Gwent Clinical Futures Public Consultation Document Blaenau Gwent Local Health Board Caerphilly Local Health Board Monmouthshire Local Health Board Newport Local Health Board Torfaen Local Health Board Gwent Healthcare NHS Trust
Message from Gwent Community Health Council On behalf of Gwent Community Health Council, I am pleased to welcome you to the Clinical Futures public consultation document. It is becoming increasingly clear that the existing pattern of health facilities and ways of working cannot deliver the kind of services you have a right to expect. Health services must change; standing still is not an option. The Welsh Assembly Government document Designed for Life addresses these issues and sets out its plans to create a world class health service for Wales over the next 10 years Now it is your chance to have your say on these radical and exciting proposals. As your local health watchdog we at Gwent Community Health Council will oversee the formal consultation process (starting on 18th September 2006 and lasting for 12 weeks). We will receive and consider all comments made during the consultation period on the proposals outlined in this document. We will then advise the local NHS organisations whether there is sufficient public support for these proposals. The NHS in Gwent is taking the lead in Wales in producing far reaching ideas for your healthcare in the 21st Century. This document sets out options for improving health services in the Gwent area by developing a new way of delivering the health services that local people need. These options are the result of more than 18 months of work and discussion with patients, healthcare professionals and their local communities. The proposals contained within this document, have been developed by local NHS organisations, including Gwent Healthcare NHS Trust, Blaenau Gwent, Caerphilly, Monmouthshire, Newport and Torfaen Local Health Boards. According to these plans, in future more care will be provided direct to you in your home, your GP surgery and some provided in community centres or clinics. Most hospital care will be provided in your Local General Hospital network. Only the most complex care will be delivered in a Specialist and Critical Care Centre that supports the network of Local General Hospitals. Please read this consultation document carefully and take a few minutes to fill in the consultation questionnaire at the back of this document. Your response is important the future of local health services in the Gwent area depends on it. Vernon Caldwell Chairman Gwent Community Health Council 2 Clinical Futures Public Consultation Document
Contents Executive Summary Chapter 1 Why we need to change Chapter 2 Chapter 3 Chapter 4 Chapter 5 Chapter 6 Chapter 7 Improving the health service for the Gwent area Developing a Local General Hospital in Newport Developing a Local General Hospital in North Monmouthshire Developing a Local General Hospital in Torfaen Developing a Specialist and Critical Care Centre Tell us what you think Glossary Consultation form Clinical Futures Public Consultation Document 3
Executive Summary In this public consultation document we explain why change is being proposed to the way in which health services are delivered in Blaenau Gwent, Caerphilly, Monmouthshire, Newport and Torfaen. We also describe the options for the future shape of hospital services. We have for some years now been discussing the possibility of developing a new model of care for the NHS in Gwent. In 2005, Local Health Boards issued a discussion leaflet called Your Healthcare- the Future and invited local people to give their views. The response was overwhelming and resulted in the development of the proposals that are outlined in this public consultation document. The proposals form the Clinical Futures plan for the Gwent area and will change the way we provide local health services by delivering more care closer to where people live, with the aim of providing Safe, high quality treatments within a reasonable timescale in modern facilities that meet your specific needs. Improved local access to clinics, treatments and tests and more support to help you to stay independent. Services that are integrated and ensure that different organisations and health professionals work together across settings to provide continuity of care. To achieve this, Clinical Futures proposes: 4 Clinical Futures Public Consultation Document
More and better primary care services delivered from GP surgeries, resource centres and directly into people s homes (Level 1) A network of 6 new Local General Hospitals delivering many of the services that are currently delivered from community hospitals and District General Hospitals (Level 2) A single Specialist and Critical Care Centre serving all of the Gwent area (Level 3) In this consultation document we ask for your views on the options we have considered for three of the new Local General Hospitals, one each for Newport, North Monmouthshire and Torfaen. We also want your views on the options for the Specialist and Critical Care Centre. Nevill Hall Hospital site or the Maindiff Court Hospital site Torfaen at one of these locations : the existing County Hospital site, or an alterative site. We also propose to build a single Specialist and Critical Care Centre which will serve the whole of Gwent and will therefore need to be located on a site accessible to the entire Gwent patient population. Our proposal is that to benefit the entire Gwent patient population, the most appropriate site would be located either at Llanfrechfa Grange, Cwmbran or at an alternative site within a three mile radius of the Croes-y-ceiliog roundabout and we would like your views on this. Through a separate consultation process we have already received support for the new hospitals planned for Blaenau Gwent and Caerphilly boroughs. These plans are excluded from this consultation process but residents of these areas will still be interested in proposals for the services they will access from the other hospitals in the network. We propose to develop Local General Hospitals in Newport at one of these locations : a new city centre site or an outof city centre site North Monmouthshire at one of these locations: the existing We would like to know which option you think would be best for each hospital and why. There are many ways to become involved in this public consultation and they are outlined in Chapter 7 of this document. Please read this consultation document carefully and take a few moments to complete the questionnaire. Clinical Futures Public Consultation Document 5
CHAPTER 1: Why we need to change Current Services The total area covered by Blaenau Gwent, Caerphilly, Monmouthshire, Newport and Torfaen Local Health Boards is shown in the map above. The population for the whole area is 550,000. Some residents of South Powys, Gloucestshire and Herefordhsire also access services from the Gwent area. services have grown rapidly over recent years, there is not yet an appropriate level of services across all parts of the Gwent area. 12 community hospitals which are focused largely around the Valleys communities. Many of these have served local people well for decades, but are now outdated and no longer appropriate for modern hospital services. Recently there have been good examples of developing new types of service such as the Integrated Health and Social Care Unit at Monnow Vale. Health services are currently delivered in the following way: Primary care services which are delivered by more than 100 GP practices across the Gwent area and a range of optometrists, pharmacists and dentists. Services in some areas are very well developed, whilst in others they are more limited through problems of recruitment and poor primary care premises. Community teams which are available in each borough and support both GP and hospital services by delivering care to people in their own homes. Although these Mental health services which are provided in various locations, often separate from other health services, with facilities that include old institutions such as Maindiff Court and St Cadocs which have long been planned for closure. Learning Disability services are currently provided in community settings and at Llanfrechfa Grange Hospital although these are currently subject to a reprovision programme which will be completed in 2007. Acute hospital services which are provided mainly at the main District General Hospitals sites the Royal Gwent Hospital and Nevill Hall Hospital - with some services also provided at Caerphilly District Miners Hospital. Demand for services at each of the District General Hospital sites has grown significantly over recent years. Tertiary (highly specialised) services are provided on regional or national basis and although some tertiary services are provided by Gwent 6 Clinical Futures Public Consultation Document
