Examine aspects of personal, environmental, behavioural factors from Bandura's Social Cognitive Theory model in the case study.

Explanation with THREE academic sources from the module's Key Reading list and ONE additional source from the Recommended Reading list.

Case Study: Royal Bournemouth and Poole hospital

Part 1 A&E to be downgraded in major overhaul of hospital services Following its clinical service review, Dorset Clinical Commissioning Group (CCG) decided that Royal Bournemouth Hospital will become an emergency hospital while Poole Hospital will be the elective centre. The decision means Poole will see its emergency department downgraded to a 24/7 urgent care centre. The CCG's decision also paved the way for the Royal Bournemouth and Christchurch Hospitals Foundation Trust and Poole Hospital Foundation Trust to ask the Competitions and Markets Authority to lift or change undertakings that block them from submitting merger proposals. Last year, the CCG announced Bournemouth as its preferred site for the emergency hospital on the basis that the capital costs (147m) would be less than for Poole (189m) and it has better access. Capital funding for the scheme has been secured from the Treasury, pending submission of the full business case. The capital cost of reconfiguring Royal Bournemouth and Poole hospitals is estimated to be 85m and 62m respectively. But the success of the plans is linked to whether the trusts will be allowed to merge. Both leadership teams believe the changes will be easier to achieve under one management structure. Tim Goodson, chief officer of Dorset CCG, said the trusts now "stand a far better chance" of being allowed to merge, compared to their previous attempt in 2013 that was thwarted by the CMA. Adapted from: Carding, N (2017) HSJ 20th September 2018 Available online at: https://www.hsj.co.uk/nhs-dorset-ccg/aande-to-be-downgraded-in-majoroverhaul-of-hospital-services/7020616.article [accessed 22/10/18] BBC News https://www.bbc.co.uk/news/uk-england-dorset-45482517 [accessed 22/07/2020]

Part 2

Record patient numbers at Poole Hospital's closing A&E A hospital's A&E department which is due to close was attended by a record number of patients on Saturday. Poole Hospital's A&E unit dealt with 235 patients across the day, as well as receiving 77 ambulances, bosses said. One visitor reported a 14-hour wait in the department by Sunday morning, although the hospital said the average waiting time was four hours. 7 The A&E service is set to move from Poole to Bournemouth under a shake-up of healthcare in Dorset. Poole Hospital's chief operating officer Mark Mould thanked staff for ensuring "safe care" was provided at the weekend in the face of "operational challenge". The emergency department move is one of a raft of measures planned by Dorset Clinical Commissioning Group (CCG) to try to avoid a projected funding shortfall of 158m by 2021. Nearly 25,000 people signed a petition asking the CCG to keep Poole Hospital A&E and maternity departments open. A legal challenge to the changes was rejected by the High Court (see article of 5th September). The hospital said there was no particular reason for the "unprecedented demand" over the weekend. One visitor to the hospital on Saturday night claimed "ambulance trolleys queued down the corridor" and there were "nowhere near" enough doctors and nurses. Under the healthcare shake-up, Poole would become a "planned care" hospital, although it would retain a 24-hour "urgent care centre" for less serious emergencies. Dorset CCG said the creation of specialist centres would save lives. The changes will be brought in over the next five years. Adapted from BBC News 11 September 2018 https://www.bbc.co.uk/news/uk-englanddorset-45482517 [accessed 22/07/2020] Dorset NHS changes: Campaigners lose legal challenge Campaigners have lost their legal bid to stop the reorganisation of hospital services in Dorset. Dorset Clinical Commissioning Group (CCG) agreed changes, including the closure of Poole's A&E, last October. Defend Dorset NHS brought a judicial review against the proposals, claiming longer travel times for emergency care would risk patient safety. However, a High Court judge has ruled in favour of the CCG. Defend Dorset said it was considering its next move. The group, which crowdfunded the challenge, has 21 days in which to launch an appeal. During a hearing at London's Administrative Court in July, lawyers argued health bosses were not informed about the risks arising from moving emergency services out of Poole Hospital. Under the plans, its A&E, maternity and paediatric services will be lost to Bournemouth, which will become the area's main emergency hospital. Poole is set to become a centre for planned treatment and operations. 8 Changes to mental health acute care include the closure and relocation of beds at Weymouth's Linden unit and the creation of extra inpatient beds at St Ann's Hospital in Poole and Forston Clinic near Dorchester. At Portland Hospital, 16 were beds closed last month as part of the reorganisation. The changes are designed to tackle a projected funding shortfall of 158m by 2021, according to the CCG. Chief officer Tim Goodson said: "We hope that the High Court's decision will reassure local people that the CCG has acted properly and in the interests of healthcare services in Dorset." He also said the changes would enable more non-emergency services to be provided closer to people's homes. The judicial review has involved "considerable cost" to the NHS, he added. In his final judgement, judge Sir Stephen Silber said: "I appreciate that some residents of Dorset will be disappointed by this decision, but it might be some compensation for them to know that the claimant's case has been very well argued, as has the case for the CCG." Adapted from BBC News 5 September https://www.bbc.co.uk/news/uk-englanddorset-45419208 [accessed 22/07/2020]

Part 3 Indeed

"Whilst working in Poole hospital, change and improvement was a vital requirement within daily practice. The delivery of intervention was personalised to ensure highest level of improvement for the individual. Discharge planning was a vital link between hospital and home. This could involve home access visits to ensure safe discharge; or completing single point of access (SPOA) referrals, to communicate specific therapy goals and support required from medical professionals within the community." January 2019 "I worked 3 years for a trust that neither appreciates/cares or looks out for their staff. From Matron level up you find that the trust is on such a tight budget, there is literally no consideration for the well-being of the patients in general, it's all about cutting back the purse strings to save as much money as possible and/or running the wards to the absolute minimum staffing levels on a chronic basis. I worked as a Staffing co-ordinator in Trauma and Surgery for just shy of 3 years, in that time I saw such a turnover of staff haemorrhaging from the wards, the mismanagement was ridiculous and frankly my only other colleague that supported my role was absent from work on long term sickness before finally resigning.... so because of this I volunteered HUNDREDS of hours!!!! (As many staff seem to, without question!) never to be given back. After 1 rolling year of having my colleague absent, I was informed during a heated confrontation with my line manager that the funding had been changed and that I would face these challenges on my own going forward. 9 Needless to say I resigned from my post immediately. Wait until 2021/2022 for the restructuring of the Dorset CCG before applying to work here." May 2019 "Experience of extremely poor management in my case. Witnessed their unprofessional and unacceptable behaviour. Experienced bullying from management. Regularly busy and stressful. Colleagues were nice." March 2020 "Its a very nice hospital to work in. I would recommend my colleagues to work with this trust especially if this is your first job with NHS as F1/2/3." April 2020 Accessed from Indeed [accessed 22/07/2020] https://www.indeed.co.uk/cmp/Poole-Hospital-Nhs-Foundation-Trust/reviews