Hospital Services Programme - Strategic Outline Business Case

The Strategic Outline Case (SOC) describes how SYBMYND partners will take the hospital services review and its recommendations forward to support realisation of shared ambitions set out in the System Plan published in November 2016.

Health and care organisations in South Yorkshire and Bassetlaw, Mid Yorkshire, and North Derbyshire (SYBMYND) have formed strong partnership working over a number of years with a reputation for delivering long term improvement to health and care for all of our local populations.

This joint working covers primary care, community care, mental health, acute and specialist care and our thinking starts with where people live, in their neighbourhoods, focussing on people being enabled and supported to stay well. Our ambition is to introduce new and improved services, to develop better coordination between those which already exists, to provide support for people who are at most risk and to adapt our workforce so that we are better meeting people’s needs.

Prevention will be at the heart of everything we do, and investing in and reshaping primary and community services and integrating mental and physical health will ensure people are supported as close to home as possible. At the same time we have an ambition that everyone should have improved access to high quality care in hospitals and that no matter where people live they should receive the same standards of care. Key to this success will be developing innovative models of care building on the work of the Working Together Acute Care Vanguard.

Following the publication of the South Yorkshire and Bassetlaw system plan the South Yorkshire and Bassetlaw Health and Care Partnership, through its Partnership Board, voluntarily initiated an independent review of Hospital Services. The Hospital Services Review (HSR) was published in May 2018 and it made a number of recommendations including ways in which acute trusts could work together more effectively to meet the needs of patients and how services are designed across SYBMYND.

Partners, including all health commissioners and acute providers across SYBMYND, have now considered the report and provided feedback on its recommendations. The independent review together with its recommendations was well received and broad support was given from system partners to take the work to the next stage.

The Strategic Outline Case (SOC) describes how SYBMYND partners will take the review and its recommendations forward to support realisation of shared ambitions set out in the System Plan published in November 2016.

The SOC is being discussed at the region’s governing body meetings and boards during the months of September and October 2018.

Below is a summary of the key recommendations which will be taken forward and which the system will build on in the next stage should all partners agree to the SOC.



Acute, community and primary care providers should continue to work together, at Place level, to ensure that services are delivered as close to patients’ homes as possible. This should be supported by standardisation of which services are being provided nearer to where people live rather than in acute hospitals.

The acute hospitals should work together more closely. ‘Hosted Networks’ should be established, initially for the 5 services included in the Independent Review. They will drive collaboration, improve workforce planning development and deployment, standardise clinical protocols to improve outcomes, and identify and roll-out cost-effective quality-improving innovations across the system.

System partners should establish a Health and Care Institute and an Innovation Hub to provide a system-wide central support for workforce and innovation across the system.



Moving care into primary care and community care. The individual Places within SYB and ND are developing an Out of Hospital Strategy to enable people and patients to be cared for outside a hospital setting where this is appropriate, and as close to home as possible. To support this, the Clinical Working Groups will work jointly with colleagues in primary care and community care to identify care pathways and services which could be delivered in non-acute settings.

Transformation of clinical models and workforce roles. In order to ensure that we are making the best use of our staff, and providing care as efficiently as possible, we will ask the Clinical Working Groups to develop new workforce models and new clinical service models. The reconfiguration modelling will take account of these new clinical workforce and clinical service models, to ensure that reconfiguration options are fit for the future and sustainable.



District General Hospitals will be maintained in every place, each with its own service portfolio comprising a core and specialist offer, working in a networked way across the region.

Providers and commissioners will consider consolidating some services onto fewer sites, in order to improve the quality of care that can be provided to patients and make the best use of available workforce:

All Emergency Departments should remain open and continue to provide 24/7 care

Paediatrics: The system will consider the consolidation of full-time inpatient paediatric units from six sites onto four or five, maintaining part-time short stay paediatric assessment units in those places that consolidate their paediatric inpatient units.

Maternity: the system will consider service models that can support changes to the paediatric services available onsite. This should include the possibility of maintaining standalone Midwifery Led Units on sites which do not have inpatient paediatrics. However we will also look at other options that can address the interdependencies between inpatient paediatrics and obstetric services.

Gastrointestinal bleeds: Given the difficulty in sustaining out-of-hours rotas for GI bleeds, the system will model consolidating its services from five (currently not all full-time) rotas to three or four full-time out-of-hours rotas.

Stroke: Hospitals should adopt a paired approach to collaborative working to deliver stroke services, whereby sites with a combination of Hyper Acute Stroke Unit (HASU) and Acute Stroke Unit (ASU) services work with sites that have only ASU/in-patient rehabilitation services, to allow rotation of staff and exposure to more development opportunities.

The system will establish a transport reference group with a remit to develop a system-wide transport strategy and the specific functions to support and deliver it.



Commissioners, providers, NHS England and NHS Improvement and the Arms-length-Bodies have being developing a collaborative approach to shared working which they will build on. Commissioners and providers recognise that the current arrangements for decision making will need to evolve to support the scale of change that is included in this report.

As the ICS develops, SYBMYND will review current governance arrangements in context of the existing legal framework and ensure these enable appropriate decision making to support the successful implementation of the recommendations in this report so that partners can improve outcomes and accessibility to services for people and patients.

This report sets out the case for change behind these agreed directions of travel, and how the system will take them forward.

Read the SOC here

See slides explaining key points from the SOC here