Turnaround Plan - United Lincolnshire
Hospitals
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*** UPDATE *** 30th September 2006
The trust board have scrapped the strategic
options part of the Turnaround plan!
The majority of the plan outlined below is to be reworked following
the appointment of Gary Walker as the new Chief Executive.
Even thou this is a major development we still do not know what the
reworked plans may contain. What we do know, however, is there is
still an intention to lease or sell part of the hospital complex
and still a threat to A&E, Maternity etc. at the hospital.
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On 27th June 2006 the Turnaround Plan v. 10.2 was
released.
The following is a summary of this plan...
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An assumption of the Trust Executive is that
a significant proportion of the deficit is directly related to the
impact of operating services across four sites, in particular issues
relating to extra operating costs and service replication. This is
further exacerbated by the rural nature of the county and a wish
to ensure equitable access to services.
The Primary Care Trusts, the Trust
and the SHA are keen to ensure that no final proposal is made on
substantial
variations in service provision until there has been a pre-consultation
period with key partners prior to statutory public
consultation. Therefore, this reportconcentrates
on the feasibility of the various options and the advantages/disadvantages as viewed from initial research and
analysis. A full public consultation document will be produced once
research and analysis has been completed. |
Approach
A long list of nine options was explored (see Section 4) with a
view to delivering clinically sustainable and financially viable
acute services over the next two years. This list was agreed at the
Trust Executive Board and shared with Medical and Nursing
Directors. It was subsequently appraised against the following key
criteria:
– Accessible Service
– Provide Service to areas of deprivation
– Meet Policy and Network recommendations
– Financial recovery realised within 2 years
– VFM and affordable service
– Effective use of Health Facilities within the Community
– Providing Healthcare in a Modern Environment
– Acceptable to ULHT's catchment Population
– Improve recruitment and retention
– Health impact (Social Employment Environment and Education) |
Selection Method
The criteria described above were weighted and
agreed by the Executive Board. A score of 200 was considered as the
baseline. Four options were above this score, three of which are
being given serious consideration. However, option 8 (a
Greenfield site new build) was outside of the feasible timescale
and therefore no further modelling work has been undertaken. |
Options Considered
An option appraisal was completed based on a number of weighted
benefits (see Appendix 1). In addition public health information
on deprivation, demographics, incidence of disease etc were used
to ensure that scoring was based on the needs of the
population. Each of the options were scored and a weighted total
was calculated. Two separate appraisals took place: one with
members of the Executive Board and the other with members of the
Clinical Policy Group. The long list of options is given below:
1. Do Nothing - continue to provide a distributed system of acute
care that maximises local access across Lincolnshire
2. Do minimum - contract ULHT to providing services only from Boston,
Grantham, Lincoln and Louth sites. Stop providing
services at Skegness, Spalding and Johnson and in all other locations.
3. This option would concentrate
cancer, specialist and complex work on the Lincoln site. In addition
Lincoln would be the hub site for Women and Children’s services
providing the County wide Neonatal Unit. Lincoln would also provide
a County wide Acute Emergency Care Network for admissions after 11pm.
Boston would remain as a District General Hospital, providing a variety
of medical and surgical procedures on a day case and short stay basis.
There would be no admissions to the Pilgrim site after
11pm at night. Grantham would become a Locality Hospital providing
for surgical admissions 8am until 6pm and medical
admissions until 11pm daily. There would be a range of elective work
(day case and short stay only). Louth would become a
Community Hospital, working with local GPs and the PCT. Peripheral
site provision to continue to be provided but in a more
efficient manner.
4. Reconfigure sites to concentrate all specialist and complex work
in balanced way across Boston and Lincoln (including Women
and Children). Grantham to become a Locality Hospital and Louth a
Community Hospital. Peripheral site provision to continue
to be provided but in a more efficient manner. Grantham will only
accept selected admissions between 8.00am and 11.00pm
(no Surgery after 6.00pm). Louth, Skegness and Spalding will have
urgent care centres led by out-of-hospital care teams.
5. Contract ULHT to provide all acute and inpatient services only
from two principal sites Boston and Lincoln. Grantham and Louth
Hospitals to be divested to other providers.
6. Contract ULHT to provide all acute and inpatient services only
from two principal sites Grantham and Lincoln. Boston and Louth
Hospitals to be divested to other providers.
7. Contract ULHT to provide all acute and inpatient services only
from two principal sites Grantham and Boston. Lincoln and Louth
Hospitals to be divested to other providers.
8. Concentrate all acute and inpatients services
on one site in a new central Greenfield location in Lincolnshire
9. Phase i - Redesign health services
based on a mixed economy of providers across care pathways. This
model will stream patients into 3 categories – Group 1 - Acute Assessment/Short
Stay; Group 2 – Specialist Acute Care; Group 3 – Post
Acute
Care. (The model is described in figure 1 on page 9) *
Phase ii - Further develop the model based on partnerships within
the health & social care community and independendent
sector.
