County Hospital, Louth has both acute and community services operating on the site. It remains an integral part of our plans for the future and will continue to provide vital services.

It will continue to provide day-case surgery for urology, ophthalmology and gynaecology, with outpatient clinics and diagnostic services also provided for selected specialities. These services are currently provided by ULHT.

Louth Hospital currently has an Urgent Care Centre which operates on a 24/7 basis. Our emerging option is for Louth to have an Urgent Treatment Centre, which would also operate 24/7. As well as continuing to provide the acute services described above, community services will continue to evolve on the site with the aim of keeping local people as close to home as possible. These services are currently provided by Lincolnshire Community Health Services NHS Trust.

At this point all suggestions will be taken on board and recorded for consideration as part of the Healthy Conversation. If you have ideas and would like to outline in detail please write or email:

Email: lhnt.hc2019@nhs.net

Write to us:

As part of the acute services review (ASR) we have reviewed the entire trauma and orthopaedic service across Lincolnshire including at Louth Hospital.  There was only one option from that review that provided the safety and quality outcomes our clinicians sought, as well as being sustainable from a workforce and financial aspect. Guidance and input from national clinical colleagues confirmed the strength of the preferred emerging option of a Centre of Excellence at Grantham Hospital.  In addition, under this preferred emerging option, we are clear that day case surgery will continue at Louth Hospital as now. There will be no changes to the orthopaedic services offered at Louth through these proposals.

No decisions will be made until after a full public consultation.

As you know, County Hospital, Louth has both acute and community services operating on the site. It remains an integral part of our plans for the future and will continue to provide vital services.

We have spoken to our clinical experts in great detail around their proposed recommendations for stroke services. The ‘golden hour’ refers to a 60 minute period from door to needle for the 15% of all stroke patients who require thrombolysis (this treatment option is only for acute ischemic stroke). Out of this 15% of stroke patients that receive thrombolysis, one third will benefit from the treatment (5%). Our clinicians believe their recommendations for  stroke services  will improve care and outcomes for the overwhelming majority of patients (95%). Every patient who uses the county’s stroke service will benefit from a fully staffed centre of excellence delivering exceptional care for improved outcomes and subsequently better aftercare.

National evidence, gathered as part of the Getting It Right First Time (GIRFT) programme, suggests that separating emergency and planned care results in a reduced number of planned care cancellations and improved patient experience.  This is because relatively high numbers of operations are cancelled on the day due to a shortage of beds, caused by emergency pressures needing these beds.

Locally, we have recently run a trial of moving planning trauma and orthopaedic procedures to Grantham and District Hospital (where there is a lower level of emergency pressure than our other hospital sites) and that has resulted in a significant reduction in the number of cancelled operations (down from an average of 43 cancellations per month to just 19 during February 2019). In fact, there have been no reported cancellations due to a lack of a beds at Grantham hospital since the trial started.

No. Grantham Hospital has not had a full A&E department for a number of years. It has only been providing a restricted range of services. Our emerging option envisages that the vast majority of conditions and patients that are treated at Grantham Hospital today will be able to receive care in the Grantham UTC. The service which has been available in the A&E Department in Grantham in recent years is in fact very close to UTC service. 

We have listened carefully to the voices of the public / councillors / petition and will continue to do so. Sometimes it is not possible to make the changes that are suggested to us because of factors such as patient safety or staffing. As part of Healthy Conversation 2019, we also want to be honest with the public about what it is and is not possible for us to deliver, and the clinical and service reasons for that. It is right that any NHS service must be safe and sustainable. We have to be realistic as we do not have the staff to run three full A&E departments and it is highly unlikely that that will change. We have 19 A&E consultant posts in Lincolnshire but only four of these have substantive consultants in posts. 

Our emerging option of a 24/7 UTC would enable more patients to receive services in Grantham than is currently the case.

A fully functioning A&E department requires a comprehensive range of back up services and facilities, such as specialist critical care and specialist medicine, emergency surgery, paediatric assessment and maternity services. Grantham Hospital does not currently have these services. 

