Gwent Clinical Futures Public Consultation Document
Blaenau Gwent Local Health Board Caerphilly Local Health Board Monmouthshire Local Health Board Newport Local Health Board Torfaen Local Health Board Gwent Healthcare NHS Trust On behalf of Gwent Community Health Now it is your chance to have your Message Council, I am pleased to welcome say on these radical and exciting you to the “Clinical Futures” public proposals. As your local health consultation document. It is becoming “watchdog” we at Gwent Community from Gwent increasingly clear that the existing Health Council will oversee the formal pattern of health facilities and ways consultation process (starting on of working cannot deliver the kind of 18th September 2006 and lasting Community services you have a right to expect. for 12 weeks). We will receive and Health services must change; standing consider all comments made during still is not an option. The Welsh the consultation period on the Health Council Assembly Government document proposals outlined in this document. Designed for Life addresses these We will then advise the local NHS issues and sets out its plans to create organisations whether there is a world class health service for Wales sufficient public support for these over the next 10 years proposals.
The NHS in Gwent is taking the lead Please read this consultation document in Wales in producing far reaching carefully and take a few minutes to fill ideas for your healthcare in the 21st in the consultation questionnaire at the Century. This document sets out back of this document. Your response options for improving health services is important – the future of local health in the Gwent area by developing a new services in the Gwent area depends way of delivering the health services on it. that local people need. These options are the result of more than 18 months of work and discussion with patients, healthcare professionals and their local communities. Vernon Caldwell The proposals contained within this Chairman document, have been developed by Gwent Community Health Council local NHS organisations, including Gwent Healthcare NHS Trust, Blaenau Gwent, Caerphilly, Monmouthshire, Newport and Torfaen Local Health Boards. According to these plans, in future more care will be provided direct to you in your home, your GP surgery and some provided in community centres or clinics. Most hospital care will be provided in your Local General Hospital network. Only the most complex care will be delivered in a Specialist and Critical Care Centre that supports the network of Local General Hospitals.
2 Clinical Futures Public Consultation Document Contents Executive Summary Chapter 1 Why we need to change
Chapter 2 Improving the health service for the Gwent area
Chapter 3 Developing a Local General Hospital in Newport
Chapter 4 Developing a Local General Hospital in North Monmouthshire
Chapter 5 Developing a Local General Hospital in Torfaen
Chapter 6 Developing a Specialist and Critical Care Centre
Chapter 7 Tell us what you think
Glossary
Consultation form
Clinical Futures Public Consultation Document 3 Executive Summary
In this public consultation document we explain why change
is being proposed to the way in which health services are
delivered in Blaenau Gwent, Caerphilly, Monmouthshire,
Newport and Torfaen. We also describe the options for the
future shape of hospital services.
We have for some years now been ◆ Safe, high quality treatments discussing the possibility of developing within a reasonable timescale in a new “model of care” for the NHS in modern facilities that meet your Gwent. In 2005, Local Health Boards specific needs. issued a discussion leaflet called “Your Healthcare- the Future” and invited ◆ Improved local access to clinics, local people to give their views. The treatments and tests and more response was overwhelming and support to help you to stay resulted in the development of the independent. proposals that are outlined in this public consultation document. ◆ Services that are integrated and ensure that different organisations The proposals form the ‘Clinical and health professionals work Futures’ plan for the Gwent area and together across settings to provide will change the way we provide local continuity of care. health services by delivering more care closer to where people live, with the To achieve this, Clinical Futures aim of providing proposes:
4 Clinical Futures Public Consultation Document ◆ More and better primary care Nevill Hall Hospital site or the services delivered from GP surgeries, Maindiff Court Hospital site resource centres and directly into people’s homes (Level 1) ◆ Torfaen at one of these locations : the existing County Hospital site, or ◆ A network of 6 new “Local General an alterative site. Hospitals” delivering many of the services that are currently We also propose to build a single delivered from community Specialist and Critical Care Centre hospitals and District General which will serve the whole of Gwent Hospitals (Level 2) and will therefore need to be located on a site accessible to the entire Gwent ◆ A single Specialist and Critical patient population. Our proposal is Care Centre serving all of the that to benefit the entire Gwent patient Gwent area (Level 3) population, the most appropriate site would be located either at Llanfrechfa In this consultation document we Grange, Cwmbran or at an alternative ask for your views on the options we site within a three mile radius of the have considered for three of the new Croes-y-ceiliog roundabout and we Local General Hospitals, one each for would like your views on this. Newport, North Monmouthshire and Torfaen. We also want your views on the options for the Specialist and Critical Care Centre.
Through a separate consultation process we have already received support for the new hospitals planned for Blaenau Gwent and Caerphilly boroughs. These plans are excluded from this consultation process but residents of these areas will still be interested in proposals for the services they will access from the We would like to know which option other hospitals in the network. you think would be best for each hospital and why. We propose to develop Local General Hospitals in There are many ways to become involved in this public consultation ◆ Newport at one of these locations and they are outlined in Chapter 7 : a new city centre site or an out- of this document. Please read this of –city centre site consultation document carefully and take a few moments to complete the ◆ North Monmouthshire at one questionnaire. of these locations: the existing
Clinical Futures Public Consultation Document 5 Current Services services have grown rapidly over CHAPTER 1: recent years, there is not yet an The total area covered by Blaenau appropriate level of services across Gwent, Caerphilly, Monmouthshire, all parts of the Gwent area. Why we need Newport and Torfaen Local Health Boards is shown in the map above. ◆ 12 community hospitals which are The population for the whole area focused largely around the Valleys to change is 550,000. Some residents of communities. Many of these South Powys, Gloucestshire and have served local people well for Herefordhsire also access services from decades, but are now outdated the Gwent area. and no longer appropriate for modern hospital services. Recently there have been good examples of developing new types of service such as the Integrated Health and Social Care Unit at Monnow Vale.
