Excellence and Choice Right Treatment, Right Place A Consultation on a Proposal to Reorganise the Delivery of Acute Services in Belfast UROLOGY 5 July 31 October 2010
Contents Foreword Patricia Donnelly, Director of Acute Services... 3 Executive Summary... 4 1. Introduction Right Treatment, Right Place... 6 2. How are urology services currently delivered?... 8 3. Why reorganise urology services now?... 11 4. Consideration of options for urology services... 14 5. What would this mean for patients, staff and hospitals?... 17 6. Workforce... 20 7. Your chance to have your say Consultation Questions... 21 Appendix 1 Programme of Consultation and Your Invitation to Comment... 22 Appendix 2 Equality and Human Rights... 24 Appendix 3 Glossary... 25 Availability in other formats If you have any queries about this document, and its availability in alternative formats then please contact: Orla Barron Acting Health & Social Inequalities Manager 1 st Floor, Graham House Knockbracken Healthcare Park Saintfield Road, Belfast BT8 8BH Tel: 028 9096 0069 Fax: 028 9056 6701 Textphone: 028 9090 2863 E-mail: orla.barron@belfasttrust.hscni.net Page 2 of 25
Foreword Patricia Donnelly, Director of Acute Services We want health and social care in Belfast to be the best. We want our hospitals to provide safe, efficient, high quality care that meets patients needs and that s what this document is about. We re aiming to offer higher standards of care through the reshaping of our services. Any changes we make would only happen after we have listened to everyone s views. As a new Trust formed in 2007 from six previous Trusts in Belfast, we were always going to look at areas where we were duplicating effort or had an opportunity to work more effectively on behalf of service users. In 2008 in our New Directions consultation document, we opened a conversation on the best way to deliver services in Belfast over the next decade. The attached document is part of the next steps. It represents a formal consultation on specific proposals for service change in Urology services. Under the banner of Excellence and Choice these proposals give more detail on how we might change services for the better. Urology is an important part of our hospitals work. Our urology teams deal with everything from incontinence to specialist reconstruction and cancer treatment. At the minute, we deliver urology services in Belfast City Hospital, Mater Hospital and Royal Hospitals and we believe there are real benefits for patients and staff in bringing these separate services together. We are therefore proposing that the three separate Urology services currently located at the Belfast City Hospital (BCH), Mater Hospital (Mater) and the Royal Hospitals (RGH) are combined at the Belfast City Hospital to form a specialist Urology inpatient service and day case for Belfast and across Northern Ireland. It is important that the Trust delivers services locally where possible; therefore urology outpatient services would continue to be delivered from the Belfast City Hospital, the Mater Hospital and the Royal Hospitals. We want to do all of this to ensure patients get the best treatment possible, by the right person, in the right place, at the right time. First, we want to listen to you. I hope you would take the time to read this document and let us know your views on the proposals. We remain committed to making improvements and delivering the type of service you expect. Help us to get it right. Patricia Donnelly Page 3 of 25
Executive Summary What is Urology? The urology service is the assessment, diagnosis and treatment of urogenital conditions, such as diseases of the kidney, bladder, prostrate and genital areas, bladder dysfunction and continence along with specialist reconstruction surgery and cancer treatments. The service is currently provided mainly at the Belfast City Hospital (83% of inpatient and day case service), in the Mater Hospital (15% of inpatient and day case service) and a day case service at the Royal Hospitals (2% of service). Two of the Trust s acute hospitals, the Belfast City Hospital and Mater Hospital, currently deliver both elective (planned) and non-elective (emergency) urology inpatient services as well as day case procedures. Ninety percent of urology service is a planned or elective service. The Belfast City Hospital provides all urology services, from core urology which covers problems with the kidney, bladder and male reproductive organs, to the specialist work of bladder construction and cancer treatments. The Mater Hospital concentrates on core urology work, with diagnostic cancer work, while the Royal Hospitals provide a single day case list. All three hospitals provide outpatient services, which are not part of this review, and existing local outpatient arrangements will continue at the three acute hospitals; Belfast City Hospital, Royal Hospitals and Mater Hospital. Service Location Options Considered The Urology multi-disciplinary project team, including service users and trades unions, identified the following service options for the delivery of urology services: Options for Consideration 1. Continue with current delivery of urology inpatients and day cases at all three hospitals (Belfast City Hospital, Mater Hospital and the Royal Hospitals). 2. Deliver all inpatient and day case urology at Belfast City Hospital. 3. Deliver all inpatient and day case urology at the Mater Hospital. 4. Deliver all inpatient and day case urology at the Royal Hospitals. 5. Deliver all inpatient urology on Belfast City Hospital and all day case at Mater Hospital. 6. Deliver all inpatient urology at Mater Hospital and all day case urology at Belfast City Hospital. Page 4 of 25