If a person is critically ill or injured, it is in that patient’s best interest to get to the right hospital with the right facilities, first time, where the treatment they receive can provide a much better outcome for them. Examples include major trauma services and the Heart Centre in Lincoln. 

Ambulances will go to Grantham’s UTC where this is appropriate. 

If critically ill and injured people present at Grantham, the UTC staff will be able to provide initial treatment including resuscitation; then the patient will be transferred to the right specialist site by an emergency ambulance if their condition indicates. Our senior clinicians recommend that patients go to the right hospital, first time, rather than going to the closest NHS location, as this will not necessarily be able to provide the right care. Patients, carers or families should always phone 999 for an emergency ambulance if they believe that there is a life threatening health situation.

We are not stopping ambulances going to Grantham Hospital. Grantham’s UTC would still be able to receive patients by ambulance.

Our senior clinicians are reviewing the current exclusion protocol (restriction criteria) to ensure that critically injured and ill patients will be cared for at the right service; treated safely and quickly by staff who have the right training and experience to give the best outcome. 

No, our emerging option is to have 24/7 access to urgent care through the introduction of an UTC at Grantham Hospital. This would reinstate 24/7 urgent care locally meaning that the vast majority of patients who need care quickly could receive it at Grantham. If you are critically ill, like today, you would be taken to an Emergency Department/Centre of Excellence to be seen by specialist services.  Senior clinical staff are confident that this emerging option is the best service for the Grantham population. 

The UTC would be open 24/7. The emerging option suggests that in the ‘out of hours’ period, access would be through NHS 111 for the reasons of patient safety. We will be listening to a wide range of feedback in order to inform our thinking, including people’s views on how the service could best be accessed. 

The NHS 111 service is able to book the patient into the right urgent care service first time so they have an appointment which is convenient for the patient and reduces their waiting time. The NHS 111 and Clinical Assessment Service has a Directory of Services informing, for example, where and when an x-ray service is available. They are able to advise the patient where to go to receive such a service meaning the patient goes to the right place first time. It will help prevent deterioration in the patient's condition, improve the speed of treatment and stop patients having to move between services. Crucially it will advise when an A&E attendance is necessary, preventing the patient wasting potentially vital time going to the UTC first.

Healthy Conversation 2019 is an engagement exercise which will continue throughout the year. We will continue to listen to patients and the public’s views over the coming months. 

We have taken into account the expected growth in population in Grantham town and feel that our emerging option of a UTC would meet this demand. Our answers above explain our thinking and clinical rationale for why an UTC is our preferred emerging option for Grantham. 

We are part of the ‘One Public Estate’ initiative with many partners involved in the development planning around Grantham, and are therefore fully aware of the future potential growth in housing, which has been incorporated into our planning work.

We believe that our emerging option will mean that the majority of Grantham’s population will continue to be seen locally. When health needs mean that they require more specialist care, our priority will be getting patients to the right place as quickly as possible. Sometimes, achieving the best outcomes for those patients will mean people must travel to places other than Grantham, as they do now.

A large consideration for our clinicians as they review services is how to best spend NHS funding, including whether we divert some of our funds away from care in order to supplement patients’ travel. We would like to hear your views on this so that we can incorporate them into our thinking.

Dr Leon Roberts, Medical Director of EMAS, said: ”Every 999 call is assessed based on the information we receive and while we aim to get to all patients as quickly as possible, those experiencing life-threatening emergencies, such as cardiac arrest or breathing difficulties, do take priority and have to be seen first.

“We categorise calls based on the National Ambulance Response Programme introduced by NHS England for all English ambulance services. This outlines what type of response should be sent to which patient.

“Working closely with GPs and our hospital and community health trust partners, we are reducing the number of people we take to accident and emergency by establishing and clarifying the most appropriate pathways.

“During busy periods we will sometimes advise patients not experiencing a life-threatening emergency that there may be a wait for an ambulance and that they may be seen more quickly if they are able to make their own way to A&E or to call back if their condition worsens.”

