‘Your NHS’ Specialist services reconfiguration 2012
Frequently asked questions
Updated 25/04/12 (click on the question to be taken directly to the answer)
1.
Which services are affected? ................................................................................................................. 2
2.
Why are we reconfiguring services? ...................................................................................................... 2
3.
Where will stroke services be based? .................................................................................................... 2
4.
Why was GRH chosen as the preferred site for Stroke services? .......................................................... 2
5.
What are the benefits for stroke patients? ............................................................................................. 2
6.
When will stroke services be centralised? ............................................................................................. 2
7.
Where will General and Old Age Medicine (GOAM) services be based? ............................................... 2
8.
What are the benefits for General and Old Age Medicine (GOAM) patients? ......................................... 3
9.
When will General and Old Age Medicine (GOAM) service change happen? ........................................ 3
10.
Where will vascular services be based? ............................................................................................. 3
11.
Why was CGH chosen as the preferred site for inpatient Vascular services? ..................................... 3
12.
What are the benefits for vascular patients? ...................................................................................... 3
13.
What are the implications for Renal services? .................................................................................... 3
14.
What are the implications for Interventional Radiology services? ....................................................... 3
15.
When will inpatient Vascular services be centralised? ....................................................................... 3
16.
What does ‘major trauma’ mean and how many patients are affected by the changes? ..................... 3
17.
What does being a ‘Trauma Unit’ mean? ........................................................................................... 4
18.
Why was GRH chosen as the preferred site for the Trauma Unit? ..................................................... 4
19.
Will there still be Trauma surgery at Cheltenham General? ............................................................... 4
20.
Will there be any changes to A&E? .................................................................................................... 4
21.
What are the plans for the helipad at GRH? ....................................................................................... 4
22.
What do the changes mean for GPs? ................................................................................................ 4
23.
What do the changes mean for ambulance services? ........................................................................ 5
24.
Are there any planned changes to bed numbers? .............................................................................. 5
25.
How many staff will be affected? ........................................................................................................ 5
26.
Who are the project leads? ................................................................................................................ 5
27.
What are the actual move dates?....................................................................................................... 5
28.
Will there be any changes to the names of wards? ............................................................................ 5
29.
Why is the Stroke Unit being split over two floors? ............................................................................. 6
30.
Are parking permits valid on both sites? ............................................................................................. 6
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1. Which services are affected?
For this current phase of reconfiguration, the services affected are Major Trauma, Stroke & TIA, Vascular
Surgery and General & Old Age Medicine (GOAM). Obviously, by changing these services, there are
implications for other linked clinical services and support services which work closely with them.
2. Why are we reconfiguring services?
The main drivers for centralising specialist services are:
– the need to consider clinical outcomes and patient safety, ensuring specialist staff see enough
patients to maintain their skills
– maintaining the availability of specialist hospital services in Gloucestershire and providing as much
care as we can in the county
– the availability of staff with specialist skills to provide consistently high quality services round the
clock.
3. Where will stroke services be based?
We will bring together the current services from both sites to Gloucestershire Royal Hospital (GRH), using
the existing stroke ward 6b, as well as ward 8a. The stroke team are currently working through the detail to
decide how best to run the two wards as a combined unit. Stroke and TIA clinics will also move to GRH.
4. Why was GRH chosen as the preferred site for Stroke services?
For stroke services, there is a critical dependency on key specialist staff to provide clot-busting
thrombolysis treatment for hyper-acute (seriously unwell) patients following the onset of symptoms. The
staff with sufficient seniority and experience are the same as those required by national standards to
support the Trauma Unit. Therefore, it was agreed that specialist hospital stroke services should be
centralised on the same site as the Trauma Unit.
5. What are the benefits for stroke patients?
Clinical evidence clearly shows that patients stand the best possible chance of survival and recovery from
stroke when assessed and treated quickly by specialist staff in a dedicated stroke unit. Centralising our
services means we combine the two teams of stroke specialist consultants and nurses, increasing the
hours in the day over which they are available to the stroke unit.
The change should also help us to see more people with high risk TIAs (mini strokes), within 24 hours of
seeking help, with increased opportunity to run clinics every day of the week.
6. When will stroke services be centralised?
We are planning to centralise stroke and TIA services on 26th June 2012. On this date, stroke patients from
Woodmancote at CGH will be transferred to Ward 8a at GRH.
7. Where will General and Old Age Medicine (GOAM) services be based?
General and Old Age Medicine (GOAM) services will remain on both sites but the distribution between the
two hospitals will change. We plan to strengthen the service at Cheltenham General Hospital (CGH) by
increasing the number of dedicated GOAM beds and clinical staff, creating equivalent services on each
site.
