help with competition issues, organisational
development for collaborative leadership, patient centred service redesign, peer learning,
practical issues like networks and rotas, the governments legal contractual frameworks
and finally, with the programme management.
>>Patricia Miller: Hello, my name is Patricia Miller. I am the Chief Executive at Dorset
County Hospital. So what will we achieve in the next 12 months? We have established our
joint venture with the acute care steering board that will manage that venture, pooling
services, staff and our financial resources. That will be supported by an integrated healthcare
record, we will have agreed, new models of care sustainable, efficient. They'll also
be tackling variation and health inequalities which we have considerable numbers.
The joint venture will enable us to deliver our SIT Programme at scale which we currently
can't do with three smaller organisations. We'll also have different contracts in place.
Longer term contracts, different payment methods in order to support the models that we'll
be running. And I think we'll be building confidence and ambition within our health
community, taking new services into the joint venture and even different organisations.
So why should NHS England choose us? We have got a burning platform but our clinical servicing
review means that we've got a credible plan and that plan has got a high chance of success
because we've got every stakeholder support and that support is unequivocal.
We've got a unique set of competition issues, as Debbie stated, and that means that we can
do some work to understand how we deal with those through the competition and market authorities
because they are real for us.
Our rural and urban community model also means that we've got learning that we can spread
right across NHS England to different communities with different characteristics of a model
that's definitely replicable. And we've got a great history in Dorset of delivering best
practice standards, innovation service improvement and spreading that learning right across England.
>>Debbie Fanning: So, we very much hope you support our application and happy to take
questions. Thank you.
>>Patricia Miller: Thanks very much.
>>Debbie Fanning: Darcy Ward in 1 NHS in Dorset and we've already got a couple of questions
right in the middle.
>>Participant: It's me again, [Inaudible].
>>Debbie Fanning: Can you move that way? I can't see you, sorry.
>>Participant: I'm here.
>>Debbie Fanning: Oh, there you are. Lovely, thank you.
>>Participant: I'm only small. Look the light should be shining off my head.
>>Debbie Fanning: I can see you.
>>Participant: Yes, innovation. Innovation and this, that, but what about innovation
in patient involvement? I haven't heard anything about innovative patient involvement from
any of the trusts or any of the Vanguards today and it was the same on Wednesday and
Thursday at the Expo.
>>Robert Talbot: Thank you for that question. We did talk about the Big Ask. I think that's
pretty innovative where the local media, the radio, newspapers, internet, through our website.
We had a huge ask of patients and partners for their opinions about the models of care
that they wanted to see. I think that was quite good.
>>Debbie Fanning: It's also fair to say that you know, over time, across the whole of Dorset,
different people have had great models of engaging. It's really important to talk to
people, to listen to people, particularly those whose voices aren't always heard. So
lots of work directly in conversations, seeking views and actively wanting to find out before
we come out with the solutions.
>>Participant: There's a second question in the middle.
>>Patricia Miller: Can I just add something to that please? The clinical services review
that we've all been part of, there's been a patient forum that's underpinned that whole
review. So at every point of which we've had a variation of the model, that model has been
solely tested with that patient group to make sure that we're on the right direction of
travel in terms of meeting our population's needs.
>>Participant: Hello there, I'm going to take a leap out of that lady's books. So, Trevor
Fernandez, patient, East of England. Can I ask you a question about, you've mentioned
that you are currently are a high performing health economy, but you also say that if you
don't do anything, you will run out of cash in '16, '17. So there's a contradiction there.
>>Debbie Fanning: There is and I think it's understanding. I think the current configuration
of services across Dorset, which was actually set up originally for recognising that each
organisation could lead on different things and develop areas of expertise, over time
through competition and tariff changes, the way that services are currently configured
is not sustainable. We're all medium size organisations, we're not large enough with
the rising standards and the rising standards, the requirement for 24/7 working, all of these
things.
I think the trusts have all looked ahead and recognised that they needed to do something
about that. Certainly within Bournemouth and Poole, they tried and it got stopped.
So it's not that people can't manage their money, it's actually the configuration of
services, the way that the population is dispersed and some of the history with that.
>>Participant: Okay, can I be cheeky and ask one more little question?
>>Debbie Fanning: Very quickly, there's somebody else waiting.
>>Participant: Okay, very quickly. You, I believe are going to have a particularly challenging
need to try and engage with your elderly patients. You mentioned about the Ask Programme. What
mechanism are you going to use to actually reach out to all of these people?
>>Debbie Fanning: I mean, one thing that I want to say is that we don't do that in isolation.
This programme is not in isolation. The Better Together Programme in Dorset, which involves
the three local authorities, all the trusts, all the providers and obviously patient representatives,
that engagement with patients is at the heart of all that we are doing in Dorset as we work
together.
There are lots of mechanisms, which I am happy to talk to you about but probably can't do
it in the time, but if we're not listening to our older people and our children and adults
of working age, if we're not listening to everybody we won't be designing services that
they want and need to use. So we are on top of that but happy to talk about that outside.
>>Patricia Miller: Question, table four. Thank you.
>>Participant: [Inaudible], just volunteering in the local community. Some of the, some
of the comments in terms of the question around innovation and the response that you gave,
quite frankly, I don't see that as innovative really, to be honest. I didn't see that as
quite standard things that we should be doing in terms of media and all those other things.
Innovative to me is where we're reflecting on people and communities that we're not reaching
and then we proactively go out, understanding on the needs of the people before we go out
there, that's what as I look at as innovative. I don't see using the media, et cetera, as
innovative. I see that as what we should be doing anyway.
And you mentioned about inequalities and I still don't feel nationally, or locally sometimes,
really, that we're still reaching those voices that we don't hear at all, or not very well.
That's what I want to hear come out innovative. It didn't come out really in that way.
>>Debbie Fanning: Okay, I am sorry about that. I think for us what we would say is that working
with our local authority partners, who are often extremely good at this and great partners
for us in working, we know where the pockets of deprivation are.
They're traditionally across Dorset in ten public health action areas and that work around
engaging with the public in those areas of particular need has been long going work.
And we build on that and we don't start from, we don't start from scratch and we're always
open to new ideas, so thank you for that. There is innovation but we're also, we're
all learning aren't we?
>>Patricia Miller: Many thanks, developing 1 NHS in Dorset. Thank you.