Being seen by the right clinician in the right place will greatly improve your outcome. The vast majority of people in Grantham will continue to be seen safely at Grantham UTC. You will only go to Lincoln if your condition requires this, One of the benefits of reviewing and improving our services is that we can make better use of our clinicians’ time. At present, in order to move staff to support services at so many sites across the county, we must use their clinical time for travel time, reducing the amount of patients they can see. Additionally, modernising our services makes them a more attractive place to work for new recruits, and we believe will reduce the amount of vacancies we currently have in the county. Both of these outcomes will reduce waiting times.

National guidance says that UTCs are GP-led and are required to be open for at least 12 hours a day, 7 days a week (including bank holidays). You can walk into UTCs during opening hours, and you may be referred to an urgent treatment centre by NHS 111 or by your GP at any time. Our emerging preferred option is to have 24/7 access to urgent care through the introduction of an Urgent Treatment Centre at Grantham Hospital. 

The Healthy Conversation is an engagement exercise which started on 5th March 2019; this is the start of that conversation. We will be listening to patients' and the publics' views over the coming months. This engagement will contribute to this preferred emerging option. No final decision will be made until after we have held formal public consultation. 

Please see urgent care on the website (https://www.lincolnshire.nhs.uk/healthy-conversation/what-conversation-about/urgent-treatment-centers) and information about engagement and consultation on the website (https://www.lincolnshire.nhs.uk/healthy-conversation/helpful-information).

The proposal for an urgent treatment centre at Grantham is all about providing 24/7 access to urgent care whilst tackling the challenges we currently face head on.

The majority of patients that are seen at Grantham today would continue to be seen in the urgent treatment centre. If patients are critically ill or injured, like today, they would be taken to a centre of excellence to be seen by a specialist. An example is the Lincolnshire Heart Centre.

The aim of this Healthy Conversation is to be open and honest with members of the public about what we can and can’t deliver at Grantham Hospital, and one option to be discussed is the possibility of reinstating 24/7 urgent access for patients in the form of an urgent treatment centre.

It’s important to remember that no decisions will be made until after a full public consultation.

Suspected heart attack or stroke

If the patient rang NHS 111 and described the symptoms of a potential heart attack or stroke, then an ambulance would be dispatched. The paramedic would assess the symptoms and start treatment in the ambulance, depending on the condition.  If the paramedic’s assessment indicated a heart attack or a stroke, he / she would liaise with The Lincolnshire Heart Centre/ stroke unit and transport the patient direct to the Heart Centre / stroke unit at Lincoln Hospital to ensure the patient receives the specialist treatment needed. If the paramedic’s assessment was that the patient did not require these specialist services e.g. chest pain NOT suggestive of a heart attack- they could be taken to Grantham hospital  – see scenario below.

If the 111 call handler was unsure about the patient’s symptoms, they can call CAS to talk to a clinician, who will advise about whether the patient needs an ambulance, or should attend the UTC.

If a patient arrived at an Urgent Treatment Centre with a suspected heart attack they would not be turned away. They would immediately be assessed and triaged as a priority while initial stages of treatment – such as blood tests and ECG – took place. If it’s evident they were having a heart attack, then the most appropriate care would be to transport them in a blue light ambulance to Lincoln Hospital’s Heart Centre where the patient would have the best and most appropriate care, and therefore the best possible outcome. There would be liaison between the UTC, ambulance service and The Heart Centre pre and during transfer of the patient. 

Patients arriving with other suspected serious conditions, such as suspected stroke, will be treated in the same way. Staff will be on hand to start treatment until the patient is transported, via blue light ambulance, to the most appropriate place for care e.g the stroke unit at Lincoln County hospital.

Someone collapses and needs resuscitating

If the patient collapses in an UTC, resuscitation and treatment would take place.  

If someone in a surrounding village / in the community collapses, the ambulance paramedics would resuscitate and treat them, then take them to the hospital which can provide the best specialist care.

Compound Fractures with compartment syndrome (needing immediate treatment or risk limb amputations) 

A compound fracture – where a broken bone has pierced the skin – is a medical emergency and a 999 call would result in patients being transported to Boston or Lincoln hospitals.  If someone presented to an UTC with a compound fracture they would be assessed, stabilised then transported to the right place for treatment.