Service Recommendations In summary, the project team recommendations were that: 1. Urology services should be located together at one acute hospital for the key benefits of streamlined clinical pathways, team working, clinical rota management and efficiency in service delivery; 2. The Belfast City Hospital offers the best location for the single urology service for Belfast because: The Belfast City Hospital has the key urology clinical linkages with gynaecology and cancer services for both the inpatient and day case service. This single service across Belfast will help deliver the Regional Review of Urology 1 which has specifically identified that specialist inpatient services would concentrate in Belfast. Developments in urology will continue to require greater use of day surgery and short stay (23 hour) units. When the proposed expanded day surgery unit at Belfast City Hospital is in place, it is envisaged that a proportion of existing inpatient work will transfer to day surgery services. Given that 90% of Urology activity is elective (planned) work, a more efficient service can be provided by bringing the staff and resources together in the appropriate facilities. Table 1 summarises the current and proposed location of urology services. Table 1 Urology Services - Current and Proposed Service Location(s) Urology Services Current Location(s) Proposed Location(s) Core Urology Belfast City Hospital Belfast City Hospital /Mater Hospital Uro-Oncology Belfast City Hospital Belfast City Hospital Stones/Endourology Belfast City Hospital Belfast City Hospital Andrology Belfast City Hospital Belfast City Hospital /Mater Hospital Reconstruction Belfast City Hospital Belfast City Hospital Female Bladder Dysfunction Belfast City Hospital Belfast City Hospital 1 Regional Review of Urology,2009, DHSSPS Page 5 of 25
1. Introduction Right Treatment, Right Place The creation of the Belfast Trust has provided us with the opportunity to review how we can continue to improve quality, efficiency and sustainability of our acute services for the longer-term. The Belfast Trust s overall purpose is to improve health and well-being and reduce health inequalities putting people at the centre of all decisions, providing services locally where possible and making the best use of our buildings and other resources. We are also making sure there is no unnecessary duplication of services and our modernisation programme MORE 2 (Maximising Outcomes, Resources and Efficiencies) is helping us find the significant efficiency savings that the Northern Ireland Assembly has asked all public bodies to make. This document describes the range of urology services that we provide, how we are proposing to redesign them and our commitment to ensuring they are of the highest possible quality. The Trust proposal is for the three separate Urology services currently located at the Belfast City Hospital, the Mater Hospital and the Royal Group of Hospitals to combine at the Belfast City Hospital to form a specialist Urology service. However, it is important that the Trust delivers services locally where possible; therefore Urology outpatient services would continue to be delivered from the Belfast City Hospital, the Mater Hospital and the Royal Hospitals. The Trust has produced this document to ensure that our staff, service users, carers and the public at large have an opportunity to provide their views on the new model for service delivery. The Trust previously consulted, in New Directions, on the direction of travel for all services delivered in Belfast. Ten overarching principles were identified which have guided our approach to reviewing and reorganising services. Specific principles were identified for acute services, children s services, mental health and other services. Those principles of specific relevance to urology services are: To provide safe, high quality, effective care This is a core objective of the Belfast Trust. Localise where possible, centralise where necessary Services are more easily accessed by people when they are delivered locally, while specialist services benefit from the concentration of expertise and experience required to deliver the highest possible levels of clinical care. The Trust therefore aims to provide its services locally where the standard of service can be assured and centralise its services where it will raise the quality of provision. 2 MORE - (Maximising Outcomes, Resources and Efficiencies) is the co-ordination of strategic, clinical, operational and financial performance to deliver the best possible care for patients and deliver maximum value for money. Page 6 of 25
