Frequently Asked Questions (FAQs) Clinical Futures (including The Grange University Hospital)

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1 Frequently Asked Questions (FAQs) Clinical Futures (including The Grange University Hospital) What is Clinical Futures? Clinical Futures is the Health Board plan for a sustainable health care system for the whole of the NHS across the Gwent area. It includes our plans for GP services, hospitals, clinics, and mental health together with services that are provided out in the community closer to where people live. Why is the Clinical Futures plan needed? Many of us are now benefitting, living longer, and leading much more active lives as a result of the advances in healthcare that the NHS has brought us e.g. more sophisticated medicines, research, advances in surgical techniques etc, but the success brought about by these advances also presents considerable challenges. Whilst most people will remain fit and well into old age, others may fall ill and in many cases they will have quite complex illnesses that take time to assess and treat. Medicine has advanced so far and now in 2017 we are treating many, many more people than ever before. This often adds significant pressure on the entire healthcare system e.g. busy GP practices, emergency departments and increased waiting times for treatment that lots of people require, such as orthopaedics and ophthalmology. For this reason we must plan across the board, in all our services from those that keep people well and out of hospital, services in hospital, and also critical care for the most serious conditions. The 3 main ways the local NHS provides care for you and your family are as follows: Care Closer to Home Over recent years we have been expanding the range of services available in communities, including realistic alternatives to hospital admission. We have been investing much more in services that support people to stay at home and keep them independent.

2 We have invested in our Frailty Teams and Falls Prevention, we also now have pharmacists, social workers and dieticians based in many or our GP surgeries to support the practice to provide a comprehensive service locally. The emphasis is much more on primary care (services outside hospital) and in community services to give people improved local access for diagnosis and treatment. Our aim is to provide as much treatment as possible close to home, without the need for a hospital admission. Hospitals, Clinics and Health Centres When people do require hospital admission, or treatment in a clinic, our existing hospital buildings will continue to provide modern local services such as rapid access to diagnosis, emergency assessment and routine services like day and short stay surgery. We have an expanded network of hospitals across Gwent including two newer facilities in Ystrad Mynach and Ebbw Vale. Both of these hospitals have single rooms to ensure privacy and dignity and the high standards of infection control. We are also bringing more of our services into single locations e.g. in new Primary Care Resource Centres, where GPs, Pharmacies and Optometrists are in one place, and in some of our hospitals where we are developing centres of excellence. This means that all the medical expertise can be available in one place and can avoid patients needing to make multiple trips for different appointments in many cases everything can be done in one visit. Critical Care For the small number of people who are seriously ill and require critical care The Grange University Hospital (formally known as Specialist Critical Care Centre) will provide a Centre of Excellence where you can receive rapid access to a full range of specialist and critical care services. All 999 ambulance calls for serious conditions would take patients from across Gwent to The Grange University Hospital. This hospital is currently being built just outside Cwmbran on the Llanfrechfa Grange Hospital site (close to the Police Headquarters). However, certain cancer treatments, head injuries, major heart surgery and serious burns will continue to be carried out in regional centres in the same way as they are now. Please see our Frequently Asked Questions on the Grange University Hospital. What is The Grange University Hospital? It is a brand new hospital with 471 inpatient beds (around 560 including trolley spaces) located near Cwmbran for people across Gwent that need highly specialised services or critical care. It was formally known as Specialist Critical Care Centre. Work has now started on site and the hospital will be completed in 2021.

