Case Study - University Hospitals of North Midlands NHS Trust Transition of Services
Case Study - University Hospitals of North Midlands NHS Trust Transition of Services
Exploring the impact of the transition of services between County Hospital in Stafford and Royal Stoke University Hospital.
Who: University Hospitals of North Midlands NHS Trust
What: Quantitative, Qualitative and Action Research
Why: Transition of Services
Where: Staffordshire
About the Client
University Hospitals of North Midlands NHS Trust
Serving around three million people across Staffordshire and beyond, the University Hospitals of North Midlands (UHNM) NHS Trust provides the full range of emergency treatment, planned operations and medical care.
The Trust has over 10,000 staff and operates between two hospitals: the Royal Stoke University Hospital and the County Hospital in Stafford. Both hospitals provide a range of general acute services for three-quarters of a million people residing in the North Midlands, and three million people across neighbouring counties and North Wales.
Specialised services include cancer diagnosis and treatment; neurosurgery; neonatal intensive care; renal and dialysis services; and paediatric intensive care. The Trust has recognised expertise in trauma; respiratory conditions; spinal surgery; and management of liver conditions.
As a teaching hospital in partnership with Keele University, UHNM has a patient-centred clinical research facility providing state-of-the-art research and teaching facilities for healthcare professionals.
The Trust aims to become one of the UK’s top university teaching hospitals by 2025 and have an established word-class reputation by 2030.
Background
In April 2013, Mid Staffordshire NHS Foundation Trust was placed under the Trust Special Administrator (TSA). The TSA recommended that a series of service transitions take place in order to assure the clinical and financial viability of Staffordshire’s Hospitals.
As part of the transition, it was recommended that Cannock Hospital be operated by The Royal Wolverhampton NHS Trust and that Stafford Hospital be operated by University Hospitals of North Staffordshire NHS Trust. The TSA recommended that services such as acute surgery, consultant-led maternity and inpatient paediatric services should be relocated from Stafford Hospitals.
The TSA recommendations were met with scepticism and opposition by Stafford residents, this culminated in 30,000-50,000 people protesting the proposed changes. The strength of public feeling was best evidenced by the campaign group Support Stafford Hospital and their “Occupy” camp which saw tents set up on the hospital grounds. The main areas of concern for the campaign group and local residents were changes to: maternity, paediatrics and emergency, urgent and critical care services.
In 2014 Mid Staffordshire NHS Foundation Trust and the University Hospitals of North Staffordshire NHS Trust merged to form the University Hospitals of North Midlands (UHNM) NHS Trust.
UHNM now provide the full range of emergency treatment, planned operations and medical care for three-quarters of a million people in Staffordshire and a further three million people across neighbouring counties and North Wales.
To support the transition of services and integration of both hospitals as part of UHNM, the Trust wanted to listen to local people about how the impacts of relocating services could be minimised. Communication was also key to the Trust and they made it a priority to communicate and engage effectively at a local level.
Engaging Communities were commissioned by the Trust to lead on an extensive research and engagement project that brought together service users, providers and the local campaign group to discuss how UHNM could move forward while providing financially and clinically sustainable health services.
Goals
Providing the public with a voice, engaging and growing trust
As with any change to health services, there is an understandably high level of devotion and concern among the public.
Due to the sensitive nature of the proposed changes, it was vital that this research and engagement project was designed with service users in mind.
In order to provide the users of both the Royal Stoke University Hospital and County Hospital with a the opportunity to share their perspectives, it was important to use a number of platforms.
Focus groups, surveys and public engagement events would provide an opportunity to discuss the potential impacts on service users.
The aim was to find out how the effects could be minimised as well as providing the public with the opportunity to meet with clinicians from the Trust to explore how the transition will be managed.
Challenges
Getting beneath the headlines to support public engagement
For a significant amount of time there was a great deal of negative attention surrounding Mid Staffordshire Foundation Trust and the Trust Special Administrator involvement.
This led to a culture of scepticism and general negativity around the transition. The lack of trust between the people of Staffordshire and NHS Trusts made engagement and communication more difficult for all involved.
This issue was compounded by ongoing influences from the media and campaign groups.
In order to overcome these entrenched issues we employed multiple approaches to encourage honest discussion and feedback on the proposed changes.
Public information events allowed for patients, relatives, campaigners and the general public to directly speak to clinicians and the Chief Executive of University Hospitals of North Midlands NHS Trust, Mark Hackett.
Solution
Quantitative, Qualitative and Action Research
The research utilised a number of different methodologies to provide patients with a platform to discuss their views and experiences around the transition of services.
Focus Groups
We ran a series of focus groups across the county in order to gather the public’s views and experiences at both County Hospital and Royal Stoke University Hospital.
Service users were provided with the opportunity to speak openly and honestly with our researchers and the chance to indicate any issues that they believed would negatively impact those using the Trust’s services.
A question bank of frequent topics raised was constructed and sent to UHNM, this was to guide their engagement and give them to opportunity to proactively respond to specific issues that were raised by service users.
Online Surveys
We developed an online survey which was designed to compliment the focus groups and provide a wider range or participants to have their say on the transition of services.
