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DTC Case study: Newham Healthcare NHS Trust

Monica McSharry, Director of Service and Organisational Development, Newham Healthcare NHS Trust

Newham is looking to centralise all acute services on one site. The area already has quite advanced partnership working and has LIFT and New Deal for Communities projects underway.

By centralising acute services trust is looking for flexibility and a critical mass which could help it find a long term solution to capacity problems and enable patients to receive more care locally. At the same time, it is intended to make more services community based particularly through the LIFT project which is building primary care one-stop facilities.

The main site will include a DTC. Its aim is to deliver high quality, cost effective scheduled diagnostic and/or treatment services that optimise service efficiency, clinical outcomes and maximise patient satisfaction. Its defining characteristics will be that:

• it embodies best and most forward thinking practice in the design and delivery of the services it provides
• it delivers a high volume of activity in a pre-defined range of routine treatments and/or diagnostics
• it delivers scheduled care that is not affected by demand for, or provision of, unscheduled care
• services are streamlined using defined patient pathways
• services are planned and booked, with an emphasis on patient choice and convenience
• it provides a high quality patient experience and creates a positive environment that enhances working the working lives of staff.

So far, orthopaedic pathways have been established, and others are being looked at with patient choice groups. The trust is also consulting users, that is people who may accompany patients or visit them at the DTC.

Procurement methodology has led to the project moving ahead very quickly – overtaking the main PFI project.

Diagnostic capacity will be provided within the DTC, but the trust is not assuming that all the pre-operative assessment will happen within the DTC. There is an ambulatory care setting on the site that will deal with this.

Facilities and services need to be flexible, able to expand and contract. It will be supported by good IT, which will link up with primary care so in the future GPs will be able to book diagnosis or treatment for patients direct to pre-assessment process on straight on to theatre lists.

The trust is investing heavily in support staff to make sure the social care element of travelling through the DTC has got as much priority as the clinical component.

The trust is also making sure the DTC reflects the need of the local community. For example community groups have looked at the designs. One suggestion for them is to have more prayer rooms as the area has a large Muslim community – users and clinicians. Local people have also said they want to use the centre as an educational facility, coming in to pick up education about healthcare.

It needs the ability to engage with a wide range of providers and the trust has looked at having visiting teams staff the unit, having national establishments, having clinicians from neighbouring authorities coming in to do operating lists, and also looking at different roles and different practitioners that can work in the facility.

The DTC will be a stand alone facility with 57 beds and eight day care trolleys within three ward facilities. There will be two operating theatres, a minor procedure theatre and two treatment rooms. The eight consulting rooms will have direct access to diagnostic facilities. Different parts of the DTC will work different hours. There will also be a pharmacy, health shop providing health information, and a café. It will cost around £14.5 million, but this figure is inflated because the site needs to be cleared of contaminated land.

Clinically, it will cover urology, gynaecology, orthopaedic and general surgery. The trust estimates that these areas account for 96 per cent of its surgical activity. Around 80 per cent of this activity is covered by about 20 procedures.

Treatment will be quicker. For example patients who have hip or knee replacements are likely to stay at the DTC for four to five days, whereas the average stay now is around 14 days.

Consideration has also been given to ways to overcome problems of recruitment in some areas; for example, whether imaging services could be provided remotely by using IT.

The anticipated benefits are:

• For the patient: separation of elected and emergency care; more personal environment; individual needs and concerns addressed; better access; more convenient.
• For the clinician: more able to practice at ‘best practice’ levels; less disruption to elective scheduled work; greater ability to increase throughput; more management input; more efficient, patient focused environment; opportunities for new ways of working.
• For the trust: improve resources for emergency flows; positive impact on waiting times and cost control; increased patient and staff satisfaction; aids retention and recruitment of skilled staff.

The trust has identified a range of issues that relate to the DTC that it needs to address. For example, it will need to manage the introduction of GP specialists and develop their role in community settings; it has more work to do to make sure the IT infrastructure is in place; the roles of hospital staff within the new set up need to be defined; the impact of design on function (and vice versa) needs to be thought through so that flexibility is maintained; the affect on the training of staff needs to be considered as the DTC will take things away from the hospital as a learning environment.

Points from the discussion

• Lots of organisations are studying care pathways. This information should be widely shared.
• If you are taking elective care out and protecting it from emergencies influencing and detracting and stopping you admit patients. If DTC works as it should work, what do you do with the acute trust? The acute trust should learn from the DTC so everything gets modernised.

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