1

The centralisation of acute services at either the Lister or QEII

Mr John Saetta – Associate Medical Director & A&E Consultant Sarah Brierley – Deputy Director, Strategic Development

East and North Hertfordshire NHS Trust

2

Strategic principles for the NHS in Hertfordshire

Agreed in 2003 during the Investing in yourHealth consultation:

• Invest in and develop community services

• Concentrate acute hospital services – a single acute site in east and north Hertfordshire

3

Overwhelming evidence

• Larger hospital units save more lives

• Specialist doctors save more lives

• New technologies, used by specialist staff, save more lives

• Better availability of consultants saves more lives

• Improving paramedic skills saves more lives

4

Patient benefits• Better clinical outcome for patients who need treatment for complex medical or surgical problems in an acute hospital

•Continuation of locally-based care for less complex problems (local general hospital & primary care) where clinically appropriate

• Increased consultant availability to care for patients, particularly those needing emergency care

• Hospital doctors and nurses would be more able to retain and develop specialist skills and expertise

• Clinical services would be sustainable in the long term

• More efficient in the long term

5

Key themes within consultation responses

Questionnaires:

• Access to care

• Clinical quality

• Sustainability

• Retention of the status quo

Comments from letters, events and other sources:

• Hatfield

• Cancer Centre services

• Impact on out of county hospitals

6

Access to care• Majority of respondents tended to prefer site closest to their home

• Concern about travel times, especially at peak periods

• Recognition of public transport limitations

• Desire for more integrated transport to support access

• Recognition that Lister has better road access and is closer to A1(M) than QEII

• Health equality impact – slightly favours Lister on balance

• Transport and access are not significant discriminating factors between options but marginally favour Lister

7

Clinical quality

• Overwhelming clinical support for consolidating acute care on a single site

• Site must be fit for purpose

• Public tended to equate proximity to acute site and clinical quality/safety

• Recognise public will require ongoing reassurance and information

• Lister preferred as offers better potential clinical adjacencies – majority of NHS respondents preferred Lister

• QEII site more challenging: financially would only be able to offer limited ongoing investment in services and quality

8

Sustainability

• Recognition of the need for sustainable acute services in the future

• Need for acute site to have sufficient capacity

• Capacity for the future: space and flexibility for efficient expansion

• Lister > QEII by 9 acres; site layout lends itself more easily to development of future services

9

Retention of two acute sites• IIYH agreed clinical model of consolidation

• Consolidation strongly supported by clinicians locally and nationally

• Key to improving quality and sustainability

• Population growth will not negate the need for a single acute site - has much greater impact on demand for primary care

• Maintaining two acute sites likely to cause deteriorating clinical quality and unsustainable services

10

Hatfield

• Disappointment at lost opportunity to develop this new hospital

• Preferred option non-financially

• Not affordable – would lead to recurrent deficit and inability to meet statutory duty to break even

• Not possible to make scheme affordable without making it too small and unfit for purpose

• Assessment confirmed by NPV - revealed Lister to be best value

• Lister option offers greatest scope for ongoing investment in service quality and development

11

Cancer Centre services

• Important issue for Hertfordshire

• 10% cancer patients undergo treatment at Mount Vernon Cancer Centre (MVCC)

• MVCC serves wider population than just Hertfordshire

• Cancer Reform Strategy (December 2007)

• Commissioner-led review in 2008

• MVCC response supports consolidation of acute services on Lister site

12

Impact on out of county hospitals

• Patients’ choices will not be impeded by acute site consolidation

• Patients can continue to choose to travel out of Hertfordshire for care

• Current activity flows incorporated onto modelling

• Commissioners linking into out of county hospitals’ planning

• Proposals designed to improve clinical outcomes in Hertfordshire

• Emergency access complemented by Urgent Care Centres

13

Conclusions of the health equality impact assessment

• Impact on minority ethnic communities, young children, older people, particularly the very old

• None of the options have distinctly different potential effects on such groups but Lister slightly better placed for access

• Any option would need to ensure that the services are adequately accessible for these groups in terms of transport and communication

14

Summary

• Access

– most frequently cited issue, Lister site marginally more accessible

-continued access to local services at local general hospital and in primary care

• Sustainability

– scope for future growth

- Lister site 9 acres larger than QEII site

15

Summary• Clinical quality

– Lister site has greater potential for optimal flexibility and clinical adjacencies

• Financial

– both options would potentially enable the trust to meet its statutory duty

- Lister site offers greater surplus for ongoing investment in services + buffer against adverse movement in costs or income

16

Summary• Public views

– questionnaires 60:40 in favour of QEII

- respondents tended to support nearest site

- concern about safety

- ongoing need for reassurance and information.

• Clinical views

– strong support for acute consolidation

- NHS staff responses tended to favour the Lister site

17

Conclusion• Healthcare will continue to be provided across a range of locations • Proposals designed to achieve the best possible clinical outcomes for our

patients• Future locations will include local general hospitals, primary care and acute

sites• On balance, the Lister option is better placed to deliver the Committee’s five

principles: Capacity Requisite investment General clinician support Reasonable access Affordability