Summary Version February 2021

Your Care, Your Views Summary version February 2021

1 Your Care, Your Views

for illustrative purposes only

Our vision

he course is set for a Hertfordshire at the Watford General nearest hospital is not always the best T transformational redesign Hospital site (and adjacent land) and site to meet your needs. But it will be of health and hospital services to extensively redevelop and refurbish the best site it can be in terms of how in west Hertfordshire. Hemel Hempstead Hospital and its services are grouped together to give St Albans City Hospital. the highest clinical outcomes possible. We have plans to provide services and buildings which will improve the patient Our aim is to breathe new life into We are grateful to our busy clinical experience and the quality and safety our hospitals, giving them all a unique staff who have shaped the proposals of our care. purpose in our three-site network that are set out in this document. and also within the wider framework There is also a more detailed version This document summarises our of local health and care services. We as well as plenty of other information new models of care; the reasons will co-locate services that work well on our website. behind them and the beneﬁts we together and minimise duplication think they will bring. Our proposals across our sites where possible. for new ways to deliver services are We really want to hear your being developed alongside exciting It is important to read and understand views on our proposals and plans for our three hospitals. the story of our services because we would be really grateful if, believe that the quality and safety of once you have understood our We are applying for funding to build your care should be our priority. The proposals, you could complete a new general hospital for west result of our plans may mean that your our online survey.

The intention of this document is to generate discussion and assist in the ongoing development of our proposals, so the information reﬂects our current thinking and may be subject to further change.

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Contents

Hospitals in and around Hertfordshire 04

Time for a change 05

Starting with strategy / Words into action 06

Doing things differently 07

Digital transformation 08

Three’s company 09

Consolidate not duplicate 10

A better working life for staff 11

Services before sites 12

Harnessing the full power of diagnostics 14

Making our sites right 15

Travel and access issues 18

How you can get involved 19

Further reading 21

3 Bedfordshire

Luton Stevenage Luton & Lister Hospital Dunstable Your Care, Your Views University Hospital

Aylesbury M1 Stoke Mandeville Hospital Hertfordshire

Hemel St Albans Hempstead St Albans Hemel Hempstead City Hospital Buckinghamshire Hospital

Watford A&E facilities Watford General Enﬁeld M25 Hospital Barnet Chase Farm Hospital Barnet Hospital Enﬁeld Bedfordshire No A&E facilities Barnet

Camden Herts Valleys Clinical Harrow Luton Commissioning Group area Hampstead Stevenage Middlesex Northwick Park Royal Free Hospital Luton & Hospital Lister Hospital County boundaries Dunstable Uxbridge Greater University Hillingdon Hospital London Hospital

Aylesbury M1 Stoke Mandeville Hospital Hertfordshire

Hemel St Albans Hempstead St Albans Hemel Hempstead City Hospital Buckinghamshire Hospital

Watford A&E facilities Watford General Enﬁeld M25 Hospital Barnet Chase Farm Hospital Barnet Hospital Enﬁeld No A&E facilities Barnet

Camden Herts Valleys Clinical Commissioning Group area Harrow Hampstead Middlesex Northwick Park Royal Free Hospital Hospital County boundaries Uxbridge Greater Hillingdon Hospital London

Hospitals in and around Hertfordshire

We provide care from three hospitals, located within around 10 miles of each other:- Hemel Hempstead Hospital, St Albans City Hospital and Watford General Hospital. We also provide outpatient physiotherapy at the West Herts Therapy Unit at Jacketts Field in Abbots Langley.

Some people in the area covered by Herts Valleys Clinical Commissioning Group (HVCCG) use services provided by other hospitals in Hertfordshire, Bedfordshire, Buckinghamshire and Greater London.