Non-specified chest pain

The appropriate place for treatment depends on the level of severity of the chest pain. A patient who is in low level / moderate pain who presents at the UTC would be assessed / treated accordingly. So, for example, the chest pain is muscular or indigestion, it would be treated in the UTC. 

If a patient is in severe pain and has called 999, paramedics would assess if it was felt to be a heart problem and would stabilise and transport the patient if needed to the The Lincolnshire Heart Centre. Similarly, if someone presented to an UTC with severe chest pain they would be assessed, stabilised and where this was felt to require specialist treatment they would then be transported to the right place for treatment.

Breathlessness 

The appropriate place for treatment depends on the level of severity of the breathlessness.  If the patient is in acute respiratory distress with oxygen saturation <91% on room air ‘unless’ the patient has significant frailty or known significant chronic lung disease they would be taken to another hospital with more specialist services.  We would not expect a patient or their family to make these assessments. 

If a patient attends an UTC, staff will be able to treat their symptoms (for example with an inhaler or nebulizer, oxygen). 

If a patient’s breathing is highly compromised at home, they should dial 999; the paramedics will stabilise and transport to the most suitable place for treatment. Similarly, if someone presented to an UTC with severe breathing problems they would be stabilised then where necessary transported to the right place for treatment.

Acute exacerbation of inflammatory bowel diseases

The appropriate place for treatment depends on the level of severity of the patient’s symptoms and whether the patient knows that they have inflammatory bowel disease and is confident to manage their illness. 

A patient who has low level / moderate symptoms could ring their GP and / or 111 and talk with a clinician for advice.  If advised, they could be booked into an appointment at the UTC for further assessment / treatment.  Those who present at the UTC would be assessed / treated accordingly.

If a patient is experiencing severe symptoms and has called 999, paramedics would assess the symptoms and treat the patient accordingly which could be to take further clinical advice over the telephone.  If further treatment is indicated, the patient will be transported to the right place for treatment.

Anaphylaxis 

An anaphylactic reaction is a severe and potentially life-threatening reaction to a trigger such as an allergy or bee sting. 

If the patient has a reduced conscious level, an ambulance should be called and the paramedic can make a decision about treatment / next steps. If someone already knows that they have an allergy and carries an epipen (medication used in emergencies to treat very serious allergic reactions to insect stings/bites, foods, drugs, or other substances) whose reaction is not improving despite self-medicating, should seek urgent clinical advice via GP, 111, at an UTC or A&E depending on the severity of their condition.  In this circumstance, if the patient experiences any reduced conscious level, an ambulance should be called and the paramedic can make a decision about treatment / next steps. 

Sepsis

Sepsis is a life-threatening condition that arises when the body's response to infection causes injury to its own tissues and organs. A diagnosis can be made in the UTC and a first treatment may be administered. The most appropriate next steps for treatment will be decided by the UTC clinical staff depending on the severity of the illness.

If the patient has a reduced conscious level (not alert) at home, an ambulance should be called and the paramedic can make a decision about treatment / next steps.  The paramedic will assess the patient and if the paramedic decides that the symptoms could be severe sepsis they will usually not be taken to an UTC. 

Diabetic emergencies

If someone’s condition is life threatening then it is crucial that the person gets to the right place at the right time. As with any life threatening situation, a call should be made to 999. If someone presents at an UTC with a diabetic emergency then the clinical team will assess that person and start treatment.

Complications of cancer

The appropriate place for treatment depends on the level of severity of the patient’s symptoms and the type of cancer diagnosis that the patient has received. 

Some potential complications of cancer and cancer treatment, e.g. chemotherapy, can be anticipated and the patient will already know the plan of care should such symptoms occur, such as directly ringing the cancer ward at Lincoln Hospital and getting clinical advice. Other complications / symptoms will not be anticipated and should be treated as an unexpected illness and depends on the severity of the symptom. 

Kidney failure
Acute kidney injury (AKI) is when your kidneys suddenly stop working properly. It can range from minor loss of kidney function to complete kidney failure. AKI normally happens as a complication of another serious illness. This type of kidney damage is usually seen in older people who are unwell with other conditions and the kidneys are also affected.

