NHS in Gloucestershire sets out plans for the future of services

10/05/06

NHS Chief Executives today shared with their staff and local partners further detail on their proposals setting out how services will need to change to bring financial stability to the county and improve efficiency whilst meeting the needs of patients in the future.

The NHS in Gloucestershire has consistently provided good quality services for its patients. Services have improved year on year and the NHS has met demanding national and local performance targets for waiting times and access to services, including A&E targets.

This performance has been reflected in annual star ratings where NHS organisations have achieved excellent results.

However, the NHS is reviewing how services are provided to ensure that every penny and every pound of public money is used well. NHS organisations are also required to pay off current deficits and balance their books in 2006/07.

In a joint statement, the PCT and NHS Trust Chief Executives in Gloucestershire said:

“We are very proud of the services we offer to patients. However, we still need to make savings and ensure that we live within our means.”

“To do this we need to speed up our plans to change services if we are to meet the needs of patients in the future.”

“This is a difficult time for the NHS in Gloucestershire, but we need to get on and secure savings quickly and at the same time explain to people why we think the changes we are proposing make sense for patients in the long run.”

For Gloucestershire’s three Primary Care Trusts (PCTs) there remains a financial gap of around £14 million in plans for 2006/07 and these savings need to be made. Whilst this is only a small proportion – around 2% - of the total spend on NHS services (£674m), urgent action needs to be taken now.

There are also financial pressures facing the county’s provider Trusts (approximately £15 million) partly due to the national requirement for all NHS organisations to reduce costs by 2.5% in 2006/07.

NHS Chief Executives in Gloucestershire have now provided more details on proposals to close the financial gap and safeguard the future of services for the long term.

As part of its proposals, the Health Community is determined to ensure that patients are only admitted to hospital when they need to be and that they are promptly and safely transferred from hospital.

In Gloucestershire, there are an above average number of people admitted to hospital beds and the length of time people spend in hospital is also above the national average.

The Health Community has proposed a number of measures which will allow it to reduce hospital beds in the county by about 240. This includes those already closed at Fairford and Tetbury and those that form part of the Delancey Hospital proposal, but excludes changes in mental health services.

To achieve this figure, further bed reductions are proposed at Gloucestershire Royal Hospital, Cheltenham General Hospital and as part of proposals for local community hospitals.

A range of measures are being put forward to support the reduction in beds (see Note 2).

The Health Community is committed to providing specialist hospital services for those who need them.

However some services may have to be provided in fewer locations and in different settings if the NHS locally is to safeguard the future of services and continue to provide good quality clinical care for patients.

The NHS in Gloucestershire will shortly be developing detailed proposals which would result in all obstetric and maternity inpatient services being provided from Gloucestershire Royal Hospital. In order to achieve early cost savings, it is proposed that the inpatient services at Stroud Maternity Hospital will close this year. The unit in Cheltenham will close when all obstetric and maternity inpatient services move to Gloucestershire Royal.

There is also a proposal to concentrate a number of relatively low volume and specialist inpatient surgical services at either Gloucestershire Royal Hospital or Cheltenham General Hospital (see Note 3).

As the Health Community looks to integrate hospital and community emergency services (including Primary Care Centres), the NHS locally will explore how best the two main Emergency Departments can work together through the full 24 hours a day period.

The NHS in Gloucestershire has already shared proposals for changes to mental health inpatient and day services for adults and older people.

The Health Community also believes it is right to consider how best to continue to develop community based services as close to the patient’s home as possible.

The Health Community remains committed to the vision set out in the recent Government White Paper.

Greater opportunities for improved rehabilitation and management of long term illness in the patient’s own home, together with primary care, new technology and improved surgery and patient management is reducing the number of hospital beds needed in any given community.

The NHS in Gloucestershire is therefore keen to ensure a viable future for community based services and to make sure that care and treatment is provided in the most appropriate place.