3 The Grange will contain all the critical care services in one place, this will include 24 hour assessment unit for major emergencies, resuscitation, intensive care etc. It will be the main hospital in Gwent for people that have suffered a heart attack, a stroke, a major accident, require major surgery, or other highly specialised care. There will be no outpatient clinics in The Grange so patients would only be admitted into the hospital in one of two ways: Following an emergency by ambulance e.g. suspected heart attack, stroke, or serious accident. Or, having been referred by their GP for a specialist service provided in The Grange eg major surgery, high risk birth, paediatric inpatient services. Critical care services that are currently in the Royal Gwent Hospital and Nevill Hall Hospital will move to The Grange. The full range of services available in the hospital are listed below. How much will it cost and where is the funding from, is it funded by PFI? It is not a PFI scheme. It will cost circa 358 million (plus inflation) of public funding from Welsh Government. What services will be in The Grange Major Emergency Treatment and Assessment Unit Critical Care Beds Acute Cardiac beds including Cardiac Catheter Laboratories Inpatient services for complex and major conditions Major elective (planned) surgery, for example colorectal surgery and major head and neck surgery Emergency General Surgery Acute Medicine This group of patients would include anyone identified by Welsh Ambulance Trust, The General Practitioner and / or pre hospital assessment as potentially requiring the services provided at The Grange University Hospital. This could be due to their past medical history, the complexity of their current conditions or their presenting symptoms. Trauma and elective orthopaedic patients with co-morbidities Those who are likely to require intensive care post operatively Haematology inpatients

4 Vascular Surgery Dependant on the future location of a potential centralised SE Wales Vascular Service Obstetrics led births Consultant led Maternity inpatients and Emergency Gynaecology Emergency endoscopy for patients that are actively bleeding Inpatient Paediatrics and Paediatric Emergency Assessment Neonatal Intensive Care and Special Care Baby Unit Diagnostics / Investigations including Radiology, CT, MRI, Interventional Radiology, Ultrasound to support the clinical services What kinds of conditions will be treated in The Grange? Emergency cases requiring resuscitation Heart attack Stroke Major surgery Intensive Care Emergency surgery & trauma Children s inpatient services and surgery Neonatal Intensive Care for babies Emergency endoscopies Obstetric inpatient treatment & high risk births Emergency assessments Where will all the staff come from? Most staff will transfer from services that currently provide critical care in the Royal Gwent Hospital and Nevill Hall Hospital. We are already receiving lots of interest from around the UK from health professionals that wish to work in a centre providing a high standard of critical care (Centre of Excellence). There will also be new roles developed within the centre. Are there wards in The Grange? Yes, there are 15 wards some of these are specifically for critical care, cardiology and paediatrics. The wards mainly comprise 32 beds with 24 single rooms with en-suite bathrooms and 2 x 4 bedded bays. Will patients from outside Gwent be treated in The Grange?

5 Patients from South Powys that require the services provided in The Grange might also be taken there, if a visitor to the area were suddenly taken ill they could be treated firstly in The Grange and then moved closer to where they live for recovery and rehabilitation. Where will I go for Accident and Emergency Treatment? eg If my lad broke his leg playing football on Saturday, where would I take him? Firstly the injury would need to be properly assessed to find out how serious it is, e.g. whether or not surgery would be needed. This assessment could take place at the Royal Gwent Hospital, Nevill Hall Hospital and Ysbyty Ystrad Fawr in Ystrad Mynach. If the injury could be treated at one of those hospitals there would be no need to transfer the patient to The Grange. For major accidents and critical care paramedics would take the patient straight to The Grange. Whilst there is no walk-in Accident and Emergency Department in the hospital, if a patient was critically ill or injured and arrived by other means (not an ambulance) they would still be seen and assessed. Will you still have to go to Cardiff for major heart surgery? Yes, regional centres of excellence will still provide treatment and care for people from across Wales. So, some treatments for cancer, serious head injuries, major heart problems and serious burns will be carried out in regional centres in Cardiff and Swansea in same way as they are now. What about ambulance response times? Can they get to The Grange quickly? The Health Board has worked closely with the Welsh Ambulance Services NHS Trust on the development of the plans for and carried out travel time analysis across Gwent, for all the population to be served by The Grange. This was the determining factor about where the hospital is located. There will also be a helipad there for the Welsh Air Ambulance helicopter. A lot of Nevill Hall Hospital patients come from the valleys and Powys. What if there are problems on these rural roads? The Health Board is working with the Welsh Ambulance Service to work through the transfer of patients to The Grange and they are well rehearsed in alternative routes should road problems occur. The hospital will also have a helipad so extremely critical emergency patients can be taken there very quickly, if this is deemed to be the best option for the patient. Where does funding for the helicopter come from? The helicopter is primarily provided by the Welsh Air Ambulance, which is charitably funded, and sometimes a Forces (Army) helicopter can be used. There are 4 air ambulances stationed in Wales. Each helicopter can be launched within

