What is the vision for the project?

To have emergency and planned surgical services in our hospitals which are sustainable and enable the provision of high quality, safe care to our patients

What are our reasons for considering change?

External – out of our control

National trends

–Greater sub specialisation in surgical specialties e.g an orthopaedic surgeon may operate on hands or feet but not usually both compared to a more generalist approach 10 years ago

–Fewer surgeons being trained with 20% fewer junior doctors entering surgery

–Royal College of Surgeons’ requirements are more demanding  for emergency and planned surgery

–NHS wide moves to consolidating services to achieve better outcomes

–These challenge the sustainability of safe surgery across multiple sites and create a compelling clinical case for change

Financial Challenge

–The financial challenges facing not just the Trust, but the NHS as a whole, are significant so things need to be done differently to protect service provision in the future

Internal Quality

–Desire to improve the patient experience eg faster access to emergency surgery and certainty for planned  surgery dates

–Want to give improved outcomes and lower mortality in the future  with higher levels of safe and harm free care

–The opportunity to create centres of excellence with space to develop services

Belief

–Our clinical leaders believe things need to change to protect and develop services and that now is the time to do so, as doing nothing will impact our ability to provide safe surgery in all specialties.

What are the benefits of making these changes?

• Improved outcomes, clinical safety and experiences for our patients;
• The ability to meet current and future clinical standards for surgery;
• Shorter waiting times and more certainty with dates for planned surgery;
• Faster access to emergency surgery and reduction in bed days waiting for such surgery;
• The ability to create centres of excellence in a number of surgical specialties;
• The capacity to deliver activity internally without the need for premium rate waiting list or private sector work;
• The opportunity to grow those specialties where there is increasing demand;
• Gains in efficiency from consolidation and best practice bench marking eg reduction in Length of Stay and increased theatre utilisation; and
• Opportunities to release financial benefits by doing things differently.

What is the current configuration of surgical services?

What is the proposed new configuration?

The proposals include investment in facilities and equipment to create centres of excellence. How will this be funded? Will it save money?

It is recognised that capital investment will be required and that will form part of the final business plan that the Trust Board considers prior to any decision making.

Potential productivity gains, reduction in spending on waiting list work and improved ways of working may provide more cost effective ways of providing current and future services; but the drivers for change are clinical to improve patient care and experiences and to meet more stringent requirements laid down by the Royal College of Surgeons.

What has been the process of the past year to 18 months?

• A Clinical Reference Group (all surgical Clinical Directors) profiled specialties and their requirements
• An independent review of national guidelines and best practice evidence was commissioned
• A Surgical Advisory Group (above plus representatives  from directorate and operations teams)  considered requirements, site facilities, interdependencies and developed two strategic options
• The last 9 months  has seen greater consideration of these 2 options, greater involvement of multidisciplinary teams, external stakeholder engagement (patients, GPs, CCGs, staff, Health Watch)
• Options have evolved and developed as operational work up has taken place to conclude with one preferred option to take to the next stage
• Overwhelming messages:

–Intend to retain local access points for local people through our 3 hospitals. This means all aspects of a patient’s journey within the Trust, apart from some surgical procedures, will remain locally delivered as now.

–Intend to retain 3 busy surgical hospitals so where one service may move out to consolidate on one site, another will move in to consolidate.

What about the current lack of dedicated paediatric theatres in some specialties?

Provision of a new dedicated paediatric theatre is included in the proposal.

How can I share my point of view?

We have a number of ways you can get in touch with us as follows:

Website:  www.heartofengland.nhs.uk/surgery-reconfiguration. Just use the feedback box.

Email: surgeryreconfiguration@heartofengland.nhs.uk

 Tel:  (0121) 424 3838

Twitter:  @heartofengland (remember to use #surgeryreconfig)

Tear-off response card in consultation information booklet – contact us if you would like us to send you a hard copy.

We are also hosting public information sessions throughout the consultation period – the details on these can be found on the web page.

Can staff and public really make any difference to the proposals?

The proposals have been developed over many months by clinicians and other staff, patient groups, commissioners and other stakeholders. We believe they are the most practical and sustainable option, but concerns and ideas from patients and staff will be explored fully and could certainly be adopted. Even if they aren’t, we will provide feedback and explain clearly why we don’t think they offer the same scope for improvements.

What are the guiding principles for the consultation?

• Open and honest;
• Accessible information;
• Clinically led;
• No decisions made;
• Engage with as many people, organisations and stakeholders as possible;
• Attend a wide range of meetings; and
• Focus on active participation.

How and when? What are the next steps?

