OUTPATIENT SERVICES IN EAST KENT HAVE YOUR SAY 9 DECEMBER 2013 TO 9 MARCH Consultation on. Making improvements to your outpatient services

Transcription

1 HAVE YOUR SAY 9 DECEMBER 2013 TO 9 MARCH 2014 Consultation on OUTPATIENT SERVICES IN EAST KENT Making improvements to your outpatient services East Kent Hospitals University NHS Foundation Trust I NHS Canterbury and Coastal Clinical Commissioning Group

2 6 WHAT WE ARE CONSULTING YOU ABOUT 8 WHY WE NEED TO CHANGE WHAT HAPPENS NOW 13 WHAT WE WANT TO DO 19 BENEFITS OF THESE PROPOSALS 23 DECIDING A WAY FORWARD 24 GIVE US YOUR VIEWS INTRODUCTION We want to improve patients experience of outpatient clinics in east Kent and are keen to hear what local people think, before making decisions about the best way forward. East Kent Hospitals University NHS Foundation Trust (the Trust) knows most people s experience of hospital care starts in an outpatient department and it is vital that this provides accessible, attractive, friendly and efficient access to their care journey. It is our aim to develop this through taking your views into consideration throughout this consultation. Having spoken to staff and patients, the Trust has developed ideas about how it could improve patient care and experience, which it believes will mean: Less travelling for more people when attending outpatient appointments (83 per cent within a 20-minute drive, a significant improvement from the current 70 per cent) Wider choice of appointment times, including early mornings, evenings and Saturdays Modernised facilities, with improved, more welcoming surroundings and all the necessary equipment A greater range of specialities offered in each outpatient clinic centre Where appropriate in some cases fewer face-to-face appointments will be needed as the use of technology is expanded over the next few years, and More one-stop sessions combining assessment, tests and treatment planning all on the same day phased in over coming years. In doing this, the Trust is proposing to consolidate its outpatient clinics onto six sites around east Kent its five hospitals in Ashford, Canterbury, Margate, Dover and Folkestone and a centre to serve people living along the north Kent coast. The Trust has looked at four possibilities for the outpatient centre on the north Kent coast and compared the facilities each of them offers. Having considered the pros and cons of each site, the Trust would prefer to base the sixth centre at Estuary View Medical Centre in Whitstable. The proposals are part of the Trust s clinical strategy for outpatient services. The strategy also includes plans to make its outpatient appointment booking systems more efficient to cut down on cancellations and numbers of patients who do not turn up for their appointments. The Trust wants to invest in improving the outpatient departments at the William Harvey Hospital, Ashford, the Kent and Canterbury Hospital at Canterbury, and the Queen Elizabeth The Queen Mother Hospital at Margate, and has already made improvements at the Royal Victoria Hospital in Folkestone, to enable the Trust to provide one-stop services in an up-to-date, pleasant environment. A few years ago, Eastern and Coastal Kent Primary Care Trust (PCT) consulted the public on The Dover Project Your Say and the effect it would have on services provided in Dover, Deal and the surrounding areas. As a result, the Trust is investing 23 million to rebuild the facilities at Dover to provide up-to-date, modern facilities for the south Kent coast population. Dover s new hospital will open in In summary, over the next few years the Trust aims to save patients a number of journeys to clinics using new technology to work smarter by developing a one-stop approach for people who currently have to make several trips in preparation for an operation. Please take the time to tell us what you think, either online, by using the survey, by letter or phone, or in person. Details for doing so are on page 25. What you tell us will influence our decisions. Dr Anne Greenhalgh Medical Director, Clinical Support Division East Kent Hospitals University NHS Foundation Trust Who is the Trust? PULL-OUT SURVEY INCLUDED East Kent Hospitals University NHS Foundation Trust has earned a reputation for safe and effective care by continually searching for improvement and better results for patients. The Trust strives to achieve the best for people in east Kent and, while it recognises that staff work extremely hard to deliver a safe and high quality service, it knows there is always room for further improvements. Although it achieves good outcomes for patients, the Trust is clear that improved treatments require improved facilities. It also knows that it needs to make the best use of the resources that it has. 2 I Outpatient Services in East Kent Outpatient Services in East Kent I 3