In West Gloucestershire, there is a proposal to close Dilke Memorial Hospital. In the longer term, the PCT would also anticipate the closure of Lydney and District Hospital as soon as a new community health facility can be developed on a new site in the Forest of Dean.

It is envisaged that the new facility would provide a wide range of local services such as primary care, diagnostics, minor operative procedures, day services and outpatients and intermediate care beds to provide rehabilitation for patients.

Within Cotswold and Vale, there have already been a number of changes including a reduction in beds at Tetbury and Fairford, in line with the PCT’s strategy of Better Healthcare Closer to Home.

In the North Cotswolds, much work has been done to ensure more efficient use of community beds in conjunction with increases in outpatient activity and community based rehabilitation and nursing care.

The PCT intends to collaborate with independent providers for a new health and social care facility in Moreton, to include new GP premises for two north Cotswolds practices, providing a greater range of outpatient services and 20-25 semi acute beds.

The PCT intends to develop community based care teams in the north Cotswolds. It also intends to work closely with an independent partner to create 10-15 intermediate care beds in Bourton. The new bed provision will replace the existing beds at Moore Cottage Hospital in Bourton.

The PCT proposes closing one of the two minor injury units in the north Cotswolds, due to low demand.

At Stroud General Hospital, the NHS is proposing that surgical services are provided on a day case basis only (including endoscopies), enabling both Berkeley and Stroud Hospitals to focus on medical and rehabilitation care.

The PCT also proposes that, in the medium term, a new health and social care facility be developed in Dursley. This would eventually mean the closure of Berkeley Hospital and Sandpits Clinic, when the new facility is opened.

In Cheltenham and Tewkesbury, the PCT is developing options for expanding rehabilitation services to support patients in returning from hospital more quickly.

This would mean having fewer hospital beds and more active rehabilitation services provided in the community, such as those provided at the Ashley House Intermediate Care Centre in Cheltenham.

It is therefore proposed to close Winchcombe Hospital and develop an enhanced range of services at Tewkesbury Hospital.

The Health Community aims to ensure that local outpatient services continue to be provided locally where appropriate and where a local hospital closes, the NHS will look at the possibility of using other local facilities such as GP premises to provide a wider range of services.

The PCTs will work with Trade Unions and Staff Side representatives to look at ways of redeploying staff where possible. Everything possible will be done to avoid compulsory redundancies.

The PCT and NHS Trust Chief Executives in Gloucestershire said:

“Our proposals are about securing patient services for the future and at the same time achieving financial stability. We know that the range of savings proposals will not be popular with everyone. We would ask the people of Gloucestershire to recognise the pressures facing the local health community as a whole and work with us to develop the best options for the future.”

The proposals will be discussed with the Overview and Scrutiny Committee on Thursday May 11. Where hospital closures are proposed, the NHS expects these changes to take place within the next 12 months.

The additional funds received over previous years have clearly been welcome. However, the majority of this money has been spent meeting the costs of new drugs, improving waiting times and meeting commitments such as the GP contract, consultant contract, pay awards, increased NI and pensions contributions and the new Out of Hours service.

By 2007/08 the financial allocation by head of population in Gloucestershire will be approximately 88% of the England average based on the below average health needs of the population in Gloucestershire. However the demand for healthcare locally does not reflect this.

Avon , Gloucestershire and Wiltshire Strategic Health Authority has now confirmed how it will be implementing national policy on NHS financial management for 2006/07. It intends to create a pool of funds to help the most financially challenged organisations in AGW pay off their 2005/06 deficits. Cotswold and Vale will receive £6.8m but overall the county’s three PCTs will lose a total of £6.5m from their expected 2006/07 allocations.

The underlying difficulty is compounded in 2006/07 by financial pressures facing the county’s provider Trusts. Significantly there will be a large reduction in the prices paid to acute hospitals through the national tariff next year.