Provide clear directions to services, developing clear pathways to access appropriate care. To develop protected elective services. To reduce unnecessary duplication and fragmentation of services. Maximise utilisation of assets There is a clear need to make best use of all existing health and social care infrastructure across the Trust and keep the need for new buildings to a minimum while also addressing risk issues, such as those attached to ageing buildings. In addition, New Directions proposed that there would be differentiation of services to improve patient care, based on the type of patient s condition and needs: Belfast City Hospital as the centre for cancer, renal and a range of general acute hospital services, with an increased focus on elective services and chronic conditions management; Royal Hospitals as the centre for major trauma services, including a heart centre, with an increased focus on emergency services; Mater Hospital as the centre for ophthalmology services and general acute hospital services; Musgrave Park Hospital as the centre of specialist rehabilitation services. Page 7 of 25
2. How are urology services currently delivered? The urology multi-disciplinary team is made up of urology surgeons, anaesthetic specialist nursing staff, and administration staff. Traditionally the field of Urology was one of the many that was delivered by general surgery. In the past 30 years Urology has developed and evolved as a separate surgical specialty. Higher specialist training in General Surgery no longer covers Urology, which now has its own training programme. 2.1 What is Urology? As a specialty, urology can be sub-divided into a number of special interest areas, most of which also comprise elements of general or core Urology work. Core Urology involves the diagnosis, medical and surgical treatment of diseases of the kidney, bladder and male reproductive organs. Urologists, regardless of special interest area, all provide core urology services. Uro-Oncology. Around 40% of urology work is cancer related and most of the diagnostics and medical or simple surgical treatments are appropriately undertaken outside of the regional centre. Less than 10% of urological cancers require radical/complex surgery. Specialist cancer services are based in Belfast City Hospital, where there are designated cancer urologists. Stones/Endourology includes the management and treatment of renal and ureteric stones. This involves open surgery, endoscopic intervention or stone fragmentation using a range of techniques and is provided at the Belfast City Hospital. Andrology includes the treatment of erectile dysfunction, particularly post prostate surgery, penile curvatures and deformities (Peyronie s disease) and other conditions of the male reproductive organs and is provided at both Belfast City Hospital and Mater Hospitals. Reconstruction: includes reconstruction of urinary continence in men, bladder reconstruction after oncological surgery and in a neuropathic bladder, bladder reconstruction in congenital and developmental difficulties and reconstruction prior to transplantation. The Consultants in Belfast City Hospital who specialise in this area work closely with the uro-oncology team and supra regional support is provided by University College Hospital London. Female/functional Urology relates to the management and treatment of incontinence and bladder dysfunction in women, which on some occasions overlaps with reconstruction surgery. Some of this work is undertaken by urologists at Belfast City Hospital although the majority is undertaken by Uro-Gynaecologists. Page 8 of 25
83% of the total inpatient and day case service is provided at the Belfast City Hospital with 15% at the Mater Hospital and 2% at the Royal Hospitals. Patients can access the service in one or more of the following ways: As an inpatient: an admission to hospital which includes an overnight stay As a day case: surgical treatment which is carried out in a single day, without the patient having to stay in hospital overnight As an outpatient: care provided on an appointment basis without requiring admission to hospital. Urology outpatient services are not part of this review. Inpatient general surgery can be delivered along one of two key pathways: Elective: This is when treatment has been planned and booked in advance, for example a patient who is placed on a waiting list for an operation and then brought into hospital on a prearranged day. This is the majority (90%) of urology work. Non-elective or emergency: This is when a patient accesses urology without prior planning, for example via one of the Trust s Emergency Departments. Two of the Trust s acute hospitals, the Belfast City Hospital and Mater Hospital, currently deliver both elective and non-elective Urology inpatient services as well as day case procedures and outpatients. The Royal Hospitals delivers day case and outpatients only. The cancer treatment services are primarily delivered at Belfast City Hospital although there is some cancer diagnostic work undertaken at the Mater Hospital. Total inpatient and day case activity is shown in Figure 1. Figure 1 sets out the Urology inpatient Finished Consultant Episodes (FCEs) and day case activity across the Trust. Page 9 of 25
Activity Figure 1: Urology Activity in Finished Consultant Episodes (FCEs) for Elective and Non Elective Inpatients 2009/10 Urology Inpatient FCEs and Daycases 2009/10 9000 8000 7000 6000 5000 4000 TOTAL Daycases 2009/10 3000 TOTAL Inpatient FCEs 2009/10 2000 1000 0 BCH MIH RVH Locations Source: Belfast Trust Information Department May 2010 Page 10 of 25