3 It would be ideal if I could see everyone (chiropodist, Paula Carr eye scan, consultant, and dietician) all on the same day as I work away. FOLKESTONE OUTPATIENT YOUR VIEWS ARE IMPORTANT TO US Outpatient services are those where patients attend a hospital or clinic but do not stay overnight. These services may include a consultation with a healthcare professional, tests and images (such as X-rays or scans) being taken, a treatment plan being agreed, or treatment being given. The four NHS Clinical Commissioning Groups that oversee healthcare in east Kent buy outpatient services for local people from a number of organisations. Some of these are local to the area and others which may offer the patient more choice or more specialist care are further afield, such as in London. East Kent Hospital University NHS Foundation Trust is the largest provider in east Kent, seeing 700,000 people a year. NHS Canterbury and Coastal clinical commissioning group consists of 22 practices across Canterbury, Faversham, Whitstable, Herne Bay, Sandwich, Ash and the surrounding rural areas. As commissioners they recognise the impact of the proposals on their area, they want to improve services, and they are very interested in hearing local people s opinion on the outpatient proposals. So NHS Canterbury and Coastal CCG has agreed to partner the Trust in the consultation process within their area, to hear your views. Their ambition is to secure the best value and highest quality from local services, at a time when health services are seeing more people every year and the national call to action is challenging health and social care to think differently to secure the future of the NHS. The Trust has engaged with all the CCGs in east Kent over the last two years. Ashford, Thanet and South Kent Coast CCGs have decided that they will be consulted by the Trust about the outpatient proposals. The four NHS Clinical Commissioning Groups (CCGs) that between them cover east Kent are: Ashford Canterbury and Coastal South Kent Coast Thanet Tenterden NHS Ashford CCG Canterbury NHS Canterbury and Coastal CCG NHS South Kent Coast CCG NHS Thanet CCG Dover Margate NHS Canterbury and Coastal CCG is undertaking a review of community based services to ensure they offer the best value for local people and make the most effective use of resources. Local people and partners such as local councils, social care and providers of community based services will be integral to creating a shared, sustainable plan for the future of health and social care. At a time when many public services are planning a future with less funding, how services make best use of what already exists will be crucial. Outpatient Services in East Kent I 5

4 Evening or weekend appointments would be preferable as I am not always available during working hours. THANET OUTPATIENT WHAT WE ARE CONSULTING YOU ABOUT East Kent Hospitals University NHS Foundation Trust (the Trust) provides the majority of outpatient services to people in east Kent and it is these services, currently provided from 15 places, that we are consulting you about. The Trust believes it can improve patients experiences of the outpatient services it offers providing more convenient appointments in modern clinical premises. This consultation is seeking your views on the Trust s proposals to reduce the number of places where it offers outpatient clinics to east Kent residents, from 15 to six. This is in order to: Improve access by making a wider range of outpatient services available on six sites in east Kent, so that more people will be able to have appointments within a 20-minute drive of home. Improve patient experience by offering outpatient clinics where a better range of facilities is available (for tests, X-rays, and scans) to help doctors diagnose patients conditions faster, assisting development of the one stop approach. LOOKING AHEAD The Trust is piloting advanced technology to improve patient experience. Some patients can have their condition monitored in their own home by a clinician in the hospital, who liaises with them about their treatment. New technology also enables a GP in their own surgery to speak about a patient s condition with a specialist hospital clinician via a video link. The use of this type of technology is growing slowly across the country and the Trust intends to develop a comprehensive choice of technology in east Kent over the coming years. This kind of approach is especially good for patients with long-term conditions. In the future, patients may even be able to use their home television or computer to take advantage of opportunities to speak to clinicians. This means there will be less necessity to visit a hospital and people will get better support in their own homes. What we are not consulting you about The proposed changes set out in this consultation document will not affect: Renal services; Children s community services; Vascular screening services; Midwifery-led community-based ante-natal and post-natal services, and Nurse-led neurology clinics. We are not planning any changes to these services, so we are not consulting you about them. Also this consultation does not include our inpatient services, or services supplied by other health service providers. While we were doing this work, NHS Swale Clinical Commissioning Group asked us to provide a one-stop outpatient centre in the Sittingbourne area for their patients. We are examining possible locations for this alongside this consultation. This is a commissioned service development and so is included here for information. It does not form part of the consultation. 6 I Outpatient Services in East Kent

5 The waiting area looks a bit tired, but does not reflect on the good service SURVEY Figure 1: The 15 sites where the Trust currently delivers outpatient clinics. Dartford Dartford, Gravesham and Swanley CCG Medway CCG Gillingham 14 Sheerness Swale CCG 15 Sittingbourne 9 Faversham Whitstable 8 10 Herne Bay 7 1 Canterbury Thanet CCG 3 11 Margate Ramsgate Sevenoaks Maidstone Canterbury and Coastal CCG 6 Deal West Kent WHY WE NEED TO CHANGE WHAT HAPPENS NOW The Trust offers more than 700,000 outpatient appointments per year around 240,000 new appointments and 460,000 follow-ups. Uckfield High Weald, Lewes and Havens CCG Tunbridge Wells Hastings and Rother CCG Rye Ashford CCG 2 Ashford 13 New Romney South Kent Coast CCG 4 12 Folkestone Hythe 5 Dover At present, the Trust provides some outpatient services from all the sites shown in Figure 1. They are: 1. Kent and Canterbury Hospital, Canterbury 2. William Harvey Hospital, Ashford 3. Queen Elizabeth The Queen Mother Hospital, Margate 4. Royal Victoria Hospital, Folkestone 5. Buckland Hospital, Dover 6. Queen Victoria Hospital, Deal 7. Queen Victoria Memorial Hospital, Herne Bay 8. Whitstable and Tankerton Hospital, Whitstable 9. Faversham Health Centre, Faversham 10. Estuary View Medical Centre, Whitstable 11. Spencer Wing at QEQM Hospital, Margate 12. St. Saviours Hospital, Hythe 13. New Romney Clinic, New Romney 14. Sheppey Hospital, Sheppey 15. Sittingbourne Memorial Hospital, Sittingbourne In the past, the Trust held clinics at some other sites, bringing the total to 22. This has reduced to 15 over the last few years for various reasons. Demand for services dropped significantly on a number of sites, so that they were no longer viable. The full list of which specialties now provide clinics in each of the current 15 locations is on page 21: in Table 3. Sevenoaks Eastbourne, Hailsham and Seaford CCG Dartford Dartford, Gravesham and Swanley CCG Tunbridge Wells Bexhill Maidstone West Kent Medway CCG Gillingham Hastings Swale CCG Ashford CCG 2 Ashford Sites from where the hospitals trust currently provides services Figure 2: The six sites proposed for a full range of outpatient services in future. Whitstable 10 Canterbury and Coastal CCG 1 Canterbury South Kent Coast CCG 4 Folkestone Thanet CCG 5 3 Dover Margate The Trust proposes that the outpatient services in east Kent need to improve to take account of: Patients views The travelling involved The time it takes to gather all necessary information for diagnosis The equipment required to provide care is not always available The outdated facilities used in some places The availability of appointment times outside normal working hours Uckfield High Weald, Lewes and Havens CCG Eastbourne, Hailsham and Seaford CCG Bexhill Hastings and Rother CCG Hastings Rye Proposed sites where a full range of outpatient services will be provided 8 I Outpatient Services in East Kent Outpatient Services in East Kent I 9