Healthcare NHS Trust e.g. Neonatal services for very sick babies, many tertiary services are provided from the University of Wales Hospital Cardiff and some from England. Reasons to change There are many pressing reasons why we need to change the way we deliver health care services in the Gwent area. Health needs are changing More people are living longer which leads to a greater need for support and care. Existing poor health and health inequalities means that the number of people in the Gwent area with ongoing long term conditions such as asthma, diabetes, heart disease, and mental illness is increasing, putting more and more pressure on health services. Better screening programmes for certain conditions such as cancers are also increasing demands on health services as we are identifying and able to treat illnesses earlier. Lifestyle changes over recent years also impact on the type of conditions that the health service cares for such as an increase in obesity, especially in children. Our current services must change to support the pressures arising from an ageing population, improved opportunities to detect illness and an increase in lifestyle related conditions. We must make services more accessible to our population Currently, local access to hospital services is generally limited, with patients having to travel to busy District General Hospitals for many services that could be provided as effectively nearer to home. Waiting times for services are often a problem due to this over reliance on district hospital services. We aim to improve local access to certain services across all parts of the Gwent area by providing more healthcare in the community through GPs, pharmacists, dentists, optometrists and community health and social care teams. In the future we want to make sure that patients see the right person, in the right place and at the right time. We must provide services that are safe and of the highest quality New ways of working and new technological developments mean that we will be able to provide a wide range of services in local communities. However, some specialist clinical staff are increasing their expertise in areas of surgery and medicine, and so raising the standards of safe and high quality treatments. To keep and improve their skills in these specialist areas, such as intensive care, it is essential that these specialists regularly see patients with the conditions they are trained to deal with. The numbers of patients that a specialist needs to see to retain specialist skills is often referred to as critical mass. Today this critical mass for specialist services needs to be based on populations of over 500,000, which is the whole catchment population of Gwent Healthcare NHS Trust. It is not possible to provide specialist services from every hospital if we want to ensure high quality services in the future and so we must change the way we organise our specialist resources. We must recruit and retain the best staff to deliver the best quality care to patients In 2009 new legislation on the maximum number of working hours per week comes into force. This will affect our ability to deliver services and we need to change the way we deliver care to ensure we can continue to provide good quality services. This will mean providing training for a range of healthcare professionals so that they can extend their traditional roles Clinical Futures Public Consultation Document 7
to enable them to carry out additional tasks with new skills and work in new multi professional teams and different working patterns. Many of our current facilities are outdated in terms of design. Limitations in the layout and environment of the buildings adds extra pressure onto staff and we need to address this by improving the working environment. This will help us recruit and retain good staff. In order to ensure high standards we need to attract good quality staff and offer them the opportunity to develop their skills in modern working environments. We must ensure that we have modern buildings which are designed to be fit for the future We know that our current estate and buildings are no longer suitable for modern healthcare services. Over 90% of hospital facilities in the Gwent area are over 30 years old and need an investment of around 80 million to comply with basic requirements. For example: The facilities are not designed for the delivery of modern services and often hinder efficiency and effectiveness. We must ensure that the buildings in which we deliver our health services are well equipped, modern and fit for purpose, supporting staff in the delivery of efficient services and providing therapeutic and healing environment for patients. You have already told us you want healthcare services to change Since February 2003 we have been asking health professionals, patients and members of the public to help describe the future service they want. Over 6,000 people, including 1,000 health care professionals, have directly helped to develop the proposals now presented in this document. Between February and May 2005, the NHS in Gwent developed a discussion leaflet called Your Healthcare The Future outlining the reasons why health services in the area have to change and suggesting a long-term vision for the future. This discussion leaflet was distributed to over 50,000 people, about 4,000 people responded. There was overwhelming acceptance of the reasons for change and support for our plans to change the way we deliver healthcare services, this formed the basis of the Clinical Futures strategy. Standards for cleanliness, privacy, dignity are often compromised because of the restrictions in our buildings and environment. Many sites have car parking and access problems and have limited capacity to expand. 8 Clinical Futures Public Consultation Document
CHAPTER 2 Improving the health service for the Gwent area Clinical Futures will transform your healthcare system. Its objectives are to: Maintain and improve the quality and effectiveness of clinical care and improve results for patients. Improve access by bringing many services closer to where people live. Improve integration and continuity of patient care through networks and strong links between health professionals and locations. Redesign services to target resources at priority areas such as community services. This will mean that there will be fewer people needing to go to hospital and less delays. Ensure that our services and buildings are designed so that they offer a therapeutic and healing environment for patients. Provide services and buildings that are reliable, sustainable and able to serve future generations It is important to ensure that the plans we develop to implement Clinical Futures are realistic and capable of achieving these objectives within a reasonable time. We aim to deliver these objectives by replacing our current system of providing services with a new system focusing on the following 3 new levels of care. Clinical Futures Public Consultation Document 9