3. Why reorganise urology services now? The formation of the Belfast Health and Social Care Trust provides an opportunity to build on the existing high quality urology services, ensuring that patients consistently get to the right person, in the right place, at the right time. There are a number of factors that contribute to this proposal to reorganise urology services now. These include the need to: Address current duplication and service efficiency The way in which specialties have developed across Belfast s acute hospitals has resulted in a fragmented system. The urology services at Belfast City Hospital and the Mater Hospital developed separately whilst a single day surgery session at the Royal Hospitals was established to support the local urology need at this hospital. There is a small consultant base at the Mater Hospital whilst the Belfast City Hospital and Royal Hospitals share a larger team of consultants. Bringing services together would enable services to provide clinical cover more efficiently for example, at present, patients who are diagnosed with cancer at the Mater Hospital are referred to the Belfast City Hospital for their follow on treatment. Improve clinical linkages, where possible Patients who need urology services often have to access other services in the management of their condition. Urology services should have ready access to the specialties of gynaecology and cancer services which is more easily achievable at the Belfast City Hospital. In addition, out of hours urology patients at the Mater Hospital are assessed by General Surgery Specialist Registrars whereas, in the Belfast City Hospital, they are assessed by Urology Specialist Registrars. Deliver compliance on medical staff rotas Contractual arrangements for doctors specify the maximum shift length and minimum break entitlements which must be provided on compliant rotas; otherwise non-compliant rotas bring financial penalties on the Trust. In order to implement compliant rotas, the Trust must have a sufficient number of doctors in post and this is increasingly difficult in services like urology that are split across two or more sites, particularly at the Mater Hospital, which has a limited number of consultant staff. Hospitals which do not have compliant rotas are less likely to attract doctors in training and services can become unsustainable. Act on Staff Support The urology clinical teams in the hospitals believe that there are potential benefits in bringing specialties together in the same hospital to form a dedicated specialist urology unit, for example, ensuring the sustainability of specialist services, flexibility in developing staff rotas, improved access to specialist nursing and other limited resources, improving team working and quality of service to the patient. Page 11 of 25
Drive forward service modernisation The Trust and the urology service will need to continue improving the efficiency of its service provision, including additional improvements in length of stay, admission on day of surgery and increased day surgery rates. This is particularly important given the tight financial constraints faced by the Trust. 3.1 What are the main benefits of reorganising urology services? Having identified the key reasons to review urology services, there are a number of benefits for patients, staff and the hospitals which must be delivered in any proposed change on delivery or location of service. These were summarised into five key areas, which guided the work of the project team in their review and reorganisation of acute inpatient and day surgery services and they are: The delivery of safe and sustainable services to our patients: Providing safe services and ensuring patients are not at risk in our hospitals is our top priority. Having appropriately trained staff working in appropriately sized teams will assist in both improving patient safety and sustaining the provision of these services. To improve service quality, effectiveness, reduce unnecessary duplication and fragmentation of services and deliver value for money: Maintaining and improving the quality of care experienced by patients is fundamental to any proposals. Reducing the existing duplication of services across three acute sites will mean patients see the right staff in the right place and this will also help teams deliver a more effective and efficient service. The Trust must optimise the use of the current operating theatre stock and the support accommodation available to us and ensure that there is some room for future growth, should the funding be available. To ensure services are appropriately clinically linked: Delivering services at the right time and in the right place requires certain services to be located close to one another; for example, urology patients will potentially need access to gynaecology and oncology services. To ensure services are accessible to service users and carers. Service users, carers, families and visitors want to have easy access to their services, whether by public transport or by car. Page 12 of 25
To ensure the Acute Services Plan is compatible with the Trust Strategic Direction The Trust Strategic Direction, which has been previously publicly consulted upon, for the four adult hospitals is: Belfast City Hospital as the centre for cancer, renal and a range of general acute hospital services, with an increased focus on elective services and a chronic conditions management; Royal Hospitals as the centre for major trauma services, including a heart centre, with an increased focus on emergency services; Mater Hospital as the centre for ophthalmology services and general acute hospital services; Musgrave Park Hospital as the centre of specialist rehabilitation services. The urology project team used these benefits criteria to assess how each service option would deliver improvements for patients and staff and considered their impact on each hospital. Page 13 of 25