6 HERE, WE EXPLORE THOSE ISSUES IN MORE DETAIL Patients views: Surveys of east Kent outpatient services were carried out in February 2011 and in May 2013, when 75 per cent of patients indicated they would be prepared to travel to another of the Trust s hospitals if they could have their tests on the same day as their appointment. Full details of the survey results are available on The results of both surveys showed that: 80 per cent of patients who responded attended their outpatient appointments by car 70 per cent said they would be prepared to travel to one of the Trust s other hospitals if they could have their tests on the same day as their clinic appointment with the clinician more than 34 per cent would prefer to have their appointments before or after the normal working day 75 per cent would like a Saturday appointment. As a result of these surveys, the Trust also knows that many people want their outpatient appointments to involve less time waiting to be seen and a much wider choice of clinic appointment times, including early mornings, evenings and weekends. It also recognises that on 10 I Outpatient Services in East Kent I sometimes have to wait for over an hour, it would be great if I could have easy access to refreshments. Margaret s story Margaret is a grandmother who lives in Headcorn and sees an eye consultant at the William Harvey Hospital in Ashford. She has developed a dark mole on the lower lid of her eye and went to discuss it with the consultant and they agreed it should be removed. The operation is being done two occasions the clinics run late and patients have to wait for their appointment. In a separate survey in September 2013, outpatients were asked for the top three improvements they would make to the service. Common themes in the responses included: reducing waiting time for appointments improving the timing of clinics having adequate seating better parking tea/coffee facilities. This survey also showed that more than 90 per cent of the patients who responded were in favour of having their assessment, diagnostic tests and treatment plans on the same day and 80 per cent were in favour of extended outpatient clinic hours, in mornings, evenings and weekends. Travel times: The Trust mapped where patients are travelling from for their outpatient appointments. Currently a total of 215,469 patients travel more than 20 minutes drive time for their clinic appointment and often have to visit several different sites for their assessment and treatment. months after that appointment, involving a second round trip of about 50 miles. But the good news is that she is being saved a third trip because she is being given her pre-assessment check in a booked phone call that the hospital will make to Margaret at her home three weeks before her operation. We think this needs to improve. We also know that, as only a few specialities are offered from some of the 15 sites, many patients have to travel to other sites for their clinic appointment. Time taken to gather all necessary information for diagnosis: Currently, when outpatient consultations happen, clinicians are able to ask patients about their symptoms and carry out a physical examination but then have to ask them to go on a separate occasion to one of the few places where the tests and images can be done. The patient then has to return another day to discuss the results once they are known. This can take several weeks and the full range of consultations and investigations can often stretch over a month or more. Patients end up spending many more weeks than necessary waiting for each of these appointments. Some patients may also have to come back to an outpatient site for a further follow-up appointment or because they need some diagnostic tests such as an X-ray or blood tests. Others have to return for pre-operative assessments. This means there are a large number of patients who, at present, have to make numerous journeys as part of their outpatient care. Equipment required: Very few of the 15 clinics where outpatient services are currently provided have the full range of equipment to help clinical staff diagnose people s illnesses or the space for modern one-stop clinics. The Trust would like to develop a one-stop approach to its outpatient services so that, over the next few years, increasing numbers of patients can have all their appointments on a single day but it can only achieve this if outpatient appointments are held on the sites that have enough space and the right equipment to provide a full range of services. Outdated facilities: A number of the outpatient locations that the Trust is using need modernising so that they can provide a welcoming environment for patients and relatives and, importantly, support the proposed new ways of delivering outpatient care and treatment. The Trust knows that some of the outpatient facilities it owns and others that it is using (but which belong to other NHS providers) are below the best standard. This can result in clinic waiting areas being too small for the number of patients being seen, as well as meaning clinicians do not have all the modern equipment or technology they need to care for patients. Certainly, most of these facilities are not equipped with the kind of technology required for modern healthcare and they lack the capacity to provide the one-stop outpatient clinics. Alan s story Alan is nearly 50 and lives in Whitstable, about eight miles from the Kent and Canterbury Hospital. He was referred to the neurology Consultant because of his persistent headaches. The only clinic was at the William Harvey Hospital in Ashford, a round trip of 42 miles. Knowing the traffic is sometimes difficult, he arrived early for his nine o clock appointment, to find there was a delay because the consultant was stuck on a train not her fault, these things happen. After about half an hour, a nurse came and explained the delay, apologised profusely and made everyone a cup of tea. An elderly lady arrived on a trolley with a care worker for one of the other two clinics using the same waiting area. The obvious solution was to wheel her into the consultant first, but when they asked the man waiting for his 9am appointment if he minded her going first, he said yes. She was seen after staff intervened. Alan said: It all seemed a bit chaotic, really. There was a lot of coming and going as people went off for tests and the clinic could do with a little modernising. I think the staff could be more discreet in their conversations, especially about other staff and departments. The doctor when we saw her was lovely and very thorough, really good. I have a repeat appointment in three months, which came through within four days.