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Time for a change

our hospital services are We have succeeded in making our Y changing dramatically. case to the government for investment Advances in technology, medical and we are delighted to be in the ‘New practice and our work with partner Hospital Programme’. Our preferred organisations in the NHS and social option is for a new emergency care care means that we must think hospital at the Watford site and for differently about the hospitals redevelopment at our two other sites. of the future, their services and We will hear more about our funding buildings. later this year. Our website has lots of detail on the business case process we The need to come to hospital as an are following. outpatient is decreasing as we offer other ways to be ‘seen’, such as video Our new and refurbished buildings will consultations or advice from a hospital be very different. We want to create specialist provided to you by your GP. pleasant, healing environments which The shift of services from hospitals are easy to find your way around and into the community and the increased where the services fit logically together. emphasis on patients being better supported to manage their own care means that we need to redesign our services to reflect these changes and be ready for new ways of working.

The proposed redesign of our services across our three hospitals will go hand in hand with plans to redevelop all three sites.

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Starting with strategy

Our proposals reflect:- Our clinical strategy sets out the rationale for our plans and outlines • our clinical strategy and our clinical them broadly, and the clinical brief brief (both currently in draft) provides detail on a service-by-service level including potential changes to • our ﬁve year organisational strategy which of our hospitals the services will be delivered from. The three • the ‘Your Care, Your Future’ priorities in our strategy are:- programme involving Hertfordshire health organisations • integrating care with primary (ie care from your GP) and community care • Hertfordshire and West Essex (health visitors, for example) Integrated Care System’s ‘ A Healthier Future’ strategy • personalising the care each patient receives (reﬂecting patient’s wishes • the NHS Long Term Plan. and individual health needs)

Links are provided in the • providing consistent, best ‘further reading’ section at practice care. the end of this document.

Words into action

o achieve these strategic aims, • create more ‘one stop’ clinics Twe will:- where several steps of your treatment (diagnostic test, a • continue to move services off consultation based on the results hospital sites and into local settings and a treatment plan) all happen where it is clinically appropriate to on the same visit do so • redesign how our services work • use technology, such as apps together and how they contribute which transmit health data to our to each site having its own clinical teams and a new integrated unique purpose. electronic patient record, to improve the safety and efﬁciency of our care

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Doing things differently

he promise of investment, the • incorporate the latest designs and • move to care models that mean T advances in technology and the best practice for infection control around 200,000 patients will no positive changes we have made longer have to travel in for an recently are an excellent starting • embrace technology to store, outpatient appointment point for considering how your transmit and monitor health data, hospital services could look in the thereby reducing hospital visits • design buildings that promote very near future. health and healing • use robots and artiﬁcial intelligence Below is a list of wide-ranging (AI) to streamline support services, • extend the service where hospital improvements. We plan to:- such as linen deliveries and admin doctors support GPs with specialist processes advice for patients (which can avoid • develop new models of care for the need for a referral and speed emergency services, endoscopy, • group services and staff together up treatment) maternity and surgery (and more to enable better clinical outcomes, in time) team working, training and • remove routine follow-up absence cover appointments (where clinically • provide new facilities for cancer appropriate) and give patients the services • reduce duplication of services choice to request one depending across sites which can affect on their recovery or if symptoms • offer more ‘one stop’ clinics quality and efﬁciency or circumstances change.

• provide a vastly increased proportion • upgrade and expand diagnostic of ensuite single rooms facilities at all three of our hospitals

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Digital transformation

he explosion of digital information (with permission) will lead High performing IT systems will boost T technologies will significantly to more joined-up care and digitised staff satisfaction and release more of increase efficiencies and improve patient records will support online their time to care for patients. the experience of our patients booking and boost the ability of and staff. clinicians to ‘see’ patients remotely, via their computer, phone or other device. Easy-to-use apps and health monitoring equipment can help patients manage Digital technology is taking care directly their own conditions and technology into patients’ homes, proving that you can also transmit health data from don’t need to come to hospital to get patients in their own homes to our hospital care. clinical teams looking after them. Our feedback so far is that virtual Implementing an electronic patient appointments are welcomed by many record will bring major beneﬁts to but we will offer alternatives for patients how we manage your care within our who would prefer their healthcare to be hospitals and also across other health delivered in more traditional ways, such as and care providers. Sharing your face-to-face appointments or phone calls.

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Three’s company

ur proposals are based on O each of our three hospital sites having a clear and valuable purpose; to be different but to work together and share the same high standards.