◆ Mental health services which are provided in various locations, often separate from other health services, with facilities that include old institutions such as Maindiff Court and St Cadocs which have long been planned for closure. Learning Disability services are currently provided in community settings and at Llanfrechfa Grange Hospital Health services are currently delivered although these are currently subject in the following way: to a reprovision programme which will be completed in 2007. ◆ Primary care services which are delivered by more than 100 GP ◆ Acute hospital services which practices across the Gwent area are provided mainly at the main and a range of optometrists, District General Hospitals sites pharmacists and dentists. Services – the Royal Gwent Hospital and in some areas are very well Nevill Hall Hospital - with some developed, whilst in others they are services also provided at Caerphilly more limited through problems of District Miners Hospital. Demand recruitment and poor primary care for services at each of the District premises. General Hospital sites has grown significantly over recent years. ◆ Community teams which are available in each borough and ◆ Tertiary (highly specialised) services support both GP and hospital are provided on regional or national services by delivering care to people basis and although some tertiary in their own homes. Although these services are provided by Gwent
6 Clinical Futures Public Consultation Document Healthcare NHS Trust e.g. Neonatal We must make services more services for very sick babies, many accessible to our population tertiary services are provided from the University of Wales Hospital Currently, local access to hospital Cardiff and some from England. services is generally limited, with patients having to travel to busy District General Hospitals for many services that could be provided as Reasons to change effectively nearer to home. Waiting times for services are often a problem There are many pressing reasons why due to this over reliance on district we need to change the way we deliver hospital services. health care services in the Gwent area. We aim to improve local access to certain services across all parts Health needs are changing of the Gwent area by providing more healthcare in the community retain specialist skills is often referred More people are living longer which through GPs, pharmacists, dentists, to as “critical mass”. Today this leads to a greater need for support and optometrists and community health ‘critical mass’ for specialist services care. and social care teams. needs to be based on populations of over 500,000, which is the whole Existing poor health and health In the future we want to make sure catchment population of Gwent inequalities means that the number of that patients see the right person, in Healthcare NHS Trust. people in the Gwent area with ongoing the right place and at the right time. long term conditions such as asthma, It is not possible to provide specialist diabetes, heart disease, and mental services from every hospital if we want illness is increasing, putting more and to ensure high quality services in the more pressure on health services. We must provide services future and so we must change the way that are safe and of the we organise our specialist resources. Better screening programmes for certain highest quality conditions such as cancers are also increasing demands on health services New ways of working and new as we are identifying and able to treat technological developments mean We must recruit and retain illnesses earlier. that we will be able to provide a wide the best staff to deliver the range of services in local communities. best quality care to patients Lifestyle changes over recent years However, some specialist clinical staff also impact on the type of conditions are increasing their expertise in areas In 2009 new legislation on the that the health service cares for such of surgery and medicine, and so raising maximum number of working hours as an increase in obesity, especially in the standards of safe and high quality per week comes into force. This will children. treatments. To keep and improve their affect our ability to deliver services skills in these specialist areas, such and we need to change the way we Our current services must change to as intensive care, it is essential that deliver care to ensure we can continue support the pressures arising from these specialists regularly see patients to provide good quality services. This an ageing population, improved with the conditions they are trained to will mean providing training for a range opportunities to detect illness and an deal with. The numbers of patients of healthcare professionals so that increase in lifestyle related conditions. that a specialist needs to see to they can extend their traditional roles
Clinical Futures Public Consultation Document 7 to enable them to carry out additional ◆ The facilities are not designed for Between February and May 2005, the tasks with new skills and work in new the delivery of modern services NHS in Gwent developed a discussion multi professional teams and different and often hinder efficiency and leaflet called “Your Healthcare – The working patterns. effectiveness. Future” outlining the reasons why health services in the area have to Many of our current facilities We must ensure that the buildings in change and suggesting a long-term are outdated in terms of design. which we deliver our health services vision for the future. This discussion Limitations in the layout and are well equipped, modern and fit leaflet was distributed to over environment of the buildings adds for purpose, supporting staff in the 50,000 people, about 4,000 people extra pressure onto staff and we need delivery of efficient services and responded. to address this by improving the providing therapeutic and healing working environment. This will help environment for patients. There was overwhelming acceptance of us recruit and retain good staff. the reasons for change and support for our plans to change the way we deliver In order to ensure high standards healthcare services, this formed the we need to attract good quality staff You have already told us you basis of the “Clinical Futures” strategy. and offer them the opportunity to want healthcare services to develop their skills in modern working change environments. Since February 2003 we have been asking health professionals, patients and members of the public to help We must ensure that we describe the future service they want. have modern buildings which Over 6,000 people, including 1,000 are designed to be fit for the health care professionals, have directly future helped to develop the proposals now presented in this document. We know that our current estate and buildings are no longer suitable for modern healthcare services. Over 90% of hospital facilities in the Gwent area are over 30 years old and need an investment of around £80 million to comply with basic requirements. For example:
◆ Standards for cleanliness, privacy, dignity are often compromised because of the restrictions in our buildings and environment.
◆ Many sites have car parking and access problems and have limited capacity to expand.
8 Clinical Futures Public Consultation Document CHAPTER 2 Improving the health service for the Gwent area
‘Clinical Futures’ will transform your healthcare system. Its
objectives are to:
◆ Maintain and improve the quality ◆ Ensure that our services and and effectiveness of clinical care buildings are designed so that they and improve results for patients. offer a therapeutic and healing environment for patients. ◆ Improve access by bringing many services closer to where people ◆ Provide services and buildings that live. are reliable, sustainable and able to serve future generations ◆ Improve integration and continuity of patient care through networks It is important to ensure that the plans and strong links between health we develop to implement ‘Clinical professionals and locations. Futures’ are realistic and capable of achieving these objectives within a ◆ Redesign services to target reasonable time. resources at priority areas such as community services. This will We aim to deliver these objectives by mean that there will be fewer replacing our current system of providing people needing to go to hospital services with a new system focusing on and less delays. the following 3 new “levels of care”.