6 3 minutes of receiving an emergency call. From three airbases, a helicopter can be anywhere in Wales within just 20 minutes. Can I choose to have my baby delivered at The Grange? Higher risk births will take place at the hospital and generally low risk births will take place in birthing units at our other hospitals. The midwifery team that provide care will be able to give advice on individual delivery plans. As there are no outpatient clinics in the hospital, won t that cause inefficiency by making medical teams work across multiple sites? The Clinical Futures Strategy focuses on providing local services for the majority of patients with The Grange providing specialist services. As significant numbers of patients use outpatient services it was decided that these should remain in local hospitals. The hospital also brings together specialist services that are currently provided across two sites, Royal Gwent Hospital and Nevill Hall Hospital, thus reducing duplication, the number of rotas required etc. This will also improve compliance with national junior doctor training requirements. Will there be any Mental Health Services in The Grange? There will be no dedicated Mental Health facilities at The Grange but Mental Health staff will work in the hospital in integrated teams. Providing high quality mental health services will remain a priority for us and these will continue to be delivered from our existing sites. Will consideration be given to for people with dementia? We are currently developing wayfinding and signage for the hospital, we also have an overall Art and Design Strategy for the hospital that will consider the environment of individual departments. Patient and visitor safety will have the highest priority and every consideration will be given to patients with dementia, or any other issues that challenge their ability to navigate the hospital safely and with ease. How much parking will be available? In The Grange there are over 1,000 car park spaces on site split between staff and visitors and agreed with the Local Planning Authority. As critical care services move out of the Royal Gwent Hospital and Nevill Hall Hospital and into The Grange pressure will ease on both of these very busy sites.

7 Can Llanfrechfa Grange staff park in the Laing O Rourke car park that was built directly in front of the Old Grange House car park now that Laing O Rourke have vacated it? The Laing O Rourke car park was built by them for the duration of the hospital project and after the hospital is finished they are required to restore back to original land. However, it is likely we will ask it is left as it is and become part of our overall complement of car parking. In the meantime Laing O Rourke require the car park and whilst seems under used at present is needed for the big meetings and supplier events as the site is getting busier in terms of staff. We can review with them periodically but for now it is not available for Health Board use. Will there be any provision for cyclists on site? There will be provision for external undercover cycle storage for around 100 bikes at The Grange. There are also showers and changing facilities close to the main entrance. There will be a green travel plan for the hospital, and whilst the Health Board will not be developing cycle paths or routes off the site, cycling will be an important part of the plan. How do you get there? The hospital will provide specialist, complex and critical care so most people would be taken there by ambulance. The Grange will not provide outpatients services. Visitors can get there via road links to the hospital primarily the A4042 from Newport and Abergavenny. It is currently being built on the old Llanfrechfa Grange Hospital site in Cwmbran, close to the Police Headquarters. The Health Board is currently working on a travel plan which will involve local transport providers. We will also be working closely with Welsh Ambulance Services NHS Trust, not only for emergency transport, but also for general patient transport. What public transport will be available to go to the site? There will be a public bus service to the site and discussions with services providers will take place to assess frequency and timing of these routes. We are also investigating public transport links between our existing hospitals as part of a Gwent wide travel plan. Will there be Wi-Fi for patients and visitors? Yes, public Wi-Fi services will be available at The Grange.