Phase iii - Develop a commercial model ("Wellness model")
based on links with private sector partners from outside the health
economy. |
Decision - HIGHLIGHTED IN YELLOW ABOVE
The long list was reduced to four possible options, each scoring
greater than 200. These were:
1. Option 3
2. Option 4
3. Option 8
4. Option 9
Option 8 was discounted owing to the timescale i.e. 10 years and
the potential lack of political support owing to high financial
capital costs. |
Preferred Options
Option 3 -
- concentrate cancer, specialist and complex work on the Lincoln
site.
- Lincoln would be the
hub site for Women and Children’s services providing
the County wide Neonatal Unit.
- Lincoln would also provide a
County wide Acute Emergency Care Network for admissions after
11pm.
|
Boston would remain as a District General
Hospital, providing a variety of medical and surgical procedures
on a day case and short stay basis. There would be no
admissions to the Pilgrim site after 11pm at night. |
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|
Grantham would become a Locality Hospital providing
for surgical
admissions 8am until 6pm and medical admissions until 11pm daily.
There would be a range of elective work (day case
and short stay only) |
Louth would become a Community Hospital, working
with local GPs and the PCT. Peripheral site
provision to continue to be provided but in a more efficient
manner.
Skegness and Spalding will have urgent care centres led by out-of-hospital
care teams. |
This option would also be combined
with the following estate reconfigurations:
- Relocate Trust HQ and lease vacated accommodation
-
Concentrate
all work within the Tower Block at Pilgrim Hospital
- All women and children’s services at Lincoln will
be based in the maternity block
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| Advantages |
Disadvantages |
1. Maintains a balance of services across the
two main sites
2. Equalises capacity across the sites
3. A&E access for East Coast maintained
4. Women and children’s services remain on the two major
sites
5. Outpatient access to services on Grantham and Louth would
be maintained |
1. Capacity at Lincoln to take overnight surgical
admissions from Grantham
2. Equity of service for women and children
3. Access to A&E services overnight at Grantham
4. Loss of income to the Trust
5. Not financially viable – does not recover the required
savings |
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Option
4 -
- concentrate all specialist and complex work in a
more balanced way across Boston and
Lincoln (including Women and Children).
|
concentrate all specialist and complex work
in a more balanced way across Boston and
Lincoln (including Women and Children). |
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|
Grantham would become a Locality Hospital
providing for surgical admissions 8am until
6pm and medical admissions until 11pm daily. There would
be a range of elective work (day case and short stay only). |
Louth
would become a Community Hospital, working with local GPs
and the PCT. Peripheral site provision to continue to
be provided
but in a more efficient manner.
Louth, Skegness and Spalding will have urgent care centres
led by out-of-hospital care teams. |
This option would also be
combined with the following estate reconfigurations:
- Relocate Trust HQ and lease vacated accommodation
- Concentrate all work within the Tower Block at Pilgrim
Hospital
- All women and children’s services at Lincoln will
be based in the maternity block
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| Advantages |
Disadvantages |
1. Allows a Centre of Excellence for Complex
Surgery
2. Allows a Centre of Excellence for Women and Children’s
3. Ensures safe services at Grantham and Louth |
1. Capacity at Lincoln County Hospital to
cope with increases in emergency activity at night
2. Access to accident and emergency services with “the
golden hour” i.e. on the East Coast
3. Equity of service for women and children
4. Potential safety issues with concentrating all neonatal
services at Lincoln – travel distances
5. Access to A&E services overnight at Grantham
6. Loss of income to the Trust
7. Not financially viable – does not recover the
required savings |
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Option
9 - Description:
Option 9 would be implemented in three phases:
Phase i - Redesign health services based on a mixed
economy of providers across care pathways. This model
will stream
patients into 3 categories - Group 1 - Acute Assessment/Short
Stay; Group 2 – Specialist Acute Care; Group
3 – Post Acute
Care. Each of the sites would deliver their services
configured in the model described in Fig. 1 (Page
12).
Phase ii - Further develop the model based on partnerships
with Health and Social Care partners allowing the
Trust to
concentrate on “Core Business” (Group
1 and 2)
Phase iii - Develop a commercial model ("Wellness
model") based on links with private sector partners
from outside the health
economy. This would involve the development of a “Health
Campus” model working with public/private partners
to include
“wellness” facilities e.g. gym, spa,
beauty treatments, complimentary therapies etc. In
addition there would be a greater emphasis
on developing commercial outlets on sites in order
to make more efficient use of the estate.
SUB OPTIONS
All variations within Option 9 assume that beds will
be streamed into:
•
Group 1 - Acute Assessment/Short Stay; Group 2 – Specialist
Acute Care; Group 3 – Post Acute Care. It is
further assumed
that there will be 3 wards in group 3 on each of
the two major sites i.e. Lincoln and Pilgrim. This
has been termed as “bed
streaming”.
9V1 – Bed streaming + Option 3
9V2 – Bed streaming + Option 4
9V3 – Bed streaming + Option 4 with A&E
at Grantham becoming an emergency care centre with
24/7 access – still no surgical
admissions after 11pm
9V4 - Bed streaming + Option 4 with A&E reconfigured
to be led from the 2 main sites i.e. not closing
at Grantham after 11pm –
still no surgical admissions
9V5 – As 9V3 with all emergency surgery ceasing
at Grantham. Surgery consisting of Orthopaedics only
9V6 – As 9V4 with all emergency surgery ceasing
at Grantham. Surgery consisting of Orthopaedics only
9V7 – Close Grantham site, remainder of services
as per option 4 |
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Option 9 - Variations
| Variation |
Version 1 |
Version 2 |
Version 3 |
Version 4 |
Version 5 |
Version 6 |
Version 7 |
| Bed Streaming |
√ |
√ |
√ |
√ |
√ |
√ |
√ |
| Grantham A&E Closed 11pm - 8am |
√ |
√ |
|
|
|
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|
Grantham A&E becomes
Emergency Care Centre |
|
|
√ |
|
√ |
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| Close the Grantham Site |
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|
√ |
Cease Emergency Surgery at
Grantham (after 6pm) |
√ |
√ |
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|
Cease all Surgery at Grantham
(excluding orthopaedics) |
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|
√ |
√ |
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| Close Pilgrim A&E 11pm - 8am |
√ |
|
|
|
|
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|
Reconfigure A&E to become
Consultant Led from 2 sites with
an Emergency Care Centre at
Grantham |
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|
√ |
|
√ |
|
Reconfigure A&E units at
Skegness and Spalding |
√ |
√ |
√ |
√ |
√ |
√ |
√ |
Women and Children's centred at
Lincoln |
√ |
|
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Women and Children's centred at
Lincoln and Pilgrim |
|
√ |
√ |
√ |
√ |
√ |
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| Contract Pilgrim to Tower Block |
√ |
√ |
√ |
√ |
√ |
√ |
√ |
| Lease Trust HQ to third party |
√ |
√ |
√ |
√ |
|
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|
Lease premises at Grantham to
GP practice |
√ |
√ |
√ |
√ |
|
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|
Retract Grantham to main
buildings lease remaining
premises |
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|
|
√ |
√ |
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| Take out the Medical take at
Louth |
√ |
√ |
√ |
√ |
√ |
√ |
√ |
Advantages/Disadvantages of the preferred version
of this option - Option 9V6
Advantages
1. Maintains a balance of services across the two
main sites
2. Equalises capacity across the sites
3. A&E access for East Coast maintained
4. Women and children’s services remain on
the two major sites
5. Outpatient access to services on Grantham and
Louth would be maintained
6. 24/7 access to Emergency Care services at Grantham
7. Centre of Excellence for Orthopaedics to be
developed at Grantham
8. Ensures safe services on all sites
9. Ensures the future viability of the Grantham
site
10. Works on a clinical led, patient centred model
of service
Disadvantages
1. Potential loss of income to the Trust
2. No access to emergency surgery at Grantham
3. No access to acute surgery at Grantham
4. No medical emergencies at Louth overnight
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| Public Perception |
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| The Trust is aware that
the options being considered may create negative
reaction from the public in certain localities as
it will be perceived as a diminution of services
and local access, particularly in the Grantham area.
Access and travel
times from Grantham will be of particular concern. |
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| Extra-Ordinary Trust Board
Meeting - 27th June 2006 |
3.10 The Interim Chairman
asked the Trust Board to adopt the Turnaround Plan.
RESOLVED
The Board unanimously adopted the Turnaround Plan. |
Option 9 – Version
6 was put
forward as the one most favoured for further
detailed consideration. It included
proposals for phase 1 of bed streaming based
on the new model of patient care for
all three main sites, reconfiguration of county
A&E
services to become consultant
led from Lincoln and Pilgrim, Women and Children’s
services also to be centred on
those two sites and at least some withdrawal
of surgery in Grantham. It was
emphasised that each component part of these
proposals contained a spectrum of
outcomes and that each part of the options was
not necessarily dependent on
another part being adopted. It was further emphasised
that no proposals would be
put to public consultation, to be led by PCTs,
without further extensive engagement
with clinicians and stakeholders and, accordingly,
no final decisions had yet been
made.
|
The Interim Chief
Executive asked the Medical Director to summarise
for the Board the clinical issues arising from
the set of options described above. The Medical
Director highlighted the concerns of some clinicians
around the provision of Critical
Care at Grantham. A review carried out by the
Critical Care Network had identified
a number of recommendations, which the Trust
had struggled to implement and
against this background, level 3 critical care
had been withdrawn. It was proposed
that emergency surgery be undertaken at the other
sites. The Medical Director
explained that without emergency surgery on site,
there may well be questions over
aspects of the A&E service as presently constituted.
|
4.4 The Chief Nurse described
the plans for Women and Children’s Services,
explaining that the midwifery managed unit at
Grantham had seen falling usage,
with below 100 births a year. Services to support
home births would continue.
RESOLVED:
The Board noted the progress made with the consideration
of strategic options as
well as the issues surrounding those options
being put forward for further detailed
work |
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