Proposed changes to Surgery at HEFT Building a sustainable future Vision To have emergency and planned surgical services in our hospitals which are sustainable and enable the provision of high quality, safe care to our patients.
Strategic Context: The future look of our hospitals All our hospitals 20mins Urgent care Antenatal & midwifery Diagnostics & outpatients Access to specialist acute care Elective surgery Birmingham Heartlands Solihull Hospital & Community Good Hope Hospital Hospital Urgent care A&E services Care for the elderly A&E services Acute medicine Home to large elective care centre Centre for complex and emergency Care for the elderly Community services hub care Home to surgical specialties Midwifery led labour unit Inpatient paediatrics Obstetric care Obstetric care Hollier Simulation Centre Academic centre
Surgery in the Trust Current Model Good Hope Heartlands Solihull Full range of surgical activity across 3 sites (except for no emergency surgery at SH) Proposed Model Solihull Heartlands Good Hope Centre for Centre for Centre for complex and certain certain surgical emergency planned specialties surgery, including surgery trauma 3
Reasons for considering change External – out of our control • National trends – Greater sub specialisation in surgical specialties e.g an orthopaedic surgeon may operate on hands or feet but not usually both compared to a more generalist approach 10 years ago – Fewer surgeons being trained with 20% fewer junior doctors entering surgery – Royal College of Surgeons’ requirements are more demanding for emergency and planned surgery – NHS wide moves to consolidating services to achieve better outcomes – These challenge the sustainability of safe surgery across multiple sites and create a compelling clinical case for change • Financial Challenge – The financial challenges facing not just the Trust, but the NHS as a whole, are significant so things need to be done differently to protect service provision in the future Internal • Quality – Desire to improve the patient experience eg faster access to emergency surgery and certainty for planned surgery dates – Want to give improved outcomes and lower mortality in the future with higher levels of safe and harm free care – The opportunity to create centres of excellence with space to develop services • Belief – Our clinical leaders believe things need to change to protect and develop services and that now is the time to do so, as doing nothing will impact our ability to provide safe surgery in all specialties
Process over the last year • A Clinical Reference Group (all surgical Clinical Directors) profiled specialties and their requirements • A Surgical Advisory Group (above plus representatives from directorate and operations teams) considered requirements, site facilities, interdependencies and developed two strategic options • The last 6 months has seen greater consideration of these 2 options, greater involvement of multidisciplinary teams, external stakeholder engagement (patients, GPs, CCGs, Health Watch) • Options have evolved and developed as operational work up has taken place to conclude with one preferred option to take to the next stage • Overwhelming messages: – Intend to retain local access points for local people through our 3 hospitals. This means all aspects of a patient’s journey within the Trust, apart from some surgical procedures, will remain locally delivered as now – Intend to retain 3 busy surgical hospitals so where one service may move out to consolidate on one site, another will move in to consolidate
Proposed future split by surgery type and site Heartlands Good Hope Solihull Most Emergency surgery Surgical Emergency assessment including orthopaedic trauma Urology emergency surgery Upper Gastrointestinal emergency surgery Planned surgery: Planned surgery: Planned surgery: Obs and gynae Obs and gynae Orthopaedics Thoracic Urology Ophthalmology Vascular Upper Gastrointestinal (UGI) Some general surgery Colorectal Bariatrics (weight loss) Paediatric Some general surgery Some general surgery ENT (Ear, Nose and Throat) to be determined All outpatient attendances as now eg consultations, imaging, physiotherapy etc Non theatre diagnostic investigations as now eg endoscopies