The appropriate place for treatment depends on the level of severity of the patient’s symptoms. 

A patient who has low level / moderate symptoms could ring their GP and / or 111 and talk with a clinician for advice.  If advised, they could be booked into an appointment at the UTC for further assessment / treatment.  Those who present at the UTC would be assessed / treated accordingly.

If a patient is experiencing severe symptoms and has called 999, paramedics would assess the symptoms and treat the patient accordingly which could be to take further clinical advice over the telephone.  If further treatment is indicated, the patient will be transported to the right place for treatment.

Seizures 

If someone’s condition is life threatening then it is crucial that the person gets to the right place at the right time. As with any life threatening situation, a call should be made to 999.  If someone presents at an UTC with a seizure then the clinical team will assess that person, start treatment and decide whether the person needs to be transported to a more specialist site.

Mental health emergencies

If a patient arrives at an UTC with a mental health emergency, the appropriate place for treatment depends on the level of severity of the patient’s symptoms.  The UTC staff will liaise with the mental health crisis team and agree a plan of care. 

Overdose

The appropriate place for treatment depends on the level of severity of the patient’s symptoms. 

A patient who has low level / moderate symptoms could go to the UTC for further assessment / treatment.  The UTC staff will liaise with A&E consultants on another site for advice if required.  They will refer the patient to Mental Health services. 

If a patient is experiencing severe symptoms and has called 999, paramedics would assess the symptoms and treat the patient accordingly which could be to take further clinical advice over the telephone.  If further treatment is indicated, the patient will be transported to the right place for treatment.

If the patient has a reduced conscious level (not alert) at home, an ambulance should be called and the paramedic can make a decision about treatment / next steps. 

Suicide attempt

An example was given of a young male who cut a vein in his arm and lost a lot of blood. An ambulance was called, his arm was dressed and then transported to Grantham A&E where he received four units of blood. He was then transferred to Boston Hospital for an operation to repair the vein.   We were asked in this scenario, what would happen with an UTC?

If Grantham A&E becomes an UTC, the young male would still be attended by paramedics following the 999 call. They would start treatment, e.g. by giving him intravenous fluids and dressing his wound and care for him while they transport him directly to Boston or Lincoln Hospital where he would receive  blood and surgical care.

The events are open to the public from 2-7pm so anyone can come and go at any time. There will be a range of display stands with information about many of the topics in the Healthy Conversation with members of staff and clinicians on hand to talk to the public.

There will not be a presentation or formal Q&A session so members of the public can walk around the displays at their own pace or focus on only the topics that interest them. There will be staff on hand to answer any questions members of the public might have.

We are working closely with local newspapers, magazines and radio stations to promote the engagement events, in addition to advertising them on social media. We also have posters across the county in hospital buildings.

The Healthy Conversation 2019 is an opportunity for staff and the public to have their say on how the future of NHS services across Lincolnshire should look – as no decisions have been made yet. So, we would encourage you to get involved and have your say as you and your colleagues know your service best.

We have lots of ways which you contact us to share your views and experiences and to work with us to improve all our services.

Complete our survey: https://www.surveymonkey.co.uk/r/HC2019ASR

Complete our general feedback form about all services: https://www.surveymonkey.com/r/HC2019feedback

Email: lhnt.hc2019@nhs.net

Write to us:

Telephone: 01522 307307

You can also attend the engagement events, details of which can be found here: https://www.lincolnshire.nhs.uk/healthy-conversation/get-involved/event-calendar

We are listening to the public's views on all services whether mentioned specifically or not in the Healthy Conversations so we understand what is important to the public. 

As a member of staff, if your specific service does not appear in the Healthy Conversation then at this time there are no changes being proposed.

Will they have to re-apply for their jobs with the community team? Will they remain employed by ULHT and be sent to work elsewhere? If employed by the community, will their pay remain the same?

We know we have excellent and dedicated staff working very hard to deliver the best for people. We want all our NHS staff to stay in Lincolnshire and feel secure in their jobs. 