Level 1: Out of hospital care The aim is to provide more care directly to people in their own homes and in local communities with a focus on health promotion, preventing ill health and maintaining independence. This will be achieved by increasing services and skills in primary care through GPs, pharmacists, optometrists and nurses. In addition working with our colleagues in the local authorities we will continue to create and expand community teams that integrate health and social care services. This will enable us to provide a more proactive and comprehensive response for people, particularly for those with long term conditions and the frail and elderly. Plans to develop out of hospital services are being progressed by each Local Health Board in the Gwent area to ensure that they respond to local needs and local circumstances. These plans are not part of this formal public consultation process but it is important to have an idea of how services will be delivered at this level in the future as they will work very closely with the new hospital network. Further details of emerging plans are available from your Local Health Board. Level 2: In hospital care Local General Hospitals A new type of hospital called a Local General Hospital will deliver the majority of hospital services, focusing on general and routine care. The Local General Hospitals will provide local access for patients to a broad range of general hospital services, taking advantage of new technology and new ways of working increase integration with out of hospital services to improve continuity of care for patients and ensure appropriate use of hospitals maintain and improve quality of care for patients by working in close cooperation with specialist and critical care services improve the environment for patients, visitors and staff work in support of each other to ensure that the needs of the collective Gwent population are addressed, and so not all of the Local General Hospitals will be the same. We are aiming to develop 6 Local General Hospitals for the Gwent Area based on the needs and characteristics of the population and access to services. In this document we are consulting on options for 3 of these Local General Hospitals; one in Newport, one in North Monmouthshire, and one in Torfaen. More information on each Local General Hospital is found in Chapters 3 to 5. With support from the local population, 10 Clinical Futures Public Consultation Document
Local General Hospitals for Blaenau Gwent and Caerphilly County Borough are already at an advanced planning stage and are due to open in 2009 and 2010 respectively. They are not part of this formal public consultation process. Chepstow Community Hospital, as a relatively new facility will function as a Local General Hospital in the new network. Level 3: Specialist and Critical Care Services A single Specialist and Critical Care Centre will provide care for people who are seriously ill or who have complex problems and cannot safely be cared for in their Local General Hospital. The Specialist and Critical Care Centre will serve the majority of the Gwent population and will: Speed up access to specialist and major emergency care by ensuring patients are directed to the correct services in the correct place as quickly as possible. Improve the quality of specialist care for patients in line with national standards, evidence and best practice. Make these specialist services more reliable and robust, 24 hours a day and sustainable in the future. Provide modern environments that maximise efficiency and effectiveness for patients, visitors and staff. Ensure that scare resources are targeted at patients who most need them Provide the potential to expand the range of tertiary (highly specialised) level services that are delivered and bring more highly specialised services into Gwent. Specialist Mental Health services are a key part of the Clinical Futures programme and detailed options on the future of these services will be consulted on in Summer 2007. This will enable the development of these services to take place in parallel with the hospital network proposed in this consultation. The objectives of clinical futures have been developed through public engagement workshops and used create a benefit criteria framework. The options considered for each new hospital in the network were scored against these benefit critera by clinicians, the Patients Panel and NHS organisations in Gwent. The scoring process identified our preferred options for each of the proposed hospitals based on nonfinancial considerations. The cost of delivering each option will be tested to see which option provides best value for money. We are seeking your views on all options in this consultation document. Clinical Futures Public Consultation Document 11
Working together in a Network Level 1 - Out of hospital services (Homes, GP practices, Resource Centres) Each of level of care has a different role in providing healthcare but all of them need to work together to ensure that patients receive continuity of care. Good communications, increased working between professional groups and the use of advanced technology will all contribute to the development of this network approach. A sample of the scope of services that will be available at each level is shown in the following table. UNSCHEDULED CARE SCHEDULED CARE Urgent treatment and advice Telephone advice and initial contact, Technology assisted self care Urgent response teams Diagnosis and Treatment Services Minor Surgery Some outpatient services, specialist GPs, e.g. dermatology WOMEN & CHILDREN Women and Children s Services Antenatal and postnatal services (midwifery led), Sexual health and Family planning advice, Child Adolescent Mental Health services, Health Visiting and School Nurses INTEGRATED CARE Integrated Care Services Health promotion, Disease prevention, screening and treatment, Detection and monitoring of long term conditions Reablement and Rehabilitation services MENTAL HEALTH & LEARNING DISABILITIES Mental Health Services Community Mental Health Teams, crisis resolution Community Learning Disabilities services, Psychological therapies 12 Clinical Futures Public Consultation Document
Level 2 - Local General Hospitals Level 3 - Specialist and Critical Care Services Urgent or Emergency Care Minor injuries and in some instances emergency assessment observation and admission Major Emergency Care Specialist emergency assessment, emergency surgery, trauma, critical care Diagnosis and Treatment Services Outpatient clinics, tests, investigations and in some instances, day case and routine operations Diagnosis and Treatment Services Complex operations, critical care, sophisticated diagnostics, some specialist outpatient clinics Women and Children s Services Outpatient clinics in appropriate environments, tests, investigations in some instances mid-wifery led birthing units Women and Children s Services High risk births, complex operations such as cancer, acutely ill children, neonatal services Integrated Care Services Rehabilitation, step up/step down care and beds, therapies, palliative care Integrated Care Services These will be provided at local level with the possible exception of some stroke services Mental Health Services Outpatient, day hospital and inpatient care for adults and older adults with mental health problems Mental Health and Learning Disability Services Psychiatric Intensive Care, Assessment and Treatment, Low secure forensic services. These will be provided in a separate unit Clinical Futures Public Consultation Document 13
CHAPTER 3 Developing a Local General Hospital in Newport The Local General Hospital in Newport will provide Newport borough residents with the majority of their routine and general services. Some services will be accessed by residents of south Torfaen, south Monmouthshire and the eastern side of Caerphilly County Borough. The hospital will have approximately 350-400 beds and may deliver the following range of services. Local Emergency Centre Diagnostic and Treatment Services An integrated service working 7 days a week including Urgent treatment and advice available 24 hours a day Emergency Assessment Unit working closely with the emergency team at the Specialist and Critical Care Centre to ensure that patients are transferred rapidly if they require specialist treatment following initial assessment. Acute medical ward with monitored beds for emergency patients who need to be admitted for further observation or tests. Rapid access clinics for urgent patients to avoid the need for hospital admissions Major accidents and serious emergencies would be directed to the Specialist and Critical Care Centre Comprehensive services for planned tests, clinics, treatments including: A wide range of specialist and general outpatient clinics Radiology facilities that include CT scans and the potential for MRI scans in the future A dedicated endoscopy suite and medical day case facility Approximately 6 operating theatres providing day case and short stay surgery for a range of procedures and conditions, supported by a surgical ward 14 Clinical Futures Public Consultation Document
