How we developed our change proposals

Identifying NHS services for improvement

Following a review led by senior clinicians and managers from across the Lincolnshire health system, eight

NHS services provided by United Lincolnshire Hospital NHS Trust (ULHT) were identified as priority areas for improvement.

This assessment was conducted using a framework of quality of care, workforce, performance and finance. The priority services identified through this review were:

  • Acute medical beds
  • Breast
  • General surgery
  • Haematology & oncology
  • Orthopaedic surgery
  • Stroke services
  • Urgent and emergency care at Grantham and District Hospital
  • Women’s and children’s services

A common thread across all of the services identified as a priority was a lack of enough suitably qualified staff in key areas. In many cases this was consistent with a national shortage.

The issues identified in each of these services were presented and discussed at a meeting of clinical leaders and key stakeholders from across the Lincolnshire health system. It was agreed that change was needed in each of them to improve quality of patient care in line with best clinical practice and advice.

How potential solutions for improving NHS services were developed and considered

To develop and consider potential solutions for improving the prioritised hospital services, we followed a process whereby we developed an initial full range of possible solutions. We carried out a thorough analysis on each of them and identified a preferred proposal for change to be taken to public consultation.

Throughout this process we ensured we had independent clinical best practice input by:

  • Involving national clinical leaders in the development of the change proposals; and
  • Asking the independent East Midlands Clinical Senate to review our change proposals

The steps we followed in this process are set out below.

Step one: Developed a ‘long list’ of options

 Following widespread agreement by senior clinicians of the need for change in the prioritised services, potential solutions for improving care provision were considered.

This exercise identified a list of options for change at a service level which were put together in different combinations to develop a ‘long list’ of nine overarching scenario-based options.

This long list of options presented a view of significant change possibilities, thereby providing a sense of what could be achieved.

Step two: Developed a ‘shortlist’ of options

 Each of the long list of options was evaluated at a clinically led workshop where clinical leaders and key stakeholders discussed the options alignment and impact against four criteria.

This evaluation was clinically led and focused on quality, safety and sustainability to collectively review and assess the impact of the scenarios on the whole Lincolnshire heath system. This identified clinical opinions on which of the options were the best fit to meet the needs of the Lincolnshire population. A shortlist of six scenario- based options was identified.

Step three: Appraised the ‘shortlist’ of options

 Each of the shortlisted options underwent a more detailed appraisal, using the evaluation criteria. This included running one options appraisal workshop with local clinical leads and key stakeholders and four option appraisal workshops with randomly selected members of the public from across Lincolnshire.

Attendees at the events were asked to consider the specific service change proposals at a specialty level (e.g. acute medicine, stroke etc.) that when combined made up the scenario based options in the shortlist.

Following a review of the outcomes of the clinical leads and key stakeholder options appraisal workshop, the public option appraisal workshops and the recommendations of the East Midlands Clinical Senate, a preferred change proposal was identified from the shortlist.

Option evaluation criteria

The evaluation criteria used to appraise the options for improving the prioritised hospital services was based on a framework developed as part of a previous programme of work, known as the Lincolnshire Health and Care Programme (LHaC).

During its development as part of the LHaC programme, the evaluation criteria were subject to a significant amount of stakeholder consultation and involvement.

As part of this programme of work the evaluation criteria underwent further testing with the public and were developed further.

The evaluation criteria used to appraise the shortlist of options are set out below.


Does the option maintain or improve clinical quality and outcomes?

Does the option maintain or improve patient experience?


Does the option maintain or improve equality of access to care?

Does the option minimise activity seen or treated at a different site or provider?


Does the option minimise the requirement for capital?

Is the implementation of the option achievable?


Does the option have an achievable workforce requirement?

Progressing the preferred option

Due to the limited capital funding available to the NHS, both nationally and locally, it is not currently possible to progress all the proposed service level changes that make up the preferred overall option at once.

In light of this, so as not to delay the benefits to patients of service change proposals, four NHS services were identified where the proposed changes could be taken forward without significant capital funding and / or the service is extremely fragile in its current state.

These areas are:

The change proposals relating to these four hospital services are the focus of this public consultation.

Impact Assessments

For each of the four service change proposals we have conducted a Quality Impact Assessment (QIA) and Equality Impact Assessment (EIA).

Our observations from these are set out in each of the service change sections later in this document.

A key focus during the public consultation will be to seek out the views of those groups of people identified through the EIAs who may be more likely impacted by the change proposals. This is described further in the next section.

We will continue to review and develop these EIAs, with independent support, throughout our public consultation in light of the feedback we receive. They will play a key part in informing the decision making process.

Click here to read our full EIAs / QIAs.

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