The broad outline for our three hospitals is:-

Watford General Hospital emergency, specialist and complex care

*St Albans City Hospital planned surgical care, planned cancer care and an urgent care service

Hemel Hempstead Hospital urgent and planned medical care, long term conditions

*Our minor injuries unit at St Albans City Hospital is temporarily closed due to the pandemic. Engagement will take place later this year about the urgent care services that will be offered.

The plans for our three hospitals reﬂect the NHS Long Term Plan which recommends a clear separation between urgent and emergency care and planned care. And within planned care, there will also be a greater distinction between surgery and medicine which will improve the way our teams and hospitals function.

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Consolidate not duplicate

eams of staff from the same In future, we expect there to be less T and related areas of medicine duplication, with a narrower range of (which we call specialties) will be services provided at all three sites. These grouped together and will have will include urgent care and outpatient the right facilities to provide the appointments for antenatal and best care. postnatal care, and audiology.

Consolidating staff and services will Your hospital appointment will help us provide many more ‘one stop’ be at the site which is the best for clinics where several steps of treatment your needs. This might not be the are covered in one visit (such as a nearest site to you. diagnostic procedure, a consultation based on the result and a discussion More detail on what services will be at about your treatment plan). which site or sites follows later in this document at pages 15, 16 and 17. There are considerable beneﬁts in terms of patient experience and staff satisfaction from working this way but will require us to reorganise our staff and services across our sites. In many cases the aim is to reduce the number of our sites providing the same specialty service from three to two, or two to one. Not every site has every speciality at present.

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A better working life for staff

aving teams stretched across two of the three hospitals) and so H services delivered from all three build stronger teams with better hospital sites can reduce training facilities and working environments. opportunities for junior staff and This will boost job satisfaction and limit effective team working. aid recruitment and retention. There will also be comfortable and Our proposals will allow specialty staff welcoming areas for our hard- to work from fewer sites (in most cases working staff to rest and recuperate.

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Services before sites

ur clinicians have been sharing The size and layout of the new ED admitted, whilst also continuing to work O their ideas on how hospital (emergency department) will enable with GPs and other health professionals services could work better for you. clinicians to have easy oversight of to avoid hospital admission for this The following information sets out patients, aided by new technology patient group wherever possible. our plans for your care. Improving which means that their observation your experience and the quality data is instantly available. This will Patients who no longer need specialist and safety of our services is at the help to ensure that care is directed to care are not best served by remaining heart of these proposals. patients with the greatest clinical need. with us because our staff and services There will be assessment spaces and are geared up for people who are acutely Emergency and diagnostic equipment so that specialist unwell. Our partners who commission specialist care teams can work in our ED to provide and provide community-based beds are care to the patient rather than moving increasing the range and type of care We are applying for funding which the patient to another area to get all available to patients who are well enough will enable us to deliver emergency the care they need. to leave hospital but need support or and specialist care from the Watford rehabilitation in a healthcare setting. General Hospital site. There is a Having the right staff, services, The main provider of adult community strong view from clinicians that equipment and access to diagnostics health services in west Hertfordshire patients requiring 24/7 consultant-led within 24 hours of admission is in (Central London Community Healthcare emergency care should be seen on a line with the NHS Plan’s ‘same day NHS Trust) will be engaging on plans specialised care site. This provides the emergency care’ approach. to support people following a hospital safest and most effective solution, with stay later this year and this may include access to the full range of specialist Our new ED will cater for the increasing reviewing the inpatient beds at Hemel expertise and equipment. ratio of frail elderly patients who are Hempstead Hospital.

