ENT, OMF and Head and Neck Cancer Services Review

Mary Hutton

27th January 2011

Service Review Aim• The aim of the service review is to deliver the

best service model and location, including meeting the national NICE Improving Outcomes Guidance for Head and Neck Cancer Services(2004).

• The scope of the review was expanded to include benign Ear, Nose and Throat and Oral and Maxillofacial Services, as it was felt the same equipment, consultants and specialist staff were required to manage these patients

Review Approach• Develop a clinically led, patient endorsed service

model• Ensure the needs of the local population are met• Ensure the solution is evidence based and in

line with Implementing Outcomes Guidance (IOG)

• Ensure the solution is affordable • Create a working environment which benefits

clinicians and patients

Review Approach

• Replicate successes of the breast review– Clinically led, patient endorsed– High quality facilitation– Dedicated project management, frequent updates

• Form follows function– Agree service model first– Then agree the criteria for site selection – Before agreeing location

Clinicians’ AspirationsAccess to specialists co-located where possible

Single cohesive team

World class patient outcomes

Nationally and internationally renowned research centre

This is our definition of “centralisation

A Hub, Satellite and Spoke modelDarzi policy -“Centralise where necessary, localise

where possible”

Hub

• Case management

• Complex treatments and diagnostics

• One stop/fast track clinics

Satellites

• Less complex treatments and diagnostics (site dependent)

• Local clinics

Spokes

• Local clinics and community/home based rehabilitation

Core services at the hub• Hub focused on a strong surgical core• ENT and Oral Maxillofacial inpatient surgery

(benign and malignant) on a single site co-located with:– Diagnostics (histopathology, cytology, radiology)– Specialist Nursing Support– Therapy Services (Dietetics, SALT)

• Multi disciplinary team case assessment, planning, management

• One stop/fast track clinics

Benefits of the new model

• Better patient outcomes• Better patient experience• Improved effectiveness and productivity• Increased efficiencies

We have mechanisms to measure the delivery of these

Local Impact• For North Somerset patients with benign ENT and OMF conditions,

services will continue to be provided in Bristol but patients would be accessing inpatient and day case services at the BRI rather than at either the BRI or Southmead.

• Bristol consultants and nurses will continue to travel to Weston General Hospital to provide both benign and malignant outpatient clinics.

• North Somerset patients with suspected cancer would continue to have their cases discussed at the central MDT, consisting of a range of clinicians, including specialists that provide services at Weston General Hospital.

• Follow up outpatient appointments will continue to be provided at Weston General Hospital, Portishead, Nailsea and Clevedon.

Timetable

• Professional Executive Committees and NHS Boards have now approved in Bath and North East Somerset, Bristol, North Somerset, South Gloucestershire, Somerset and Wiltshire

• Presentation to Scrutiny Committees in January 2011

• Proposed implementation earliest May 2012

Service Reconfiguration Guidance

GP Commissioners• Professional Executive Committees have agreed

proposals• Locality Boards have been briefed• Supporting letters from a range of GP

commissioners• Opportunities to comment on service

specification• GP representation on advisory panel (the panel

making the location recommendation)

Public & Patient Involvement• Public and Patient representation on Project

Board• Public and Patient (User Reference Group)

established to contribute to the development of key documents

• Continued commitment from providers to work with this group in developing service and monitoring its performance

• Regular newsletters for those who do not want to be so actively involved

Patient views on involvement• Patients involved from beginning, now also ENT and

OMF• User group set up specific to review • Patient rep. on decision-making groups gives

impetus to the patients’ view• Valued being included in design of ward 5 and

aspects of service delivery• Able to offer unique advice to improve patient

experience e.g. design, H&N Register, relatives• Important to be part of team with clinicians and other

service personnel to give our experience

Patient involvement

“We were pleased to be included in the Head & Neck/ENT Review for

reconfiguring the service as more than just a ‘tick-in-the-box’ consultation. We have truly been part of the team on this

project.”

Liz Eley, patient representative.

Evidence base

• Clinicians are in agreement that a centralised service is required

• We have worked with patients to document expected benefits

• University Hospitals Bristol have committed to measuring these benefits

• A baseline is being established

Clinicians’ views on involvementThis process is challenging, because

we are making things better..

• Scope• Pace• Inclusion• Flexibility

Patient choiceDarzi policy“Centralise where necessary, localise

where possible”• Underpinning principle of the review• Only complex surgery will be centralised• The location of outpatient services will stay the same, with

Frenchay and Southmead as outpatient sites until 2014 after which time services will be provided at Southmead with either Cossham, Thornbury or Frenchay sites offering an alternative location

• Independent Treatment Centres offers an alternative for less complex surgery

• Community ENT and OMF services being developed locally

RecommendationThe Project Board recommends the OSC

supports:

• The Boards of Bristol, North Somerset and South Gloucestershire PCTs in revoking their previous Bristol Health Services Plan decision to centralise adult ENT services at Southmead

• PCT Boards in agreeing the the proposed clinical service model

Recommendation (cont.)• PCT Boards decision to agree for the

centralised hub to be located at the BRI and managed by University Hospitals Bristol

• PCT Boards decision to agree for UH Bristol to work with local commissioners and providers from across the network to ensure there is good access to spokes across the network area