The Healthier Together programme is a review of how NHS services are run across the South East Midlands. It has three main aims:
The programme covers the whole of the South East Midlands and is focused on services currently delivered through five main hospitals at Kettering, Northampton, Milton Keynes, Luton & Dunstable and Bedford.
The review is focusing on six areas:
There are 12 NHS organisations working as partners in the Healthier Together programme:
The programme is led by doctors from the five hospitals and from local general practices working alongside patient representatives and stakeholders.
We live in a changing world. We know that the population of the South East Midlands is growing and that local people are living longer. For example, the population of the South East Midlands is expected to grow from 1.6 million to 1.9 million by 2021 – an extra 300,000 – equal to the size of Northampton and Kettering put together.
In ten years’ time, we are likely to have a third more people aged over 65. In twenty years’ time, we are likely to have two thirds more people over 65.
We also know that in Corby, Luton and Milton Keynes, the number of new babies born will be higher than the national average.
Those changes create different demands for health services and we need to plan how we are going to meet those demands now.
We also recognise that all public services – including the NHS – are under financial pressure. We need to ensure that local NHS services are as efficient as they can be delivering the best value for money.
Around 200 clinicians and GPs have worked with patient representatives on six Clinical Working Groups (CWGs) focused on Planned Care; Maternity Services; Children’s Services; Long Term Conditions; Cancer; Emergency and Urgent Care. Each CWG has met at least five times and has produced a draft report of findings.
In addition there has been direct engagement with around 9,000 patients, local people, stakeholders and NHS staff through road shows, deliberative events, surveys and questionnaires.
For example, A&E should be open 24 hours a day and 7 days a week requiring consultant presence for 16 hours each day to meet minimum guidelines from the Royal College of Emergency Medicine. This does not happen and, given recruitment difficulties and financial restraints, will not happen across all five sites for at least seven to ten years.
There are corresponding shortages of clinicians with specialist skills in maternity units and in children’s services.
The CWGs believe that concentration of specialist staff at specialist centres on fewer sites serving the whole of the South East Midlands would enable safety and service standards to be met 24/7 in a sustainable way.
For example, the Planned Care CWG reported that more cases could be carried out on a day care basis requiring no overnight hospital stay due to advances in surgical technique, drugs and equipment. More complex operations could be carried out in specialist planned surgery centres using some existing sites.
Similarly more children’s services could be dealt with by GPs and other health professionals in the community.
For example, the Long Term Conditions CWG identified the need for greater collaboration between hospital and community health services with local authority social services teams to develop joined up services for patients.
Healthier Together has directly engaged with around 10,000 people including patients, NHS staff, stakeholders and local residents through a programme of activities including local events, surveys and questionnaires. The key findings so far include:
More than 200 local clinicians – including hospital doctors and GPs – have worked for the past year alongside patient representatives on our six clinical working groups. Together, they have identified opportunities for potential service improvement in the following areas – cancer, long term conditions, maternity, children, planned care and emergency/urgent services. The final reports of the clinical working groups will contain the clinical evidence, national quality standards and best practice detail which will underpin reconfiguration proposals and secure the future of high quality health services for a population of 1.6 million rising to 1.9 million by 2021.
The six clinical working groups are finalizing their reports and the programme board will approve these in March.
The evidence we have looked at tells us that many simpler procedures could be developed closer to patients’ homes while some more complex, specialist procedures could be concentrated on centres of excellence. That would mean less travel for many people as services move into primary and community settings, but for some there could be further to travel if they require more complex or specialist care. In emergencies, these patients would be taken by ambulance to the nearest hospital with specialist teams to care for the patient, however this already happens in many cases across the South East Midlands.
We believe that this approach would be consistent with what local people and patients have been telling us – that quality and safety of services is the most important factor and they rank this quality above considerations of travel and transport.
We do recognise though that travel and transport is a very important issue for many people – particularly those living in more rural locations and those who have to rely on public transport. We need to do more research on this issue and have set up a dedicated Travel and Transport Working Group to look into these issues in more detail.
No. Health commissioners believe it is best to plan for mental health services in each local area rather than across the whole of the South East Midlands.
However, we understand that people with mental health conditions may also use other NHS services and we fully recognise the benefits of treating the “whole person”. For example, our Long Term Conditions Clinical Working Group has considered dementia alongside other conditions that older people experience. Senior mental health professionals are involved in the review and we are very keen to learn of the view of local people with mental health conditions.
Healthier Together has already come into direct contact with around 10,000 people through our engagement and communications programme.
We will continue to engage with local people through a series of events and activities because we recognise the importance of learning the views of as many local people as possible.
Our contact details are:
Telephone: 01908 278 735
From April 1, five Clinical Commissioning Groups (CCGs) will take responsibility for the planning and commissioning of health services in Northamptonshire, Milton Keynes, Bedfordshire and Luton. Our local hospitals have also made important decisions about their own future: Bedford Hospital has signalled its intention to find a partner to help it achieve Foundation Trust status; and Northampton General and Kettering General Hospital have announced their intention to hold discussions on partnership working up to and including possible merger.
The CCGs are well placed, given their clinical expertise and knowledge of local services, patient experiences and community views to ensure that recommendations from Healthier Together’s clinical and patient-led working groups are translated into local public consultations.
It is clear from the evidence gathered by the six clinical working groups that, in order to deliver the best possible patient outcomes for a growing and ageing population, transformation is needed and this will rely on greater co-ordination between services. This will mean the development of pathways of care that integrate health services delivered in and out of hospital together with social services.
No hospitals will close. Northampton, Kettering, Milton Keynes, Luton & Dunstable and Bedford will all continue to provide most local services
All five hospitals will have an A&E and maternity service
Our first priority is safe, sustainable, high quality services
Our recommendations will be based on clinical evidence and local need
No decisions without full public consultation
Healthier Together Programme Office
NHS Milton Keynes
Bletchley MK3 6RT
T. 01908 278735