Fit for the Future: Developing specialist hospital services in Gloucestershire

Fit For the Future
 

The Fit for the Future public consultation on options for organising a number of specialist hospital services across the Cheltenham General and Gloucestershire Royal Hospital sites ran from 22 October til 17 December.

Thank you to everyone who has taken the time to feedback to this consultation.

The Final Output of Consultation report has been published and is available below.

A Citizens’ Jury ran from 19 January to 28 January. The Jury report, Jurors report and recordings of presentations is available via the Citizens’ Jury tab below.

You may also wish to sign up to our new engagement platform where you can share your views, experiences and ideas about local health and care services https://getinvolved.glos.nhs.uk.

NHS Gloucestershire Clinical Commissioning Group’s Governing Body met on Thursday 18 March to give conscientious consideration to all of the information they were presented with, including the Fit for the Future Decision Making Business Case (DMBC). At this meeting they approved a number of resolutions relating to the medium and long term future of specialist hospital services across the Cheltenham General and Gloucestershire Royal hospital sites. You can read more here.

NHS Gloucestershire Clinical Commissioning Group Governing Body –  18 March 2021

Please read the Stakeholder briefing sent out prior to the meeting here.

The Governing Body meeting was streamed live from the NHS Gloucestershire CCG Youtube channel. A link direct to the live stream was posted to this page once the meeting began.


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There is now an opportunity for the public, staff and stakeholders to comment on additional information prior to decision making in March 2021. See here.

The following documents are now available to download:

 Citizens’ Jury – Jurors’ Report

Citizens’ Jury – Report of the Jury (includes further information about the jury e.g. recruitment)

Updated Trauma and Orthopaedic Pilot Evaluation

Planned General Surgery update

Output of Consultation report


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Read a short introduction to Fit for the Future

Watch a short overview of Fit for the Future featuring Prof Mark Pietroni, Medical Director at Gloucestershire Hospitals NHS Foundation Trust


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We would like to say a huge thank you to everyone who took part in the extensive programme of consultation – on-line, in person, by post and by phone. We are pleased to publish the  Output of Consultation report and appendices below.

The Output of Consultation Report sets out the background to Fit for the Future, our approach to communications and consultation and the responses to the consultation.

An Interim Output of Consultation Report was published in January 2021 and can be found below

The Interim Output of Consultation Report is supported by a series of Appendices, which can be found below.

Next steps

A consultation review period will then follow giving Gloucestershire Hospitals NHS Foundation Trust and NHS Gloucestershire Clinical Commissioning Group an opportunity to carefully review the feedback received to inform decision making in spring 2021.


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A Citizens’ Jury met via Zoom for eight days between 19 January to 28 January.

For all the background information, copies of presentations and audio recordings of plenary sessions, visit the Citizens’ Jury page here.


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*Translated by Bilingual Cardiff. Thank you to Aneurin Bevan Health Board for coordinating this translation for us.


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This survey has now closed. Thank you to everyone who has taken the time to feedback to this consultation. We will read all of your responses and these will be published as part of the Output of Consultation report which will be available on this web page in January 2021.


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How to get involved online

There are lots of ways for you to get involved and share your views on our proposals from the comfort of your own home. We have three types of event planned:

  • Public online sessions, including Q&A, hosted by Gloucestershire Hospitals NHS Foundation Trust on Facebook or YouTube
  • Public online sessions, including Q&A, hosted by Gloucestershire Live on Facebook
  • Cuppa and Chat sessions – on all specialities, organised to replace the Information Bus tour*

*please note we have pencilled in further Information Bus dates from December, which are subject to national restrictions being lifted as planned. Find all the info in the ‘how to get involved offline’ section below.

Date / time Title How to
access
How to
submit a question
How to
watch back later
Mon 2 Nov
12.30-2pm
Acute Medicine – Clinical Q&A YouTube:
Glos Hospitals
ghn-tr.centresofexcellence@nhs.net

or via the discussion forum on Get Involved in Gloucestershire

Watch here
Weds 11 Nov
12.30-1pm
Gastroenterology – Glos Live Q&A Facebook:
GlosLiveOnline
Look out for posts on the Glos Live or Glos Hospitals Facebook pages asking for questions

Or via the discussion forum on Get Involved in Gloucestershire

Watch here
Mon 16 Nov
11am-12pm
Cuppa and Chat – Stroud MS Teams event.
Email glccg.gig@nhs.net to book a place
Email glccg.gig@nhs.net or via the discussion forum on Get Involved in Gloucestershire n/a
Tues 17 Nov
3-4pm
Cuppa and Chat – Cotswolds MS Teams event.
Email glccg.gig@nhs.net to book a place
Email glccg.gig@nhs.net or via the discussion forum on Get Involved in Gloucestershire n/a
Weds 18 Nov
12.30-1pm
Acute Medicine – Glos Live Q&A Facebook:
GlosLiveOnline
Look out for posts on the Glos Live or Glos Hospitals Facebook pages asking for questions

Or via the discussion forum on Get Involved in Gloucestershire

Watch here
Fri 20 Nov
11am-12pm
Cuppa and Chat – Tewkesbury Zoom event.
Email glccg.gig@nhs.net to book a place
Email glccg.gig@nhs.net or via the discussion forum on Get Involved in Gloucestershire n/a
Tues 24 Nov         3-4pm Cuppa and Chat – Forest of Dean Zoom event.
Email glccg.gig@nhs.net to book a place
Email glccg.gig@nhs.net or via the discussion forum on Get Involved in Gloucestershire n/a
Weds 25 Nov
10-11am
Cuppa and Chat – Cheltenham Zoom event.
Email glccg.gig@nhs.net to book a place
Email glccg.gig@nhs.net or via the discussion forum on Get Involved in Gloucestershire n/a
Weds 25 Nov
12.30-1pm
Trauma and Orthopaedics  – Glos Live Q&A Facebook:
GlosLiveOnline
Look out for posts on the Glos Live or Glos Hospitals Facebook pages asking for questions

Or via the discussion forum on Get Involved in Gloucestershire

Watch here
Fri 27 Nov
2.30-3.30pm
Cuppa and Chat – Gloucester Zoom event.
Email glccg.gig@nhs.net to book a place
Email glccg.gig@nhs.net or via the discussion forum on Get Involved in Gloucestershire n/a
Weds 2 Dec
12.30-2pm
Acute Medicine (acute medical take) – Clinical Q&A Facebook:
Glos Hospitals
ghn-tr.centresofexcellence@nhs.net

or via the discussion forum on Get Involved in Gloucestershire

Watch here
Weds 2 Dec
12.30-1pm
General Surgery – Glos Live Q&A Facebook:
GlosLiveOnline
Look out for posts on the Glos Live or Glos Hospitals Facebook pages asking for questions

Or via the discussion forum on Get Involved in Gloucestershire

Watch here
Thurs 3 Dec
12-1pm
Gastroenterology Inpatient Services – Clinical Q&A Facebook:
Glos Hospitals
ghn-tr.centresofexcellence@nhs.net

or via the discussion forum on Get Involved in Gloucestershire

Watch here
Thurs 3 Dec
2-3.30pm
General Surgery – Clinical Q&A Facebook:
Glos Hospitals
ghn-tr.centresofexcellence@nhs.net

or via the discussion forum on Get Involved in Gloucestershire

Watch here
Fri 4 Dec
9-10.30am
Image Guided Interventional Surgery (IGIS) – Clinical Q&A Facebook:
Glos Hospitals
ghn-tr.centresofexcellence@nhs.net

or via the discussion forum on Get Involved in Gloucestershire

Watch here
Fri 4 Dec
1.30-3pm
Trauma and Orthopaedic Inpatient Services – Clinical Q&A Facebook:
Glos Hospitals
ghn-tr.centresofexcellence@nhs.net

or via the discussion forum on Get Involved in Gloucestershire

Watch here
Tues 8 Dec
3-4pm
Cuppa and Chat about Fit for the Future – All localities Zoom event. Email glccg.gig@nhs.net to book a place Email glccg.gig@nhs.net or via the discussion forum on Get Involved in Gloucestershire
Weds 9 Dec
10-11am
Cuppa and Chat about Forest of Dean Community Hospital – All localities Zoom event.
Email glccg.gig@nhs.net to book a place
Email glccg.gig@nhs.net or via the discussion forum on Get Involved in Gloucestershire
Weds 9 Dec
10-11am
Image Guided Interventional Surgery – Glos Live Q&A Facebook:
GlosLiveOnline
Look out for posts on the Glos Live or Glos Hospitals Facebook pages asking for questions

Or via the discussion forum on Get Involved in Gloucestershire

Ways to get involved offline

There are several ways to get involved and share your views on our Fit for the Future proposals offline.