In Grantham A&E specifically, we expect that the vast majority of patients visiting the A&E now would continue to visit the Urgent Treatment Centre (UTC) in the future, if implemented. Therefore the same skills and expertise that are required today will be required in the future. We will be listening to patients', the publics' and staff views over the coming months. This Healthy Conversation engagement will contribute to the plans for Grantham Hospital.  No final decision will be made until after we have held formal public consultation. 

As for the potential changes to staff jobs in the future (either roles or employer) will be consulted with staff through normal HR processes. We reiterate we know we have excellent staff and want to keep these staff working in Lincolnshire and feeling secure in their jobs

Any potential changes to staff jobs will be consulted on with staff through normal HR processes. We know we have excellent staff and want to keep these staff working in Lincolnshire and feeling secure in their jobs. We will do our best to cause minimal disruption to staff.  Their skills and expertise that are required today will be required in the future.

Any substantial changes to services require full public consultation before any decisions are made.  Public consultation will take place at a later date.  The NHS is  subject to national regulator timelines, so we are unable to say exactly when public consultation will take place.  Once public consultation starts, we will then be able to set out the timescale for subsequent decisions and potential service changes will happen.

The Healthy Conversation 2019 is an opportunity for staff and the public to have their say on how the future of NHS services across Lincolnshire should look – as no decisions have been made yet. So, we would encourage you to get involved and have your say as you and your colleagues know your service best.

We have lots of ways which you contact us to share your views and experiences and to work with us to improve all our services.

Complete our survey: https://www.surveymonkey.co.uk/r/HC2019ASR

Complete our general feedback form about all services: https://www.surveymonkey.com/r/HC2019feedback

Email: lhnt.hc2019@nhs.net

Write to us:

Telephone: 01522 307307

You can also attend the engagement events, details of which can be found here: https://www.lincolnshire.nhs.uk/healthy-conversation/get-involved/event-calendar

We are working with many partners in the county in order to ensure Lincolnshire is presented as a thriving and appealing place to live and work.

Our Talent Academy brings together health and care organisations from across the county to help recruitment and skills development for our current and future workforce. The academy’s initiatives include visiting schools, organising careers fairs, and developing our apprenticeship programme to inform and encourage careers in health care.

Alongside our colleagues across the health and care sector in the county, we have also established Lincolnshire’s Attraction Strategy programme. This group focuses upon promoting the appeal of Lincolnshire as a place to live and work, as well as raising awareness of the career opportunities in the county.

Lincolnshire has developed a model for international recruitment that has now been adopted across England, thanks to the success we saw in the county.  To date, Lincolnshire has benefited from 26 additional GPs from this scheme and is just starting another recruitment / training programme.

Central to Lincolnshire’s ‘grow our own’ recruitment initiative, the University of Lincoln’s Medical School is currently interviewing for its first students who will start training in September 2019. One of our much needed staff groups, paediatric nurses will also be trained at the university from September 2019, as will another valuable skill set for the county, midwifery.

Today, there are 100,000 vacant posts in the NHS nationally, that’s just under 8%. In Lincolnshire, we have approximately 1,000 unfilled posts; that’s about 10%. It is a national problem, but it is worse in Lincolnshire.

Unlike our recruitment rate, Lincolnshire has a good retention rate – lower than the national average. So, on the whole, when most people move here for a job, they tend to stay.At the end of March, one of our trusts had a vacancy rate of just 5.48%. For those staff that do leave, all get an exit interview. Themes for leaving are varied and include: relocation, promotion and work/life balance. Furthermore, we have an Attraction, Recruitment and Retention Working Party, which looks at all issues around working in our NHS such as:

• How do we attract people to live in Lincolnshire?  
• How do we attract people with the right specialisations?

We look at the psychological contract we have with our staff, which includes issues like training and education as well as rewards.

Patients will go home to receive rehabilitation. This year we are increasing the Stroke Rehabilitation Team in the community with the aim of getting people home as soon as possible, which provides a better quality of care and outcome for the patient.

