How we developed our change proposals

Identifying hospital 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
  • Orthopaedics
  • Stroke
  • Urgent & emergency care
  • Women’s & 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 hospital 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 option 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 options; 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 on the four criteria.

This evaluation was clinically led and undertaken through the lens of 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 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 short listed 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 short list.

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 option was identified from the short list for each of the four services.

The underpinning principles to our change proposals

All four of the service changes we are proposing are underpinned and shaped by the same set of principles. These are set out below.

All of our change are based on

National clinical evidence

Feedback from our public and stakeholder engagement’

What our clinical service leads believe is right for patients

What external clinical experts and advisors say is best practice


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