Maternity Services Services will include: Consultant and Midwife antenatal and postnatal care Midwifery led birthing unit for women who are likely to have normal deliveries, with single ensuite delivery and aftercare rooms and water birth facilities Services for Children A new dedicated, purpose designed Children s Outpatient Department providing: Dedicated waiting areas and play area Clinic rooms and counselling facilities Family room Rehabilitation and Support Care Providing on site support to the acute beds through: Intensive rehabilitation beds to care for people following strokes, operations and falls for example. Sub acute beds for people with long term conditions Some palliative care beds to provide choice for patients Integrated therapies including physiotherapy, occupational therapy and hydrotherapy Mental Health Services An integrated unit with a range of adult and older adult services including: Outpatient services and bases for community mental health teams Day care facilities Acute beds Assessment and treatment beds Respite and support care beds Clinical Futures Public Consultation Document 15
The options for the Local General Hospital in Newport are: Option A: Do minimum - Redevelop the Royal Gwent Hospital Description of option A A minor redevelopment of Royal Gwent Hospital site with a minimal amount of refurbishment to the current wards and emergency services. Mental Health services would continue to be based in St Cadocs Hospital and there would be no improvement to the physical access to the hospital site. Under this option St Woolos hospital would close. Option B: Major redevelopment of the Royal Gwent Hospital Description of option B A significant redevelopment of the current Royal Gwent Hospital facility with major improvements and redesign of the ward areas and the maternity facilities. Under this option, an Emergency assessment area and diagnostic and treatment centre would be built. Mental Health services would be based in a new facility on the site and they would be linked but not fully integrated with the Local General Hospital. Under this option St Cadocs and St Woolos hospitals would close. Assessment of option A This option would achieve limited improvements in quality of care because of the constraints of the existing building which does not lend itself to the delivery of modern services. Limited upgrading of patient areas would not lead to the required improvements in privacy, safety and comfort and would not provide a better working environment for staff. The current access problems for the site would remain, albeit with a little less congestion. Pedestrian access into and around the building would remain a problem because of the sloping nature of the site and the tower block structure. This option would also create disruption to existing services at it focuses on changes to the core of a busy hospital. This option would not provide a solution for the long term. Assessment of option B This option would provide significant opportunities to improve the quality of care by reorganising services within the hospital. It would also deliver better integration with mental health services and a building that is more future proof. However, access issues would remain due to the location and physical access to the site from a busy city centre road, and the sloping nature of the site which makes pedestrian access and movement difficult. Improvements in design would be limited by existing buildings. In particular one of the biggest drawbacks of this option would be the significant disruption to operational services, requiring temporary relocation of services on other parts of the site and leading to a long construction time on site. Conclusion This option does not deliver the required benefits and is only included for the purpose of comparison Conclusion Whilst this option delivers some benefits it also presents some real practical difficulties. It should only be considered if no alternative sites are available. 16 Clinical Futures Public Consultation Document
Option C: New build at alternative Newport city centre site Description of option C A new hospital facility built on an alternative city centre site. The hospital would have a dedicated Local Emergency Centre designed to modern standards. There would also be a purpose built Midwifery led Birthing Centre, child friendly paediatric outpatient facilities and diagnostic and treatment centre. Mental Health services would be located within the hospital campus. The site would need to ensure adequate car parking and access. Under this option The Royal Gwent, St. Cadocs and St. Woolos hospitals would close. Option D: New build hospital at alternative out of city site Description of option D A new building on an alternative site out of Newport city centre but close to the M4. As a new hospital facility, option D would contain all the same services and units as option C and as detailed in the specification for Newport Local General Hospital. The site would be located out of Newport City centre but with good access from the M4 between junctions 26 and 28. Under this option, the Royal Gwent, St. Cadocs and St Woolos hospitals would close. Assessment of option C Developing a new building provides the potential to achieve best practice in terms of how services are organised and delivered, therefore improving the quality of care, integration of services and providing the right capacity to meet demand. From an environmental point of view the best design ideas can be included in the building, maximising patient safety, privacy and comfort, and improving efficiency and effectiveness for staff. A new site also avoids the practical difficulties associated with disruption to operational hospital services. Although an alternative site provides the opportunity to improve entrances and car parking, a city centre site does run the risk of having congested roads in the surrounding area. Purchasing a site that is not already used for a hospital can also pose challenges in terms of site acquisition, development and planning permission. Assessment of option D Developing a new building provides the potential to achieve best practice in terms of how services are organised and delivered, therefore improving the quality of care, integration of services and providing the right capacity to meet demand. From an environmental point of view the best design ideas can be included in the building, maximising patient safety, privacy and comfort, and improving efficiency and effectiveness for staff. A new site also avoids the practical difficulties associated with disruption to operational hospital services, and a site that is located out of the city centre could deliver ease of access from main transport routes. However, taking the hospital services away from the city centre also means taking them away from the hub of public transport services which also needs to be considered. In addition this may be contrary to regeneration efforts in Newport City Centre. Conclusion This option is one of the preferred options because it can deliver benefits in terms of quality, access, an improved environment and better integration of services. It should be pursued if it can also offer value for money. Conclusion This option also delivers many of the same benefits as option C, although it does not offer the same access advantages. It could be pursued if an alternative city centre site is not available and does not offer value for money. Clinical Futures Public Consultation Document 17
CHAPTER 4 Developing a Local General Hospital in North Monmouthshire The Local General Hospital in north Monmouthshire will provide services to north Monmouthshire, south Powys, residents of Blaenau Gwent and north Torfaen. The hospital will have between 180 and 200 beds and may deliver the following range of services: Local Emergency Centre Diagnostic and Treatment Services A single integrated service working 7 days a week incorporating; Urgent treatment and advice available 24 hours a day Emergency Assessment Unit working closely with the emergency team at the Specialist and Critical Care Centre to ensure that patients are transferred rapidly if they require specialist treatment following initial assessment. Acute medical ward with monitored beds for emergency patients who require admission for further observation or tests. Rapid access clinics for urgent patients to avoid the need for hospital admissions Major accidents and serious emergencies would be directed to the Specialist and Critical Care Centre Comprehensive services for planned tests, clinics, treatments including: A wide range of specialist and general outpatient clinics Radiology facilities that include CT and the potential for MRI scanning in the future A dedicated endoscopy suite and medical day case unit A suite of operating theatres providing day case and short stay surgery for a range of procedures and conditions, supported by a surgical ward. 18 Clinical Futures Public Consultation Document