4. Consideration of options for urology services A multi-disciplinary project team was established which brought together a broad range of clinical and managerial staff from across the Trust, Consultant Urologists, imaging, nursing, Allied Health Professionals (AHPs), trades unions, service users and other staff identified, and made recommendations on the possible options for the future delivery of the service. The options that were considered by the Project Team were: 1. Continue with current delivery at all three hospitals (Belfast City Hospital, Mater Hospital and The Royal Hospitals) 2. Deliver all inpatient and day case urology at Belfast City Hospital 3. Deliver all inpatient and day case urology at the Mater Hospital 4. Deliver all inpatient and day case urology at the Royal Hospitals 5. Deliver all inpatient urology Belfast City Hospital and all day case at Mater Hospital 6. Deliver all inpatient urology at Mater and all day case Urology at Belfast City Hospital. The project team considered the options against the 5 benefits criteria: To deliver safe and sustainable services to our patients The service is currently provided across three hospitals. The project team consensus was that the current service configuration will not enable the service to meet the challenges of future service delivery as readily as other options. By bringing together all urology services into one acute hospital there are benefits for both service users and staff as the Trust will expect to improve productivity, reduce service duplication and share learning and expertise between staff. For example, urology patients are more likely in the future to receive day surgery treatment rather than be treated as an inpatient. Further additional day surgery facilities will be required to meet this changing profile of urology, which are not available in all hospitals. The limitations on junior doctor availability due to the Working Time Directive means that this medical resource must be better organised in order to make the most efficient use of their time and this can be better accommodated with services on a single site. The majority of urology services, around 83%, are currently provided at Belfast City Hospital and 15% at the Mater Hospital and 2% at the Royal Hospitals. Therefore there is insufficient theatre space for the total service to be provided at the Mater Hospital or the Royal Hospitals. Option 2 at the Belfast City Hospital has the necessary capacity for the service. Page 14 of 25
To improve service quality, effectiveness and reduce unnecessary duplication and fragmentation of services and deliver value for money A single site option would reduce duplication of service provision and would thus improve efficiency. Providing services from one site would yield economies of scale and would ultimately be more resource efficient. Option 2 removes service duplication by locating all services in the Belfast City Hospital. All members of the urology team would be able to work more closely on a single site and therefore share expertise and learning which is key to improving outcomes for patients. Options 5 and 6 do not contribute to improving service quality and effectiveness or reduce unnecessary duplication of services. Rather, they continue with duplication of the urology services across three sites. Urology services in a single hospital would also offer some resource efficiency as a result of economies of scale and the elimination of duplication. To ensure services are appropriately clinically linked At present both the Belfast City Hospital and Mater Hospitals have access to all essential clinical linkages. There are some linkages which urology want to develop further for example, the link with uro-gynaecology, and general gynaecology services, the development of the Laparoscopic Robot, and the link with cancer services. The strengthening of these links would be more difficult if the services remained in two or three hospitals. New Directions proposes that Belfast City Hospital will become the major centre for elective surgery this is a key linkage for urology services. The review is also proposing that Gynaecology Services will be sited at the Belfast City Hospital. Technological advances in robotics can be utilised by uro-gynaecology and thus avoid duplication of investment in equipment. Cancer Services are already provided at Belfast City Hospital. Options 5 and 6 would split the service across two sites, thus compromising the ability to meet all of the required clinical linkages. The Belfast City Hospital offers the best current and proposed clinical linkages for urology. To ensure services are accessible to service users and carers The Belfast City Hospital rates well in terms of accessibility it has good public transport access via train, bus and is situated close to the centre of Belfast thus making it accessible from all parts of Belfast. There are also adequate parking facilities at the Belfast City Hospital, with a number of patient car parks at various locations on the hospital site. Page 15 of 25
