Trust Update On Reform and Modernisation Proposals

Statement form Hugh McCaughey, South Eastern HSC Trust Chief Executive “Following the Trust Board meeting on 24th November 2010 our proposals were supported by the Health and Social Care Board and submitted to the Department of Health, Social Services and Public Safety. I can now advise that the DHSSPS has approved our plans and I want to take this opportunity to bring people up to date with regards to how our reform and modernisation proposals will be implemented. There is some urgency about taking forward the proposals for the Emergency Department at the Downe and we would hope to implement these in April this year.  The changes to mental health and disability services require capital development and the timescale is likely to be 18 months to two years. “Firstly, I want to allay some fears about changes to the Emergency Department at the Downe Hospital.  I want to emphasise that there will continue to be a 24 hour service at the Downe. I also want to highlight that our proposal has widespread support from many GPs in the Down area, but importantly, overwhelming support from those GPs who deliver the existing Out of Hours Service.  These are the people who will actually staff it and have to make it work.  It was also supported at the Health and Social Care Board meeting by senior GPs from across N. Ireland who indicated they thought the proposal was an innovative way to maintain emergency services in country localities.  You will see a comment from one of them on this page. “Thus, just to reiterate, from 8.00am to 10.00pm there will be no change to the existing arrangements. During the night from 10.00pm to 8.00am, the vast majority of people will still be treated locally through accessing the GP Out of Hours by the usual arrangements. I am determined that the Downe Emergency Care Department does not have to suddenly cease its service as happened elsewhere in Northern Ireland, thus I believe these changes provide a viable and sustainable solution for the future.  Importantly throughout the night patients will continue to be able to be admitted and treated, whilst bringing certainty and stability to a department we are struggling to staff and hence keep open. [caption id="attachment_17657" align="alignleft" width="267" caption="Hugh McCaughey, South Eastern HSC Trust Chief Executive updates on the reform and modernisation proposals."][/caption] “In turning to our Mental Health proposals I remain convinced that the plan to bring together three small acute-inpatient facilities into one centre of excellence will deliver a real improvement in the care for patients. I appreciate that for some people there will be difficulties regarding accessibility and we will liaise closely with those that it may affect to ensure that we minimise such difficulties. We believe strongly that the improvement in local community services  and the enhancements we can offer in a single inpatient unit outweighs the additional travel a small number of people will experience “Our third set of proposals are focused on improving disability services. The Trust plans to reshape and enhance what we provide for people with physical and learning disabilities, by changing the way that services have been traditionally delivered. The new services we want to introduce will be developed in partnership with service users, the voluntary and community sectors. They will have as their primary aim the needs and desires of those who will use them and will seek to maximise independence, offer choice and variety, which will improve the life chances and outcomes experienced by users, their families and carers. “Finally, people may have concerns, or indeed there may be misunderstandings about what is proposed.  To address and improve public understanding, we have set up an e-mail address where you can have your queries answered.  If you have a specific query which is not addressed on this page pleas e mail us on trustline@setrust.hscni.net“ North Antrim General Practitioner endorses South Eastern Trust proposal for Downe Hospital. Dr Brian Hunter, a practicing General Practitioner in Co. Antrim and Chair of the Northern Local Commissioning Group, commended the South Eastern Trust for the innovative solution to staffing issues in Downe Hospital Emergency  Department as it allowed direct GP admission to medical beds to be retained and also supported the provision of a 24 hour service at the front door of the hospital. He further said that this way of working may prove to be an example for us all to learn from as we seek to meet the needs of our communities. Dr Darren Monaghan, Consultant in Emergency Medicine at the Downe, highlights the need for change and the new model of Urgent Care : “The new model has been developed because of the well documented difficulties in recruiting middle grade doctors and is a way of maintaining safe and sustainable services for the future. The Downe Emergency Department has been relying heavily on locum doctors for night shifts and it has not always been possible to get them.  The last thing we wanted was for the front door of the hospital to close at night. “Under the new arrangements, the vast majority of people will notice no significant difference in their treatment in the Downe. The Out of Hours General Practitioners will be able to admit medical patients to the hospital at night.  There is a strong clinical network in place in the Trust and GPs can  call on doctors at the Ulster Hospital to assist in diagnosis through computer links and digital radiology links. “Initially some GPs were sceptical about the new model, but through the working groups which were set up it’s fair to say we now have a closer working relationship, better understanding and more support for the proposal.  