Reference Advisory Group
The Reference Advisory Group brought together the Trust; support user groups; local press; campaign groups; local politicians; and Healthwatch to find ways of minimising the impacts of the transition of services and improve communication and engagement approaches with the public.
Public Information and Engagement Events
A series of three public events took place in Stafford, Leek and Stoke-on-Trent to inform and engage the public with changes to services at both hospital sites under UHNM. The events comprised of a panel including the Chief Executive of the Trust, commissioners and clinicians; a Q&A session; and a marketplace where service users could ask questions and gain direct responses.
Findings
Mixed opinions and concerns over transport
Overall, the experiences of both County Hospital and Royal Stoke University Hospital were viewed as largely positive. Standards of care received by staff and the accessibility of services were rated highly.
Negative feedback from the public was often focused on the time taken to travel between the two hospital sites.
Beyond just gathering the positive and negative views of the people of Staffordshire, we were able to pinpoint a series of suggestions from the engagement.
Suggestions for minimising the impact of the transition that takes into account the needs of the local population included increasing capacity in terms of beds and staff; developing an assessment unit as part of a midwife-led maternity unit; having a 24-hour paediatric assessment unit and providing a clear patient pathway for diabetes services.
Accessibility and transport were often raised as important issues by service users, particularly related to the availability of parking; travel time to and from hospitals; and discharge of patients. There were calls for the new Trust to communicate regularly and transparently with service users about what further changes will occur.
Recommendations
Improving communication and public engagement
Our first recommendation was that the Trust should improve its communication with the public and service users. We recommended using both traditional forms of media e.g. posters, radio and newspaper notifications along with ‘discovery roadshows’, public events that provide engagement opportunities for patients to get involved with future changes.
Where possible, patients should also be invited to patient involvement groups to regularly collect information on service user views and experiences.
Improving patient involvement and experience
ECS suggested that the Trust develop specific co-design and evaluation panels that would encourage the involvement and participation of patients in order to recommend improvements to services that result in good practice approaches.
Address challenges to accessibility and transport
We recommended that the Trust should advertise the use of its shuttle bus for some service users and relatives to make transport between the site hospital sites more convenient.
Additionally, the Trust needed to provide clarification on the availability of parking at the Royal Stoke University Hospital site and raise awareness of other transport methods.
ECS also recommended that the Trust consider tackling issues around the discharge of patients in safe and affordable ways, given the issues raised around transportation.
Impact
Extensive changes for the Trust, service users and the public
Due to the scale of this research and engagement, we have already seen a wide range of impacts and outcomes for service users and the public in general.
Despite the size and depth of this work, we were able to ensure that those service users and members of the public who wanted to participate in the research were able to share their viewpoints, suggestions and thoughts.
Of particular benefit were the public engagement events. Feedback from the events was positive and attendees stated that the opportunity to ask specific questions to the Chief Executive, Mark Hackett and other managers and clinicians was a positive experience.
One of the major impacts of this project has been the increase of public awareness and understanding of the transition of services. As well as the provision of additional systems and strategies to minimise the impact on service users. Additionally, this project has enabled University Hospitals of North Midlands NHS Trust to have a far greater impact in meaningfully engaging and communicating with the public on the changes.
The development of a dedicated Reference Advisory Group allowed for greater discussion of the sustainability of the new Trust. This initiative led to the campaign group agreeing that clinical assurance processes for transitioning services were robust.
By putting in place a formal meeting of concerned parties we were able to gain an open, honest and positive result which in turn helped to communicate this assurance to the wider public and to reduce negative concerns about the transition.
Moving Forward
Engaging Communities are supporting the Trust with improving patient involvement with the co-design of services such as the paediatrics rapid access clinic and maternity led unit.
For the Trust, this project has led to a number of recommendations that they have accepted and are beginning to implement. As a result, the Trust are more actively engaging with the public to continuously communicate about services and future changes. Engaging Communities are now working with the Trust on a second engagement project focused on improving communication and patient experience.
Testimonial by Trish Rowson, Director of Nursing University Hospitals of North Midlands NHS Trust
“Engaging Communities delivered a successful programme of public and patient engagement on behalf of the Trust to support the integration of local hospital services following the review into Mid Staffordshire NHS Foundation Trust.
The team’s expertise and understanding of health services and our local communities meant they were able to provide a robust solution ensuring our local communities were informed and engaged in planned changes to services. We were very pleased with the levels of participation. Their comprehensive research report provided excellent feedback and insight and we have taken forward all of their recommendations.
We are now working with Engaging Communities on a second phase programme of engagement which is testament to the excellent work undertaken last year and their expertise in engaging our local population”
About Engaging Communities Solutions CIC (ECS)
Engaging Communities is an independent, not for profit, community interest company that works to give the public a voice in the way services are delivered.
To do this we bring together public engagement, consultation and consumer advice services within a central organisation.
We work to support the voice of the community and to offer an effective way for people to be involved in the services that provide for their health and social care needs.
We enable better decisions to be made by health and social care organisations based on the experiences and views of the public and the collection and analysis of data.
We involve people in ways that are both efficient and effective.
We use our expertise and industry knowledge to maximise our impact on engagement.