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Building resilient hospital services

The lead Medical Director for the Devon Sustainability and Transformation Partnership talks about new ways of working for hospitals across the county:

One of the successes of our recent Acute Services Review has been the adoption of a networked approach to hospital services across Devon.

Issues with service resilience, largely due to staffing shortages, led to reviews of stroke, maternity and emergency services. Led by clinicians, we found these services should continue to be delivered in all four of Devon’s hospitals on the grounds of safety.

All four leadership teams agreed to try new ways of working together to ensure continued and resilient delivery of safe services across Devon.

Last October we put in place a formal arrangement to provide mutual support for any hospital facing short-term service challenges that it couldn’t manage on its own. That might be due to staff sickness, or retirement, or a surge in demand giving rise to a need for extra capacity. This has improved the collaboration between hospitals and we believe there will be a lower likelihood of individual services getting into difficulties.

This approach has been recognised nationally as an ‘exemplar of good practice’.

Across Devon, we’ve made use of this arrangement several times since it was launched, and we’re proving that we have the ability to solve our own problems.

For example, specialists from Exeter have been working with the breast service in Plymouth to help cover staff sickness, and senior doctors from Exeter and Plymouth have been supporting staff in Barnstaple’s obstetrics service. Consultants from Plymouth, Exeter and Torbay worked together with the stroke service in North Devon and set up a rota to help cover a short-term gap in the service due to a retirement.

By working as a single team like this, we are showing that we can support each other to address service challenges, aiming to maintain access to specialist services across the county.

We are building on many years of successful clinical collaboration and our new approach to partnership working is much broader than the commitment to provide mutual support to cover short-term gaps in service.

In my own hospital in Torbay, for example, we started this year with four consultant histopathologists. The service really demands seven or eight, but by the end of 2018 we expect to be down to one or two due to expected retirements. At that level, it will be impossible for us to continue to run a full service. So we have been working with our colleagues in Exeter, North Devon and Plymouth to plan and develop a networked service.

We will recruit consultants wherever we can in the system and develop ways of working to cover work from Torbay. We believe that, in areas where there are national shortages, we can develop more attractive posts by developing linkages between the traditionally separate individual hospital services.

In future an IT linkage with digitisation of histopathology work will support flexibility of cover and remote working. In the coming months we will be working to align our processes and IT systems to make sure that changes in histopathology services don’t impact negatively on patient pathways.

Other areas we’re looking at, where we know we have longer-term challenges, include medical physics, haematology, cancer services and ear, nose and throat (ENT).

By working as one clinical team across Devon, we aim to give people equity of access to specialist treatment wherever they live, whilst providing as full a range of services as possible in all four of our hospitals.

Rob Dyer

Dr Rob Dyer is the Medical Director for Torbay and South Devon NHS Foundation Trust and also the Lead Medical Director for the Devon Sustainability and Transformation Partnership.

A Consultant Physician and Endocrinologist, Dr Dyer trained in Birmingham and Newcastle and has been a consultant since 1994, first in Northumberland and Newcastle, and from 1998 at Torbay Hospital. His clinical specialisms are in diabetes, endocrinology and thyroid problems.

Dr Dyer also holds the position of Associate Medical Director for Long Term Conditions and Transformation and has a long-standing interest in integrated care models, patient self-management and prevention in long term conditions. He has experience of management of acute medical admissions and sub-specialty endocrine and thyroid cancer management.

As Medical Director he plays a key role at Board level, and as part of the Executive Team, in influencing and shaping the Trust’s strategic direction and in driving improvement in quality and safety.

In his Lead Medical Director role for the Devon Sustainability and Transformation Partnership he chairs the Clinical Cabinet, which brings together medical directors and clinicians from across the health system.

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2 comments

  1. Rebecca Wheeler says:

    Hi, I work in the HIOW system in UEC services we have significant middle grade dr issues in ED. I’d love to know more about a networked solution for ED?