7 It would be good if I could just turn up and have everything done on one day and stop having to use my holiday for two or three appointments. WHAT WE WANT TO DO Over the past two years, the Trust has taken account of the survey findings and discussed its outpatient services with a wide range of people and groups, who have said how they think these services need to be improved. The Trust has used this feedback to develop the proposed improvements. In essence, the ideas are to: Improve the booking system to allow the Trust to make more use of facilities and offer a greater range of outpatient appointments and services from each site Improve patient access by providing outpatient appointments early in the morning, later in the evening and on Saturday mornings Make sure outpatient facilities are fit for purpose and meet patients needs and the requirements of the Equalities Act Make better use of technology to reduce the number of clinics patients have to attend for face-to-face appointments, and Reduce the number of trips patients have to make by developing one-stop outpatient clinics, where patients receive their assessment, diagnostic tests and treatment plan on the same day. THE PROPOSAL IS THAT: aeast Kent s outpatient services are consolidated in six co-ordinated outpatient clinics, instead of the current 15 sites, and that these centres will: Mean substantially more patients receive their outpatient care within a 20-minute drive of home Offer an extended working day Be fit-for-purpose, modern and welcoming to people of all abilities Have sufficient space to accommodate the clinics and the extended range of equipment needed to inform clinicians diagnosis and patients treatment decisions Facilitate an increase in the use of technology over the next few years, and Enable the Trust to increase over the next few years the number of patients who can attend a one-stop clinic on a single day instead of having to visit several places spread over several weeks. I want to be able to have a seat while I am waiting for an appointment, too often there is not enough room. SURVEY 2013 What do you think? What do you think about these ideas? Are there any other ways we could improve patients experience of outpatient services? Outpatient Services in East Kent I 13

8 b The proposed clinic centres are based in places that are all able to fulfil the requirements set out in section a) on the previous page. William Harvey Hospital, Ashford Kent and Canterbury Hospital, Canterbury What do you think? What are your thoughts on the proposal to have six outpatient clinics? cthe Trust has looked carefully at four locations from where it currently delivers some outpatient services in the north Kent coastal area, to see if one of them could accommodate an outpatient centre. These are: Faversham Health Centre (FHC) Whitstable and Tankerton Hospital (W&T) Estuary View Medical Centre in Whitstable (EVMC) and What do you think? Queen Elizabeth The Queen Mother Hospital, Margate Buckland Hospital, Dover (developing more fully when the new hospital opens in 2015) Royal Victoria Hospital, Folkestone (except MRI) Site on north Kent coast Queen Victoria Memorial Hospital, Herne Bay (QVMH) The Trust proposes that the sixth clinic centre should be located on the north Kent coast at Estuary View Medical Centre. In an option appraisal the Trust compared 17 aspects of the facilities the four places currently offer and considered what investment would be needed to make them suitable (see Table 1). What do you think about the points the Trust has compared between these sites? Are there any other aspects of the facilities that you think should be considered? The Trust concludes that: Faversham Health Centre does not have enough space to provide a one-stop outpatient centre with the range of equipment and specialties that would make it work well for patients and clinicians Queen Victoria Memorial Hospital at Herne Bay would require significant investment to install modern diagnostic facilities and does not have as many other related services on the same site as the medical centre What do you think? What are your thoughts on the preferred option for the north Kent coast? Whitstable and Tankerton Hospital does not have enough space to provide a one-stop outpatient centre with the range of equipment and specialties that would make it work well for patients and clinicians, and Estuary View Medical Centre is a purpose built modern facility, offering a wide range of existing facilities which is well located to serve patients on the north coast and is therefore the Trust s preferred option for the sixth outpatient clinic centre. Table 1: Summary of the option appraisal by the Trust 14 February 2013 SITE X-ray and ultrasound tests Pathology services including blood tests Facilities for MRI scanner Availability of Ophthalmology clinic equipment Bariatric facilities (for very obese patients) Decontamination of endoscopes Related services in the same place Technology links for Telemedicine Percentage of patients in north coast within 20 minutes drive by car Dedicated car parking Faversham Health Centre Whitstable & Tankerton Estuary View Medical Centre QVMH Herne Bay Unavailable Unavailable Available Limited availability (4 days only) Limited availability Unavailable Available 5 days a week Unavailable Unavailable Available (portable unit) Available 5 days a week Unavailable Limited availability Available Available Unavailable Unavailable Unavailable Unavailable Available Unavailable Unavailable Available Unavailable GPs, MIU, pharmacy None GPs, theatre, pharmacy and MIU Feasible Feasible Feasible Feasible 57.4% 74.8% 100% 74.8% Next to pay & display 100+ spaces Approximately 15 spaces Approximately 135 spaces Public transport Good Good Some bus routes and improvements planned Suitable clinical rooms Adequate waiting area that meets disability requirements Building fabric and facilities Disability and Discrimination Act compliance Buildings that are fit for purpose Able to provide one-stop clinics with diagnostics Podiatry theatre Approximately 45 spaces Good Limited availability Limited availability Available Available Yes Yes Yes Yes Poor Poor Excellent Good Limited compliance None compliant Compliant Compliant Design unsuitable Design unsuitable Yes Yes No, due to lack of diagnostics and lack of rooms No, due to lack of diagnostics and lack of rooms Yes - able to provide one-stop with diagnostics Limited diagnostics and availability of rooms Full details of the option appraisal are available from 14 I Outpatient Services in East Kent Outpatient Services in East Kent I 15

