Telford & Wrekin LINk

Have YOUR say about the future of our local

hospitals

Keeping hospital services in Shropshire, Telford and Wrekin

PUBLIC CONSULTATION

9 December 2010 – 14 March 2011

Keeping it in CountySecuring the future of hospital services in Shropshire

RAISING PUBLIC AWARENESS - the need for change- the options + benefits of reconfiguring hospital services- the consequences of not taking action in the near future

The case for change

Keeping it in the CountySecuring the future of hospital services

in Shropshire,Telford and Wrekin

The context

1. The level of external scrutiny by independent regulators, professional bodies/colleges AND patient ‘watchdogs’ is greater than ever

3. A drift of services ‘out of county’ – this could become even more of an issue

2. Difficulty in recruiting (and retaining) specialists

The purpose of the changes

“The proposals reflect what the doctors who provide the services, and the GPs who send their patients to use them, think should be done to improve safety and quality and make sure these services are provided within Shropshire, Telford and Wrekin for a very long time to come.”

“They are most definitely not aimed at saving money or cutting services.”

THE PRINCIPLESunderpinning the proposed reconfiguration

• Two vibrant, well-balanced, successful hospitals

• A commitment to having an A&E on both sites

• Access to acute surgery from both sites

Risks and Challenges

Changes are needed because it is

increasingly difficult to provide services

SAFELY

Services that are particularly affected by these challenges

• inpatient surgery

• children’s services

• maternity care

The key issues

Population Demographics

• Serve a population of over 500,000• An ageing population• Deprivation – rural and urban• Long Term Conditions and lifestyle related illness

• Shropshire

Shropshire290,900; Ageing;Rural deprivationHigh life expectancy; Higher than average/ rising levels of LTC’s

Telford & Wrekin170,000; fast-growing ageing population; Increasing birth rate Densely populated; high levels of deprivation; Higher than average levels of obesity, smoking-related admissions and deaths and cardio-vascular disease

Powys62,000 of 131,900; AgeingRural deprivation; Sparsely populated; Good health status compared to Welsh averages

THE QUALITY OF MATERNITY CARE

Ageing buildings….. not fit for purpose

Even if money is spent on the building, its future life span is limited to between five and ten years.”

Providing the right level of care for children in hospital

With reduced numbers of children’s specialist doctors nationally, our paediatric consultants are increasingly concerned about staffing our two existing children’s units with the right level of doctors.

SURGICAL CARE - 24/7

• Surgeons specialise today – so carry out a smaller range of more complex operations than in the past

• Increasingly skilled surgeons are able to deliver better results – patients benefit.

• BUT leads to fewer general surgeons which makes it difficult to organise services so that the right specialists are available at any time of day or night.

Decision time….

HOW were the proposals developed?

• Specialist doctors, nurses and GPs other health professionals responsible for running the services concerned.

Patients and carersand a wide range of organisations that represent them

.

4 key tests BEFORE publishing their proposals an Assurance Panel was asked to check that the PCTs proposals met the 4 KEY TESTS laid down by the Secretary of State for Health:

1. local GPs (who will be responsible for commissioning services) support the proposals;

2. local patients and patient representatives are involved

3. the need for reconfiguration is supported by clinical evidence ;

4. the changes proposed will enhance patient choice.

AND ALSO: how far they believed the proposals would improve outcomes for patients in the future, and are affordable and sustainable.

4 options

Option 1: Do nothing and maintain all services as they are.

Option 2: Move some services from PRH to RSH and vice versa to make the most effective use of staff, equipment and buildings.

Option 3: Concentrate all services on one site, either in a brand-new hospital - or in one of the existing two hospitals.

Option 4: Concentrate all major urgent inpatient and emergency activity on the site of one of our existing two hospitals,with plannedactivity at the other

Option 1: Do nothing and maintain all services as they are

“If we did nothing, we expect it would result in services being moved out of the Shropshire, Telford and Wrekin area altogether. In those circumstances, many patients would end up travelling greater distances to receive their hospital care.”

“This does not provide a practical and satisfactory solution to the problemwe have outlined.”

