Following detailed clinical review and discussions with members of the NHS Reference Group and the Trust’s Council of Governors, Gloucestershire NHS Hospitals Foundation Trust has confirmed how they will bring together a number of specialist hospital services.
The original proposals, developed by clinicians and managers in early 2011, included centralising a small number of hospital services to bring specialist staff together on to one site to make services more responsive and efficient for patients.
Clinicians and managers want to ensure that patients can access the full range of specialist skills in the county when they need them most, improve health outcomes and make best use of the resources available.
There was strong support for bringing the specialist hospital services together, on clinical grounds, as part of the comprehensive ‘Your NHS’ public engagement exercise held in the Spring of 2011.
Following support from the County’s Health, Community and Care Overview and Scrutiny Committee at their meeting in July 2011, the centralisation of emergency paediatric assessment took place in Autumn 2011 and the centralisation of first outpatient appointments for symptomatic breast care patients took place in late 2011.
HCCOSC members also supported one site options for a Trauma Unit in Gloucestershire and for specialist hospital based stroke care services, but further work was needed to confirm the preferred sites for both based on clinical benefit, including links to other hospital services.
Clinicians and managers have also been exploring the preferred single site for all inpatient vascular services. A decision to bring these services together, on clinical grounds, followed an earlier county-wide consultation.
The Board of Gloucestershire Hospitals NHS Foundation Trust has now agreed a set of recommendations, endorsed by the Trust’s Council of Governors, based on clinical links to other services, the availability of facilities and the need to ensure the sustainability of both hospital sites:
- The creation of a single Trauma Unit for major Trauma (multiple, severe injuries) at Gloucestershire Royal Hospital (GRH). Action will now be taken so that GRH can be accredited as a Trauma Unit by April 2012, as part of the regional Severn Network. GRH was chosen as the preferred site for the Trauma Unit due to the need for it to be co-located with Paediatric and Obstetric emergency services.
The establishment of a single Trauma Unit does not affect accident and emergency services and A&E Departments will continue at both Cheltenham General Hospital and Gloucestershire Royal Hospital.
- The strengthening of the General and Old Age Medicine (GOAM) service at Cheltenham General Hospital (CGH) to ensure that more patients from the east of the county can be cared for in Cheltenham. This change is planned to take place in the Summer of 2012. There will be an increased number of dedicated GOAM beds at CGH, with additional medical and nursing cover. GOAM services provide care for a wide range of patients with complex medical needs, which often require treatment from a range of professionals. Services will also continue to be provided at Gloucestershire Royal Hospital.
- Centralisation of specialist hospital stroke services at Gloucestershire Royal Hospital, which will also support an improved service for patients who suffer transient ischaemic attacks (mini strokes). This change is planned to take place in the Summer of 2012.
For stroke services, there is a critical dependency on key specialist staff to provide clot-busting 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.
- Centralisation of inpatient vascular services at Cheltenham General Hospital. This change is planned to take place in the Summer of 2012. Vascular surgery involves the reconstruction or repair of disease damaged arteries and veins. It is highly specialised and relies on a limited number of experienced clinicians.
Mr Simon Dwerryhouse, Specialty Director for General Surgery, said “We believe that consolidating the inpatient vascular service on to a single site will enhance the service we provide to the people of Gloucestershire. It will allow us to deliver high quality, specialist care around the clock in dedicated facilities and safeguard the future of vascular services in the county.”
Consultant Physician, Stroke Service, Dr Kate Hellier said: “We believe the change in how we organise stroke care will help us to see more people with high risk TIAs (mini strokes), within 24 hours of seeking help, by running clinics on every day of the week.
"We will also be able to increase the number of specialist staff available around the clock to provide specialist stroke services when patients arrive at hospital, such as expert clinical assessment, scans and treatment decisions and increase the number of patients transferred to a stroke unit within 4 hours.”
Commenting on a single Trauma Unit, Mr Aidan Fowler, Chief of Service, Surgical Directorate said: “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.”
We believe that these changes will mean that the chances of survival for severely injured patients will improve.”
Chair of the Gloucestershire Clinical Commissioning Group and local GP, Dr Helen Miller said: “For the majority of health services, we are seeing a shift in the way care is provided with a greater emphasis on caring for people closer to home, or in their home, where appropriate.”
“That said, when people are seriously unwell or there are significant concerns over their health, the NHS needs to ensure specialist hospital services are organised in a way that will ensure quality of care, ensure safety of patients, improved health outcomes and make best use of the money available.”
“It is clear from the patient and public engagement exercise that respondents understood and acknowledged the clinical benefits of these proposals.”
The NHS Reference Group is made up of representatives from NHS Gloucestershire, NHS Trusts, the Health, Community and Care Overview and Scrutiny Committee and Gloucestershire LINk.