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
–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
–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
–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
–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?
|Emergency Surgery – all specialties including orthopaedic trauma Planned surgeryObstetrics & GynaecologyThoracicVascularColorectalUpper Gastrointestinal (UGI)BariatricsGeneral SurgeryUrologyENTPaediatricsurgery
||Emergency SurgeryGeneral surgery including ColorectalOrthopaedic traumaPlanned Surgery OrthopaedicsObstetrics & GynaecologyVascular (minor)ColorectalUrologyGeneral SurgeryOphthalmology
||No emergency surgery Planned Surgery OrthopaedicsGynaecologyGeneral SurgeryUrologyOphthalmology
What is the proposed new configuration?
|Emergency Surgerymost specialties (excl Urology and UGI)Orthopaedic trauma Planned surgeryObstetrics & GynaecologyThoracicVascularColorectal
Some General Surgery
|EmergencySurgery General surgery assessmentUrologyUpper Gastrointestinal Planned Surgery Obstetrics & GynaecologyUrologyUpper Gastrointestinal
Some General Surgery
|No emergency surgery Planned Surgery OrthopaedicsOphthalmologySome General Surgery
Possibly some ENT
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.