We have also developed new protocols and pathways in conjunction with local GPs which clarify how people will receive the best treatment under the new model. We are also working closely with the Northern Ireland Ambulance Service to deal with the possible impact of any change. “I personally would not be signing up for any model which I felt was not safe for patients in the local area. This model will secure the future of the Downe’s Emergency Department and we will continue to work with GPs, meeting regularly to ensure the new arrangements are working efficiently. Operational procedures for the new model for the Downe Hospital Emergency Department. The Downe Hospital Emergency Department will operate between the hours of 8am and 10.00pm.  From 10pm at night until 8am the following morning 365 days a year, the department will be replaced by a General Practitioner Out of Hours service with the ability to admit medical patients directly to the Downe hospital. Patients who have attended the Emergency Department prior to 10pm  will continue to be managed by medical staff who  will remain in the department until these patients are appropriately managed. The Emergency Department nursing staff will be present on a 24-hour basis to assist in the care of patients. With the new model patients who have phoned 999 for an emergency ambulance will not be brought to the Downe Hospital between the hours of 10pm and 8am  but likely transferred to the Ulster hospital or other Belfast hospital as the agreed protocol with NI Ambulance Service and the Belfast Trust indicates. The main emphasis of the new model out of hours from 10pm -8am is that it functions as a GP out of hours centre rather than an Emergency Department . This is not “GP’s running Casualty”.  With the new model the GPOOH would encourage patients to phone before presenting to the service, as is the case with the out of hours service presently.  This will enable them to speak to the GPOOH staff to discuss what options are best for the patient.  If patients do turn up at the department without phoning they will of course still be seen by the GPOOH but this may incur a wait.  However, what is offered is more than a stand alone GP Out of Hours; there will be the ability to admit patients; there will be Emergency Department Nursing and other staff; there will be diagnostic services and there will be expert advice available from elsewhere. The GP’s will have on-call support from both the Emergency Medicine Consultant on call for the Trust for telephone advice as well as the medical team resident in the Downe and the Consultant Physician on call for the Downe Hospital Patients who self present to the hospital between 10pm and 8am with medical conditions, such as chest pain, shortness of breath, vomiting and diarrhoea will be seen initially by the GP.  If the GP considers that these patients require a medical admission to the Downe Hospital then the GP will have the ability to arrange this and these patients would not normally need to be transferred out of the hospital. Patients self presenting with surgical problems such as acute abdominal  pain, suspected appendicitis will be seen initially again by the GPOOH. If it is felt they need admission to hospital they will be referred to the Ulster Hospital in Dundonald to be assessed by the emergency department and surgical teams. This is what currently happens in the Downe Hospital. Patients presenting between the hours of 10pm and 8am with minor injuries will have a range of options made available to them.  If their treatment can be completed on their initial attendance this will happen.    Patients may also be brought back to the Emergency Department the next morning for Emergency Department staff to review them at a clinic dedicated to this purpose.  If required patients may be transferred to the Ulster Hospital Dundonald for further treatment, as currently happens now, e.g. serious fractures. Patient safety remains our paramount concern and whilst this model has been carefully considered with the stakeholders and had a few “dry runs”, it will continue to be monitored so that we can provide evidence of efficacy and safety going forward. Frequently Asked Questions Is there a plan to close or downgrade the Downe Hospital? There are absolutely no plans to close or downgrade the Downe Hospital. The Trust is committed to making the Downe Hospital succeed now and in the future.  There are some changes that need to be made to ensure that the hospital continues to serve the local population in a safe and sustainable way. These changes, along with the new services that the Trust are bringing to the hospital, will ensure that the Downe Hospital remains an excellent hospital providing an ever growing range of services for many years to come. What will happen when  the Downe Emergency Dept closes from 10pm – 8am? The Trust is proposing to deliver the night time service through the GP Out of Hours team, which is currently located beside the Emergency Department in the Downe. This team will have the support of Emergency Department nursing staff and other support staff in the Downe and Emergency Department consultants at the Ulster Hospital. The Trust is confident that 97% of patients currently attending the Emergency Department at the Downe Hospital will still be able to have their treatment there. What happens if I become chronically ill, or have a heart attack for instance? There will be clear management arrangements in place between the Downe Hospital, the local GPs, the Ambulance Service and the Ulster Hospital for any patient requiring acute care that cannot be met via the Downe’s Emergency Department. Similar arrangements are in fact already in place and work extremely well. What will happen if we don’t make changes to the Downe Emergency Department? If we do not move to this model the staff shortages in the Downe, which are similar to other smaller Emergency Departments, will inevitably result in an unplanned and unpredictable short term closure.  