Gloucestershire Hospitals NHS Foundation Trust will be paid up to £17m less, than it will receive this year for the same number and case-mix of patients. Gloucestershire Partnership NHS Trust is forecasting a £5.2m deficit in 2006/07, whilst Great Western Ambulance Trust is forecasting a shortfall of £1.5m for the Gloucestershire area. These figures include the national requirement to make a cash efficiency saving of 2.5% in year.

NHS organisations in Gloucestershire have already introduced strong controls to improve their efficiency and reduce their costs. These include controls on recruitment and spending on goods and services, controls on use of bank and agency staff and spending on areas such as training.

• Reducing inappropriate 999 calls by tougher clinical triage and referring patients to the most appropriate treatment
• Making sure there are senior doctors and nurse consultants at all points of the patient journey, including emergency departments, medical assessment units and on hospital wards to help avoid unnecessary admissions.
• Fully integrating emergency departments and GP out of hours services
• Having short stay medical wards in the District General Hospitals to support early transfer from hospital
• Introducing daily emergency outpatient appointments for general medicine and surgery
• Increasing capacity in community services and also ensuring that community hospital staff work more effectively in supporting transfer from hospital
• Ensuring that once patients have completed the final phase of acute rehabilitation they are discharged from hospital. This may mean in some cases PCTs commissioning a new range of services in the community through the independent sector as well as increasing community nursing and other services.

The range of proposals describes changes, not only to hospital based services, but also across the range of services provided in the community. It will be for each organisation to agree its business plans for the future.

All of our proposals are aimed at reducing costs and ensuring quality of care.

Recommendations for consideration by the Health Overview and Scrutiny Committee (OSC) on 11 May 2006 to proceed without further consultation:

• Reducing management costs across the PCTs as part of reconfiguration proposals
• Ceasing to fund GP practices for GP appraisals
• Ceasing to fund PCT discretionary GP locum payments
• Ensuring more effective and efficient drugs prescribing across the board
• Deferring further development of healthcare services in Gloucester Prison over the year
• Not proceeding with piloting the nurse led unit at Cheltenham General Hospital
• Reducing staffing and/or opening hours at Minor Injury Units to reflect periods of low demand at Dilke Memorial, Berkeley and Tewkesbury Hospitals (and consideration given to North Cotswolds)
• Reviewing current use of funds within the Smoking Cessation Service
• Reviewing spend in current community dental service
• Reviewing on call services for Child and Adolescent Mental Health Services
• Reviewing patient support, information and health promotion services
• Reducing the number of follow up outpatient visits
• Redeployment of ambulance staff and vehicles from Newent to other parts of Gloucestershire to reflect demand

Recommendations for consideration by the OSC on 11 May 2006 for limited consultation:

• Rationalising mental health inpatient services for adults and older people onto two sites and review of day services
• Changes to Community Hospital provision in Gloucestershire
• Improving rehabilitation and reducing length of stay by increasing rehabilitation in patient’s own home and in community facilities. This will lead to a reduction in hospitals beds and the closure of Delancey Hospital in due course
• Reviewing access to ambulance patient transport services
• Reviewing the current model for the primary care Out of Hours service.

Recommendations for consideration with the OSC on 11 May 2006 being brought forward for earlier discussion regarding the appropriate level of consultation:

• Rationalising in-patient acute services onto one site where it is clinically and cost effective to do so. Detailed proposals will include:

• Provision of all obstetric and maternity inpatient services from Gloucestershire Royal Hospital
• Concentration of relatively low volume and specialist inpatient surgical services at either Gloucestershire Royal Hospital or Cheltenham General Hospital for:
• Oral and maxillofacial
• Vascular
• Gynaecology
• Urology.

Day cases and outpatients would continue at both hospitals. It is anticipated that the services would be split broadly equally between the two hospitals to ensure maximum clinical linkages and use of facilities.

• Reviewing arrangements for trauma and emergency care
• Determining the most effective location for the delivery of Breast Services.