9 d The Trust wants to develop the use of new technology. Telehealth is a way of treating patients in a separate location from the clinicians. This is remote patient monitoring. The Trust is piloting some telehealth initiatives and demonstrating that patients can benefit from not having to return to hospital for blood pressure checks or other types of monitoring. Telemedicine can improve access to healthcare by using remote consultations between health professionals. This is currently used around the country and is beneficial for GPs who can contact hospital clinicians via a computer and speak to each other via a video link. Digital First is a Department of Health initiative that aims to reduce unnecessary face-to-face contact between patients and healthcare professionals by using technology. The Trust is committed to exploring and using these initiatives and over time will increase the use of this modern technology to improve the patients experience by reducing travel and visits to hospital sites. It would be nice to have my appointments at one hospital. What do you think? What do you think about these ideas to use more technology to work smarter? e With the Trust s six site model, the Trust will be able to develop the one-stop approach. The one-stop clinic model offers - on the same day: your first appointment at a Consultant s clinic, where you talk to the clinician about your condition all relevant diagnostic tests (X-rays, scans, blood and/or urine tests) a proposed treatment package based on the test results, which you discuss with the doctor leading your care the choice of a mutually convenient date for your treatment or operation any pre-assessment tests needed for that treatment or operation What do you think? What do you think of the one-stop approach for outpatient clinics? Do you support the proposal to expand the one-stop shop approach? Parking and transport Patients have indicated that two important issues for them are parking and public transport. Previously patients had to guess the length of time they would need for their visit and buy a ticket to cover it. This led in some cases to patients paying too much to make sure they were covered, but for those whose time ran out, it could end in a parking ticket. In the autumn a significant improvement was made by introducing Pay on Foot to the car parks. Patients only pay for the time they use. A ticket is given on entry to the car park and you pay for the time you have used at a machine just before you leave. Patients have also said they would like to see improvements in public transport to hospitals. In response discussions have been taking place with transport providers to introduce seven new routes across east Kent and to increase the frequency of services on other routes. Outpatient Services in East Kent I 17

10 My carer works in a school, so evenings and weekend would be better. BENEFITS OF THESE PROPOSALS The proposals offer a range of benefits to patients. 1. Less travelling for more people: The Trust checked the travel times for patients around east Kent and worked out how they would improve if the proposals in this document are put in place. The results are shown in Table 2, with significant increases in the numbers of patients within a 20 minute drive of one of the proposed outpatient clinic centres. Table 2: Travel times for patients in each of East Kent s Clinical Commissioning Group areas Clinical Commissioning Groups Canterbury and Coastal Percentage of patients currently within 20 minutes drive Percentage of patients within 20 minutes drive in the future Number of patients currently within 20 minutes drive 69% 90% 127, ,418 Thanet 84% 97% 135, ,652 Ashford 83% 94% 101, ,905 South Kent Coast 53% 62% 111, ,019 TOTAL 70.1% 83.5% 475, ,994 Number of patients within 20 minutes in the future for the proposed six sites The travel times analysis also found that: more than 91,000 additional people will be within 20 minutes drive of their appointments 71,000 people will have their journeys reduced to some extent even if their drive is more than 20 minutes About 25,000 appointments (3.6 per cent) would involve people travelling further than they do currently. 2. Wider choice of appointment times: The Trust looked at patients comments about the choice of clinic times on offer. Both the Trust and the CCG agree it is too restrictive and know a number of patients would appreciate a more flexible and extended range of available appointment times. In the Trust s outpatient surveys in February 2011 and May 2013, people were asked which appointment times they would prefer: Early morning Daytime Evening Outpatient Services in East Kent I 19