Maternity Services Services will include: Consultant and Midwife antenatal and postnatal care Midwifery led birthing unit for women likely to have normal deliveries with single ensuite delivery and after care rooms, and water birth facilities Services for Children A new dedicated, purpose designed Children s Outpatient Department providing: Dedicated waiting areas and play area Clinic rooms and counselling facilities Family rooms Children s Centre for children with disabilities Rehabilitation and Support Care Providing on site support to the acute services through Intensive rehabilitation beds for people following strokes, operations and falls for example Sub acute beds for people with long term conditions Some palliative care beds to provide choice for patients Integrated therapies unit including physiotherapy, occupational therapy and a hydrotherapy pool Mental Health Services An integrated unit providing: Outpatient services and base for community mental health teams Day care facilities Acute beds Assessment and treatment beds Respite and support care beds Clinical Futures Public Consultation Document 19
The options for the Local General Hospital in north Monmouthshire are: Option A: Do minimum - Minor redevelopment of Nevill Hall Hospital in Abergavenny Description of option A Minor redevelopment of Nevill Hall site with a minimal amount of refurbishment to the current layout of wards and emergency services. Under option A Mental Health services would remain at Maindiff Court. Option B: Major redevelopment of Nevill Hall Hospital Description of option B A significant reconfiguration and redevelopment of the current Nevill Hall Hospital facility. Emergency assessment facilities would be rebuilt and situated close to key diagnostic and critical care services. Mental Health facilities would be provided in accommodation close to the hospital and physically linked to it. Internal redesign of wards and departments would be included but within the limitation of the core building. Under this option Maindiff Court would close. Assessment of option A This option would achieve limited improvements in quality of care due to the constraints of the current building which would not be significantly improved. Limited upgrading of patient areas would not deliver the required improvements in privacy, safety and comfort and would not improve the environment for staff. Although the Nevill Hall site is accessible to its catchment population, under option A the problems of physical access to the site and on site parking would remain unaddressed. The redevelopment included in this option would cause disruption to the current services which will impact on patients, visitors and staff. This option would not provide a solution for the long term. Assessment of option B This option would provide significant opportunities to improve the quality of care by reorganising services within the hospital. The presence of Mental Health service on site would improve the integration of services and the building would be more sustainable for the future. The Nevill Hall site does offer good access for the catchment populations in terms of location. Although there would be internal redesign and improvement of clinical areas, the current building does not allow for a fully effective and efficient environment. Future standards in relation to privacy and dignity and control of infection are difficult to address. In addition, the development work required to achieve this option would cause significant disruption to current services. This would impact on our capacity to treat patients during the development and building work. Conclusion This option does not deliver the required benefits and is only included for the purpose of comparison. Conclusion Whilst this option delivers some benefits, it also presents some practical problems and does not enable full implementation of best practice. 20 Clinical Futures Public Consultation Document
Option C: Build a new Local General Hospital on the Nevill Hall site Description of option C A totally new facility on the current Nevill Hall site delivering the full range of services of an enhanced Local General Hospital. In line with the description of the North Monmouthshire Local General Hospital, the hospital would have a separate Local Emergency Centre and diagnostic and treatment centre. There would also be a purpose built Midwifery led Birthing Centre and child friendly paediatric outpatient facilities. The Children s Centre would be rebuilt on the same site. Mental Health services would be integrated with the Local General Hospital. Under this option Maindiff Court would close. Assessment of option C Developing a new building offers the potential to achieve best practice in terms of how services are organised and delivered. Modern building design will improve the quality of care, maximise the integration of services and ensure the right capacity to meet demand is provided. From an environmental point of view the best design ideas can be included in the building maximising patient safety, privacy and comfort. A significant advantage of this option is that the new facility could be built alongside the current Nevill Hall Hospital and be developed with minimal disruption to current operational services. The Nevill Hall site offers good access to the catchment populations and under this option immediate access would be improved in terms of entrances and parking. However, this option may not be achievable in terms of planning constraints and this uncertainty is a disadvantage. Option D: Build the Local General Hospital on the Maindiff Court site Description of option D A new build Local General Hospital on the Maindiff Court site in Abergavenny. As a new hospital facility option D would contain all the same services as option C and as detailed in the specification for North Monmouthshire Local General Hospital. Under this option, Nevill Hall hospital would close and mental health facilities would remain at Maindiff Court. Assessment of option D By building a new facility we can ensure that best practice is achieved when organising how services are delivered. This will improve the quality of care, ensure that services are integrated and allow us to build in the right amount of capacity to meet the demand. From an environmental point of view the best design ideas can be included in the building, maximising patient safety, privacy and comfort and also improve efficiency and effectiveness for staff. Furthermore, Maindiff Court site is already owned by the NHS so problems associated with purchasing a new site are avoided. Although a development on Maindiff Court site would take into account the need for good entrances and car parking, access for the catchment populations of Blaenau Gwent, north Torfaen and north Monmouthshire may not be equitable. A drawback of this option is the potential disruption to the services currently provided at Maindiff Court and any temporary relocation of operational services which will add to the amount of construction time required on site. Conclusion This option is one of the preferred options because it can deliver benefits in terms of quality, access, an improved environment and better integration of services. It should be pursued provided any planning issues are resolved and it can also offer value for money. Conclusion This option does offer significant benefits although access may not be as good as the current hospital at Nevill Hall. It should be considered as one of the preferred options if it can offer value for money and the Nevill Hall option is not achievable. Clinical Futures Public Consultation Document 21
