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Managed Clinical Network Manchester Experience

Managed Clinical Network Manchester Experience. Dr P Umesh Prabhu Consultant Paediatrician Medical Director, Bury NHS Trust. Where Are We Now?. Greater Manchester 6 Health Authorities 10 Trusts 14 Hospitals Providing children’s services Within 20 Miles radius

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Managed Clinical Network Manchester Experience

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  1. Managed Clinical Network Manchester Experience Dr P Umesh Prabhu Consultant Paediatrician Medical Director, Bury NHS Trust.

  2. Where Are We Now? • Greater Manchester • 6 Health Authorities • 10 Trusts • 14 Hospitals Providing children’s services • Within 20 Miles radius • 700,000 Childhood Population • 30,000 Annual Births in 12 Hospitals • No single unit has > 5000 delivery • Range 1800 - 4000 • Some hospitals are just 3 miles apart

  3. R B O N

  4. Children’s Services Project • Lead by CE of a Health Authority • Representation • Professionals - All Speciality • CHC • Colleges • Users • GPs • Health Authority

  5. Aim - SHAPING THE FUTURE How To Provide The Best Possible Service To Women And Children Of Manchester?

  6. Drivers For Change • Working Time Directive • Junior doctors New Deal • Juniors training need • Clinical Governance - Quality agenda • Public Expectations • College Recommendations • Changing needs of children and family • NHS Plan • Human Resource Issues

  7. 4 Sub Groups • Paediatric Medical Emergency • Maternity and Neonatal Group • Accident & Emergency • Paediatric Surgery

  8. Group’s Recommendations • To deliver high quality service • All agencies, health, social services, education and voluntary sector must work very closely • Care pathways should be established • Managed clinical network should be developed • Emergency care should be provided locally by trained professionals

  9. Recommendations • Current model of working is not sustainable and will not be able to provide the standard of care needed • New Model

  10. New Model • Locality Provision • Medical, Emergency, Community Care • Extended day basis • Population 250,000 • Specialist • Comprehensive Medical, Surgical, Emergency services 24 hours • Populations 500,000 • Super-specialist • Regional -full array of tertiary services

  11. New Model • From 14 In-patient sites to • 6 or so In-Patient Units. • But vast majority service provided locally by the team - Managed Clinical Networks

  12. Manchester is ideally placed • Always rains - Paediatricians work hard • Within a radius of 20 miles - 14 hospitals providing care for mother and children • Excellent motorway links • Some hospitals are just 3 miles apart

  13. Run With This Excellent Idea What A Brilliant Idea?

  14. Welcome To BORN Venture Future Of Maternity & Paediatric Service At Bury, Oldham, Rochdale, & North-Manchester

  15. R B O N

  16. BORN

  17. BORN - Where Are We Now? • 4 Units Providing Children Services • 770,000 Population • 9,200 Deliveries • 3 Units with • Maternity • Neonatal ICU & SCBU • Paediatric Service • 1 Unit with • Maternity • SCBU • Within a Radius of 10 Miles

  18. Work-Shop • 70 Professionals • Paediatricians • Obstetricians • Anaesthetists • Midwives, Paediatric Nurses • GPs • Trust - CEO, MDs and NDs • Heath Authority • College President (Prof. Dunlop) and secretary (Pat) • Experts (Dr Warriyar, Dr. Milligan………..)

  19. Services We Considered • Maternity & Neonatal Service • Isolated Midwife led unit • Midwife led unit attached to the consultant led unit • Consultant Led or Based Service • Ashington Model • Effect On Paediatric In-patient service • Effect On Paediatric Surgical Service • Effect On A&E Service

  20. Our Options • Cost Of Maintaining All Singing & Dancing Unit in all 4 sites • 32 Extra Consultant Paediatricians • 32 Extra Consultant Obstetricians • Associated Cost • Midwives • Nurses • PAMs and Others • Can We Justify it? • Can We Find Them? • Can They Maintain their skill? • Can We Provide Adequate Training?

  21. Our Options • Options • No Change – Not an option • Single Combined Obstetric unit And “Local” • Antenatal and postnatal service • Excellent out reach nursing/midwives service • Two Combined units And “Local” • Antenatal and postnatal service • Excellent out reach service • One Combined unit with another midwife lead unit • Antenatal and postnatal services • One Combined unit with another Ashington Model

  22. Unanimous Agreement!!!!!!!!!! • Women and Child Centred Care • Cannot continue on 4 sites • In-patient provided from 2 sites • 5000 delivery Each • Both maternity and paediatric in-patient should be on same site • Quality should not be compromised • No isolated midwife led units • Midwife led unit attached to consultant led unit • Managed clinical networks

  23. Pleased With My Achievement What A Fool?

  24. Challenges • Politicians • You Are Not Going To Close My Maternity Unit • Public • My Family Can’t Visit Me And My Baby • Media • No More “Bury Babies” • Some Professionals • I am all for change as long as it doesn’t affect me • Imminent Organisational changes • BORN Merger approved

  25. Where Do We Go From Here? • Who Knows The Answer?

  26. My Vision

  27. I Am All For Progress But It Is Change I Don’t Like Mark Twain

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