The Royal Hospitals has fairly good access to public transport by bus; parking can be an issue on this site and due to the geographical spread of the facilities across the site the proximity of patient car parks to ward areas can vary. Work is ongoing to increase the number of car parking spaces at the Royal Hospitals. In terms of accessibility, the Mater Hospital is fairly well served by bus. Parking provision can be an issue as can the proximity of patient car parks to the wards. To ensure the Acute Service Plan is compatible with Trust Strategic Direction The Belfast City Hospital was identified as the major centre for elective (planned) surgery and, given that 90% of urology activity is elective, Option 2 offers more relevant clinical linkages than Options 3 and 4 and is compatible with the Trust strategic direction. Preferred Option In summary, the project team recommendations were that: Urology services should be located together at one acute hospital for the key benefits of streamlined clinical pathways, team working, clinical rota management and efficiency in service delivery; The Belfast City Hospital offers the best location for the single urology service for Belfast because: - The Belfast City Hospital has the key urology clinical linkages with gynaecology and cancer services for both the inpatient and day case service. - This single service across Belfast will help deliver the Regional Review of Urology which has specifically identified that specialist inpatient services would concentrate in Belfast. Developments in urology will continue to require greater use of day surgery and short stay (23 hour) units. When the proposed replacement day surgery unit at Belfast City Hospital is in place, it is envisaged that a proportion of existing inpatient work will transfer to day surgery services. - Given that 90% of Urology activity is elective (planned) work, a more efficient service can be provided by bringing the staff and resources together in the appropriate facilities. Page 16 of 25
5. What would this mean for patients, staff and hospitals? The proposed model for urology is outlined below: The development of a single specialist inpatient and day case unit for elective and emergency urology services in Belfast at the Belfast City Hospital. Table 2: Urology Service - Current and Proposed Service Location(s) Urology Service Current Location(s) Proposed Location(s) Core Urology Belfast City Hospital/ Belfast City Hospital Mater Hospital Uro-Oncology Belfast City Hospital Belfast City Hospital Stones/Endourology Belfast City Hospital Belfast City Hospital Andrology Belfast City Hospital/ Belfast City Hospital Mater Hospital Reconstruction Belfast City Hospital Belfast City Hospital Female Bladder Dysfunction Belfast City Hospital Belfast City Hospital 5.1 What does this mean for patients? A single site location for urology services at the Belfast City Hospital will have advantages for patients, across Belfast and Northern Ireland: Providing safe and sustainable services By providing a single consultant on call and junior doctor rotas, patients will have access to these staff on site 365 days per year. This is not currently available at the Mater Hospital and is more sustainable in a single specialist unit. Improving service quality and reducing duplication A single site urology service provides the opportunity to provide more modern service delivery, for example, 23 hour stay for some procedures. This will reduce service duplication caused by referring patients between the Mater Hospital and Belfast City Hospital and ensure the scarce specialist resources, such as specialist nurses who also support provision of the diagnostic cystoscopy services, are available equally to the population. Page 17 of 25
Accessible for users and carers Belfast City Hospital is in an accessible location for the population of Belfast and Northern Ireland, with good car parking and public transport access. By bringing the service together at the Belfast City Hospital, this will improve equity of access for patients, whereas previously the service delivery by the single consultant at the Mater Hospital would have reduced during leave and absence. Ensure services are appropriately clinically linked Patients would benefit from further development of linkages between urology specialists and cancer services and gynaecology, which are proposed to relocate fully to Belfast City Hospital. 5.2 What would this mean for each hospital? The delivery of safe and sustainable services Junior doctor rotas would provide cover across the service and a single consultant on-call rota will be established. All urology services would be delivered in a specialist unit in the Belfast City Hospital. This would lead to more efficient management of patients, eliminating inequality of access to surgery and improving quality of care for patients, and helping the Trust to meet waiting time targets for the benefit of patients. Compatibility with the Trust Strategic Plan Given that 90% of the urology service is elective (planned), this proposal is compatible with the Trust Strategic Plan, with the Belfast City Hospital as the main centre for elective surgery. Ensuring Services are appropriately clinically linked The key urology linkages are at the Belfast City Hospital with cancer services and gynaecology, which is proposed to relocate fully to the Belfast City Hospital. As well as all the benefits for clinical working, this would ensure joint access to technological advances in robotics which will be particularly valuable to urogynae. 5.3 What would this mean for staff? Ensuring Services are appropriately clinically linked All members of the urology team would be able to work more closely on a single site, sharing expertise and learning which is key to improving outcomes for patients. The urology team would have an increased opportunity to engage in multi-disciplinary working with colleagues in, for example, gynaecology and cancer services. Multidisciplinary working has been shown to improve patient outcomes. There would be a greater number of urologists and other multi-disciplinary team members available for a single site rota than is possible with the current situation. Staff would benefit Page 18 of 25
from delivering a Urology service which is more flexible to meet need and respond to the Working Time Directive challenges as a result of combining services at the Belfast City Hospital. Improving service effectiveness and reduce duplication The urology team would be able to better utilise its staff, facilities and equipment when located in one centre and not split across three hospitals. In addition, all specialist urology equipment would be based in one centre instead of duplicated on two or three sites, as is the case currently, providing improved efficiencies in the service. Page 19 of 25
6. Workforce The Trust would put in place a range of support mechanisms for staff to manage the potential change process. These may include: Staff support Career counselling Training in application and interview preparation Retraining/re-skilling for new roles Advice and guidance on Human Resource policies and procedures The main impacts anticipated for staff are: Relocation If the proposal is approved, it would require the relocation of some staff to facilitate all Urology services being delivered at the Belfast City Hospital. The Trust has in place agreed protocols with Trade Unions on relocation and/or redeployment. The protocols have been developed in recognition of the fact that location of work is of major importance to staff, and to provide assurance, guidance and a process incorporating best practice, and the provision for regional agreements on excess mileage and the application of the Trust s flexible working agreements. Consideration may be to redeploying staff to other posts in the Mater Hospital. New ways of working/retraining or reskilling As the Trust is proposing to provide all urology services on the Belfast City Hospital, staff would be offered appropriate training/retraining if their job roles change. The Trust would work in partnership with Trade Union Side to consider how it would minimise any adverse impact on the workforce resulting from the proposed changes. Page 20 of 25
7. Your chance to have your say Consultation Questions The Trust wishes to consult as widely as possible on the proposal. Please use this consultation questionnaire to register your comments by 31 October. Appendix 1 provides additional information on the Trust s communication, consultation and engagement processes and how you can be involved. 1. Do you agree with the proposal to bring urology services onto a single acute hospital site? 2. Do you agree with the proposal to locate urology services at the Belfast City Hospital as part of the major elective centre. 3. If you do not agree with the proposal to locate urology services at the Belfast City Hospital, where do you think the service should be located and give your reasons. Page 21 of 25
Appendix 1 Programme of Consultation and Your Invitation to Comment This document is one of a suite of documents that represent a formal public consultation between Belfast Trust and the citizens we serve on how we would like to deliver our acute services. The consultation period will open on 5 July 2010 and close on 31 October 2010. All the documents will be available to our staff and the public using both the Trust s intranet and internet pages, and by posting them to relevant organisations. We will hold a series of meetings with staff, Trade Unions, service users, carers and clients to ensure they are fully engaged in the consultation papers. A report will be presented to Trust Board in December 2010. The Trust Board meeting is open to the public. We are committed to ensuring that we consult broadly on these proposals. If you have any enquiries regarding the consultation programme, please contact the Communication Department at Belfast Trust on 9096 0077. Your invitation to comment Please tell us your name and address at the beginning of your reply. If you are commenting on behalf of an organisation, please tell us its name and what it does. If you have consulted other people or organisations, please let us know. Responses in writing should be sent to: William McKee, Chief Executive Belfast Health and Social Care Trust c/o Public Liaison Services Communications Department 1 st Floor, Nore Villa Knockbracken Healthcare Park Saintfield Road Belfast BT8 8BH Alternatively, comments may also be emailed to: stakeholdercomms@belfasttrust.hscni.net Page 22 of 25
