CCGs and others for 20 years • This year - South West CSU merged with South and Central Southern CSUs, covering most of South of England • Ordnance Survey licensing - OpenData & PSMA (2010/11) • OS Multi-Client Contractor License (2011) • Growth in demand from wider NHS • Growing team of GIS analysts/developers • Location Intelligence, GIS analysis and mapping • HealthGIS Maps (on-line mapping portal) • Licensed Distribution Partner with Ordnance Survey (2014)
CCG • Following NHS England recommendations for centralised services • Service provider sites – Taunton and Yeovil hospitals • Blue-light emergency transport travel time analysis • Private vehicle travel times • Public transport access • Population analysis within travel times • Hospital catchment areas • GIS analysis was influential in changing the final CCG board decision on this review
Clinical Commissioning Group looked into how a proposed centralised stroke service, based at Musgrove Park Hospital Taunton, would affect the population of Somerset. • This followed an Independent Expert Panel report in November 2013 recommending significant changes to stroke services in Somerset. • Somerset is a large county measuring 1,330 square miles and 70 miles across. Previously, the service review had assumed that closing the stroke services at Yeovil Hospital would benefit patients clinically. • However, it was decided to use GIS analysis to see how the proposed changes would impact the population…
Hospital and Ambulance Trust activity data • Ordnance Survey digital data and mapping • MiniScale • 1:250,000 colour raster • Meridian2 (travel analysis) • Code-Point Open • Boundary-Line • AddressBase Plus • Code-Point with Polygons • MapInfo Professional • RouteFinder – drive-time analysis • Basemap TRACC – public transport travel analysis
Calculated average, maximum, minimum travel times • Fixed “Call to Scene” and “On Scene” times • “Scene to door” times with and without Yeovil Hospital • “Call to door” times with and without Yeovil Hospital • Without Yeovil, call to door times ALL exceed 60 minute target time • This was the most influential information
Hospital • Considering visiting families and carers • Visiting Times 2pm to 4pm • BaseMap TRACC To hospital between 1pm and 3pm From hospital between 3pm and 5pm
public transport access to and from hospitals • The table shows that without Yeovil Hospital, public transport access to Taunton or Dorchester hospitals will more than double from around 42 minutes to around 90 minutes when travelling in the afternoon or in the evening. • The table shows that, without Yeovil Hospital, there is no access travelling back from either hospital in the evening. Average time of patients with access Average time of patients with access Average time of patients with access Average time of patients with access All patients to YDH 1,023 884 86% 41.82 926 91% 43.20 917 90% 42.61 495 48% 34.38 Somerset patients to Taunton 810 579 71% 90.09 532 66% 93.41 545 67% 91.87 1 0% 70.47 Dorset patients to DCH 213 130 61% 84.41 99 46% 82.51 98 46% 77.74 0 0% n/a All patients to Taunton or DCH 1,023 709 69% 89.05 631 62% 91.70 643 63% 89.72 1 0% 70.47 To hospital afternoon From hospital afternoon From hospital evening To hospital evening Total no. of patients No. of patients with access < 2 hrs No. of patients with access < 2 hrs No. of patients with access < 2 hrs No. of patients with access < 2 hrs
access to hospitals • Averages for afternoons and evenings Public Transport travel times for all patients to Yeovil hospital To hospital afternoon From hospital afternoon To hospital evening From Hospital evening 0-10 mins 4% 5% 9% 1% 0-20 mins 20% 23% 19% 12% 0-30 mins 29% 32% 35% 22% 0-40mins 41% 42% 45% 28% 0-50 mins 50% 53% 55% 35% 0-60 mins 59% 62% 60% 41% 0-70 mins 70% 66% 76% 47% Public Transport travel times for Somerset patients to Taunton hospital To hospital afternoon From hospital afternoon To hospital evening From hospital evening 0-10 mins 0% 0% 0% 0% 0-20 mins 0% 0% 0% 0% 0-30 mins 0% 0% 0% 0% 0-40mins 0% 0% 0% 0% 0-50 mins 0% 0% 0% 0% 0-60 mins 0% 1% 1% 0% 0-70 mins 9% 6% 11% 0%
of hyper-acute services would improve outcomes for patients in Somerset is not definitive. The Independent Clinical Expert for the business case has suggested that TSTFT would find it challenging to move in the short term towards being the single hyper-acute centre for stroke services and ensure that such a move resulted in a better service for patients than they currently receive. This is particularly the case because of the rural nature of Somerset and the travel time implications which would mean that Taunton would have to show it can achieve door to needle times that were on average 20 minutes better than Yeovil could achieve in order simply to stand still compared to the status quo (for the small number of patients requiring thrombolysis). Neither the general academic research evidence available on centralisation, nor the Independent Clinical Expert’s work has provided a convincing case that would be credible to local people that the loss of their local access to hyper-acute care and the increased travel times would be mitigated by improved outcomes above what they could have had from services at Yeovil (if those services are properly developed). We do, however, note the intention of NHS England to develop plans this year to centralise stroke services in two areas which may provide further evidence.” Source: Stroke Services Review Consultation Business Case Version 4. Governing Body 4 June 2014
easy to understand way • Evidence-based information resulted in accurate decision making • Results showed that the 60 minute call-to-door target time for stroke patients would not be achievable for many patients • Decision was made not to close the service at Yeovil Hospital • The methodology and techniques used are repeatable for other service reviews and other geographical areas
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