• – Public consultation period commencing 13th October for 14 weeks.
• – Extensive range of events to encourage and facilitate active participation from as many individuals and stakeholder groups as possible
• – Ongoing operational design and implementation planning running in parallel to public consultation to facilitate an iterative process.
• – Trust Board will decide how to proceed early in 2015 – any implementation will be phased and planned to commence from spring 2015.

• No impact for most of our patients – we see about 1.2 million patients per annum and undertake approximately  45,000 theatre operations.
• No impact for outpatient attendances.
• Better quality care for our surgical patients sustainable in the long term.
• Small percentages of patients’ attendances are for a surgical intervention.
• Support for patients and relatives travelling further for their operation is being designed in conjunction with Stakeholder Reference Group.
• Feedback from this group so far is positive, understanding the rationale for considering change and seeing the potential benefits of reconfigured, consolidated surgical provision such greater certainty for planned surgery and all the experts in one place.

Travel – are there plans for moving patients between sites? Would there be adequate parking for staff who work at more than one site? Would more patients opt to go to a private healthcare provider if it means they don’t have to travel further away for their surgery?

Patients have also raised the issue of transport and we are exploring options. Parking for staff will have to be addressed too, so we’ll be reporting back on these issues later.Patients can already choose to receive their treatment from a private provider, and we do not believe that travelling a short additional distance for the procedure as part of their care will have a significant impact on their decision-making process. There is a much larger risk that people will vote with their feet if we do not improve the way that we deliver services, as these will quickly become unfit for purpose when professional bodies like the Royal College of Surgeons press for higher standards and better outcomes.What are the practicalities of moving patients between sites, and over the provision of surgeon/consultant care for outpatient appointments?Operating under our current model we already move patients between sites to give them the care they need.  We believe our new plans will give us more clarity about when and how this is managed and make the process more efficient for patients and staff.

Staffing for those affected by the proposals – will staff numbers stay the same or decrease? What about staff who don’t want to move with the service they work in? These proposals mean big changes for theatre staff, what is being done to communicate and work with them?

We are not planning any reduction in staff numbers and we are committed to giving the relatively small number of staff who would be affected as much choice as possible about whether to move or to stay at the same site and retrain if necessary. We will be having further meetings with affected staff and taking more of these out into ward and theatre areas to connect better with these staff.We will also do more work to develop the intranet as a first port of call for information as the consultation progresses. The project team are very happy to meet staff in department groups if they want to find out more information and to talk about the proposals.

Staff affected by the proposals  –  what additional training will be needed, and how the Trust’s Faculty of Education manage this within the required time frames?

It is true that there may be challenges in ensuring that any staff that don’t choose to move with their speciality (should it move sites) and wish to develop new skills are re-trained and the Faculty will play an important role in this process. We don’t know the details until we have an agreed plan and staff have expressed their wishes. A Faculty team sits on the workforce subgroup to monitor the situation.

Will Good Hope end up being downgraded and become a ‘cottage hospital’?

We are committed to retaining surgery on all three sites. Good Hope remains an important part of the proposed plan and will retain all its core services as well as its own distinct range of specialties. It is not being downgraded.

What do the proposals mean for urology services at Solihull Hospital?  

Professor Matthew Cooke, Deputy Medical Director for Strategy and Transformation, says: “Under the proposals patients will still be able to access urology services at Solihull Hospital. Most attendances for a urology condition are out-patient based, such as consultations with specialists or diagnostic procedures, and this would not change. There are also some other urology procedures that don’t need the full operating theatre facility, for example, cystoscopy, which would also continue to be carried out at Solihull Hospital. Under current plans, which are subject to public consultation, it is proposed that patients who require surgical procedures which need to take place in an operating theatre would be treated in the centre of excellence for urology that would be created at Good Hope Hospital. Currently some Solihull patients already travel to Heartlands or Good Hope for some types of specialist urology surgery.

“We are absolutely committed to running three busy surgical hospitals and under the proposals Solihull Hospital would become the centre of excellence for all orthopaedic and ophthalmic surgery carried out within the Trust, so would actually carry out more operations than it does now.

“The public consultation, which launched in October, is an opportunity for as many local people as possible to hear the Trust’s proposal for reconfiguring some surgical specialties so they can then give their views. No decisions around any services moving between hospital sites have yet been made and there will be no losses to any services within the Trust.

“We would encourage local people to come along to one of the meetings to find out more about the proposals, or alternatively access the range of information and feedback mechanisms that are available on the Trust’s website: www.heartofengland.nhs.uk/surgery-reconfiguration. Alternatively, email: surgeryreconfiguration@heartofengland.nhs.uk, call 0121 424 3838 or give us your views via the @heartofengland twitter account.”

Please fill out our surgery feedback form below and leave your details if you would like us to contact you: