Update on the COVID-19 temporary service changes and the Fit for the Future programme

On Tuesday 13 July, we updated the county’s Health Overview and Scrutiny Committee (HOSC) on a number of COVID-19 temporary service changes and also set out our thoughts on next steps for the Fit for the Future programme.

In response to the unprecedented challenges of the COVID-19 pandemic, and with the support of the HOSC, the NHS in Gloucestershire put in place a number of temporary service changes across the Cheltenham (CGH) and Gloucester (GRH) hospital sites and in community hospitals from spring 2020.

These changes were designed to reduce the risk of transmission, support the continuation of essential services and staffing arrangements and give confidence to local people that local hospitals were safe.

The Emergency General Surgery and Vascular Surgery temporary service changes (centralised at GRH) align to the Fit for the Future permanent changes agreed in March 2021 and have therefore been implemented.

The significant majority of COVID-19 temporary changes have served their purpose well and will come to an end by August 2021, with the proposed exception of a small number of services; where we feel there is the potential to provide continuing benefits to patient care (see below) and to ensure we can remain responsive to any further waves of COVID-19 this year.

Acute Stroke Ward, including Acute Rehabilitation

We will keep the Acute Stroke and Rehabilitation Ward at Cheltenham General Hospital and retain the additional 6 Rehabilitation beds at the Vale Community Hospital, Dursley as a temporary service change until March 2022.

The hyper acute stroke services – specialist life-saving care for patients immediately after a stroke – will remain at Gloucestershire Royal Hospital.

This extension of the temporary arrangements will give the NHS more time to monitor the impact of the changes for patient care and carry out a full evaluation to develop potential solutions for the long term development of stroke care in Gloucestershire.

High care Respiratory services

We will keep high care Respiratory services at Gloucestershire Royal Hospital as a temporary service change until March 2022, to ensure they are  responsive to any further ‘waves’ of COVID-19.

Again, this will give us more time to carry out further analysis of the impact of the changes and consider potential changes to this service over the longer term.

Medical Day Unit (MDU)

We will keep the MDU at Cheltenham General Hospital as a temporary service change until March 2022.

The Medical Day Unit (MDU) is a nurse led service open 8am to 4pm, Monday to Saturday and provides a range of planned day case procedures (infusions, biopsies and treatments) for medical and surgical patients.

Given the wider positive benefits already identified by locating the MDU at CGH, both for patients who need to access services at the MDU, but also for patients accessing Emergency Department services at GRH, we will:

  • Keep the Medical Day Unit at CGH as a temporary service change (to minimise the disruption to patients and staff); whilst at the same time;
  • Carry out targeted engagement with affected patient groups regarding a longer term proposal for the location of the Medical Day Unit.

Gloucestershire Health and Care NHS Foundation Trust – the Minor Injury and Illness Unit (MIIU) at Dilke Memorial Hospital and update on other MIIUs

Due to the restrictive space and environment at Dilke Memorial Hospital, the community MIIU will remain closed until all social distancing measures can be removed.

As part of exciting plans to refurbish the MIIU at Stroud General Hospital, this Unit will close temporarily – most likely from mid-August 2021 until December 2021.

Although walk in services are available at neighbouring MIIUs, the preference is for local people in the Stroud district to call 111 to book appointments at nearby Vale Community Hospital, Dursley or other MIIUs in the county.

The NHS is working towards restoring pre-pandemic opening hours at Lydney and Cirencester MIIUs by the end of August 2021 and Stroud in December 2021.

Update on the Fit for the Future programme

We also updated HOSC members on the Fit for the Future programme.

As you are aware, Fit for the Future – Phase 1 was about developing solutions and options for the future of a number of specialist hospital services, alongside a vision for Centres of Excellence.

We are now beginning to take a look at the next phase of the Fit for the Future programme (see below) to see if other areas of service could benefit from change on the journey to excellence.

Fit for the Future programme – Phase 1

An implementation update for the permanent changes agreed in March 2021 can be found in the briefing to HOSC (13 July meeting) here

This includes Acute Medicine (Acute Medical Take), Emergency General Surgery, Image Guided Interventional Surgery, Vascular Surgery, Trauma and Orthopaedic Inpatient Services and Gastroenterology Inpatient Services.

Development of new options for Planned General Surgery, taking into account feedback received during public consultation, is subject to discussion with the Clinical Senate and ongoing engagement with current patients.

Lung Function and Sleep Services

Given the need to create space for the agreed creation of an Image Guided Interventional Surgery Hub at Gloucestershire Royal Hospital (Fit for the Future – Phase 1) and the impact on the ‘footprint’ for Lung Function and Sleep Services, the Trust has been exploring the best possible solutions for patient care.

Our proposal is to create a permanent ‘hub and spoke’ model for Lung Function and Sleep Services with a main ‘hub’ where most of the activity would take place at Cheltenham General Hospital and a ‘spoke’ service at Gloucestershire Royal Hospital, including support to inpatient and outpatient services for people with lung cancer.

Given this change would need to happen to create space for the approved IGIS Hub at GRH, we will carry out targeted engagement with affected patient groups through the process for formal service change.

Fit for the Future programme – next phases

With Phase 1 changes agreed and implementation underway, we are starting to explore the next phases of the Fit for the Future programme and consider other services that could benefit from change on the journey to excellence.

As part of our desire to engage with the HOSC at an early stage, we have shared a long list of initial services on the basis that any potential changes would be subject to best practice involvement and consultation practices.

Information can be found in the HOSC briefing paper (13 July) here

Please be assured that we will continue to work in positive partnership with the county’s health overview and scrutiny committee at each stage and as plans develop and will also keep you informed throughout.

 

Dr Andy Seymour
Clinical Chair
NHS Gloucestershire
Clinical Commissioning Group
Prof Mark Pietroni
Medical Director
Gloucestershire Hospitals
NHS Foundation Trust
Dr Amjad Uppal
Medical Director
Gloucestershire Health and
Care NHS Foundation Trust