  • Phone us: if you’d like to have a chat over the phone, call Freephone 0800 0151 548, leave a message and someone will call you back
  • Request a hard copy of the booklet: we’d be happy to send hard copies of the booklets in the post, just give us a call on the number above or email glccg.gig@nhs.net to make a request. We also have Easy Read copies available on request.

Help us gather views from as many people as possible, tell your friends and neighbours how they can get in touch, or request copies of the booklet to give to them.

Talk to the team at a public drop-in event

Unfortunately due to new Covid-19 restrictions introduced from Thursday 5 November, we have had to cancel the Information Bus Dates originally planned for November 2020.

During the lockdown, we will continue to make every effort to promote the consultation/s across the county in other ways.

We have planned additional Information Bus dates in early December 2020, although these may be subject to further change if the the restrictions are extended beyond 2 December 2020. Our drop-in events run between 10am and 2pm unless stated otherwise. We hope that you will be able to drop-in to one of the following:

  • Thursday 3rd December, Cheltenham High Street
  • Thursday 3rd December, Tesco, Cheltenham (3pm-6pm)
  • Friday 4th December, Gloucester Quays
  • Friday 4th December, Tesco, St Oswalds, Gloucester (3pm-6pm)
  • Saturday 5th December, Newerne St Car Park, Lydney
  • Monday 7th December, Stroud Tesco
  • Tuesday 8th December, Cirencester Market Square
  • Wednesday 9th December, Stow Market Place
  • Thursday 10th December, Spring Gardens Car Park, Tewkesbury
  • Friday 11th December, Coleford Clock Tower

Events which have already taken place:

  • Monday 2nd November,  Cheltenham High Street
  • Tuesday 3rd November, Cinderford Co-op
  • Wednesday 4th November, Gloucester Quays

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Q. What is Fit for the Future about?

A. It is part of the One Gloucestershire vision focussing on the medium and long term future of specialist hospital services at the Cheltenham General and Gloucestershire Royal Hospital sites.

The feedback from Engagement showed there is support to continue to develop a ‘centres of excellence’ approach, which reflects the way a number of inpatient services are already concentrated in one place, such as cancer care in Cheltenham and children’s services in Gloucester.

We have been involving staff, patients, local people and the public in looking at a number of other services and potential ‘solutions’.

Q. What are the aims of Fit for the Future?

A. The aim is to improve health outcomes, reduce waiting times, limit the number of cancelled operations and ensure people see the right specialist to meet their needs at the right time.

More information on the aims and the need for change can be found in the full consultation booklet.

Q. What is Fit for Future not about?

A. It is not about the temporary changes we have had to make now to respond to the COVID-19 pandemic.

Some of the medium to long term changes we are proposing relate to the same services where temporary changes have been made recently.

However, there are no proposals to close Cheltenham General Hospital’s Emergency (A&E) Department or change the pre-COVID-19 opening hours or staff arrangement, which includes consultants, doctors, nurses and allied health professionals.

Full facilities for resuscitating, stabilising and treating patients would continue to be in place.

Q. Who is ‘One Gloucestershire’ and why are they leading the consultation?

A. The One Gloucestershire Integrated Care System ICS) is a partnership between the county’s NHS and care organisations. The NHS partners of One Gloucestershire are:

  • NHS Gloucestershire Clinical Commissioning Group (CCG)
  • Primary care providers (GP surgeries)
  • Gloucestershire Health and Care NHS Foundation Trust
  • Gloucestershire Hospitals NHS Foundation Trust (the Trust that runs Cheltenham General Hospital and Gloucestershire Royal Hospital)
  • South Western Ambulance Service NHS Foundation Trust.

Together they plan and provide NHS services – from GP surgeries and community services to the most specialist hospital services.

Q. Who is being consulted?

A. NHS and care staff, local patients, carers, the public and our community and voluntary partners. We also invite feedback from people in neighbouring areas who use services in Gloucestershire.

Q. What are people being consulted about?

A. How we organise the following specialist hospital services across Cheltenham General and Gloucestershire Royal Hospitals in future (A-Z):

  • Acute Medicine (specifically ‘acute medical take’)
  • Gastroenterology inpatient services
  • General Surgery (emergency general surgery, planned Lower gastrointestinal (GI)/colorectal surgery and day case Upper and Lower GI surgery)
  • Image Guided Interventional Surgery (IGIS) including Vascular Surgery
  • Trauma and Orthopaedics (T&O) inpatient services.

There is a simple description of each of these services and what they do at the start of each service section in both the full and summary consultation booklets.

Q. Do you have a preferred way of organising these specialist services in the future?

A. Yes, apart from planned Lower GI (colorectal) inpatient general surgery. The work to date, including patient, public and staff engagement, has not led us to a preferred option for the location of this service. We are keen to hear your views.

Q. Why are you consulting now when the COVID-19 pandemic is still an issue?

A. We’ve considered very carefully when to start public consultation. There is an imperative to consult now because of the potential benefits for patients, families, carers and staff that could be realised.

Because of the important safety requirements of COVID-19, we will be using more ‘virtual’ methods of consultation, which many people have become so familiar with. We also plan to offer others forms of ‘socially distanced’ face to face consultation activity where we can.

We will adapt our consultation activities in line with any changes to national or local guidance regarding the COVID-19 pandemic situation during the consultation period.

Q. How are you consulting?

A. The different ways that people can find out more and tell us what they think are set out on pages 10 and 11 of the full consultation booklet and on page 7 of the summary consultation booklet.

Q. What if people cannot access information online?

A. If you are in contact with people who might not be able to access information online please do tell them about the Fit for the Future consultation and ask them to write to us or call us:

FREEPOST RRYY-KSGT-AGBR, Fit for the Future, Sanger House, 5220 Valiant Court, Gloucester Business Park, Gloucester GL3 4FE.

Or call Freephone to leave a message on: 0800 0151 548.

Q. What happens next?

A. We will be open to receiving feedback between 22 October and 17 December 2020. All feedback will be read and put into an ‘Output of Consultation’ Report.

A second Fit for the Future Citizens’ Jury will be held in January 2021 to consider the feedback from this consultation, record their observations and make their recommendations to decision makers.

There will then be a consultation review period, where Gloucestershire Hospitals NHS Foundation Trust and NHS Gloucestershire Clinical Commissioning Group (CCG) will carefully consider all of the feedback at meetings in public in March 2021.

A final decision will be made at the CCG Governing Body meeting on 11 March 2021. This will be streamed on the internet.

Acute Medicine (Acute Medical Take)

Q. What are the potential benefits of the preferred option?

A. The preferred option has emerged following an extensive programme of engagement including a Citizens’ Jury and a public workshop to explore potential solutions.

The aim is to improve access for patients to specialist doctors 24/7, ensure strong and safe staffing levels 24/7, reduce waiting times for hospital admission and improve outcomes from treatment by improving links with other related services on site.

Q. What would the preferred option mean for patients presenting at Cheltenham A&E?

A. Many patients attending the A&E departments can be diagnosed and treated the same day and return home. Sometimes this involves coming back to hospital for a follow up appointment at either CGH or GRH.

Patients assessed by the clinical team at CGH A&E or GRH A&E that need a hospital stay and can safely go straight to a specialist ward at either Cheltenham or Gloucester would continue to do so.

Patients presenting to CGH with an uncertain diagnosis, for example where further specialist investigation is required to determine which specialty team they need to be referred to, or those patients that need to stay in hospital under the care of the Acute Medicine team, would be transferred to the GRH Acute Medical Unit (AMU).

Q. Would Cheltenham General Hospital’s A&E Department remain open?

A. Yes. Cheltenham General Hospital (CGH) would continue to have a consultant led A&E open 8am–8pm and a nurse led service 8pm-8am, 7 days a week.

It would provide a wide range of emergency care services with facilities for resuscitating, stabilising and treating patients as required.

Walk in patients would be able to access the service as before (pre COVID-19 temporary changes).