The final configuration of GOAM wards will be:
Gloucestershire Royal Hospital
Ward 4b
Ward 9b
Cheltenham General Hospital
Ryeworth
Kemerton Annexe
Avening
For an interim period, between July 2012 and centralisation of vascular services, the GOAM wards will be:
Gloucestershire Royal Hospital
Ward 4b
Ward 9b
Cheltenham General Hospital
Ryeworth
Kemerton Annexe
Woodmancote
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8. What are the benefits for General and Old Age Medicine (GOAM) patients?
General and Old Age Medicine (GOAM) patients often have complex medical needs and need multidisciplinary care. Historically, our resources for these patients have been weighted towards GRH. The
planned redistribution will increase the number of patients from the East of the county who can be cared for
in Cheltenham and ensure we have consistent clinical cover on both sites.
9. When will General and Old Age Medicine (GOAM) service change happen?
This change will be carried out in two phases. Phase one will take place in July 2012 following the
centralisation of stroke services. At this point, we will change the distribution of services, using
Woodmancote ward at CGH for GOAM patients. The second phase will take place when vascular services
centralise which allows time for improvements to be made to the environment on Avening ward.
10. Where will vascular services be based?
The inpatient vascular service will be centralised to Cheltenham General Hospital (CGH) on Woodmancote
ward. Outpatient services and daycase surgery will remain at both main sites, and in community hospitals.
Vascular laboratories, which have specialist staff and scanning equipment, will remain on both sites.
11. Why was CGH chosen as the preferred site for inpatient Vascular services?
The Trust’s Main Board agreed the recommendation for inpatient vascular services to be centralised to
Cheltenham General after some considerable discussion. The decision was taken based on a number of
factors including clinical links to other services, the availability of facilities and the need to ensure the
sustainability of both hospital sites. The Reconfiguration Programme Board had fully considered all of the
linkages between vascular and other clinical services and recognised that centralisation to CGH was a
compromise solution, given the location of stroke and renal services in particular at GRH. However, it was
agreed that each of the links could be maintained through new ways of working and the priority was to
centralise the service to secure its future in the county.
12. What are the benefits for vascular patients?
Vascular surgery is highly specialised and relies on a limited number of experienced clinicians. It is a
service which is increasingly being managed on a network basis, with a reducing number of specialist units
nationally. By bringing together our existing teams we will increase the hours in the day during which
specialist staff are available on the vascular unit and create a sustainable service in the county.
13. What are the implications for Renal services?
Some Renal patients require arteriovenous fistula (AVF) surgery to create an access point for dialysis.
These patients are assessed and operated on by vascular surgeons following a doppler scan performed by
vascular scientists. The AVF service will be retained on an outpatient and daycase basis at GRH.
14. What are the implications for Interventional Radiology services?
Interventional Radiology services will remain on both sites but procedures for vascular inpatients
(angiography, angioplasty and endovascular aneurysm repair (EVAR)) will move to CGH with the rest of
the surgical service. This represents a considerable change for the IR team, and investment is required to
provide the required physical capacity and equipment at CGH for the increased workload. The project
team has started to develop detailed plans for staffing and estates changes so that these can be factored
into the overall implementation timescales.
15. When will inpatient Vascular services be centralised?
This change is dependent on considerable estates changes to provide the necessary additional capacity for
Interventional Radiology at CGH. The change will take place in 2013, following this work.
16. What does ‘major trauma’ mean and how many patients are affected by the changes?
‘Major Trauma’ is defined as multiple, serious injuries that could result in disability or death. These might
include serious head injuries, severe gunshot wounds or road traffic accidents. Major Trauma is defined in
the scientific literature using the Injury Severity Score (ISS), which assigns a value to injuries in different
parts of the body and totals them to give a figure representing the severity of injury. An ISS greater than 15
is defined as Major Trauma. This would include serious injuries such as bleeding in the brain or a fracture
of the pelvis and cases of multiple injuries.
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National statistics indicate that there are approximately 200 major trauma patients per year for our
population, however a fair proportion of these already go directly to Frenchay hospital in Bristol due to the
nature of their injuries. We estimate that fewer than 100 patients per year across both sites will be affected
by the new arrangements.
17. What does being a ‘Trauma Unit’ mean?
There is now a considerable body of evidence demonstrating that people with major trauma do much better
if they are cared for in specialist trauma services, as part of a clinically managed trauma network, which
has immediately available all the necessary specialist staff and equipment, 24 hours a day, 7 days a week.
For the South West region, two trauma networks have been established which went live in April 2012: the
Peninsula Trauma Network in the south and the Severn Trauma Network in the north, of which
Gloucestershire is a part.
Networks are based on a ‘hub and spoke’ model with a Major Trauma Centre (MTC) supported by Trauma
Units. The MTC for the Severn Network is Frenchay Hospital in Bristol, which achieved its accreditation
following a detailed assessment in October 2011. Other hospitals in the region now function as Trauma
Units to receive patients who need stabilisation before transport to the MTC, and take patients from their
region back following initial treatment at the MTC.
