What we will do

Acute services review recommends closer working between hospitals to improve services

Clinicians in Devon today (20 June 2017) announced the results of a review into how some hospital services could be provided more effectively in future.

Local doctors, nurses and consultants have been reviewing a range of services in hospitals in Exeter, Plymouth, Torquay and Barnstaple since late 2016.

The review was undertaken because doctors said key acute hospital services were likely to become unsustainable in future due to difficulty recruiting key clinical staff, large increases in demand for services – and difficulty meeting national service standards.

Services such as stroke, maternity, paediatrics and neonatal care and urgent and emergency care were included in the first stage of the review. Other services will be reviewed in a later second stage.

Hundreds of clinicians, nurses, managers and patient representatives contributed to the review through workshops, events and feedback.

Announcing the results of the first stage, clinicians said that all four acute hospitals in Devon, would continue with A&E, emergency stroke services and maternity services. This would be acknowledged by stronger collaboration between clinical teams and new networking and workforce solutions.

Other key recommendations include:

  • 24/7 urgent and emergency care services (including A&E) should continue to operate at our four main acute hospitals – the Royal Devon and Exeter Hospital, North Devon District Hospital, Derriford Hospital and Torbay Hospital.
  • We will continue to provide first-line emergency response for people experiencing symptoms of a stroke at all four hospitals. This will include rapid stroke assessment, diagnostics and thrombolysis. These services will be supported by ‘Acute Stroke Units’ (ASUs) at all four sites, and will ensure rapid intervention and aftercare for those with a stroke.
  • We will work towards clinical best practice to improve outcomes for stroke patients by developing two specialist ‘Hyperacute Stroke Units’ (HASUs) in Exeter and Plymouth where patients will receive 3 or more days of intensive treatment for their stroke immediately following emergency treatment, following which they will return home or to their local ASU.
  • Retaining consultant-led maternity services at all four main hospital sites is proposed. These specialist units have access to 24/7 clinical care and the specialist services to provide more intensive care when that is needed.
  • Delivering choice for home or midwifery-led births will continue to be provided in line with the national strategy ‘Better Births’. Therefore, clinicians have recommended that we adopt the strong evidence base for midwifery-led units co-located with consultant-led units.
  • Maternity, neonatal and paediatric inpatient services will be retained at all four main hospital sites

The clinical recommendations are the first stage in the review. As part of the second stage, the recommendations will be tested in more detail to ensure they can be delivered with safe, cost-effective and reliable staffing solutions for the future.

Only once this assurance work is complete, can the recommendations be finalised. This is an important step, as the recommendations do not, at this time, immediately solve all the problems that drove the need to review these services.

Should the final proposals be likely to result in significant change to local services, the public will be fully consulted in line with the NHS’ statutory requirements. A full timetable would also be developed and published.

  1. Briefing on the first stage of the Acute Services Review – the clinical recommendations
  2. Proposed decision-making criteria – Evaluation of feedback
  3. Public feedback report from engagement events in March 2017

What we will do: Acute & specialist services

We are carrying out a review of acute services across Devon and will work with frontline clinicians, patients and our communities to come up with a set of proposals for change. This review will consider a range of factors such as quality of care, resilience of our workforce and affordability, as well as those suggested by our clinicians and stakeholders.

The review is focusing on the most important and the most vulnerable acute services first. These include:

  • Stroke services, including hyper-acute and stroke rehabilitation (December 2016 to March 2017)
  • Maternity and paediatrics (January 2017 to March 2017)
  • Urgent and emergency care. (January 2017 to March 2017)

Because this is such an important issue for Devon, it will rightly take several months of collaboration, discussion and planning to ensure our shared goal of sustainable acute and specialist service provision across Devon. We will work with patient representatives, communities and stakeholders to help develop proposals to achieve our aims.

How to get involved in the Acute Services Review