CHAPTER 5 Developing a Local General Hospital in Torfaen The Local General Hospital in Torfaen will provide services for Torfaen residents and will have between 110 and 130 beds and may deliver the following services; Urgent Care Centre Diagnostic and Treatment Services Maternity Services Services for Children A purpose designed unit including; Urgent treatment and advice available 24 hours a day A base for urgent response teams in the community A range of planned services including Specialist and general outpatient clinics Routine diagnostic services including x ray, ultrasound, heart/chest tests A minor surgery facility A colposcopy facility This will include the majority of Consultant and Midwife antenatal and postnatal clinic services, supported by ultrasound. A new dedicated, purpose designed Children s Outpatient Area to provide a range of specialist physical and emotional health services for children and families including: Dedicated waiting area/play area Clinic and counselling facility Family room 22 Clinical Futures Public Consultation Document
Rehabilitation and Support Care Working closely with other hospitals in the network to transfer Torfaen residents into dedicated rehabilitation services following problems such as a stroke or a fall, or for care following surgery: Intensive rehabilitation beds working closely with the emergency and surgical services to care for people following admissions for problems such as strokes, operations and falls. Sub acute beds for people who are admitted because of long term conditions such as chest problems. Some palliative care beds to provide choice for patients Integrated therapies unit including physiotherapy and occupational therapy Mental Health Services An integrated unit facilitating local provision of a range of adult and older adult services including: Outpatient services Day care facilities Acute beds Assessment and treatment beds Respite and support care beds Bases for community mental health teams Clinical Futures Public Consultation Document 23
The options for the Local General Hospital in Torfaen are: Option A: Do minimum A refurbishment of County Hospital Description of option A A minor amount of capital investment to essential building work at County Hospital. The refurbishment would address backlog maintenance issues and statutory requirements. Whilst there would be no plans to expand capacity at County hospital, Mental Health services would continue to be based at the County Hospital site in Ty Siriol and Talygarn. Option B: Build a new Local General Hospital on the County Hospital site Description of option B A new build Local General Hospital facility on the current County hospital site replacing the existing community hospital buildings. The existing mental health facilities of Ty Siriol and Talygarn would be retained. Assessment of option A This option would not achieve improvements in quality of care due to the constraints of the current building which would not be significantly improved. There would be only essential upgrading of patient areas which would not deliver the required improvements in privacy, safety and comfort and would not improve the environment for staff. Although the County Hospital site does offer good access for the local population, there would be no improvements to parking on site. This option would not provide a solution for the long term. Assessment of option B Developing a new building offers the potential to achieve best practice in terms of how services are organised and delivered. This improves the quality of care, ensures services and departments are appropriately integrated and provides enough capacity to meet demand. From an environmental point of view the best design ideas can be incorporated into the building which will help maximise patient safety, privacy and comfort and improving efficiency and effectiveness for staff. Mental Health facilities at Ty Siriol and Talygarn would remain on site ensuring good integration with Local General Hospital services. The location of County Hospital does provide good access for Torfaen Borough. However, immediate access to the site would remain difficult as it is set in a residential area and this would need careful consideration with the planning authority. In addition there would be some disruption to operational services during the development Conclusion This option does not deliver the required benefits and is only included for the purpose of comparison. Conclusion This is one of the preferred options as it offers significant benefits in terms of access, quality of care and improved environments for patients and staff. It should be pursued if it provides value for money. 24 Clinical Futures Public Consultation Document
Option C: Build a new Local General Hospital on a new site with Mental Health services Option D: Build a new Local General Hospital on a new site without Mental Health services Description of option C Provide a totally new hospital facility on a new site in the vicinity of current County site. The full range of services as described in the Torfaen Local General Hospital specification would be provided with new mental health services located and integrated on the same site as the hospital. Under this option the current County Hospital, Ty Siriol and Talygarn would all close. Description of option D Option D offers a similar proposal as option C above but under this option mental health services would continue to be provided from Ty Siriol and Talygarn on the County Hospital site. Under this option County Hospital would close. Assessment of option C As with option B, developing a new building offers the potential to achieve best practice in terms of how services are organised and delivered. This improves the quality of care, ensures services and departments are appropriately integrated and provides enough capacity to meet demand. From an environmental point of view the best design ideas can be incorporated into the building which will help maximise patient safety, privacy and comfort and improving efficiency and effectiveness for staff. Mental Health facilities would be situated on the same site, improving integration of these services with the hospital services. Assessment of option D Option D offers many of the same benefits and planning considerations as option C. However, under this option Mental Health services would remain at Ty Siriol and Talygarn which would not improve the integration of services. Building on a new site will enable full consideration to be given to the need for adequate access in terms of care parking and public transport. A development on a new site will also reduce disruption to operational services during the building of the new facility. However, purchasing and building a hospital on a site that is not currently used for these types of services can pose challenges in terms of site acquisition, development and planning permission. Conclusion This is one of the preferred options, it offers the same benefits as option B and should be pursued if it provides value for money. Conclusion Whilst this option delivers many benefits, the absence of mental health services on the same site is a disadvantage. This option should not be pursued. Clinical Futures Public Consultation Document 25
CHAPTER 6 Developing Specialist and Critical Care Services The Specialist and Critical Care Centre will provide services for the whole of the catchment population, including Blaenau Gwent, Monmouthshire, Newport, Torfaen, the majority of Caerphilly County Borough and South Powys. It is estimated that it will require between 450 and 500 beds. Major Emergency Centre Critical Care Diagnostic and Treatment Service This will have specialist assessment and treatment facilities including: Medical and surgical emergency assessment Paediatric assessment Trauma Resuscitation facilities A ward area for observation and treatment of emergencies Telemedicine to support links to Local General Hospitals Some patients will be directed to the Major Emergency Unit via the ambulance service, whilst others will be transferred there following assessment and stabilisation at a Local Emergency Centre. To support both the emergency and specialist work the Centre will have Intensive care beds Coronary care and stroke care beds High dependency beds These will include A suite of operating theatres for both emergency and planned operations Specialist diagnostic and treatment services that cannot be duplicated at Local General Hospital sites e.g. cardiac catherisation Comprehensive pathology services A limited number of outpatient clinics as most of this work will be undertaken at Local General Hospitals 26 Clinical Futures Public Consultation Document