Summary of proposed changes Good Hope (GHH) Solihull (SH) Heartlands (BHH) Plus Minus Plus Minus Plus Minus Urology Orthopaedics Orthopaedics Urology Orthopaedics Urology All emergency Planned and Planned from Emergency Emergency and Planned from SH emergency GHH (trauma) to be planned and BHH (trauma) all on one site UGI/Bariatrics Ophthalmology Ophthalmology UGI/Bariatrics Gynaecology UGI/Bariatrics All emergency (only 3 lists) From GHH (only 4 lists) Emergency and Planned from SH planned and BHH Possibly ENT Emergency and Gynaecology Emergency and Possibly ENT planned (only 4 lists) planned colorectal colorectal No Change Obstetrics and Gynaecology Planned Minor General Surgery Obstetrics and Gynaecology General Surgery assessment Thoracics Planned Minor General Surgery Vascular Paediatrics Emergency surgery Outpatient attendances for Outpatient attendances for Outpatient attendances for consultations, imaging, consultations, imaging, consultations, imaging, physiotherapy physiotherapy physiotherapy Non-theatre diagnostic Non-theatre diagnostic Non-theatre diagnostic investigations investigations investigations 7
Potential Benefits • The ability to meet current and future clinical standards for surgery • Better outcomes and experiences for our patients • Shorter waiting times and more certainty with dates for planned surgery • Faster access to emergency surgery and reduction in bed days waiting for such surgery • The ability to create centres of excellence in a number of surgical specialties • The capacity to deliver activity internally without the need for premium rate waiting list or private sector work • The opportunity to grow those specialties where additional revenue could be secured eg bariatric surgery • Gains in efficiency from consolidation and best practice benchmarking eg reduction in Length of Stay and increased theatre utilisation • Opportunities to release financial benefits by doing things differently
Impact on patients • No impact for most of our patients – we see about 1.2 million patients pa and undertake approximately 45,000 theatre operations • No impact for outpatient attendances • Better quality care for our surgical patients sustainable in the long term • Small percentages of patients’ attendances are for a surgical intervention • Support for patients and relatives travelling further for their operation is being designed in conjunction with Stakeholder Reference Group • Feedback from this group so far is positive, understanding the rationale for considering change and seeing the potential benefits of reconfigured, consolidated surgical provision such greater certainty for planned surgery and all the experts in one place
To Heartlands Trauma To Solihull Orthopaedic Centre Elective Care Centre
Spells with a T&O Procedure at GHH (Patients aged 17+) January – December 2013 GHH Drive Times New Hospital drive Times SOL <=10 Mins <=15 Mins <=20 Mins <=30 Mins <=40 Mins <=10 Mins <=15 Mins <=20 Mins Elective 1,059 17.5% 44.3% 69.9% 69.4% 98.8% 0.1% 0.5% 2.6% SOL <=30 Mins <=40 Mins <=10 Mins <=15 Mins <=20 Mins <=10 Mins <=15 Mins <=20 Mins Day case 70.4% 98.7% 0.2% 0.5% 3.4% 1,483 20.2% 48.4% 75.9% BHH <=10 Mins <=15 Mins <=20 Mins <=30 Mins <=40 Mins <=10 Mins <=15 Mins <=20 Mins Emergency 18.8% 46.4% 71.3 % 77.1% 99.9% 1.5% 17.6% 37.8% 1,332
Spells with a T&O Procedure at GHH (Patients aged 17+) January – December 2013 The table below shows the drive time from the residential location of patients age 17+ attending Good Hope for a T&O procedure to Walsall, UHB and S&WB hospital. Drive Time (Mins) Hospital 10 15 20 30 40 Total 8 96 804 2,737 3,762 3,874 Walsall 0.2% 2.5% 20.8% 70.7% 97.1% 100.0% 6 17 56 1,982 3,205 3,874 UHB 0.2% 0.4% 1.4% 51.2% 82.7% 100.0% 8 15 1,030 2,614 3,605 3,874 S&WB 0.2% 0.4% 26.6% 67.5% 93.1% 100.0% *This is for all patient classes i.e.. Planned and emergency
To Good Hope urology surgery centre
Spells with a Urology Procedure at BHH (Patients aged 17+) January – December 2013 BHH Drive Times New Hospital drive Times GHH <=10 Mins <=15 Mins <=20 Mins <=30 Mins <=40 Mins <=10 Mins <=15 Mins <=20 Mins Elective 694 19.0% 40.5% 62.1% 71.8% 98.3% 3.3% 10.2% 22.9% GHH <=30 Mins <=40 Mins <=10 Mins <=15 Mins <=20 Mins <=10 Mins <=15 Mins <=20 Mins Day case 69.0% 98.9% 1.0% 3.5% 14.0% 3002 23.2% 49.3% 71.7% GHH <=10 Mins <=15 Mins <=20 Mins <=30 Mins <=40 Mins <=10 Mins <=15 Mins <=20 Mins Emergency 18.0% 43.7% 62.7% 77.3% 97.8% 5.0% 16.2% 30.2% 1,118
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