Clinical Futures Public Consultation Document 9 Level 1: Out of to have an idea of how services will be ◆ maintain and improve quality of care hospital care delivered at this level in the future as for patients by working in close co- they will work very closely with the new operation with specialist and critical The aim is to provide more care directly hospital network. care services to people in their own homes and in local communities with a focus on health Further details of emerging plans are ◆ improve the environment for patients, promotion, preventing ill health and available from your Local Health Board. visitors and staff maintaining independence. This will be achieved by increasing services and skills ◆ work in support of each other to in primary care through GPs, pharmacists, ensure that the needs of the collective optometrists and nurses. In addition Level 2: In hospital care Gwent population are addressed, working with our colleagues in the local – Local General Hospitals and so not all of the Local General authorities we will continue to create and Hospitals will be the same. expand community teams that integrate A new type of hospital called a Local health and social care services. General Hospital will deliver the majority We are aiming to develop 6 Local of hospital services, focusing on general General Hospitals for the Gwent Area This will enable us to provide a more and routine care. based on the needs and characteristics proactive and comprehensive response of the population and access to for people, particularly for those with The Local General Hospitals will services. long term conditions and the frail and elderly. ◆ provide local access for patients to In this document we are consulting on a broad range of general hospital options for 3 of these Local General Plans to develop out of hospital services, taking advantage of new Hospitals; one in Newport, one in services are being progressed by each technology and new ways of working North Monmouthshire, and one in Local Health Board in the Gwent area Torfaen. More information on each to ensure that they respond to local ◆ increase integration with out Local General Hospital is found in needs and local circumstances. These of hospital services to improve Chapters 3 to 5. plans are not part of this formal public continuity of care for patients and consultation process but it is important ensure appropriate use of hospitals With support from the local population,
10 Clinical Futures Public Consultation Document Local General Hospitals for Blaenau services in the correct place as programme and detailed options on the Gwent and Caerphilly County Borough quickly as possible. future of these services will be consulted are already at an advanced planning on in Summer 2007. This will enable stage and are due to open in 2009 ◆ Improve the quality of specialist the development of these services to and 2010 respectively. They are not care for patients in line with take place in parallel with the hospital part of this formal public consultation national standards, evidence and network proposed in this consultation. process. Chepstow Community best practice. Hospital, as a relatively new facility The objectives of clinical futures will function as a Local General ◆ Make these specialist services more have been developed through public Hospital in the new network. reliable and robust, 24 hours a day engagement workshops and used and sustainable in the future. create a benefit criteria framework. The options considered for each new hospital ◆ Provide modern environments in the network were scored against Level 3: Specialist and that maximise efficiency and these benefit critera by clinicians, the Critical Care Services effectiveness for patients, visitors Patients Panel and NHS organisations and staff. in Gwent. The scoring process identified A single Specialist and Critical Care our preferred options for each of the Centre will provide care for people who ◆ Ensure that scare resources are proposed hospitals based on non- are seriously ill or who have complex targeted at patients who most need financial considerations. The cost of problems and cannot safely be cared for them delivering each option will be tested to in their Local General Hospital. see which option provides best value for ◆ Provide the potential to expand the money. The Specialist and Critical Care Centre range of tertiary (highly specialised) will serve the majority of the Gwent level services that are delivered We are seeking your views on all options population and will: and bring more highly specialised in this consultation document. services into Gwent. ◆ Speed up access to specialist and major emergency care by ensuring Specialist Mental Health services patients are directed to the correct are a key part of the Clinical Futures
Clinical Futures Public Consultation Document 11 Working together in a Level 1 - Out of hospital services Network (Homes, GP practices, Resource Centres)
Each of level of care has a different role in providing healthcare but all of them need to work together to ensure Urgent treatment and advice Telephone advice and initial contact, that patients receive continuity of care. Technology assisted self care Good communications, increased Urgent response teams working between professional groups
and the use of advanced technology UNSCHEDULED CARE will all contribute to the development of this network approach.
A sample of the scope of services that Diagnosis and Treatment Services will be available at each level is shown Minor Surgery in the following table. Some outpatient services, specialist GPs, e.g. dermatology SCHEDULED CARE
Women and Children’s Services Antenatal and postnatal services (midwifery led), Sexual health and Family planning advice, Child Adolescent Mental Health services, Health Visiting and School Nurses WOMEN & CHILDREN
Integrated Care Services Health promotion, Disease prevention, screening and treatment, Detection and monitoring of long term conditions Reablement and Rehabilitation services INTEGRATED CARE INTEGRATED
Mental Health Services Community Mental Health Teams, crisis resolution Community Learning Disabilities services, Psychological therapies MENTAL HEALTH & & HEALTH MENTAL LEARNING DISABILITIES LEARNING
12 Clinical Futures Public Consultation Document Level 2 - Local General Hospitals Level 3 - Specialist and Critical Care Services
Urgent or Emergency Care Major Emergency Care Minor injuries and in some instances emergency Specialist emergency assessment, emergency assessment observation and admission surgery, trauma, critical care
Diagnosis and Treatment Services Diagnosis and Treatment Services Outpatient clinics, tests, investigations and in Complex operations, critical care, sophisticated some instances, day case and routine operations diagnostics, some specialist outpatient clinics
Women and Children’s Services Women and Children’s Services Outpatient clinics in appropriate environments, High risk births, complex operations such as tests, investigations in some instances mid-wifery cancer, acutely ill children, neonatal services led birthing units
Integrated Care Services Integrated Care Services Rehabilitation, step up/step down care and beds, These will be provided at local level with the therapies, palliative care possible exception of some stroke services
Mental Health and Mental Health Services Learning Disability Services Outpatient, day hospital and inpatient care Psychiatric Intensive Care, Assessment and for adults and older adults with mental health Treatment, Low secure forensic services. These problems will be provided in a separate unit
Clinical Futures Public Consultation Document 13 Local CHAPTER 3 Emergency An integrated service working 7 days a week including Centre ◆ Urgent treatment and advice available 24 hours a day Developing a ◆ Emergency Assessment Unit working closely with the emergency team at the Specialist and Critical Care Centre to ensure that patients are transferred rapidly Local General if they require specialist treatment following initial assessment.
◆ Acute medical ward with monitored beds for Hospital in emergency patients who need to be admitted for further observation or tests. Newport ◆ Rapid access clinics for urgent patients to avoid the need for hospital admissions Major accidents and serious emergencies would be directed to the Specialist and Critical Care Centre The Local General Hospital in
Newport will provide Newport borough residents with the majority of their routine and Diagnostic and Comprehensive services for planned tests, clinics, general services. Some Treatment treatments including: Services ◆ A wide range of specialist and general outpatient services will be accessed by clinics residents of south Torfaen, ◆ Radiology facilities that include CT scans and the potential for MRI scans in the future south Monmouthshire and the ◆ A dedicated endoscopy suite and medical day case facility eastern side of Caerphilly ◆ Approximately 6 operating theatres providing day case County Borough. The hospital and short stay surgery for a range of procedures and conditions, supported by a surgical ward will have approximately 350 -
400 beds and may deliver the following range of services.
14 Clinical Futures Public Consultation Document Maternity Services Services will include: ◆ Consultant and Midwife antenatal and postnatal care
◆ Midwifery led birthing unit for women who are likely to have normal deliveries, with single ensuite delivery and aftercare rooms and water birth facilities
Services for Children A new dedicated, purpose designed Children’s Outpatient Department providing:
◆ Dedicated waiting areas and play area
◆ Clinic rooms and counselling facilities
◆ Family room
Rehabilitation and Support Providing on site support to the acute beds through: Care ◆ Intensive rehabilitation beds to care for people following strokes, operations and falls for example.
◆ Sub acute beds for people with long term conditions
◆ Some palliative care beds to provide choice for patients
◆ Integrated therapies including physiotherapy, occupational therapy and hydrotherapy
Mental Health An integrated unit with a range of adult and older adult Services services including: ◆ Outpatient services and bases for community mental health teams
◆ Day care facilities
◆ Acute beds
◆ Assessment and treatment beds
◆ Respite and support care beds
Clinical Futures Public Consultation Document 15 The options for the Local General Hospital in Newport are:
Option A: Do minimum - Redevelop the Option B: Major redevelopment of the Royal Gwent Hospital Royal Gwent Hospital
Description of option A Description of option B A minor redevelopment of Royal Gwent Hospital A significant redevelopment of the current Royal site with a minimal amount of refurbishment to the Gwent Hospital facility with major improvements and current wards and emergency services. Mental Health redesign of the ward areas and the maternity facilities. services would continue to be based in St Cadocs Under this option, an Emergency assessment area Hospital and there would be no improvement to the and diagnostic and treatment centre would be built. physical access to the hospital site. Under this option Mental Health services would be based in a new St Woolos hospital would close. facility on the site and they would be linked but not fully integrated with the Local General Hospital. Under this option St Cadocs and St Woolos hospitals would close.
Assessment of option A Assessment of option B This option would achieve limited improvements This option would provide significant opportunities to in quality of care because of the constraints of the improve the quality of care by reorganising services existing building which does not lend itself to the within the hospital. It would also deliver better delivery of modern services. Limited upgrading integration with mental health services and a building of patient areas would not lead to the required that is more future proof. improvements in privacy, safety and comfort and However, access issues would remain due to the would not provide a better working environment for location and physical access to the site from a busy staff. The current access problems for the site would city centre road, and the sloping nature of the site remain, albeit with a little less congestion. Pedestrian which makes pedestrian access and movement access into and around the building would remain a difficult. Improvements in design would be limited problem because of the sloping nature of the site and by existing buildings. In particular one of the biggest the tower block structure. This option would also drawbacks of this option would be the significant create disruption to existing services at it focuses on disruption to operational services, requiring temporary changes to the core of a busy hospital. This option relocation of services on other parts of the site and would not provide a solution for the long term. leading to a long construction time on site.
Conclusion Conclusion This option does not deliver the required benefits and Whilst this option delivers some benefits it also is only included for the purpose of comparison presents some real practical difficulties. It should only be considered if no alternative sites are available.
16 Clinical Futures Public Consultation Document Option C: New build at alternative Option D: New build hospital at Newport city centre site alternative out of city site
Description of option C Description of option D A new hospital facility built on an alternative city A new building on an alternative site out of Newport centre site. The hospital would have a dedicated city centre but close to the M4. As a new hospital Local Emergency Centre designed to modern facility, option D would contain all the same standards. There would also be a purpose built services and units as option C and as detailed in the Midwifery led Birthing Centre, child friendly paediatric specification for Newport Local General Hospital. The outpatient facilities and diagnostic and treatment site would be located out of Newport City centre but centre. Mental Health services would be located with good access from the M4 between junctions within the hospital campus. The site would need to 26 and 28. Under this option, the Royal Gwent, St. ensure adequate car parking and access. Under this Cadocs and St Woolos hospitals would close. option The Royal Gwent, St. Cadocs and St. Woolos hospitals would close.
Assessment of option C Assessment of option D Developing a new building provides the potential Developing a new building provides the potential to achieve best practice in terms of how services to achieve best practice in terms of how services are organised and delivered, therefore improving are organised and delivered, therefore improving the quality of care, integration of services and the quality of care, integration of services and providing the right capacity to meet demand. From providing the right capacity to meet demand. From an environmental point of view the best design ideas an environmental point of view the best design ideas can be included in the building, maximising patient can be included in the building, maximising patient safety, privacy and comfort, and improving efficiency safety, privacy and comfort, and improving efficiency and effectiveness for staff. A new site also avoids and effectiveness for staff. A new site also avoids the practical difficulties associated with disruption to the practical difficulties associated with disruption to operational hospital services. operational hospital services, and a site that is located out of the city centre could deliver ease of access from Although an alternative site provides the opportunity main transport routes. to improve entrances and car parking, a city centre site does run the risk of having congested roads in However, taking the hospital services away from the the surrounding area. Purchasing a site that is not city centre also means taking them away from the already used for a hospital can also pose challenges hub of public transport services which also needs to in terms of site acquisition, development and planning be considered. In addition this may be contrary to permission. regeneration efforts in Newport City Centre.
Conclusion Conclusion This option is one of the preferred options because This option also delivers many of the same benefits as it can deliver benefits in terms of quality, access, option C, although it does not offer the same access an improved environment and better integration of advantages. It could be pursued if an alternative city services. It should be pursued if it can also offer value centre site is not available and does not offer value for for money. money.
Clinical Futures Public Consultation Document 17 Local CHAPTER 4 Emergency A single integrated service working 7 days a week Centre incorporating; Developing a ◆ Urgent treatment and advice available 24 hours a day ◆ Emergency Assessment Unit working closely with the emergency team at the Specialist and Critical Care Local General Centre to ensure that patients are transferred rapidly if they require specialist treatment following initial assessment.