11 Table 3: Summary of where the Trust proposes services will be provided from in the future. Results were broadly the same for each survey: Around 25 per cent people who responded would prefer early morning appointments Around 60 per cent would prefer daytime appointments and About 13 per cent would prefer evening appointments. People were also asked about whether they would like Friday evening, or Saturday appointments. A little over 50 per cent would be prepared to attend a clinic on Friday evening Around 75 per cent would be happy with a Saturday clinic The Trust plans to extend the working day for outpatient clinics. Most specialties will offer three sessions Monday Thursday, with only the first two on Fridays: Early (7.30am 11.00am) Day (11.30am 3.00pm) Late (3.30pm 7.00pm) The Trust also proposes to run outpatient clinics on Saturday mornings with appointments between 9am 11.30am. 3. A greater range of specialities offered in each site: The extended range of specialties that would be available in the proposed six outpatient sites is shown in Table More opportunities for one-stop clinics: The Trust has already begun to deliver some of its outpatient services through one-stop models of care, for example in Urology and Breast Surgery outpatient services. The Trust is expecting the number of patients able to take advantage of these improvements to grow over the next three years. All of this on a single day in a single place only about 20 minutes car drive from home for most people. 5. Fewer face-to-face appointments as the use of new technology expands: Telemedicine and telehealth are growing initiatives across the NHS and Trust clinicians have been looking at opportunities to use them for some time. SPECIALITY Breast surgery Cardiology Cardiothoracic surgery Clinical haematology Clinical oncology Colorectal surgery Dermatology Endocrinology Ear Nose Throat Gastroenterology General medicine General surgery Geriatric medicine Gynaecology Haematology Haemophilia Nephrology Neurology Nuclear medicine Service improvements to reduce follow ups Telemedicine improvements expected One stop work increasing as appropriate William Harvey Hospital Kent & Canterbury Hospital Queen Elizabeth The Queen Mother Royal Victoria Hospital Folkestone Dover Buckland Hospital Estuary View Medical Centre Queen Victoria Hospital Deal Whitstable & Tankerton Hospital Faversham Health Centre Queen Victoria Memorial Hospital Herne Bay New Romney Clinic Sheppey Hospital Sittingbourne Memorial Hospital St Saviours Hospital Hythe Spencer Wing at QEQM Margate Obstetrics Jenny s story Jenny, who is in her 60s, found a lump in her breast. She was very anxious because her family has a bad history with breast cancer, so she mentioned to her GP that she has private health insurance because her late husband wanted to be sure she could get prompt treatment if she ever needed it. Her GP, who had herself had breast cancer, persuaded Jenny to give the NHS a chance with the Trust s one-stop breast clinic. (All suspected cancer patients are seen within two weeks.) I was extremely impressed, Jenny said. My appointment was at 9.50am and by 11.50am I had seen the consultant, had a mammogram and an ultrasound and I had seen the consultant again and got my results. Everyone was really kind and gentle and they were all so efficient at the same time. I really hadn t expected to have such a good experience, so I had to write and say thank you to all concerned. Jenny lives in Stelling Minnis, so she is about 10 minutes from the Kent and Canterbury Hospital, with William Harvey Hospital about 20 minutes away. Jenny chose to drive for just under an hour to the clinic at Queen Elizabeth the Queen Mother Hospital in Margate as this was the earliest offered appointment. Peace of mind is the most important thing, she said. Ophthalmology Oral surgery Orthodontics Orthopaedics Paediatrics Pain management Restorative dentistry Rheumatology Thoracic medicine Trauma Urology Vascular surgery Hand therapy Neuro physiology Occupational therapy Orthotics Physiotherapy Pre-assessment Speech and language therapy Activity increase Activity will increase at this site No change There will be no change to the current service New service A new service will be provided at this site The service is currently not provided at this site No future service The service will no longer be delivered at this site 20 I Outpatient Services in East Kent Outpatient Services in East Kent I 21

12 6. Fit-for-purpose facilities: In addition to opening the new Dover hospital in 2015, the Trust plans to improve the outpatient facilities at its other sites over the next few years. Over 5 million is to be spent on improving these facilities at the Queen Elizabeth The Queen Mother Hospital in Margate, Kent and Canterbury Hospital, Canterbury and the William Harvey Hospital in Ashford. Helen s story Helen is a nurse living and working in Folkestone. She was sent for an MRI scan by her GP when he referred her to the Ear, Nose and Throat Consultant for problems with her nose and sinuses. She went to William Harvey Hospital, Ashford, for the scan before Christmas 2012, a 27-mile round trip. Her clinic appointment in February was at the Royal Victoria Hospital, Folkestone, first thing one afternoon, where the Consultant decided to use an endoscope to examine her. He saw her again at the end of the clinic to discuss putting her on the waiting list for an operation. She had to take most of the afternoon off for her pre-assessment checks at Kent and Canterbury Hospital in June, a week before the surgery. The timing of this was important because the Consultant wanted her to get antibiotics at the same time. The journey was 34 miles. This fragmented process disrupted three work days, took more than six months with all the anxiety of not knowing what would happen or when and involved three trips to different hospitals totalling 61 miles of driving. If she could have had it all done in one day at the new hospital in Dover, she would have known the whole picture within a few hours, had one disrupted work day and one round trip of just 22 miles. 7. Value for money: The proposals have financial benefits for patients and the Trust with the potential for savings for commissioners in the medium/long-term. Patients will save on travelling and the time taken for the current system involving several different appointments. The CCGs will realise long-term savings on the numbers of outpatient appointments they need to fund, which can be reinvested in other services. The Trust will realise savings on the travel expenses of its staff running isolated clinics in a wide range of locations, and on the rent it pays for the rooms in which those clinics are held. 8. Other benefits: The Trust also aims to improve patients experience by streamlining arrangements for making appointments, increasing car parking and investing in public transport to all proposed six sites. In future, for all new patients we aim to contact the patient directly to arrange a mutually convenient date for them to attend. If the patient s next appointment is within eight weeks, a convenient time will be agreed. If the next appointment is more than eight weeks in the future, the patient s name will be registered and eight weeks before their appointment is due the booking clerk will telephone the patient to arrange a suitably convenient time so that cancelled clinics can be avoided and the number of patients who do not attend their appointment is reduced. This will also allow the Trust to establish any special requirements an individual patient may have. WORKFORCE IMPLICATIONS The Trust expects it would take two or three years to put all the changes outlined in this document in place. The Trust has not yet discussed with the staff involved how they would work or how individual jobs might be affected because it does not want to pre-empt the outcome of the consultation. Changes that impact on staff will be implemented through best practice and in accordance with the Trust s policies and national terms and conditions. The Human Resources teams from the Trust (EKHUFT) and Kent Community Health NHS Trust will liaise to ensure that staff employed by the latter to support EKHUFT s outpatient clinics, are managed appropriately within the requirements of good HR practice, national terms and conditions and current employment law requirements. DECIDING THE WAY FORWARD All the feedback received in the consultation will be collated and independently analysed by the University of Kent. This analysis will be presented to the Board of the Trust and the governing body of NHS Canterbury and Coastal CCG. They will consider it in relation to: Equity and equality every patient should receive the same high standards of clinically effective outpatient care. Accessibility a broader range of services should be available as close to patients homes as possible. Choice Patients should have as much choice as possible about appointment times and arrangements, such as one-stop clinics and the use of new technology. Sustainability the changes must link effectively with CCG plans to secure better care for patients with long-term conditions, take account of integrated urgent care, and the review of community based care; and fit with the Trust s clinical strategy and business plans. Value for money services should demonstrate more efficient use of resources. Outpatient Services in East Kent I 23