8 How will the roads around the site change? Work on the road system started during the initial construction phase of the building. There will be a new roundabout on Caerleon Road just after leaving the A4042 before the current hospital drive. This will include a road to the emergency entrance for ambulances, a road to reach the car parks and main entrance, and a service delivery road. What will happen to the rest of the Llanfrechfa site? Is there still a plan for housing? The Torfaen LDP (Local Development Plan) continues to reserve the land to the right of the hospital main drive for housing, but there are no plans to build houses at this time. However Grange House (the old house on the right hand side of the site) is a listed building and will continue to provide office accommodation for the Health Board. What happens to the Accident and Emergency Departments at the Royal Gwent Hospital and Nevill Hall Hospital? Highly specialist services to treat patients with conditions that are serious and immediately life threatening will move out of the Royal Gwent Hospital and Nevill Hall Hospital and into The Grange when it opens. These will include many services like the following Hyper acute stroke services Cardiac care Critical care Intensive care This means that in an emergency patients who need to be treated by a specialist team will go directly to The Grange where the highest levels of care and diagnostic support will be available 24 hours a day, 7 days a week. The A&E Departments at The Royal Gwent Hospital and Nevill Hall Hospital will need to change as they will no longer have the full range of back up services to support a full A&E Department. It is important to remember that the number of patients with very serious life threatening conditions are actually a small proportion of the number of patients that go to A&E, so significant numbers of patients will still be seen at Royal Gwent Hospital and Nevill Hall Hospital.

9 What happens to hospitals like Ysbyty Ystrad Fawr and Ysbyty Aneurin Bevan? These are our two newest hospitals in Ystrad Mynach and Ebbw Vale and they will continue to grow and develop as more services are provided from them. Both have all single rooms with en-suite bathroom facilities which makes them extremely good for infection control. We still need all our hospitals, these newer hospitals, and hospitals such as Chepstow Community Hospital and County Hospital. They will continue to provide services as they have done in the past i.e. treatment that doesn t need to be carried out in a critical care environment. We will also continue to develop services across our network of hospitals, Primary Care Resource Centres and clinics. What will replace the critical care areas in Royal Gwent Hospital and Nevill Hall Hospital? The hospitals will continue to provide many diagnostic, treatments, therapies and inpatient care. We are currently looking at options to make optimum use of the space released by The Grange, we want to rationalise older accommodation on these sites in the future. In Caerphilly many people are sent on to the Royal Gwent Hospital from Ysbyty Ystrad Fawr, will the new hospital opening mean that people are sent on there? There will be a jointly agreed protocol with Welsh Ambulance NHS Trust and our clinical staff to ensure that in an emergency the ambulance takes the patient to the most appropriate hospital for their treatment and care. If a patient attends at any of our other hospitals they would be assessed and treated where it is clinically most appropriate for their condition. They would only be referred onto The Grange if their condition was critical or life threatening. What arrangements will be in place to transfer patients from The Grange to their local hospital? We are working closely with Welsh Ambulance Services NHS Trust and they would provide patient transport between our hospitals. The Gwent wide travel plan will also consider other non-emergency transport between all our hospitals and local transport networks. Why is so much investment being put into the critical care, isn t it Social Care that needs more money? Our Clinical Futures plan redefines the whole system of care. The Grange will provide just one element of the whole healthcare system in Gwent.

10 It s a key piece in the jigsaw to complete our network of hospitals. The larger element of the system is the development of community and primary care to be able to support people help themselves to stay healthy and independent without the need for hospital admission. The Health Board will continue to work closely with local authorities to strengthen the capacity for all social care services for the citizens of Gwent. How does The Grange compare to the University of Wales Hospital in Cardiff? The University of Wales Hospital in Cardiff provides a full range of inpatient and outpatient services from very serious conditions to minor conditions for the population it serves. It is also a regional centre for specialist services (for all South Wales) for such illnesses as brain injuries, major heart surgery and organ transplants. The Grange is a dedicated centre for critical care and specialist services for Gwent and South Powys. There will be no routine outpatient appointments at The Grange. Routine planned operations (for conditions that are not critical), outpatient services, rehabilitation and general diagnostics will continue to be provided at our existing range of hospitals. Are you adopting a local jobs for local people policy during the build? Who is the contractor please? The contractor for the hospital is Laing O Rourke and they are making every effort to recruit locally. Obviously there are a huge range of skills employed on the site and for some specialist work they may need to go out of the area to recruit people with those skills. When The Grange is complete, will there be more or less inpatient beds in the Aneurin Bevan University Health Board area? The new hospital will provide an additional 471 in-patient beds (over 500 including trolley spaces) which will result in a reduction of beds at the Royal Gwent and Nevill Hall Hospital. Further work is now being undertaken to develop the detailed clinical models for the hospital network as a whole, including our community hospitals. This work will determine the overall bed capacity requirements of the Health Board as a whole once The Grange is opened. So overall we expect the Health Board's bed numbers to reduce following the opening of The Grange, it is difficult to say by precisely how many as many clinical models will change over the next few years, this coupled with continuing work to provide much more Closer to Home means that less inpatient beds will be required in the future.