Hospital in ◆ Acute medical ward with monitored beds for emergency patients who require admission for further North observation or tests. ◆ Rapid access clinics for urgent patients to avoid the need for hospital admissions Monmouthshire Major accidents and serious emergencies would be directed to the Specialist and Critical Care Centre
The Local General Hospital in north Monmouthshire will provide services to north Diagnostic and Comprehensive services for planned tests, clinics, Monmouthshire, south Treatment treatments including: Services ◆ A wide range of specialist and general outpatient Powys, residents of Blaenau clinics Gwent and north Torfaen. ◆ Radiology facilities that include CT and the potential for MRI scanning in the future
The hospital will have ◆ A dedicated endoscopy suite and medical day case unit between 180 and 200 beds ◆ A suite of operating theatres providing day case and and may deliver the following short stay surgery for a range of procedures and conditions, supported by a surgical ward. range of services:
18 Clinical Futures Public Consultation Document Maternity Services Services will include: ◆ Consultant and Midwife antenatal and postnatal care
◆ Midwifery led birthing unit for women likely to have normal deliveries with single ensuite delivery and after care rooms, and water birth facilities
Services for Children A new dedicated, purpose designed Children’s Outpatient Department providing:
◆ Dedicated waiting areas and play area
◆ Clinic rooms and counselling facilities
◆ Family rooms
◆ Children’s Centre for children with disabilities
Rehabilitation and Support Providing on site support to the acute services through Care ◆ Intensive rehabilitation beds for people following strokes, operations and falls for example
◆ Sub acute beds for people with long term conditions
◆ Some palliative care beds to provide choice for patients
◆ Integrated therapies unit including physiotherapy, occupational therapy and a hydrotherapy pool
Mental Health An integrated unit providing: Services ◆ Outpatient services and base for community mental health teams
◆ Day care facilities
◆ Acute beds
◆ Assessment and treatment beds
◆ Respite and support care beds
Clinical Futures Public Consultation Document 19 The options for the Local General Hospital in north Monmouthshire are:
Option A: Do minimum - Minor Option B: Major redevelopment of redevelopment of Nevill Hall Hospital in Nevill Hall Hospital Abergavenny Description of option B Description of option A A significant reconfiguration and redevelopment of the current Nevill Hall Hospital facility. Emergency Minor redevelopment of Nevill Hall site with a assessment facilities would be rebuilt and situated minimal amount of refurbishment to the current layout close to key diagnostic and critical care services. of wards and emergency services. Under option A Mental Health facilities would be provided in Mental Health services would remain at Maindiff accommodation close to the hospital and physically Court. linked to it. Internal redesign of wards and departments would be included but within the limitation of the core building. Under this option Maindiff Court would close.
Assessment of option A Assessment of option B This option would achieve limited improvements in This option would provide significant opportunities to quality of care due to the constraints of the current improve the quality of care by reorganising services building which would not be significantly improved. within the hospital. The presence of Mental Health Limited upgrading of patient areas would not deliver service on site would improve the integration of the required improvements in privacy, safety and services and the building would be more sustainable comfort and would not improve the environment for for the future. The Nevill Hall site does offer good staff. Although the Nevill Hall site is accessible to its access for the catchment populations in terms of catchment population, under option A the problems of location. physical access to the site and on site parking would Although there would be internal redesign and remain unaddressed. The redevelopment included improvement of clinical areas, the current building in this option would cause disruption to the current does not allow for a fully effective and efficient services which will impact on patients, visitors and environment. Future standards in relation to privacy staff. This option would not provide a solution for the and dignity and control of infection are difficult to long term. address. In addition, the development work required to achieve this option would cause significant disruption to current services. This would impact on our capacity to treat patients during the development and building work.
Conclusion Conclusion This option does not deliver the required benefits and Whilst this option delivers some benefits, it also is only included for the purpose of comparison. presents some practical problems and does not enable full implementation of best practice.
20 Clinical Futures Public Consultation Document Option C: Build a new Local General Option D: Build the Local General Hospital on the Nevill Hall site Hospital on the Maindiff Court site
Description of option C Description of option D A totally new facility on the current Nevill Hall site A new build Local General Hospital on the Maindiff delivering the full range of services of an enhanced Court site in Abergavenny. As a new hospital facility Local General Hospital. In line with the description option D would contain all the same services as of the North Monmouthshire Local General Hospital, option C and as detailed in the specification for North the hospital would have a separate Local Emergency Monmouthshire Local General Hospital. Under this Centre and diagnostic and treatment centre. There option, Nevill Hall hospital would close and mental would also be a purpose built Midwifery led Birthing health facilities would remain at Maindiff Court. Centre and child friendly paediatric outpatient facilities. The Children’s Centre would be rebuilt on the same site. Mental Health services would be integrated with the Local General Hospital. Under Assessment of option D this option Maindiff Court would close. By building a new facility we can ensure that best practice is achieved when organising how services are delivered. This will improve the quality of care, Assessment of option C ensure that services are integrated and allow us to Developing a new building offers the potential to build in the right amount of capacity to meet the achieve best practice in terms of how services are demand. From an environmental point of view the organised and delivered. Modern building design will best design ideas can be included in the building, improve the quality of care, maximise the integration maximising patient safety, privacy and comfort and of services and ensure the right capacity to meet also improve efficiency and effectiveness for staff. demand is provided. From an environmental point Furthermore, Maindiff Court site is already owned by of view the best design ideas can be included in the NHS so problems associated with purchasing a the building maximising patient safety, privacy and new site are avoided. comfort. A significant advantage of this option is that the new facility could be built alongside the current Although a development on Maindiff Court site would Nevill Hall Hospital and be developed with minimal take into account the need for good entrances and disruption to current operational services. The car parking, access for the catchment populations Nevill Hall site offers good access to the catchment of Blaenau Gwent, north Torfaen and north populations and under this option immediate access Monmouthshire may not be equitable. A drawback would be improved in terms of entrances and parking. of this option is the potential disruption to the services currently provided at Maindiff Court and any However, this option may not be achievable in terms temporary relocation of operational services which will of planning constraints and this uncertainty is a add to the amount of construction time required on disadvantage. site.
Conclusion Conclusion This option is one of the preferred options because This option does offer significant benefits although it can deliver benefits in terms of quality, access, access may not be as good as the current hospital an improved environment and better integration of at Nevill Hall. It should be considered as one of the services. It should be pursued provided any planning preferred options if it can offer value for money and issues are resolved and it can also offer value for the Nevill Hall option is not achievable. money.