18. Why was GRH chosen as the preferred site for the Trauma Unit?
Clinical leads agreed that a one-site model for a Trauma Unit is the only sensible and viable option for the
long term given the challenges of meeting the national standards and that this should be at GRH because
co-location with obstetric and paediatric services is vital.
19. Will there still be Trauma surgery at Cheltenham General?
Yes. The new network arrangements only affect the very small number of critically injured patients
described above. Less severely injured general and orthopaedic (bone fracture) trauma patients will
continue to be taken by ambulance to their nearest hospital for assessment and surgery if required.
20. Will there be any changes to A&E?
There will be no changes to the availability of emergency services at both hospitals for walk-in patients.
By reconfiguring individual services, we change the pathways for those patients and need to ensure our
‘front door’ emergency services are configured appropriately. This includes working closely with
ambulance services and GP practices to ensure that patients reach the appropriate hospital for their
condition.
21. What are the plans for the helipad at GRH?
There are currently flight restrictions in place for the helipad at GRH. An extension to the helipad is in our
capital programme for this financial year (2012-13). The aim of this will be to have a fully operational
helicopter landing function restored.
The national standards for Major Trauma do not require hospitals due to be designated as Trauma Units to
have a helipad. The clinical and transfer pathways being established in the trauma network are designed
predominantly on the basis of transport by road since this is the normal mode of travel. The pathways
obviously need to operate consistently well at all times, whereas helicopters are only able to fly during
daylight hours and in good weather.
22. What do the changes mean for GPs?
The changes mainly affect patients brought in as emergencies, so we will be communicating specifically
with the Single Point of Clinical Access (SPCA), as well as individual practices, to ensure they have all the
necessary information on how to direct patients requiring admission. Changing the balance of General and
Old Age Medicine beds between sites means that some practices used to referring all their patients to one
site, may in future have patients admitted to both.
The changes for vascular surgery affect elective patients also, although outpatient services will remain as
they are currently so there are no changes to the referral routes for elective patients.
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23. What do the changes mean for ambulance services?
The Great Western Ambulance Service (GWAS) needs to change its protocols to ensure that patients
reach the appropriate hospital as we reconfigure. We have worked closely with GWAS leads throughout
the process of decision-making for these changes and continue to do so as they are implemented.
24. Are there any planned changes to bed numbers?
There are no plans to change the total number of beds on either of the hospital sites (CGH or GRH). The
reconfiguration plans are based on trying to bring together the relevant services and make the best use of
the available ward space on both sites.
25. How many staff will be affected?
We recognise that these changes will affect a considerable number of staff, a proportion of whom will be
expected to change their normal base of work, or adapt to a different role. We are currently working
through the detail for each change to understand the exact number of staff involved and ensure that those
staff affected have the information they need about the process and what to expect. The Trust’s Policy for
Staff Affected by Organisational Change will be used throughout this process.
26. Who are the project leads?
The changes are being overseen by a Reconfiguration Programme Board chaired by Sally Pearson,
Director of Clinical Strategy and with senior representation from all relevant clinical and support services.
The key leads for implementation are as follows:
Stroke & GOAM project team
Chair:
Mark Silva, Specialty Director for GOAM, Neurology & Stroke
General Management lead: Roger Blake
Nursing lead:
Sandra Attwood
Vascular project team
Chair:
Simon Dwerryhouse, Specialty Director for General Surgery & Urology
General Management lead: Annemarie Vicary
Nursing lead:
Caroline Elcock
Major Trauma project team
Chair:
Simon Clint, Consultant Surgeon and Trauma Lead
Programme Manager:
Jenny Hill
27. What are the actual move dates?
As the programme board agrees the timeline for each implementation, we will cascade this through the
project teams and publish it on the intranet and in Outline. Specific email communications will be sent in
the run up to actual move dates.
The current sequence of planned moves is as follows:
Ward 8a to Rehab 1 (temp move):
Woodmancote to Ward 8a (permanent):
Rehab 1 to Woodmancote (temp move):
Avening decant (temp move):
Woodmancote to Avening (permanent):
Avening & ward 4a to Woodmancote (permanent):
Thursday 26th April 2012
Tuesday 26th June 2012
Early July 2012
To be confirmed
To be confirmed
To be confirmed
28. Will there be any changes to the names of wards?
We will retain the current names associated with the physical ward spaces. This is to prevent confusion
with way-finding and emergency plans. The only minor change will be the addition of ‘Stroke Unit’ for the
signage for Ward 8a, to mirror the current 6b.
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29. Why is the Stroke Unit being split over two floors?
There isn’t the floor space in the Tower block to accommodate the required number of beds as well as
therapy space all on one level.
30. Are parking permits valid on both sites?
Yes, staff transferring between sites can use their existing car parking permits. Further information on
travel and parking for staff is available on the Travel & Parking section of the intranet (internal only).
Information for patients and visitors is available on our website.
These questions will be updated regularly during the programme implementation. If you would like to raise
a question please email comms@glos.nhs.uk.
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