No. We have modelled demand for services so we can make sure there are enough staff to see patients. One of the core reasons for bringing the workforce together is to increase specialism, reduce waste and time travelling, and therefore improve our ability to recruit new staff.

Your local Healthier You: NHS Diabetes Prevention Programme is here to support people at risk of developing Type 2 diabetes.

Programmes will be held in a range of locations across Lincolnshire East, Lincolnshire West, South Lincolnshire and South West Lincolnshire.

If there isn't a programme running in your area at the time of your referral, you will be placed onto the area waiting list until the next programme begins. You also have the opportunity to attend programmes in other areas should you wish.

If you would like to speak about a referral to the service, please discuss this with your GP surgery.

For any questions about your referral or for help in understanding more about the scheme, please contact us on 0333 577 3010. Our booking team are available from 8am to 5pm Monday to Friday.

If your condition needs the attention of a GP or another healthcare professional, the pharmacist will recognise this. They will advise you to see your GP or the most appropriate healthcare professional.

Many pharmacies are open during evenings and weekends so you can see your local pharmacist anytime. Just walk in, you don't need an appointment. You can have a confidential consultation with the pharmacist in a private area of the pharmacy.

We all know prevention is better than cure, and it is common sense for us to focus together on making this responsibility part of everyday life for Lincolnshire.  Prevention or knowing how to live a healthier life by changing habits and lifestyle choices is the first step. We’ve already got a number of services in place to help with this, for example;

• there is lots of information available on the NHS website to help people look after themselves when suffering from more minor conditions
• the Self Care Forum also offers a wealth of further help and advice on self-care and
• ASAPLincs (click here) helps you to identify your symptoms, get self-care advice and find relevant services. 

Social Prescribing is a way for primary care services to refer patients with social, emotional or practical needs to a range of local non-clinical services.

GPs, nurses, housing providers, social care teams and even family members have referred people to the Social Prescribing service to work with them to identify non-medical interventions such as social activity, diet, relaxation and exercise.

The services are often provided by the local voluntary sector, but statutory services provided by councils, housing associations or the NHS can also be involved.

The prescriptions can include referrals to everything from arts groups and volunteering to activities that involve physical exercise, such as gardening and dance clubs.

Social Prescribing has proven benefits across the country including increasing independence and social inclusion.

Joined up care closer to home will support you to stay well, look after you at home or in the community, and help keep you at home and out of hospital wherever possible. It will also ensure that if you go to hospital you are able to return home sooner, by providing community support as required.

This means that the services in your local community will work together and with you to receive the support and care you need in familiar surroundings close to family and friends. The services working together include GPs, community services, community mental health services, adult social care, care homes, home care services and the third sector and voluntary organisations; but you are the most important partner in this.

As an NHS programme of work, you might hear this referred to as Home First or Integrated Community Care (ICC). This is a high priority for Lincolnshire. We are already committing lots of resource to improving this joined up care closer to home, working with patients and health and care partners across the county to agree common goals and how to achieve them.

We know people do better mentally and physically if they can be cared for in or close to home by health and care staff based in the community and the evidence supports this. Evidence suggests that older people can lose their independence and can find it harder to return back home when admitted to hospital. They may also develop further health issues as a result of changing their regular routine.

You will only be admitted to hospital if your care needs and treatment cannot be met at home, or if you need to see a hospital based specialist. In addition, for those that do need hospital care, emergency ‘admissions’ are increasingly being treated through ‘same day emergency care’ without the need for an overnight stay.

If people are waiting for crisis service will they still be seen in relation to the changes to A+E services. How will it all link and work together?

Mental health crisis services will not be affected by changes to urgent care services in the county. Lincolnshire Partnership NHS Foundation Trust will continue to provide county wide mental health crisis support and is working with local commissioners and NHS England to look at new ways of further improving crisis care in Lincolnshire.

The mental health services at the Manthorpe Centre in Grantham will also remain unaffected by wider system changes and will continue to be supported by East Midland Ambulance Service when patients need emergency physical health care.

The NHS organisations in Lincolnshire will continue to work closely together to make sure their plans take each other’s services into account and complement each other wherever possible.