Clinical Futures Public Consultation Document 21 Urgent CHAPTER 5 Care A purpose designed unit including; Centre ◆ Urgent treatment and advice available 24 hours a day Developing a ◆ A base for urgent response teams in the community Local General Diagnostic Hospital in and A range of planned services including Treatment ◆ Specialist and general outpatient clinics Services ◆ Routine diagnostic services including x ray, Torfaen ultrasound, heart/chest tests
◆ A minor surgery facility
◆ A colposcopy facility The Local General Hospital in
Torfaen will provide services Maternity Services This will include the majority of Consultant and Midwife for Torfaen residents and will antenatal and postnatal clinic services, supported by ultrasound. have between 110 and 130 beds and may deliver the Services for Children A new dedicated, purpose designed Children’s Outpatient Area to provide a range of specialist physical and following services; emotional health services for children and families including:
◆ Dedicated waiting area/play area
◆ Clinic and counselling facility
◆ Family room
22 Clinical Futures Public Consultation Document Rehabilitation and Support Working closely with other hospitals in the network to Care transfer Torfaen residents into dedicated rehabilitation services following problems such as a stroke or a fall, or for care following surgery:
◆ Intensive rehabilitation beds working closely with the emergency and surgical services to care for people following admissions for problems such as strokes, operations and falls.
◆ Sub acute beds for people who are admitted because of long term conditions such as chest problems.
◆ Some palliative care beds to provide choice for patients
◆ Integrated therapies unit including physiotherapy and occupational therapy
Mental Health An integrated unit facilitating local provision of a range of Services adult and older adult services including: ◆ Outpatient services
◆ Day care facilities
◆ Acute beds
◆ Assessment and treatment beds
◆ Respite and support care beds
◆ Bases for community mental health teams
Clinical Futures Public Consultation Document 23 The options for the Local General Hospital in Torfaen are:
Option A: Do minimum – A Option B: Build a new Local General refurbishment of County Hospital Hospital on the County Hospital site
Description of option A Description of option B A minor amount of capital investment to essential A new build Local General Hospital facility on the building work at County Hospital. The refurbishment current County hospital site replacing the existing would address backlog maintenance issues and community hospital buildings. The existing mental statutory requirements. Whilst there would be no health facilities of Ty Siriol and Talygarn would be plans to expand capacity at County hospital, Mental retained. Health services would continue to be based at the County Hospital site in Ty Siriol and Talygarn.
Assessment of option A Assessment of option B This option would not achieve improvements in quality Developing a new building offers the potential to of care due to the constraints of the current building achieve best practice in terms of how services are which would not be significantly improved. There organised and delivered. This improves the quality would be only essential upgrading of patient areas of care, ensures services and departments are which would not deliver the required improvements in appropriately integrated and provides enough capacity privacy, safety and comfort and would not improve the to meet demand. From an environmental point of environment for staff. Although the County Hospital view the best design ideas can be incorporated into site does offer good access for the local population, the building which will help maximise patient safety, there would be no improvements to parking on site. privacy and comfort and improving efficiency and effectiveness for staff. Mental Health facilities at This option would not provide a solution for the long Ty Siriol and Talygarn would remain on site ensuring term. good integration with Local General Hospital services. The location of County Hospital does provide good access for Torfaen Borough.
However, immediate access to the site would remain difficult as it is set in a residential area and this would need careful consideration with the planning authority. In addition there would be some disruption to operational services during the development
Conclusion Conclusion This option does not deliver the required benefits and This is one of the preferred options as it offers is only included for the purpose of comparison. significant benefits in terms of access, quality of care and improved environments for patients and staff. It should be pursued if it provides value for money.
24 Clinical Futures Public Consultation Document Option C: Build a new Local General Option D: Build a new Local General Hospital on a new site with Mental Hospital on a new site without Mental Health services Health services
Description of option C Description of option D Provide a totally new hospital facility on a new site Option D offers a similar proposal as option C above in the vicinity of current County site. The full range but under this option mental health services would of services as described in the Torfaen Local General continue to be provided from Ty Siriol and Talygarn Hospital specification would be provided with new on the County Hospital site. Under this option County mental health services located and integrated on Hospital would close. the same site as the hospital. Under this option the current County Hospital, Ty Siriol and Talygarn would all close.
Assessment of option C Assessment of option D As with option B, developing a new building offers Option D offers many of the same benefits and the potential to achieve best practice in terms of planning considerations as option C. how services are organised and delivered. This However, under this option Mental Health services improves the quality of care, ensures services would remain at Ty Siriol and Talygarn which would and departments are appropriately integrated and not improve the integration of services. provides enough capacity to meet demand. From an environmental point of view the best design ideas can be incorporated into the building which will help maximise patient safety, privacy and comfort and improving efficiency and effectiveness for staff. Mental Health facilities would be situated on the same site, improving integration of these services with the hospital services.
Building on a new site will enable full consideration to be given to the need for adequate access in terms of care parking and public transport. A development on a new site will also reduce disruption to operational services during the building of the new facility.
However, purchasing and building a hospital on a site that is not currently used for these types of services can pose challenges in terms of site acquisition, development and planning permission.
Conclusion Conclusion This is one of the preferred options, it offers the Whilst this option delivers many benefits, the absence same benefits as option B and should be pursued if it of mental health services on the same site is a provides value for money. disadvantage. This option should not be pursued.