Option 2: Move some services from PRH to RSH

“It would enable us to continue to provide all the hospital services we are currently providing. Most patients would receive their care at the same hospital as they do now. For some inpatient services, some people who currently use the Princess Royal Hospital would go to the Royal Shrewsbury Hospital and vice versa.”

This is the PCTs preferred option

Option 3: Concentrate all services on one site, either in a brand-new hospital or in one of our

two existing hospitals

Building a brand-new hospital to replace both PRH and RSH would be the ideal. new facilities from scratch up-to-date equipment purpose-built accommodation all our staff and services together

 

In the financial climate now facing the nation, that money is not available – so it is is not affordable or feasible

This would cost = £350 - £400 million + This was looked at in a feasibility study in 2009.

Option 4: Concentrate all major inpatient and emergency activity on one site, with planned

activity at the other

Many potential benefits – and strongly supported by clinical staff.But in practice there is more urgent and emergency activity than elective or planned activity.

If we were to implement this option one site would not have very much work, but the other site would very busy - and without significant expansion in facilities, the service would be overwhelmed.

 

 

Neither affordable nor feasible

The details:WHAT changes

are being proposed?

Most outpatients would continue to go to the same hospital as now

Under the proposals, some specialist services would move from the Royal Shrewsbury Hospital to the Princess Royal Hospital in Telford, and vice versa

Most ‘day case’ patients would go to the same hospital as now

The PCTs ‘Preferred Option’ for PRH

• Establishment of a Women’s and Children’s centre on the PRH site

– The obstetric unit would move from RSH to PRH.

– The Neonatal Intensive Care Unit would move from RSH to PRH and be co-located within the Women’s and Children’s centre

– Consolidation of inpatient paediatrics onto a single site at PRH with enhanced Paediatric Assessment Units on both sites

• Head and Neck services would transfer from RSH to PRH due to the high level of paediatric activity

Midwifery Led Units would remain on BOTH SITESAll women would receive their antenatal and postnatal appointmentsat the SAME LOCATION AS NOW

Childrens services at PRH

• Inpatient children’s services would be concentrated at PRH site, with both sites providing children’s assessment units

 • Children attending hospital as an outpatient (the

majority of children who use hospital services) would continue to go to the same hospital as they do now.

 

* The neonatal intensive care unit (for newborn babies needing intensive care) currently on the RSH site would move to PRH site, so that it is in the same place as the consultant-led maternity unit and inpatient children’s services

Gynaecology + ENT services

INPATIENT gynaecology services would be concentrated in future at the women’s and children’s centre within PRH.

OUTPATIENT or day care gynaecological services would go to the same hospital as now.

Head and neck services including specialist surgery for cancer patients,

+ Ear, Nose and Throat problems would be seen at PRH -800 children each year

PRH RECAP 24-hour A&E departmentOutpatient clinicsDay case proceduresEmergency medical service (e.g. heart attacks, serious chest infections)Midwife-led maternity unitEmergency and inpatient orthopaedic surgeryChildren’s inpatient unitChildren’s assessment unit (24 hours)Consultant-led maternity unitNeonatal unitInpatient head and neck services, including ear, nose and throatInpatient gynaecology services and breast surgery services

The PCT’S Preferred Option – for RSHImproved facilities in the midwifery led unit at RSH

Acute inpatient surgery at RSH site

The establishment of a vascular surgical centre at RSH

Improved facilities for cancer patients at RSH (with the support of Lingen Davies)

RSH recap 24-hour emergency surgery

Emergency and planned inpatient vascular surgery

Emergency and planned inpatient colorectal surgery

Emergency and planned inpatient upper gastro-intestinal surgery

Emergency and inpatient orthopaedic surgery

Emergency medical service (e.g heart attacks, serious chest infections)

Outpatient clinics

Day case procedures

Midwife-led maternity unit

Children’s assessment unit (not overnight)

Major trauma (such as road traffic accidents) 24-hour A&E department

All urgent medical cases

including strokes, heart attacks and serious chest infections would go to the same hospital as now – supported by non-resident senior surgeons

A&E services

• The maintenance of a 24 hour A&E service on both sites

• Major trauma would continue to be seen at RSH

• Long bone trauma would be seen in both A&E’s

Stroke Services Urology services

Urology involves treatment of the kidneys, bladder, urinary tract and prostate. Work is currently taking place to determine at which of our two hospitals inpatient urology should best be concentrated in future.

