In June 2018, a collaborative agreement was established between Northern Devon Healthcare NHS Trust and the Royal Devon and Exeter NHS Foundation Trust to provide support to NDHT in the short to medium term in addressing some of the challenges we face in providing acute services.
This agreement builds on the long-standing clinical networking arrangements already in place between the two trusts and initially runs until summer 2020. By then we need to have developed our plans for hospital services in northern Devon to ensure we have sustainable arrangements for the future.
To do this, we are undertaking a review of a selection of the key services needed by the population of northern Devon, with the starting place being that we need a hospital in North Devon with a 24/7 A&E.
There are three challenges which have affected our clinical and financial sustainability for many years.
- Remoteness: North Devon District Hospital (NDDH) is the most remote acute hospital in mainland England.
- Workforce: Remote hospitals tend to experience heightened workforce challenges and being a smaller hospital means that vacancies can have a greater impact on teams. The graphic (right) illustrates how workforce challenges affect us locally and some of the work we are doing to reduce this impact.
- Finance: Both remoteness and workforce pressures mean some of our services cost more to run than other NHS hospitals and this has led to increased pressure on the Trust’s financial position. The Trust ended the 2018/19 financial year with a £17m deficit, with a plan beginning in 2019/20 to move towards financial balance.
As we carry out this work, we want to understand how these challenges impact our services more fully, so we can determine how we can best provide sustainable services for the future.
The findings of this work will be fed into Devon’s Long Term Plan, as well as the work that has commenced on a Peninsula Clinical Services Strategy.
Suzanne Tracey, chief executive of NDHT and the RD&E, said: “The acute services review work showed clearly that we need a hospital in North Devon with a 24/7 A&E and other supporting services.
“We now need to look closely at how we deliver on that commitment and ensure that we achieve safe, high quality and sustainable clinical services for the population of northern Devon.
“In the time I’ve been in post, I’ve heard from many of you about the transport and access difficulties people face locally, and how important our services are to people.
“We are really committed to providing as much as we can locally and I want to recognise and build on how innovative our staff have been in coming up with solutions and different ways of working to support this.
“However we need to be realistic about what we can do. We have been experiencing significant workforce challenges in some of our services as a result of national shortages for some time and these are unlikely to be resolved in the near future.
“We will be looking closely at these vulnerable services and those which are crucial to supporting A&E to help us develop our future plans, which will set out how we will deliver sustainable services to the population of northern Devon for years to come.”
Which services are we looking at?
Our agreed starting point is that we need a hospital in North Devon with a 24/7 A&E, so we are interested in ensuring our A&E is surrounded by strong services which meet the needs of the local population.
We are focusing on 11 key services, shown in the table (note that two services appear in both columns).
Since March, we have been meeting with the clinical teams leading these services to understand their vision and plans for the future, and what support they may need to achieve them.
We see this as a really positive and important piece of work that will form the cornerstone of our future plans for all local healthcare services. This will also help us to make a decision about what form the organisation will take in the future.
Involving patients and the community
We are working with staff, patients and the community to ensure as many views as possible are captured as we develop our plans.
We are currently talking to patients with lived experience of the services we are focusing on to understand what is important to people when using these services. If you have experience as a patient or carer/family member of any of the 11 services, we would love to hear from you. If you would like to participate, please contact email@example.com.
We are also meeting with community groups and representatives to talk about this process and we will be providing regular updates.
If you’d like to sign up for updates, please contact firstname.lastname@example.org and let us know you’d like to join the mailing list for Trust news.
Read the full briefing document here.