1. Have YOUR sayabout the future of our local hospitalsKeeping hospital services in Shropshire, Telford and Wrekin PUBLIC CONSULTATION Telford 2010 – 14 March 2011 9 December & Wrekin LINk
2. 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
3. Keeping it in the County Securing the future of hospital services in Shropshire,Telford and WrekinThe case for change
4. The context1. The level of external scrutiny 2. Difficulty in by independent regulators, recruiting (and professional bodies/colleges retaining) AND patient „watchdogs‟ is specialists greater than ever 3. A drift of services „out of county‟ – this could become even more of an issue
5. 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 aimedat saving money or cutting services.”
6. 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
7. Risks and ChallengesChanges are needed because it is increasingly difficult to provide services SAFELY
8. Services that are particularly affected by these challenges• inpatient surgery• children‟s services• maternity care
9. The key issues
10. Population Demographics• Serve a population of over 500,000• An ageing population• Deprivation – rural and urban• Long Term Conditions and lifestyle related illnessShropshire Telford & Wrekin Powys 170,000; fast-growing290,900; ageing population; 62,000 of 131,900;Ageing; Increasing birth rate AgeingRural deprivation Densely populated; high Rural deprivation;High life expectancy; levels of deprivation; Sparsely populated;Higher than Higher than average Good health statusaverage/ rising levels of obesity, compared to Welshlevels of LTC‟s smoking-related• Shropshire admissions and deaths averages and cardio-vascular disease
11. THE QUALITY OF MATERNITY CARE
12. 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.”
13. Providing the right level ofcare for children in hospitalWith reduced numbers of children‟s specialistdoctors nationally, our paediatric consultantsare increasingly concerned about staffing ourtwo existing children‟s units with the right levelof doctors.
14. 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.
15. Decision time….
16. HOW were the proposals developed?• Specialist doctors, nurses and GPs other health professionals responsible for running the services concerned. Patients and carers and a wide range of organisations that represent them
17. 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 outcomesfor patients in the future, and are affordable and sustainable.
18. 4 optionsOption 1: Do nothing and Option 3: Concentrate allmaintain all services as they services on one site, eitherare. in a brand-new hospital - or in one of the existing two hospitals.Option 2: Move some Option 4: Concentrate allservices from PRH to RSH major urgent inpatient andand vice versa to make the emergency activity on themost effective use of staff, site of one of our existingequipment and buildings. two hospitals,with planned activity at the other
19. 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 andsatisfactory solution to the problemwe have outlined.”
20. 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
21. 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 This would cost = £350 - £400 million + This was looked at in a feasibility study in 2009.In the financial climate now facing the nation, thatmoney is not available – so it is is not affordable orfeasible
22. 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
23. The details:WHAT changes are being proposed?
24. Under the proposals, some specialist services would move from the Royal Shrewsbury Hospital to the Princess Royal Hospital in Telford, and vice versa Most outpatients would continue to go to the same hospital as now Most „day case‟ patients would go to the same hospital as now
25. The PCTs „Preferred Option‟ for PRH Midwifery Led Units would remain on BOTH SITES All women would receive their antenatal and postnatal appointments at the SAME LOCATION AS NOW• 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
26. 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
27. Gynaecology + ENT servicesINPATIENT gynaecology services would be concentrated in future atthe women‟s and children‟s centre within PRH.OUTPATIENT or day care gynaecological services would go to thesame hospital as now.Head and neck services including specialist surgery forcancer patients,+ Ear, Nose and Throat problems would be seen at PRH -800 children each year
28. PRH RECAP24-hour A&E departmentOutpatient clinicsDay case proceduresEmergency medical service (e.g. heart attacks, seriouschest 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
29. The PCT‟S Preferred Option – for RSHImproved facilities in themidwifery led unit at RSHAcute inpatient surgery atRSH siteThe establishment of avascular surgical centre atRSHImproved facilities forcancer patients at RSH (withthe support of Lingen Davies)
30. 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) Major trauma (such as road traffic accidents) 24-hour A&E departmentOutpatient clinics Midwife-led maternity unit Day case procedures Children‟s assessment unit (not overnight)
31. All urgent medical casesincluding strokes, heart attacks andserious chest infectionswould go to the same hospital as now –supported by non-resident seniorsurgeons
32. 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
33. Stroke Services Urology servicesUrology involves treatment of the kidneys, bladder,urinary tract and prostate. Work is currently takingplace to determine at which of our two hospitalsinpatient urology should best be concentrated infuture.The PCTs also want to discuss the local pattern ofstroke services, taking into account how best tointroduce new techniques and develop services in linewith modern standards.Views are being sought about both services aspart of the consultation.
34. ISSUES which still need to be addressed• 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 Improving The Health Of Our Community
35. What are the costs / funding implications?
36. 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
37. Capital Costs• 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 Improving The Health Of Our Community
38. When might thechanges happen?
39. Planning the changes Phase Objective Timescale1a Discussion and Developing a robust proposal August to Design Option modelling November 20101b Assurance and Assurance process November 2010 Consultation Public consultation December 2010 to March 20112 Planning for Planning, securing finance and April 2011 to April Implementation undertaking procurement 20123 Implementing the Implementation commences Phased approach Change from April 2012 Improving The Health Of Our Community
40. 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 sametime or at the same pace. Patient safety would be a top
41. Consultation questions
42. Consultation questionsWhat do you think about the overall proposals?What do you think about the specific proposals forinpatient children‟s services?What do you think about the specific proposals for maternity services?What do you think about the specific proposalsfor ACUTE surgery?Are there any comments you would like to make aboutthe location of urology? Or about the future pattern oflocal stroke services?Are there any other comments you would like to make?
43. HAVE YOUR SAYThis public consultation runsfrom 9th December 2010 to14th March 2011.During that time the PCTs want to hearthe views of as many people aspossible about their proposals.
44. How you can get a copy of the full document OR SUMMARYfull and summary consultation documentsare available on request. EasyRead or largeprint 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
45. Feedback ONLINE :• www.shropshire.nhs.uk• www.telford.nhs.uk• www.sath.nhs.uk• www.ournhsinshropshireandtelford.nhs.uk or EMAIL to: email@example.com
46. Write a letter setting out your viewsFREEPOST RRZR-SZAA-BUBZReconfiguration of Hospital Services,Oak Lodge, William Farr House,Shropshire County NHS PCT,Mytton Oak Road,Shrewsbury SY3 8XL or EMAIL firstname.lastname@example.org
47. 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
48. Please copy your feedback to Telford & Wrekin LINkSuite 1, Conwy HouseSt Georges RoadDonningtonTelford TF2 7BF01952 email@example.com take part in an online discussion about Keeping it inthe County at www.telfordtalks.com