11 Will there be major traffic congestion in the area once The Grange opens? We don't envisage that there will be any major problems with traffic once the hospital opens. There were two independent transport surveys carried out as part of the Business Case for the new hospital to determine its location. This hospital will be very different to the Royal Gwent and Nevill Hall Hospital - one of the main differences is there will be no outpatient appointments carried out there, so fewer people will be coming and going to the hospital. Most of our staff and visitors will access the new hospital from the A4042 and staff at the hospital will be working 24/7 across a range of different shift patterns so there should be no major peaks in traffic. Staff section How many staff will be working in The Grange? We estimate that up to 3,000 staff across a variety of professions will be delivering services at the new hospital site, with a number of these working flexibly across hospital sites. There will be approximately 600 staff working at the hospital at any one time. How can I get involved in the planning of services? Keeping staff engaged in service and workforce changes is important. As the plans progress staff will be kept informed and involved with developments through a variety of communication methods. When will I know where I will be working? We anticipate that staff will know well in advance of the new hospital opening. This will be undertaken through ongoing staff engagement, which will become more formalised once the workforce plans have been fully developed. Will there be staff changing facilities? Yes, there is a large staff change facility including showers and disabled cubicles. Whist staff will not have the same individual locker each time they use it, a locker will be available for the duration of their shift. There will also be facilities to lock small valuables e.g. wallet, mobile phone on wards and in departments. Will I be based at one hospital or move between hospitals? The new hospital network may require staff to work flexibly across hospital sites depending on their skills and patients need. This will become clearer as the detail around service models and workforce plans evolve.

12 Will administration staff move to The Grange? The new hospital will require a range of essential administration staff to be based at the hospital. The increase in use of digital technologies and new service models will improve administration services. Administration support required for clinical services is deemed essential and this will become clearly as these plans progress. Will I require new skills? We value the skills of our staff and the changes will be an excellent opportunity in redefining the skills the Health Board require for a number of years to come. It is likely that some staff will require new or extended skills, these will need to carefully planned and coordinated. You will be supported in developing the skills you require through the PADR process. Will there be new jobs available at The Grange? The new hospital will be staffed through staff relocating from Royal Gwent and Nevill Hall. However, there may be opportunities for staff to take on new roles both in the hospital network and the community setting. What will be my patterns of work? Staff may be required to work different patterns of work to meet service demands and patient needs. You will be engaged and consulted about any proposed changes to working patterns. How will staff be selected to work at each hospital? There are services which will centralise onto one site and staff will be expected to move with these services. Where services will continue to be provided on multiple sites staffing of these services will need to be undertaken through transfer of existing staff skills from Nevill Hall and Royal Gwent Hospital. Staff will be offered to state their preferences of working through their PADR. There will also be additional roadshows and workshops with staff well in advance of the opening of The Grange, providing opportunities for staff to self-select. Further details will be communicated on how this might work once the workforce plan are completed. There may also be formal selection processes through the management of change, where contractual changes are being made. We would hope that the hospital network will offer staff choices to be able to work at multiple sites.

13 How will you find enough doctors and nurses to staff the Grange? Many existing staff will move to work in The Grange plus we have an ongoing recruitment process to attract the best doctors and nurses to work in our area. The hospital will be a major draw for people to come and work for us not only at The Grange but also in our other hospitals as part of an exciting new model of healthcare.