The PCTs also want to discuss the local pattern of stroke services, taking into account how best to introduce new techniques and develop services in line with modern standards.

Views are being sought about both services as part of the consultation.

ISSUES which still need to be addressed

Improving The Health Of Our Community

• Extended travel time for a minority of patients• Patient pathways will need to be agreed and

understood by all• Paediatrician cover at RSH for acutely ill and injured

children being taken to the RSH out of hours (NB severely injured children are transferred to Birmingham now – this will continue)

• The potential need to transfer children safely between the two sites

• The needs of rural communities need to be responded to under a new configuration e.g. Powys and parts of Shropshire

What are the costs / funding implications?

Revenue implications

• No additional £/funding from commissioners

• Whilst not solving the Trust’s financial challenges, the changes will give opportunities to strengthen the Trusts financial position

• Will remove the current hold up on making changes- and create a new opportunity to look at current models of care and working practices

Capital Costs

Improving The Health Of Our Community

• New build at PRH - Women’s and children’s centre

• RSH - refurbishment of existing facilities

• Both in the range of £27 - £30 million

• Discussions with NHS West Midlands regarding the level of capital support – likely to be in the form of a loan, repayable over 25 years

When might the changes happen?

Planning the changes

Improving The Health Of Our Community

Phase Objective Timescale

1a Discussion and Design

Developing a robust proposalOption modelling

August to November 2010

1b Assurance and Consultation

Assurance process

Public consultation

November 2010

December 2010 to March 2011

2 Planning for Implementation

Planning, securing finance and undertaking procurement

April 2011 to April 2012

3 Implementing the Change

Implementation commences Phased approach from April 2012

WHAT HAPPENS at the end of the consultation ?

• By the end of MARCH 2011 - all three boards will decide, in the light of the outcome of this consultation, whether and how far to proceed with the proposals.

• If the boards agree changes will start this Spring

• All the changes would be implemented by 2014.

Not all the changes would necessarily take place at the same time or at the same pace. Patient safety would be a top priority at every stage in the process.

Consultation questions

Consultation questions

What do you think about the specific proposals for inpatient children’s services?

What do you think about the specific proposals for maternity services?

What do you think about the specific proposals for ACUTE surgery?

Are there any comments you would like to make about the location of urology? Or about the future pattern of local stroke services?

Are there any other comments you would like to make?

What do you think about the overall proposals?

HAVE YOUR SAY

This public consultation runs from 9th December 2010 to 14th March 2011.

During that time the PCTs want to hear the views of as many people as possible about their proposals.

How you can get a copy of the full document OR SUMMARY

full and summary consultation documents are available on request. EasyRead or large print are also available. •Call 01952 580478 or 0800 032 1107•Or download from

www.shropshire.nhs.uk

www.telford.nhs.uk

www.sath.nhs.uk

www.ournhsinshropshireandtelford.nhs.uk

 

Feedback ONLINE :

• www.shropshire.nhs.uk

• www.telford.nhs.uk

• www.sath.nhs.uk

• www.ournhsinshropshireandtelford.nhs.uk

or EMAIL to: ournhsinsat@nhs.net

Write a letter setting out your views

FREEPOST RRZR-SZAA-BUBZ

Reconfiguration of Hospital Services,

Oak Lodge, William Farr House,

Shropshire County NHS PCT,

Mytton Oak Road,

Shrewsbury SY3 8XL

or EMAIL ournhsinsat@nhs.net

ATTEND A PCT MEETING

• Thursday 13th January 7pm - Shrewsbury Town Football Club

• Thursday 20th January 7pm - Oswestry Memorial Hall

• Wednesday 9th February 7pm - Craven Arms Community Centre

• Wednesday 16th February 7pm - Holiday Inn, Telford

Please copy your feedback to Telford & Wrekin LINk

Suite 1, Conwy House

St Georges Road

Donnington

Telford TF2 7BF

01952 614180 enquiries@telfordandwrekinlink.org.ukor take part in an online discussion about Keeping it in the County at www.telfordtalks.com

QUESTION TIME…..