Clinical Futures Public Consultation Document 25 Major CHAPTER 6 Emergency This will have specialist assessment and treatment Centre facilities including: Developing ◆ Medical and surgical emergency assessment ◆ Paediatric assessment
◆ Trauma
Specialist and ◆ Resuscitation facilities
◆ A ward area for observation and treatment of Critical Care emergencies ◆ Telemedicine to support links to Local General Hospitals
Services Some patients will be directed to the Major Emergency Unit via the ambulance service, whilst others will be transferred there following assessment and stabilisation at a Local Emergency Centre. The Specialist and Critical
Care Centre will provide Critical Care To support both the emergency and specialist work the services for the whole of Centre will have ◆ Intensive care beds the catchment population, ◆ Coronary care and stroke care beds including Blaenau Gwent, ◆ High dependency beds
Monmouthshire, Newport, Diagnostic These will include Torfaen, the majority of and Treatment ◆ A suite of operating theatres for both emergency and Caerphilly County Borough Service planned operations ◆ Specialist diagnostic and treatment services that and South Powys. It is cannot be duplicated at Local General Hospital sites – e.g. cardiac catherisation estimated that it will require ◆ Comprehensive pathology services
◆ A limited number of outpatient clinics as most of this between 450 and 500 beds. work will be undertaken at Local General Hospitals
26 Clinical Futures Public Consultation Document for the Specialist and Critical Care Maternity Centre would be within a 3 mile radius services The majority of antenatal care will be provided at the Local General Hospitals. The Centre will provide: of Croes-y-ceiliog, Cwmbran, with good access to the A4042. At this ◆ Consultant led maternity services including delivery location 95% of patients can reach suites, ward and theatres the Specialist and Critical Care Centre ◆ A Midwifery led unit to provide choice for women who within 30 minutes and 100% of do not want to use the Local Midwifery led Unit patients can get there within an hour. ◆ Fetal medicine services Although not a factor in the travel times study, the central location Services for of the Specialist and Critical Care Children These will include: Centre means minimum disruption ◆ Neonatal intensive care unit and relocation of specialist staff currently working in existing District ◆ In patient ward for emergency assessment and General Hospitals in Newport and planned operations Abergavenny. It will also help ◆ Limited outpatient provision as this will be available reduce staff travel times between the at Local General Hospitals Specialist and Critical Care Centre and the Local General Hospitals in the future network. In Patient This will include Support It is important to note that options to ◆ Ward facilities for acute emergency patients centralise specialist and critical care ◆ Ward facilities for pre and post operative care services at either of the existing District General Hospitals were considered ◆ Therapy facilities to support early rehabilitation and at an earlier stage in the planning recovery process. They were not included in the shortlist of options because of the travel times study as well as a number The location of the Specialist and some parts of the patient catchment of physical and practical constraints Critical Care Centre was raised as population are concentrated in urban on those sites. Similarly, other site an important issue for members of areas such as Newport City, other parts options in the vicinity of the current the public and clinical staff in public such as Monmouthshire and South District General Hospitals were also engagement events in 2005. It Powys are widely dispersed. discounted from further consideration remains a key issue and we need to because they would not achieve ensure that acceptable travel and One of the stages in determining optimum travel times for the whole access times can be assured. The the location for the Specialist and population. location needs to reflect the fact that Critical Care Centre was to get an the people who use these services expert assessment of the appropriate Having identified what we consider come from a wide geographical area location. A travel times analysis to be the best area for the SCCC, and experience a wide range of issues was undertaken based on the Trust’s the following options are considered that affect transport and access, existing patient catchment population as possible solutions. We would like for example, low car ownership in but using the future configuration of your views on both the area and the deprived areas or poor public transport services described in this document. options. in rural communities. Although This indicated that the best location
Clinical Futures Public Consultation Document 27 The options for the Specialist and Critical Care Centre are:
Option B: A new build Special & Option A: Do Nothing Critical Care Centre at Llanfrechfa Grange Hospital, Cwmbran Description of option A Continue with current District General Hospital model Description of option B of providing specialist and critical care services at both Build the new Specialist and Critical Care Centre on the Royal Gwent and Nevill Hall hospitals. Under the Llanfrechfa Grange site in Cwmbran. As a new this option there would be some minor development to facility, the hospital would be state of the art and built increase our capacity in certain specialities, increasing to modern design principles. All the key elements of by a modest amount, access to emergency services the SCCC including an Emergency Assessment Unit, and routine surgery. a Maternity and Children’s Hospital and a Diagnostic and Treatment Centre as detailed in the description of the SCCC would be provided.
Assessment of option A Assessment of option B Continuing with specialist, critical and major Building a new hospital facility will allow us to emergency services on 2 District General Hospital achieve best practice in terms of how services are sites will not allow us to implement best practice organised and delivered. This will improve the quality and achieve improvements to the quality of care. of care at the Specialist and Critical Care Centre by The current system is not sustainable for reasons incorporating modern hospital design. Services would described in Chapter 1 and if they remain fragmented be integrated and enough capacity would be included there are limited opportunities to integrate services to meet current and future demand. This option and some specialist services would become fragile locates the SCCC in the central zone in accordance and unsustainable. The buildings are outdated and with the travel times analysis and therefore assures do not offer a therapeutic environment for patients that acceptable travel and access times can be or good working conditions for our staff. Problems achieved for the catchment population. of congested sites, limited parking and access issues The NHS already owns the Llanfrechfa Grange site would remain unaddressed under this option. This which minimises the possible difficulties of purchasing option would not provide a solution for the long term. a new site and the new development would provide good access via entrances and adequate parking.
However, some services are already provided from Llanfrechfa Grange and these would need to be reprovided prior to any developments starting on site.
Conclusion Conclusion This option is not sustainable and does not deliver the This is one of the preferred options as it delivers the required benefits. It is included only for the purposes desired benefits of good access for the whole patient of comparison. population, good quality specialist care, a therapeutic environment for patients and will ensure integration of services. This option should be considered if it offers value for money.
28 Clinical Futures Public Consultation Document Option C: A new build Special & Critical Care Centre at an alternative site in the central zone
Description of option C The development of the SCCC in a central zone with good access to the A4042. This option considers non- NHS owned sites within the central zone. This site would need to be large enough to accommodate all the required components of the SCCC as detailed in the SCCC specification.
Assessment of option C Like option B, building a new hospital facility will allow us to achieve best practice in terms of how services are organised and delivered. This will improve the quality of care at the Specialist and Critical Care Centre by incorporating modern hospital design. Services would be integrated and enough capacity would be included to meet current and future demand. This option locates the SCCC in the central zone in accordance with the travel times analysis and therefore assures that acceptable travel and access times can be achieved for the catchment population.
However, purchasing a site that is not currently used for hospital services can potentially be difficult. There may be planning constraints and external environmental factors which may influence how achievable the option is.
Conclusion This is one of the preferred options as it offers the same benefits in terms of quality, access, environment and integration as option B. This should be considered if it can also offer value for money.
Clinical Futures Public Consultation Document 29 We realise that everyone – patients, staff and the whole CHAPTER 7 community – have an interest in how health services should
Tell us what be delivered. We hope that this document has helped you you think understand more fully why we believe we need to change the way we organise and deliver our health services and in
particular the proposed hospital network.