13 HOW TO PROVIDE US WITH YOUR FEEDBACK Information about the proposals set out in this consultation is available on a dedicated page on the Trust website where you can complete the online survey. Printed copies of the main consultation document and summary document include a pull-out version of the survey and are being made widely available on hospital sites and at current outpatient clinics, in GP practices, leisure centres and community centres. Ten public meetings will be held over the 13 week consultation period so that anyone who wishes to attend and discuss their views first hand with staff and clinicians can do so. If you would like us to come to a local meeting and listen to the views of your group or organisation, please contact us to arrange a date and time. A series of focus groups will be held to gather the views of individuals or communities who are unlikely to contribute to the consultation through the usual routes. PLEASE CONTACT US AT viewsonoutpatient@nhs.net Call: (extension 76727) Write To: Communications Office, Freepost RSGJ-CLYR-UCKY, Queen Elizabeth The Queen Mother Hospital, St Peters Road, Margate CT94AN DATES AND TIMES OF PUBLIC MEETINGS ARE: GLOSSARY Hythe TUE 17 DEC Margate FRI 24 JAN Faversham THU 13 FEB The Imperial Hotel Princes Parade Hythe CT21 6AE 9.30am to 12.30pm Global Generation Church Unit 2 Westwood Industrial Estate Strasbourg Street Margate CT9 4JJ The Alexander Centre Preston Street Faversham ME13 8NZ 9.30am to 12.30pm Ambulatory care Health services provided on an outpatient basis to those who visit a hospital or other healthcare facility and depart after treatment on the same day. Outpatient Someone who has a consultation, tests and/or treatment at a hospital or clinic with no overnight stay. Dover TUE 7 JAN The Ark Noah s Ark Road Dover CT17 0DD 10am to 1pm Whitstable WED 15 JAN Seasalter Christian Centre Faversham Road Seasalter Whitstable 6pm to 9pm Folkestone MON 20 JAN The Grand Hotel The Leas Folkestone CT20 2XL 2pm to 5pm 9.30am to 12.30pm Herne Bay WED 29 JAN The Kings Hall Beacon Hill Herne Bay CT6 6BA 6.30pm to 9.30pm Deal THU 6 FEB Deal Town Hall High Street Deal CT14 6TR 6pm to 9pm Ashford WED 19 FEB Holiday Inn Ashford Central Canterbury Road Ashford TN24 8QQ 2pm to 5pm Canterbury TUE 25 FEB St Mary s Bredin Church 59 Nunnery Fields Canterbury CT1 3NJ 2pm to 5pm Diagnostic tests Blood or urine tests, X-rays, ultrasound and other imaging techniques that help clinicians see what is happening inside the body to help them diagnose a person s condition. Equalities Act Passed in 1995, this law makes it illegal to offer a public service which is inaccessible to someone because of their physical or learning disabilities. Follow-up A second or subsequent appointment to check on the outcome of a treatment plan. Option appraisal Comparing key points about several alternatives to guide a choice that ensures agreed objectives are met as closely as possible. Pharmacy outlet A chemist s shop which dispenses prescription drugs. Pre-assessment tests Checks made by a nurse before you have an operation or other healthcare procedure. Telehealth Use of new technology to enable a clinician to monitor a patient who is at home. Telemedicine Use of new technology to help clinicians to discuss a patient access to relevant medical images and information. Therapy Treatment that helps you regain your ability to carry out tasks of daily living. 24 I Outpatient Services in East Kent Outpatient Services in East Kent I 25