General Surgery

Q. What is the aim of the proposals?

A. Options have been developed following an extensive programme of engagement including a Citizens’ Jury and a public workshop to explore potential solutions.

The aim is to ensure patients are more likely to see the right specialist, first time and have the best possible experience of care and outcomes from surgery.

It’s also about ensuring fewer cancelled or delayed operations, safe and sustainable staffing levels and rotas for the service and better supervision of junior doctors.

Q. What are the potential benefits of centralising Emergency General Surgery?

A. We believe this change would reduce waiting times for surgery.

We also think it would improve outcomes of treatment – because both kinds of sub specialists – Upper and Lower GI (colorectal) surgeons, would be available at all times and all emergency patients would have access to the Surgical Assessment Unit.

It would ensure 24/7 access to an emergency theatre, which also reduces waiting times and improves outcomes.

It could also benefit staffing – the experience for junior doctors and recruitment and retention of staff would be improved.

Q. What are the potential benefits of centralising planned Lower GI (colorectal) inpatient General Surgery?

A. We think centralising planned Lower GI (colorectal) services on a single site would improve quality of care, establishing a dedicated specialist team made up of colorectal surgeons, specialist nurses and other specialist staff.

It would reduce the risk of operations being cancelled, because there would be dedicated facilities available for use by the specialist team.

The work to date, including patient, public and staff engagement, has not led us to a preferred option for the location of planned Lower GI (colorectal) general surgery and we are therefore keen to listen to the views of all as part of this consultation.

Q. What are the potential benefits of centralising Upper GI and Lower GI General Surgery Day Cases?

A. We believe centralising General Surgery Day Cases on the Cheltenham General site would improve the patient experience, because there would be increased capacity for operations, fewer cancellations and care would be provided in a modern, new and dedicated facility.

There would also be more time for staff to provide self-care advice to patients.

Image guided interventional Surgery (IGIS)

Q. What is the preferred option for IGIS?

A. The preferred option is to bring together the staff and resources we have and establish a 24/7 hub for IGIS at GRH with an IGIS spoke service at CGH to support oncology, urology and other surgical specialties.

Q. What are the potential benefits of this preferred option?

A. We believe these changes would reduce travel for patients who currently have to go outside of Gloucestershire for certain procedures and increase access to less invasive surgery techniques, which can improve outcomes.

It would also help us attract and keep the very best staff in Gloucestershire, investing in new cutting edge technology and making best use of it.

Vascular surgery, interventional cardiology and interventional radiology use similar equipment, similarly trained support staff and have similar processes for caring for patients following a procedure.

These services also regularly need specialist input from each other and in many cases are treating the same group of patients.

Gastroenterology inpatient services

Q. What is the preferred option?

A. The preferred option is to make the current pilot scheme permanent and for Gastroenterology inpatient services to remain on the Cheltenham General Hospital site.

Q. What are the potential benefits of this preferred option?

A. We believe this would ensure patients can continue to be seen and treated more quickly by the right specialists resulting in shorter hospital stays and a better experience of care.

It would also ensure that doctors and nurses working within the service can focus on their specialist area of care, which in turn should support staff recruitment and retention.

The pilot scheme has reduced waiting times by freeing up the team to carry out more endoscopy procedures and outpatient clinics and a permanent change would help the service to build on this.

Trauma and orthopaedic inpatient services

Q. What is the preferred option?

A. The preferred option is to make the current pilot scheme permanent.

This means Trauma surgery (emergency orthopaedics) remaining on the Gloucestershire Royal Hospital site and the majority of planned orthopaedic surgery remaining on the Cheltenham General Hospital site.

Q. What are the potential benefits of this preferred option?

A. We believe this would help us to consolidate and build on the improvements made since the pilot scheme was introduced in 2017.

These include a reduction in waiting times for trauma surgery, fewer cancelled operations for planned surgery and patients’ experiencing shorter hospital stays following hip and knee surgery.


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Fit for the Future: Overview

Fit for the Future: Acute Medicine

Fit for the Future: Trauma and Orthopaedic Inpatient Services

Fit for the Future: General Surgery

Fit for the Future: Gastroenterology


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  • The Equality and Engagement Impact Assessment can be viewed here

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