Availability in other formats If you have any queries about this document, and its availability in alternative formats then please contact: Orla Barron Acting Health & Social Inequalities Manager 1 st Floor, Graham House Knockbracken Healthcare Park Saintfield Road, Belfast BT8 8BH Tel: 028 9096 0069 Fax: 028 9056 6701 Textphone: 028 9090 2863 E-mail: orla.barron@belfasttrust.hscni.net Freedom of Information Act (2000) Confidentiality of Consultations Belfast Trust will publish an anonymised summary of responses following completion of the consultation process; however your response, and all other responses to the consultation, may be disclosed on request. We can only refuse to disclose information in limited circumstances. Before you submit your response, please read the paragraphs below on the confidentiality of consultations and they will give you guidance on the legal position about any information given by you in response to this consultation. The Freedom of Information Act gives the public a general right of access to any information held by a public authority, in this case, Belfast Trust. This right of access to information includes information provided in response to a consultation. We cannot automatically consider information supplied to us in response to a consultation as information that can be withheld from disclosure. However, we do have the responsibility to decide whether any information provided by you in response to this consultation, including information about your identity, should be made public or withheld. Any information provided by you in response to this consultation is, if requested, likely to be released. Only in certain circumstances would information of this type be withheld. Page 23 of 25
Appendix 2 Equality and Human Rights Equality and human rights underpin the services that health and social care provide. They are integral to all functions of the Belfast Health and Social Care Trust such as service delivery, policy formulation, employment and procurement. The Trust recognises that equality in health and social care is not about people getting the same treatment equality means people accessing person-centred, person-led, quality care which meets their needs. Human rights are founded on 5 fundamental values: fairness, respect, equality, dignity and autonomy. The Trust has incorporated both respect and dignity in its corporate values and behaviours. Moreover, the Trust s higher purpose is to improve health and well-being and reduce health inequalities - by working in partnership with others and by engaging with staff to deliver safe, improving, modernising cost effective health and social care. Under Section 75 of the Northern Ireland Act 1998, the Belfast HSC Trust is obliged to consider the implications for equality of opportunity and good relations. As part of this assessment, the Trust also considers implications for human rights and disability. This means the Trust is not only morally and ethically bound to deliver its acute services to its users in an equitable fashion with respect and dignity; but it also is statutorily bound to do so. Section 75 of the Northern Ireland Act 1998 Section 75 (1) of the NI Act 1998 requires Belfast HSC Trust, in carrying out its work, to have due regard to the need to promote equality of opportunity between persons of different religious belief, political opinion, racial group, age, marital status or sexual orientation, between men and women generally, between persons with a disability and persons without and between persons with dependants and persons without. Section 75 (2) requires the Trust to promote good relations between persons of different religious belief, political opinion or racial group. The Trust is carrying out an equality impact assessment on this proposal to ensure that it undergoes a full and systematic analysis to firstly, determine the extent of differential impact upon the 9 aforementioned groups and secondly establish if that impact is adverse If so, the Trust must consider alternative policies to better achieve equality of opportunity or measures to mitigate the adverse impact. The Belfast Health and Social Care Trust is committed to listening to the view of staff, service users, carers and families and advocacy groups and the wider public and making an informed decision on the basis of these consultation responses. Page 24 of 25
Appendix 3 Glossary Glossary of abbreviations AHP BCH ED EQIA WTD FCE NIAS RGH SpR Allied Health Professional Belfast City Hospital Emergency Department Equality Impact Assessment Working Time Directive Finished Consultant Episode Northern Ireland Ambulance Service Royal Group of Hospitals Specialist Registrar Glossary of terms Allied Health Profession Day case Elective surgery Emergency surgery Working Time Directive Finished Consultant Episode A clinical profession distinct from medicine, dentistry and nursing, such as physiotherapy, occupational therapy, speech and language therapy and dietetics A surgical procedure carried out without an overnight hospital stay A surgical procedure which has been planned and booked in advance A surgical procedure which is of an urgent nature and has not been planned or booked in advance A law seeking to protect the health and safety of workers which limits the number of hours that doctors are allowed to work over an average week An episode of medical treatment during which a patient is under the care of a single, named consultant Page 25 of 25