Health Improvement Programme for
Doncaster 2000 - 2003

The White Paper 'The New NHS: Modern and Dependable' established the framework for modernising the NHS. Those issues where activity is already ongoing, have been dealt with in the various sections of the Health Improvement Programme (HImP). However there are a range of other areas in which activity is being reviewed. This is a summary of those development areas.

1. Critical Care: The pressures facing critical care provision have been highlighted in both the medical and national press. The ever increasing demand for emergency services, which includes critical care provision, has led the Doncaster Royal Infirmary & Montagu Hospital NHS Trust (DRI/MMH Trust) to establish an Intensive Care/High Dependency Care Review Group which has specific Terms of Reference. The report from that group will be considered in discussions about future priorities.
   
   
2. North Trent Vascular Services: The 'Chief Executives Group' highlighted the problems of providing adequate vascular services for North Trent in 1998. A Working Group was established and published a report in October 1999. As a basis for their review, the Working Group considered and approved a set of evidence based standards for vascular services. These standards have been agreed and subsequently used to produce a service specification detailing the minimum infrastructure against which providers could assess their service delivery. Only the DRI and Sheffield Vascular Institute at the Northern General Hospital fully meet these standards at the moment.
   
   
3. Orthopaedic Services: The DRI/MMH Trust has experienced difficulties associated with long waiting times for outpatient appointments, overcrowding in the fracture clinics and a perception of the service being under resourced. A report published in October 1999 identified a series of recommendations which included the need to consider the management of elective and trauma services separately. All the recommendations along with the financial implications are currently under review and will form the basis of discussions about the place of this issue in future priorities.
   
   
4. Rehabilitation Services: A review of rehabilitation services is taking place and the Working Group established to take this forward has been given specific Terms of Reference. The results of the review will be used to inform the debate about future priorities.
   
   
5. Neurology Services: A review of the neurological services was carried out in response to concern from patients and clinicians about the waiting times to see a neurologist. The review considered the resources of the service, the efficiency of the service and the demand on the service. The review found that the service was over performing for the resources allocated and the clinic time was used to capacity. The recommendations of the review will be taken forward by a working group which will provide recommendations to be considered in discussions about future priorities.
   
   
6. Continuing Care: There will need to be a revision of the Continuing Care Criteria which will have implications for future discussions on priorities. The criteria will then be revised every two years to allow service changes and developments to be reflected in the criteria.
   
   
7. Service and Organisational Configuration:
   
   
   • Acute Services. In Doncaster, the audit of acute services concluded that DRI/MMH Trust's existing links with Bassetlaw Hospital & Community Services NHS Trust should be further developed and strengthened, whilst retaining clinical and organisational links with Rotherham General Hospital NHS Trust and their acute services. The Bassetlaw and Doncaster Partnership was established in October 1995. The two Trusts applied for accreditation as a joint cancer unit and achieved the standard for partial accreditation in 1998. Substantial joint working has now commenced in preparation for the second round of cancer service accreditation which is due to take place in the autumn of 2000. The opportunity for the DRI/MMH Trust to provide services beyond the Doncaster catchment has enabled the Trust to maintain specialist services which would not be viable for Doncaster alone.
     
     
   • Social Services. Since 1993, Social Services departments have embraced major changes. The development of a mixed economy of care has led to large scale commissioning and purchasing of home care, day care and other community care services from the independent sector with considerable management, practice and support service implications. There has been an increasing emphasis on the development and publication of statutory plans to steer improvement to service delivery. Many of these are prepared in partnership with other agencies. The Directorate has also had to respond to the Government's modernising agenda. In response to these increased demands the Directorate is undergoing a restructuring and has been organised into four areas. In addition the current geographical boundaries defining areas of service provision will be realigned to those of the three primary care groups in Doncaster. This is designed to strengthen the partnership working between Social Services, Health and the Primary Care Service.
     
     
8. Commissioning Specialised Services: Specialist services fall into three categories, namely national priorities, services to be paid 'particular attention' and regional priorities. The Audit Commission undertook a review of Specialist Services Commissioning in early 1999. This report highlighted a number of areas for action by Doncaster Health Authority and the North Trent Health Authorities as a whole. These actions are: undertake value for money studies across a range of specialist services; take forward a rolling programme of development of service specifications, which include auditable quality standards and clinical outcome measures, and develop a formal mechanism with North Trent Health Authorities for considering service developments which links into individual Health Authority approval mechanisms. Work is ongoing to achieve the Trent Region work programme, which includes national priorities, in conjunction with other Health Authorities in Trent. Work will continue with other Health Authorities in North Trent to achieve the objectives set out in the District Audit Commission report of 1999.