We would like to hear what you think 1. Fill in the Questionnaire about our ideas and plans. Your and send it to us. opinion will be key to helping us make a decision in early 2007 about There is a questionnaire in the the future of local hospital services. middle of this document. Simply fill The programme of consultation will it in and put it in the pre-addressed run from 18 September to the 8 envelope. No stamp needed. Please December 2006 and will include a make sure we receive your completed number of public events. questionnaire by 8 December 2006.
No decision will be taken until the views expressed during the 2. Go on-line and fill in our consultation period have been fully response form considered. The decisions we need to make will involve the locations of the Give us your feedback directly on the following Local General Hospitals and website at www.clinicalfuturesgwent. the services provided in them: wales.nhs.uk
◆ Newport Local General Hospital 3. Join our Virtual Health ◆ North Monmouthshire Local Forum General Hospital Technology plays an increasingly ◆ Torfaen Local General Hospital important part on our everyday lives. We are taking advantage of this by And the location of the Specialist and creating a virtual health forum. People Critical Care Centre and the services it who subscribe to the forum will be would provide. invited to express their views on key themes that emerge from other There are many ways in which you consultation activities; we will use can contact us and ensure that your this forum to explore these themes views are heard. further. You can become a member of
30 Clinical Futures Public Consultation Document this virtual health forum by registering through the Clinical Futures Website at www.clinicalfuturesgwent.wales. nhs.uk
4. Come to one of our public meetings to meet us and tell us what you think
We have arranged a series of meetings and discussion forums in your local areas where you will have the opportunity to discuss our proposals in more detail. At these meetings there will be people from the Trust, your Local Health Board and some clinical health professionals who will be able to answer any of your questions.
Details of public meetings in your area will be advertised in your local newspaper, and posters will be placed at libraries and other public buildings. Details will also be available on our website.
5. If you run a community group you can ask us to come to one of your meetings and talk about Clinical Futures.
We have a team of people who can come along to meetings to tell you more about the proposals in the document and help you make decisions about the options. To book a meeting, ring 01633 623461.
If you need any further help or information, ring our helpline on 01633 623461.
Clinical Futures Public Consultation Document 31 Acutre and Sub-acute CT Scan The abrupt onset, in reference to a Computer tomography (also known disease or illness. Acute often also as CT, CT scan, CAT or computerised describes an illness that is of short axial tomography) scans use x-rays to duration rapidly progressive, and in produce precise cross-sectional images Glossary need of urgent care. ‘Acute’ is a measure of the body. of the time scale of the disease and is in contrast to ‘sub-acute’ and ‘chronic’ Designed for Life sub-acute indicates longer duration or Designed for Life was launched by the less rapid change. ‘Chronic’ indicates Welsh Assembly Government in May indefinite duration or virtually no 2005 and is Wales’’ strategy for the change. future of health and social care. The strategy outlines the kind of health and Cardiac Catheterisation social care services we can expect by Cardiac catheterisation is a way to find 2015. out detailed information about your heart and coronary arteries. Cardiac District General Hospitals catheterisation is where a very thin Hospitals that provide acute medical plastic tube is passed into the chambers and surgical services for their catchment of the heart. The catheter can also be populations. passed into the main blood vessels of the heart (the coronary arteries). Fetal Medicine Some pregnancies require additional Community Healthcare care and fetal Medicine involves Services provided in the community investigations and detailed such as Health Visiting and District ultrasound scanning for the Nursing. diagnosis and confirmation of fetal abnormality. Community Health Councils Community Health Councils are Intermediate Care independent health service watchdogs Care which includes observation, for their local areas. They help and nursing, therapy and rehabilitation advise people who wish to make complaints about NHS services. They Local Health Boards offer information and advice about Local Health Boards exist in order to health and related services in their improve the health and healthcare of the area to local people and they must be local population. They were established consulted by Trusts and Local Health in 2003 to take over the responsibilities Boards about substantial changes to of the Health Authorities in Wales and health services within our area. were given three quarters of the NHS health budget in Wales. They decide Critical Mass what health services their populations The numbers of patients that a specialist need and then pay hospital trusts, needs to see to retain specialist skills is family doctors, dentists and others to referred to as critical mass. provide these services.
32 Clinical Futures Public Consultation Document MRI Scan referral from a primary or community unplanned or unscheduled, where an An MRI, (magnetic resonance imaging) health professional such as a GP. individual is seeking attention from a scan is a radiology technique that uses Examples of scheduled care include a hip health or social care professional. magnetism, radio waves and a computer replacement operation or kidney dialysis. to produce images of the body structures. Scheduled care patients may be admitted Value for money The MRI scanner is a tube surrounded either as an inpatient or a day case Value for Money is the term used to bya giant circular magnet. The patient patient, or they may attend an outpatient assess whether or not an organisation is placed on a moveable bed which is consultation or clinic. has obtained the maximum benefit inserted in to the magnet. from the goods and services it acquires Secondary care and/ or provides, within the resources The Model of Care Healthcare mainly provided in a hospital available to it. It not only measures The description of how healthcare services setting. the cost of goods and services, but also are designed, who they are delivered by takes account of the mix of quality, and where they should be delivered. Service user/patient/ client cost, resource use, fitness for purpose, Someone who uses the services of the timeliness and convenience to judge National Service Framework NHS. whether or not, when taken together, (NSF) they constitute good value. Government policy setting out core Service Re-design standards for services. Looking at how existing services can be This glossary will be updated on the changed for the better. website as required in response to NHS Trusts questions raised during the consultation Statutory organisations with responsibility Social care period. for providing a range of community and Services that attend to peoples’ social acute services. needs.
Palliative Care Specialist community teams care provided to patients are the end Teams providing a high level of support for stages of their live which seeks to relieve people, often visiting daily or more often or soothe the symptoms or a disease or when required. disorder without effecting a cure. Telemedicine Primary Care Use of telecommunications technology for Healthcare provided in a community medical diagnosis and patient care when setting led by a GP, community nurse or the clinician and patient are separated by similar. distance. Telemedicine includes pathology, radiology, and patient consultation from a Respite Care distance. Respite care provides a carer temporary relief from the responsibilities of caring for Tertiary care individuals with chronic physical or mental Very specialist services, often only disabilities. provided from few organisations in the country. Scheduled Care Scheduled care means planned specialist Unscheduled care medical care or surgery, usually following Unscheduled care is any event that is
Clinical Futures Public Consultation Document 33 Notes
34 Clinical Futures Public Consultation Document