NHS West Sussex Health & wellbeing for life

The formal review process has now ended.

The Fit for the Future process began with the launch of a public consultation in 2006. The intention was to assess how healthcare was changing, and to engage with as many people as possible to establish how the local NHS should respond to those changes to ensure that hospital services in West Sussex were high quality, safe, sustainable and affordable to the public purse.

During the consultation process the decision was made to keep all the county’s A&E departments, a decision which still stands. As a result of the extensive consultation and engagement, in May 2008 ‘Option 3’ was chosen as the best way forward for West Sussex – one major general hospital in the county, supported by two local general hospitals including acute medicine, intensive care, and planned surgery. The decision to centralise services was driven by strong evidence that in many cases larger clinical teams meant better, safer services for patients.

Following the choice of the model of hospital services, NHS West Sussex (then known as West Sussex Primary Care Trust) had to decide where the major general hospital would be located.

This choice essentially came down to the question of whether inpatient paediatrics, emergency surgery, and consultant-led maternity services would be centralised at St Richard’s Hospital in Chichester, or at Worthing Hospital.

In June 2008 the PCT Board decided to centralise these services at Worthing. Central to this decision was evidence that this decision offered the best access to services to the greatest number of people, including those living in areas with the poorest health outcomes and the highest levels of deprivation. The PCT also decided that consultant-led maternity services provided by Brighton and Sussex University Hospitals Trust should be centralised.

In October 2008 the Royal West Sussex Hospitals Trust, and Worthing and Southlands Hospitals Trust announced they would begin talks over a possible merger. In the light of this significant development the PCT decided to suspend the Fit for the Future process, and to then look again at its decisions if the merger went through. In April 2009 the merger was finalised, bringing about the creation of Western Sussex Hospitals NHS Trust and the lifting of the suspension of Fit for the Future.

Three Commissioning for Quality Groups were set up to compile ‘commissioning intentions’ for inpatient paediatrics, emergency surgery, and consultant-led maternity services, setting out the standards that NHS West Sussex expected providers to meet. These standards were accepted by the PCT Board in July 2009. Service providers were then asked to respond, showing how they could organise themselves to meet these standards. The PCT has been assessing these responses, and in particular whether the merger, and other changes since June 2008, has meant that the original Fit for the Future decisions should be changed.

On 5 November 2009 representatives of NHS West Sussex met with counterparts at Western Sussex Hospitals NHS Trust to discuss the new possibilities around inpatient paediatrics, emergency surgery, and consultant-led maternity services in the light of the merger. It was agreed that it was now possible to maintain all three services at Chichester and Worthing, subject to a detailed programme of work which both Trusts agreed was required to secure the long term future of the services, and to best serve local patients. This agreement was formed into a recommendation to the NHS West Sussex Board.

On 26 November 2009 the NHS West Sussex Board decided to accept the recommendation to amend last year’s Fit for the Future decisions. The acceptance of the recommendation means that the PCT will now work with local providers of NHS hospital and community services to ensure that all services continue to be provided on both sites. That decision marks the end of the formal Fit for the Future process, although the job of NHS West Sussex to continually plan and buy the right services for the local population, and then to check these services are delivering, will go on.

The Fit for the Future initiative had been one of the largest and most complex service reconfiguration programmes led by NHS West Sussex. It involved extensive public consultation and the participation of most NHS Trusts in West Sussex and Brighton & Hove.

Such a major exercise faced considerable challenges but also generated important innovations in pubic involvement and communications.

Two years on from the launch of the programme provided an opportunity to review the lessons learned by the NHS and its partners.

The report below examines both what worked well and what should be done better or differently on future occasions.