Maternity services Services for Children In Patient Support The location of the Specialist and Critical Care Centre was raised as an important issue for members of the public and clinical staff in public engagement events in 2005. It remains a key issue and we need to ensure that acceptable travel and access times can be assured. The location needs to reflect the fact that the people who use these services come from a wide geographical area and experience a wide range of issues that affect transport and access, for example, low car ownership in deprived areas or poor public transport in rural communities. Although The majority of antenatal care will be provided at the Local General Hospitals. The Centre will provide: Consultant led maternity services including delivery suites, ward and theatres A Midwifery led unit to provide choice for women who do not want to use the Local Midwifery led Unit Fetal medicine services These will include: Neonatal intensive care unit In patient ward for emergency assessment and planned operations Limited outpatient provision as this will be available at Local General Hospitals This will include Ward facilities for acute emergency patients Ward facilities for pre and post operative care Therapy facilities to support early rehabilitation and recovery some parts of the patient catchment population are concentrated in urban areas such as Newport City, other parts such as Monmouthshire and South Powys are widely dispersed. One of the stages in determining the location for the Specialist and Critical Care Centre was to get an expert assessment of the appropriate location. A travel times analysis was undertaken based on the Trust s existing patient catchment population but using the future configuration of services described in this document. This indicated that the best location for the Specialist and Critical Care Centre would be within a 3 mile radius of Croes-y-ceiliog, Cwmbran, with good access to the A4042. At this location 95% of patients can reach the Specialist and Critical Care Centre within 30 minutes and 100% of patients can get there within an hour. Although not a factor in the travel times study, the central location of the Specialist and Critical Care Centre means minimum disruption and relocation of specialist staff currently working in existing District General Hospitals in Newport and Abergavenny. It will also help reduce staff travel times between the Specialist and Critical Care Centre and the Local General Hospitals in the future network. It is important to note that options to centralise specialist and critical care services at either of the existing District General Hospitals were considered at an earlier stage in the planning process. They were not included in the shortlist of options because of the travel times study as well as a number of physical and practical constraints on those sites. Similarly, other site options in the vicinity of the current District General Hospitals were also discounted from further consideration because they would not achieve optimum travel times for the whole population. Having identified what we consider to be the best area for the SCCC, the following options are considered as possible solutions. We would like your views on both the area and the options. Clinical Futures Public Consultation Document 27
The options for the Specialist and Critical Care Centre are: Option A: Do Nothing Description of option A Continue with current District General Hospital model of providing specialist and critical care services at both the Royal Gwent and Nevill Hall hospitals. Under this option there would be some minor development to increase our capacity in certain specialities, increasing by a modest amount, access to emergency services and routine surgery. Option B: A new build Special & Critical Care Centre at Llanfrechfa Grange Hospital, Cwmbran Description of option B Build the new Specialist and Critical Care Centre on the Llanfrechfa Grange site in Cwmbran. As a new facility, the hospital would be state of the art and built to modern design principles. All the key elements of the SCCC including an Emergency Assessment Unit, a Maternity and Children s Hospital and a Diagnostic and Treatment Centre as detailed in the description of the SCCC would be provided. Assessment of option A Continuing with specialist, critical and major emergency services on 2 District General Hospital sites will not allow us to implement best practice and achieve improvements to the quality of care. The current system is not sustainable for reasons described in Chapter 1 and if they remain fragmented there are limited opportunities to integrate services and some specialist services would become fragile and unsustainable. The buildings are outdated and do not offer a therapeutic environment for patients or good working conditions for our staff. Problems of congested sites, limited parking and access issues would remain unaddressed under this option. This option would not provide a solution for the long term. Assessment of option B Building a new hospital facility will allow us to achieve best practice in terms of how services are organised and delivered. This will improve the quality of care at the Specialist and Critical Care Centre by incorporating modern hospital design. Services would be integrated and enough capacity would be included to meet current and future demand. This option locates the SCCC in the central zone in accordance with the travel times analysis and therefore assures that acceptable travel and access times can be achieved for the catchment population. The NHS already owns the Llanfrechfa Grange site which minimises the possible difficulties of purchasing a new site and the new development would provide good access via entrances and adequate parking. However, some services are already provided from Llanfrechfa Grange and these would need to be reprovided prior to any developments starting on site. Conclusion This option is not sustainable and does not deliver the required benefits. It is included only for the purposes of comparison. Conclusion This is one of the preferred options as it delivers the desired benefits of good access for the whole patient population, good quality specialist care, a therapeutic environment for patients and will ensure integration of services. This option should be considered if it offers value for money. 28 Clinical Futures Public Consultation Document
Option C: A new build Special & Critical Care Centre at an alternative site in the central zone Description of option C The development of the SCCC in a central zone with good access to the A4042. This option considers non- NHS owned sites within the central zone. This site would need to be large enough to accommodate all the required components of the SCCC as detailed in the SCCC specification. Assessment of option C Like option B, building a new hospital facility will allow us to achieve best practice in terms of how services are organised and delivered. This will improve the quality of care at the Specialist and Critical Care Centre by incorporating modern hospital design. Services would be integrated and enough capacity would be included to meet current and future demand. This option locates the SCCC in the central zone in accordance with the travel times analysis and therefore assures that acceptable travel and access times can be achieved for the catchment population. However, purchasing a site that is not currently used for hospital services can potentially be difficult. There may be planning constraints and external environmental factors which may influence how achievable the option is. Conclusion This is one of the preferred options as it offers the same benefits in terms of quality, access, environment and integration as option B. This should be considered if it can also offer value for money. Clinical Futures Public Consultation Document 29