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Women’s and clinical fit on a cancer site where there more than half a million outpatient children’s services will also be comprehensive diagnostics attendances. And around 200,000 of and cancer care and support services, those were for medical care. Most women’s and children’s services such as a cancer information centre. (inpatient care and births) will be at The new location will be a much The opportunity to invest in the Hemel Watford General Hospital where they better environment for patients. Hempstead site, the increase in the will be close to theatres, assessment 70+ population and a new approach facilities, diagnostics and the ED. This Some cancer care will be provided (nationally and internationally) to will reduce transfer time between from all three sites, but St Albans will planned medical care present the departments and allow clinical teams be the main cancer diagnostics, care perfect backdrop for our changes. to be based together. We will continue and support base. This will help us to provide antenatal, postnatal and co-ordinate care better and reduce We plan to bring clinicians from outpatient care in all three hospitals the number of hospital visits for different medical specialties together and planned gynaecology surgery at patients who have been referred and provide new diagnostic facilities St Albans. with suspected cancer. and the latest technology so that we can give first class care to a large Expectant mothers and their birth Surgery for children and higher risk and growing group of patients. This partners will benefit from individual or highly complex surgery will be approach will improve teamworking rooms that are equipped to support provided at Watford, where there and efficiency as well as provide them at all stages of their labour. is access to critical care if required. easy access to an experienced physician Delivery suites, in line with the very Purpose-built spaces called ‘medirooms’ when a review or second opinion latest building standards, will provide will allow patients (at the Watford site) is required. spacious ensuite facilities. to have an individual room for both pre and post-operative care on the Our intention is to make the hospital Children who need inpatient care day of their surgery. a calm and healing environment, for will be cared for in purpose-designed it to be easy to find your way around single rooms with improved facilities St Albans City Hospital has been our and for the services to use a ‘one stop’ for their carers, and there will be new Covid-free site where we have been approach. outpatient facilities too. able to continue some services whilst our main site at Watford has been Our care will be consultant-led, caring for large numbers of Covid-19 supported by other clinicians with patients. The advantages of separating specialist expertise in medical care and Planned surgery and cancer planned and emergency care have long term conditions. Our patients will been brought into sharp focus in be at the centre of a network of health We plan to expand the volume and 2020 and 2021. and social care professionals and there range of surgery provided at St Albans will be a shared ethos around patients City Hospital. We will increase the remaining as well as possible in their theatre and procedure room capacity, own homes without the need for an provide enhanced post-surgical Planned medical care emergency hospital admission. recovery care and extend the range of diagnostic facilities. These improvements, Our vision is for Hemel Hempstead There will be a strong ‘multidisciplinary’ combined with a stronger consultant Hospital to be a centre of excellence approach and our digitised patient surgeon presence and more specialist for people from across west records will aid closer working with staff located together, will enable St Hertfordshire who have long term other parts of the health service Albans City Hospital to develop into a and/or multiple conditions and need through the sharing of health data comprehensive planned surgery and care on an outpatient basis. (with permission), including customised cancer centre for patients across west electronic health records for chronically Hertfordshire. Many tens of thousands of patients ill patients. every year will benefit from the Emergency endoscopy (insertion of a transformation in how this site works. Conditions catered for at Hemel long, thin tube via the mouth or anus to Hempstead Hospital will include: investigate tissue or organs) will continue Most people’s experience of our general medicine, older peoples’ to be provided at Watford. Our planned hospital care is through planned services, cardiology, dermatology, endoscopy service at Hemel Hempstead, appointments. In 2019/20 there were diabetes and endocrinology, which is in a cramped environment, around 150,000 attendances at our rheumatology, respiratory and many, will move to St Albans, along with urgent and emergency care services many more. A full list can be found in cystoscopy. These services are a better across our three sites compared to the longer version of this document.

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Harnessing the full power of diagnostics

ur proposals recognise We are aiming to create a new rapid At Watford, which will be our emergency O that great hospital care has diagnostics centre at St Albans City care site, we will be updating and diagnostics at its heart. We plan Hospital, offering MRI, CT and other expanding the diagnostic services to to increase the speed with which diagnostics including endoscopy and best provide rapid and accurate staff make diagnoses for patients nuclear medicine (a medical imaging diagnoses for our most unwell patients. by investing in equipment across and treatment specialty using a our three hospitals. gamma camera). This will provide Hemel Hempstead Hospital will have extensive support to all patients, plain ﬁlm x-rays, MRI, CT, ultrasound A fast and accurate diagnosis can especially cancer patients, and and DEXA scanning (bone density answer questions about symptoms, underlines the rationale of St Albans test) diagnostic facilities to support its alleviate anxiety and determine the being our planned surgery and role as our base for planned medical best course of treatment. cancer site. care services.