14 FREQUENTLY ASKED QUESTIONS Have you factored into your planning deprivation and demographics? A wide range of criteria have been used in developing the proposals including capacity at different sites, facilities, access for patients, areas of deprivation and demographics. Why have you chosen to have six sites? The Trust wanted the majority of its patients to be able to access services within 20 minutes drive of their home. This plan will also enable us to offer a full range of outpatient services supported by all the necessary equipment and staff. This would not be possible on a larger number of sites. Will you be providing children s outpatient clinics outside school time, and during evenings and weekends? Yes, there will be clinics offered outside school time, during evenings and at weekends. Will parking be a problem if you are reducing the number of sites from 15 to six? The Trust has looked into this very carefully and believe that adequate parking spaces will be available at each of the selected sites. By extending the clinics working day by several hours the Trust will be making better use of all the facilities, including parking. How does a one-stop clinic work? Patients attend an outpatient appointment where they will be seen by a clinician, have diagnostic tests (X-rays and blood tests for example), discuss a treatment plan and arrange any further appointment where necessary. Patients who may require surgery will also be offered pre-operative checks and should be able to arrange a date for their operation. With the planned reduction in sites, will the six sites become over-crowded? The Trust is proposing to extend the working day and offer Saturday morning clinics thereby increasing the number of appointments, and availability over a longer period. This means that there will not be a concentration of patients attending clinics between 9am and 5pm. The Trust is planning to make improvements to the outpatient departments in the hospitals at Ashford, Canterbury and Margate. Also the new hospital at Dover will have an outpatient department that will be double the current size, and the preferred site for the north Kent coast will have enough room for all patients from that area. As a result of these improvements patients should find the facilities more comfortable than they do now. Why is Deal Hospital not one of the six sites being consulted on? A few years ago, Eastern and Coastal Kent Primary Care Trust consulted the public on the Dover Project your say and the effect it would have on services provided in Dover, Deal and the surrounding areas. As a result of that consultation and its outcome, the Trust is investing 23 million to re-build the Dover Hospital to provide up-todate, modern services for the south Kent coast population. Dover s new hospital will open in early NHS South Kent Coast CCG are separately working with their GP members and local people on potential services to be provided from Deal hospital. Deal hospital will provide an on-going hub for community services and may include outpatient style services where these are needed locally. Why can t you keep all my outpatient services open at my local hospital on the north Kent coast (Faversham/ Whitstable/ Herne Bay)? The number of patients using the Trust s services at each of these sites is small due to the facilities available. The proposed new outpatient clinic on the north Kent coast will be able to cater for all these patients to the highest modern standards. It is not financially possible to run services from multiple sites and bring all of these sites up to the required standard. Does this mean my local community hospital will close? No, changing where outpatient clinics are provided does not mean community hospitals will close. As with all potential change it provides local people and the NHS with an opportunity to consider how community hospitals might usefully contribute to the future of health and social care. NHS Canterbury and Coastal CCG is undertaking a review of community based services to ensure they offer the best value for local people and make the most effective use of resources. Local people and partners such as local councils, social care and providers of community based services will be integral to creating a shared, sustainable plan for the future of health and social care. At a time when many public services are planning a future with less funding, how services make best use of what already exists will be crucial. Why is the NHS in East Kent not looking at all these issues together? The four Clinical Commissioning Groups (CCGs) do work together, however the proposals for the outpatient services affect the different CCGs and their patients to different degrees. Three of the clinical commissioning groups: NHS Ashford, NHS South Kent Coast and NHS Thanet have considered the proposals and believe that although they will be beneficial to their population by increasing the number of outpatient services provided locally and the quality of facilities available, for many patients services remain largely the same. On this basis it was felt by their Governing Bodies that there was no benefit to being more involved in the consultation. NHS Canterbury and Coastal CCG recognise there will be an impact on more of their patients and therefore they are taking an active role in the consultation itself; to ensure they know what the views of local patients, carers and member practices are before they make their final decision on the proposals. I don t have a car and I can t drive, are there good public transport links to each of the six sites? The Trust has looked into this thoroughly and each of the sites has good public transport links. It is also working with Stagecoach to improve some bus routes and the frequency of bus services. If I attend a one-stop clinic which is going to take several hours will I be able to leave the clinic to get a drink and something to eat? Each of the six sites will have a snack bar, restaurant or shop available where people will be able to buy refreshments. The outpatient nurses will ensure you don t lose your place in the clinic schedule. Isn t this just all about saving money? While there will be some financial benefits and financial prudence is required in all aspects of public services, the key driver behind these changes is to improve the services so that patients have a much better experience and greater access to outpatient services. Will you text me to remind me of my appointment time like my dentist or hairdresser does? Yes, the Trust has already started to do this and plans to roll this out to all patients who would like it over the next year. When I arrive for my outpatient appointment, how will I check in? Each of the sites will have a central outpatient reception where you can speak to a member of staff and there will also be a self check-in screen available similar to those used at your local GP surgery. This consultation document discusses proposed changes to EKHUFT s outpatient services. No inference should be drawn about either the services or facilities offered by other healthcare providers. 26 I Outpatient Services in East Kent Outpatient Services in East Kent I 27