CHAPTER 7 Tell us what you think We realise that everyone patients, staff and the whole community have an interest in how health services should be delivered. We hope that this document has helped you understand more fully why we believe we need to change the way we organise and deliver our health services and in particular the proposed hospital network. We would like to hear what you think about our ideas and plans. Your opinion will be key to helping us make a decision in early 2007 about the future of local hospital services. The programme of consultation will run from 18 September to the 8 December 2006 and will include a number of public events. 1. Fill in the Questionnaire and send it to us. There is a questionnaire in the middle of this document. Simply fill it in and put it in the pre-addressed envelope. No stamp needed. Please make sure we receive your completed questionnaire by 8 December 2006. No decision will be taken until the views expressed during the consultation period have been fully considered. The decisions we need to make will involve the locations of the following Local General Hospitals and the services provided in them: 2. Go on-line and fill in our response form Give us your feedback directly on the website at www.clinicalfuturesgwent. wales.nhs.uk Newport Local General Hospital North Monmouthshire Local General Hospital Torfaen Local General Hospital And the location of the Specialist and Critical Care Centre and the services it would provide. There are many ways in which you can contact us and ensure that your views are heard. 3. Join our Virtual Health Forum Technology plays an increasingly important part on our everyday lives. We are taking advantage of this by creating a virtual health forum. People who subscribe to the forum will be invited to express their views on key themes that emerge from other consultation activities; we will use this forum to explore these themes further. You can become a member of 30 Clinical Futures Public Consultation Document
this virtual health forum by registering through the Clinical Futures Website at www.clinicalfuturesgwent.wales. nhs.uk 4. Come to one of our public meetings to meet us and tell us what you think We have arranged a series of meetings and discussion forums in your local areas where you will have the opportunity to discuss our proposals in more detail. At these meetings there will be people from the Trust, your Local Health Board and some clinical health professionals who will be able to answer any of your questions. Details of public meetings in your area will be advertised in your local newspaper, and posters will be placed at libraries and other public buildings. Details will also be available on our website. 5. If you run a community group you can ask us to come to one of your meetings and talk about Clinical Futures. We have a team of people who can come along to meetings to tell you more about the proposals in the document and help you make decisions about the options. To book a meeting, ring 01633 623461. If you need any further help or information, ring our helpline on 01633 623461. Clinical Futures Public Consultation Document 31
Glossary Acutre and Sub-acute The abrupt onset, in reference to a disease or illness. Acute often also describes an illness that is of short duration rapidly progressive, and in need of urgent care. Acute is a measure of the time scale of the disease and is in contrast to sub-acute and chronic sub-acute indicates longer duration or less rapid change. Chronic indicates indefinite duration or virtually no change. Cardiac Catheterisation Cardiac catheterisation is a way to find out detailed information about your heart and coronary arteries. Cardiac catheterisation is where a very thin plastic tube is passed into the chambers of the heart. The catheter can also be passed into the main blood vessels of the heart (the coronary arteries). Community Healthcare Services provided in the community such as Health Visiting and District Nursing. Community Health Councils Community Health Councils are independent health service watchdogs for their local areas. They help and advise people who wish to make complaints about NHS services. They offer information and advice about health and related services in their area to local people and they must be consulted by Trusts and Local Health Boards about substantial changes to health services within our area. Critical Mass The numbers of patients that a specialist needs to see to retain specialist skills is referred to as critical mass. CT Scan Computer tomography (also known as CT, CT scan, CAT or computerised axial tomography) scans use x-rays to produce precise cross-sectional images of the body. Designed for Life Designed for Life was launched by the Welsh Assembly Government in May 2005 and is Wales strategy for the future of health and social care. The strategy outlines the kind of health and social care services we can expect by 2015. District General Hospitals Hospitals that provide acute medical and surgical services for their catchment populations. Fetal Medicine Some pregnancies require additional care and fetal Medicine involves investigations and detailed ultrasound scanning for the diagnosis and confirmation of fetal abnormality. Intermediate Care Care which includes observation, nursing, therapy and rehabilitation Local Health Boards Local Health Boards exist in order to improve the health and healthcare of the local population. They were established in 2003 to take over the responsibilities of the Health Authorities in Wales and were given three quarters of the NHS health budget in Wales. They decide what health services their populations need and then pay hospital trusts, family doctors, dentists and others to provide these services. 32 Clinical Futures Public Consultation Document
MRI Scan An MRI, (magnetic resonance imaging) scan is a radiology technique that uses magnetism, radio waves and a computer to produce images of the body structures. The MRI scanner is a tube surrounded bya giant circular magnet. The patient is placed on a moveable bed which is inserted in to the magnet. The Model of Care The description of how healthcare services are designed, who they are delivered by and where they should be delivered. National Service Framework (NSF) Government policy setting out core standards for services. NHS Trusts Statutory organisations with responsibility for providing a range of community and acute services. Palliative Care care provided to patients are the end stages of their live which seeks to relieve or soothe the symptoms or a disease or disorder without effecting a cure. Primary Care Healthcare provided in a community setting led by a GP, community nurse or similar. Respite Care Respite care provides a carer temporary relief from the responsibilities of caring for individuals with chronic physical or mental disabilities. Scheduled Care Scheduled care means planned specialist medical care or surgery, usually following referral from a primary or community health professional such as a GP. Examples of scheduled care include a hip replacement operation or kidney dialysis. Scheduled care patients may be admitted either as an inpatient or a day case patient, or they may attend an outpatient consultation or clinic. Secondary care Healthcare mainly provided in a hospital setting. Service user/patient/ client Someone who uses the services of the NHS. Service Re-design Looking at how existing services can be changed for the better. Social care Services that attend to peoples social needs. Specialist community teams Teams providing a high level of support for people, often visiting daily or more often when required. Telemedicine Use of telecommunications technology for medical diagnosis and patient care when the clinician and patient are separated by distance. Telemedicine includes pathology, radiology, and patient consultation from a distance. Tertiary care Very specialist services, often only provided from few organisations in the country. Unscheduled care Unscheduled care is any event that is unplanned or unscheduled, where an individual is seeking attention from a health or social care professional. Value for money Value for Money is the term used to assess whether or not an organisation has obtained the maximum benefit from the goods and services it acquires and/ or provides, within the resources available to it. It not only measures the cost of goods and services, but also takes account of the mix of quality, cost, resource use, fitness for purpose, timeliness and convenience to judge whether or not, when taken together, they constitute good value. This glossary will be updated on the website as required in response to questions raised during the consultation period. Clinical Futures Public Consultation Document 33
Notes 34 Clinical Futures Public Consultation Document