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Making our sites right

e have set out the rationale W for the way we want to reorganise our services and we have described how we will group specialty staff together to increase quality and efficiency and reduce duplication. The information set out below is to help you understand which services will go where. The longer version of this document gives more detail on any change from site to site.

To be provided at the Watford General Hospital site ... • women’s and children’s services (high • a lower environmental impact from risk and low risk maternity, neonatal using greener power, heat and light • a well-designed and technology- care, children’s inpatient care and and by using materials with a lower enabled building for your healthcare surgery and emergency and specialist carbon emission count services gynaecology) • the ability to accommodate services • extended and improved emergency • a wide range of outpatient and clinical from Mount Vernon Cancer Centre and specialist care services support services if required

• an urgent treatment centre • new specialist services (such as inpatient neurology, inpatient • a larger emergency department chemotherapy and some additional We understand that news with assessment areas cardiology) so that local people will no of construction at Watford longer need to travel outside of west might make you worry about • an acute inpatient admissions service Hertfordshire for care disruption but please bear in mind that we are not rebuilding • high risk surgery • a multi-storey car park (which removes on the same footprint as the need to walk up/down the steep our current buildings. The • critical care hill on this site and has pay-on-exit construction is taking place technology) on land next to the current • a fracture clinic next to the buildings. Also, in line with the emergency department • reworked car and public transport other frontrunners in the New access routes and drop off points Hospital Programme, we will • complex diagnostics be using ‘modern methods of • a vastly improved working construction’ which means that • multidisciplinary meeting spaces environment for staff, with better many components of our new so that staff from different specialties areas for rest and recuperation building will be made off-site. can work together for the beneﬁt This reduces the amount of on- of our patients • landscaped green spaces, coffee site building work. shops, restaurants and leisure facilities.

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St Albans City Hospital will… • become the location for a new • benefit from enhanced technology endoscopy unit to support cancer • have a new and unique purpose as care and other specialties • provide improved facilities for breast the site for specialist planned surgical care services care and cancer services for people in • offer gastroenterology and associated west Hertfordshire hepatology services • provide spaces for multidisciplinary meetings so that staff from different • broaden its range and volume of • provide urgent care services specialties can work together for the surgery (including surgery that was (a review will take place in Spring benefit of our patients previously provided at Watford) 2021 to establish the exact type and level of services) • offer refurbished recovery areas • provide better and faster diagnosis following surgery following a significant upgrade to its • be the location for an increasing MRI and CT provision number of ‘one stop’ clinics • provide wheelchair access for audiology (not previously available • offer nuclear medicine (a medical • offer cancer-related support services at this site) imaging and treatment specialty and an information centre using a gamma camera) – moved • remain as our ‘clean’ hospital; ie a to this site as it sits better with • undergo a complete replacement of site we can protect from infectious cancer care theatre and procedure room facilities disease outbreaks and where we can continue to provide services • offer pre and post-surgery whilst our main site provides care appointments to patients with infections, such as Covid-19.

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Hemel Hempstead Hospital will… • be the location for an increasing “In creating a base for planned number of ‘one stop’ clinics medical care at Hemel Hempstead • have a new and unique purpose Hospital, our patients can see a as the site for specialist planned • offer health and wellbeing support range of clinicians all under one medical care site for people in for a wide range of long term roof. Great hospital care doesn’t west Hertfordshire conditions just happen on emergency sites or on busy wards – it can be in a calm • provide urgent care services • provide spaces for multidisciplinary environment where everything the meetings so that staff from different patient needs has been thought • broaden its range and volume of care medical specialties can work for people with long term conditions together for the beneﬁt of our through and is close at hand.” patients Dr Sundeept Bhalara • become our site for specialist diabetes and rheumatology • become a model for how planned Consultant rheumatologist and care can be delivered from a clinical director for specialties • beneﬁt from enhanced technology multi-specialty site, embracing medicine the latest best practice • expand outpatient services for paediatrics, respiratory, cardiology • provide a calm and supportive and dermatology environment where services are logically grouped together and • provide better and faster diagnosis, where there is an ethos of keeping with MRI, CT and DEXA scanners people as well as possible in their own homes. • offer refurbished outpatient facilities