This would undoubtedly undermine the future of the department and potentially undermine the hospital.  The proposal by the Trust will ensure that by combined working with local GP’s, who know the needs the population best, we have the opportunity to shape and sustain the care for the local population at a local level. This is a much better model than being dependent upon short term locums. What are the new services that have been developed at the Downe? At the same time as making these important changes the Trust continues to bring in new services. Over the past three years we have introduced fracture surgery, cataract surgery and a midwife led delivery service. In addition, we have commenced bowel cancer screening and a sexual health service in the Downe. There has been a further £2.4 million invested in the past year and more staff are employed compared to last year. We are delivering more activity and increasing the range of services provided. The Downe Hospital  is an excellent hospital with a very bright future. Why did you close 15 beds in the Downe Hospital if you are committed to its future? What difference will it make to patients? The closure of 15 beds in the hospital should make no difference to patients. Healthcare delivery has been evolving over many years. 20 years ago we delivered half the level of activity through twice the number of beds. Advances in medicine, improvements in daycase management and reductions in patient length of stay mean that we don’t need the same number of beds to meet our patient needs. We are still   able to deliver the same level of service through reduced bed numbers. How will the Disability proposals affect the Down area? The Disability proposals affect all three sectors across South Eastern Trust, Lisburn, North Down and Ards and Down. With regard  to Learning Disability services the Trust proposes to modernise Day Care Services to address the changing needs of the population. This is due to people with complex health needs surviving into adulthood and the general learning disabled population experiencing the same aging related conditions as the general population.  The Trust proposes to extend the range of day opportunities with other service providers and target statutory day care services on those with most complex needs.  This will provide a flexible and differentiated range of day services. In regards to Learning Disability Residential Services the Trust wishes to provide the residents at Struell Lodge with the opportunity through person centred planning to identify their future housing needs in line with the Bamford principles.  Struell Lodge is the only remaining statutory residential unit in South Eastern Trust. In regards to Physical Disability Services the South Eastern Trust proposes to modernise day care services to ensure that individuals can be supported were possible within their own communities; and also to target rehabilitation services more effectively.  This proposal effects all three sectors across South Eastern Trust not just the Down Sector. What are the proposals for Mental Health Services in the Down area? The proposals are to develop community services in the Downe sector which equates to an investment of over £1m, including a new 18 bedded community facility for people with mental health conditions.  The Trust has in the last year opened a 5 bed supported accommodation facility for people with serious mental health conditions and the opening times of the assessment centres has increased to 8pm 7 days a week.  The Trust has also developed home treatment services for the Down sector with additional staff and has invested in other services such as psychological therapies which has meant more staff for the Down area. Given all this investment, we now have and will have in the future a reduced requirement for inpatient beds as more people choose to be treated at home.  In view of this, we intend to have one single inpatient facility proposed on the Lagan Valley Hospital site and we plan to replace the acute psychiatric inpatient provision in the Downe with an inpatient psychiatric service for people who require longer term hospital treatment.  In this respect, the Downe Hospital offers the best accommodation in Northern Ireland for patients with such needs. What will happen to patients currently in the Downshire? In Downshire there are currently three wards which mainly offer a service to long-stay patients.  Approximately 50% of these patients do not require hospital treatment and should be living in their own accommodation in the community.  To this end, the Trust is proposing to develop an 18 bedded facility in Downpatrick.  The majority of the remaining patients will require continued hospital treatment in a low secure environment, and it is these patients we would propose to move to the new Downe Hospital with ensuite accommodation. We are taking Mental Health Services out of the Downpatrick area by closing the Downshire. That’s wrong. We are taking patients out of an old and inadequate building.  We are providing services in better accommodation in the Downe, in new homes in Downpatrick and in community services supporting people in their own homes.  We are also keeping many of the jobs and the skills which our staff in Downshire have developed and are using them to support people to lead better lives in the community.]]>