The Princess Alexandra Hospital Logo

Developing more effective pathways

The Trust in partnership with WECCG has commenced an exciting programme of clinical pathway review and redesign for our local health system.

Our healthcare system both nationally and locally is challenged with increasing demand and a finite number of resources. It is therefore important that we transform the way we deliver services to provide the biggest improvements in health outcomes and resource utilisation while ensuring that the patients and their needs are at the forefront.

The review of clinical pathways within our local health system provides an opportunity to re-examine current processes and explore the development of best practice pathways with a view to providing high quality, safe and efficient streamlined care that supports nationally mandated targets as well as delivering a high level of patient satisfaction.

Across primary and secondary care, some pathways have to varying degrees been reviewed over the years, but there is very little evidence that any changes have been evaluated on an ongoing basis (audit) nor is there clear rationale supporting the changes documented, as many of the pathway redesign work has tended to be reactive to new guidelines or treatments. Developing a consistent approach for reviewing clinical pathways and a methodology for redesigning and implementing them in West Essex will ensure that our pathways are robust and fully integrated across our local health system.

By initiating this programme of work we will ensure that there is a consistent approach to clinical care within our local health system, from the GP to our hospital. It will provide us with the opportunity to be innovative in the way we managed conditions, using examples of best practice from hospitals across the country.

Integrated care

Throughout 2014-2015 the Trust focused on working with partners to plan for the future. In common with many other hospitals of a similar size the Trust has faced significant challenges relating to its financial performance, clinical and quality standards.

Over the next 10 years the population in West Essex and East Hertfordshire is forecast to increase at 1.04% per annum-25% faster than the population of England. Much of this growth will come from people aged over 75 (2.3% increase per year) and a large proportion will be clustered in the Trust’s principal catchment areas owing to the planned housing developments around Harlow and Bishop’s Stortford.

This population growth coupled with the significant health needs of the local population and the development of new technologies requires the Trust to develop a new model of care that will be fit the future. Creating a hospital that meets local needs will require change and the Trust has engaged with partner organisations to explore how it could integrate both horizontally (i.e. in partnership with acute Trusts in Essex, Hertfordshire, London and/or Cambridge) and vertically (i.e. partnerships with primary, community, mental health and social care organisations in and around Harlow).

Working with its health and social care partners across our area the Trust is trying to develop a new kind of seamless health and social care service.

The Integrated Care Programme is a venture into the kind of seamless and personalised health and social care that has yet to be achieved in this country. It could lead to radical changes in the way people look after their own health, the way they access health and social care services and the way in which local services are organised, including the possibility of a new integrated care organisation.

The programme involves detailed investigation and strong collaboration between partners. It’s ambitious and challenging, but there is a strong sense of urgency, particularly in west Essex where there is extreme pressure on the capacity and financial sustainability of the current health and care system.

The future

Our vision is to become an excellent provider of local integrated care. Underpinning this is our mission to provide first-class services built around the core services which support a thriving local hospital. Serving a local population of around 350,000 – 400,000 PAH would remain the provider of local hospital care for most people living on the West Essex and East Herts border. Core hospital services would include:

  • Urgent and emergency care services which operate on a “24/7” basis
  • Acute medicine and services for the frail elderly - for example pneumonia, heart failure, liver disease
  • Emergency surgery for non-complex cases - for example, abscesses, internal bleeding, bowel obstruction
  • Elective surgery - in-patient, day case and outpatient procedures
  • Maternity service - midwifery-led birthing unit, consultant-led obstetrics with level II neonatal care
  • Paediatrics - paediatric assessment and in-patient services
  • Oncology and chemotherapy
  • Diagnostic services - X-ray, ultrasound, CT, MRI and pathology
  • Critical care services – for high dependency (level II) and intensive care (level III) patients.

In addition to these core services the Trust has an ambition to develop its value proposition within the local health system by:

  • By utilising its pool of clinical expertise to provide services in the community including integrated provision of the management of long term conditions, outreach acute services and admission prevention services, particularly for the older people and children
  • By acting as the hub for a much more effective system of integrated care for the local population providing for example greater provision of rehabilitation and intermediate care services for patients from major acute units, as well from the community.

Enhancing and deploying our expertise to new ways of working

The Trust envisages that it will:

  • Be expert at rapid diagnostics and urgent ambulatory treatment, with effective and seamless arrangements for handing-on patients and for the maintenance and management of Long Term Conditions (LTCs). We envisage that physicians currently working in hospital will increasingly be providing some services in the community, supporting integrated provision for the management of long-term conditions in primary care. We believe this will help to reduce the overall cost of meeting the local demand for healthcare.
  • Be expert at local care, provided as near to a patients’ home as possible, including hospital at home. Utilising technology the Trust will develop expertise in managing acute conditions outside the four walls of the hospital.
  • Provide a bridge between specialist tertiary services and primary care based services. We envisage PAH will have a strong link both into the community and into specialist services provided in major acute hospitals. Supported by strong partnerships with other (specialist) health providers the Trust will deliver the best outcomes for patients.
  • Further develop its network arrangements to maintain appropriate clinical skills and expertise within its workforce to be able to provide local specialised acute care wherever appropriate, sustainable and cost effective. We envisage more joint appointments especially in some surgical specialties to support the recruitment and retention of the highest calibre of clinical expertise locally.