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Travel and access

e know that access and our hospitals. And we will improve the many improvements we plan W travel are commonly cited parking on all three sites. to put in place. concerns associated with hospital care in west Hertfordshire. We are We understand that the relocation We will be setting up a travel and committed to addressing this as our of some of our services may mean access reference group, and will plans progress. As well as reducing that some people will need to travel conduct indicative travel impact analysis the need for people to visit our further than they do now. However, for several of our key service areas. hospitals sites through adopting some people will travel less far and The outcome of this analysis will be new models of care, we will work hopefully all of our patients will make available for consideration alongside the with local authority partners to find less frequent journeys as a result of engagement feedback later this year. ways to make it easier to get to

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How you can get involved

e want to enable feedback W from our staff, patients, carers, stakeholders and other Take part in our survey members of our local community to be considered as part of our This survey asks for your views on our draft clinical strategy, draft decision-making. We are therefore clinical brief, and our proposed three site model. planning a two phase engagement programme. The first phase will run It would be helpful if you could read this document fully (or the fuller version here) until 24 March 2021. before completing the survey. The closing date for the survey is midnight on 24 March 2021. We will review and analyse feedback at the end of each phase of engagement to ensure that any conflicting suggestions can be considered together. We have arranged for the Attend online meetings and events feedback from this first phase of engagement to be independently We will be running an extensive community engagement programme analysed to help us consider the so that you can learn more about our proposals, ask questions, hear feedback as we develop more specific from a wide range of people including patients, carers, community and voluntary plans. We will share the independent groups, in dialogue with healthcare organisations, professional partners, and our analysis, our response and updated managers and staff. There will be opportunities to learn about the many aspects of proposals through a second phase our redevelopment programme including design and planning. of engagement in mid-May. This will Among the planned events, we will hold dedicated events for specific service areas: enable us to test our proposals in more detail and get further feedback from • diagnostics - endoscopy, DEXA bone scanning and nuclear medicine our community and stakeholders. • medicine • surgery We will address feedback from the formal engagement through a response Please also visit our website as we will continue to update it with additional content, document and during any follow-up such as interviews with key staff and bitesize presentations on key topics. engagement activities, rather than responding to individual responses while the formal engagement is taking place. We will, however, monitor feedback as it comes in and will clarify any frequently asked questions or Join our stakeholder reference group common misunderstandings on our dedicated website pages. We’ve already set up a stakeholder reference group (SRG) involving patients, carers, community and voluntary groups in thinking about our emerging ideas. New members are always welcome. If you would like to join this group, please visit our website.

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Join our travel and access group

We are setting up a travel and access reference group to make sure that transport and other access issues are fully considered as we develop our plans. We very much want patients, carers and community groups to be represented on this group, working alongside transport planners from local councils, public transport providers and East of England Ambulance Service. You can sign up to join this group on our website here.

Get involved in the design and planning process

There will also be opportunities for community engagement as part of the building design and planning process. Running in parallel with the engagement work outlined in this document, our architects BDP will be inviting members of the local community to have their say on the design and access proposals which are being created as part of the planning application process.

The next steps

Thank you for reading this and thank you again if you have completed the survey! We are grateful to everyone who has taken part in our various engagement activities over the past five years.

We look forward to hearing more from those we have already engaged with and we also hope to reach new audiences who haven’t yet had their say on the future of health services in west Hertfordshire.

The next milestone is to review the shortlisted options in more depth to identify the final preferred option (the one that provides the best overall balance of benefits and costs) which we will take forward to the next stage – full business case. We expect to make this decision this summer and then submit our proposal for approval from NHS England, the Department of Health and Social Care (DHSC) and by Her Majesty’s Treasury.

We expect to hear if all the funding we have applied for has been approved by the end of 2021 or early 2022. It is possible that the impact of the current pandemic may lead to movement in some of these timescales.

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