Lincolnshire Partnership NHS Foundation Trust offers specialist health support to people with learning disabilities who require assessment and/or treatment for their physical or mental health, including support with behaviours of concern.

• A single point of access (SPA) for all referrals
• Four community hubs - a multi-disciplinary team which provides the whole range of specialist learning disability professions
• Autism diagnosis and liaison - providing a liaison service which supports access to mainstream health services and ensures reasonable adjustments are made
• County-wide community home assessment and treatment team

The NHS is responsible for delivering medical and health care services and local councils are responsible for public transport. However, we fully appreciate how crucial transport is so that patients can access NHS services, therefore we are working closely with Lincolnshire County Council on a joint transport strategy to improve public transport and look at other viable options to supplement patient travel. We have worked to a principle of the most regular care requirements remaining close to home, such as routine screens in cancer care for example. It is when care needs become more complex and specialised that we introduce further travel; we have heard from Lincolnshire’s public that the right care, first time is the priority, even if that means further travel. A large consideration for our clinicians as they review services is how to best spend NHS funding, including whether we divert some of our funds away from care in order to supplement patients’ travel. We have worked with EMAS throughout the process to date and continue to do so.

This varies according to where people live and which services they require. There is not one answer, but the additional mileage will be the difference between the current care location and the new suggested one. We have worked to a principle of the most regular care requirements remaining close to home, such as routine screens in cancer care for example. It is when care needs become more complex and specialised that we introduce further travel; so far, we have heard from Lincolnshire’s public that the right care, first time is the priority, even if that means further travel.

In some cases this will likely be in an ambulance, because it is the more specialist care that they need, for example, after a stroke. That means that they will be in the care of a trained paramedic.

In some cases it will be by own or public transport. We are doing lots of partner work with providers across the county to examine how to make this more accessible, including voluntary car schemes. We are also investing a lot of time engaging with communities that will be most likely affected by this to explore the impact and what is important to them in this instance. This is one of our priority work streams in 2019.

A large consideration for our clinicians as they review services is how to best spend NHS funding, including whether we divert some of our funds away from care in order to supplement patients’ travel. We would like to hear your views on this so that we can incorporate them into our thinking.

None of the buildings on the Lincoln County Hospital site are 100% unoccupied.

The Lincoln hospital site will need to adapt and we are working closely with partners to determine how to address parking, as well as make other forms of transport to and from the site more accessible.

At the end of 2017/2018 Lincolnshire NHS’ financial deficit was £124.4m. This is forecast to grow to £199.6m by 2022/23 if the current demand patterns for healthcare and how services are organised to deliver them do not change. The combination of changes that we are talking about in Healthy Conversation 2019 aims to reduce this to zero (detail below) by 2022/23.

It will cost £3.6million in revenue costs to pay for the capital required for new buildings to support the ASR, with a further £0.8m invested in community stroke services to support that element. The revenue cost is like paying off a mortgage over 20 years.

Many of the emerging options will require additional capital funding, primarily for building works. We are currently exploring how this additional capital money could be secured and will continue to work to do so.

It is important to note that we, the NHS in Lincolnshire, will only be able to progress to full public consultation on options once we have both completed our discussions with NHS England, and identified the source of the capital required so we know proposals are deliverable. We are addressing these as a priority, although it is not possible to say today when this will be.

We use various methods alongside online promotion. We have distributed information to local radio stations, newspapers and magazines (including those with extensive village distribution) and we also use posters which are displayed in local businesses, GP practices and hospital buildings to promote the engagement events. We have used bus sides and flyers, as well as council magazines which reach every household in the county. As we reach public consultation on certain aspects within Healthy Conversation 2019, this activity will increase.

In Lincolnshire we have the urgent care home visiting service provided by LCHS or the Physician Response Unit provided by LIVES.

When we review any care process, we look at the least wasteful way to provide better, safer healthcare to our patients – with no delays. We aim to add value in any activity which improves the patient's health, wellbeing and experience.  It's about being able to do more with the resources available; every pound of waste saved is a pound that can be reinvested in new treatments and better care for the people of Lincolnshire. 

We have several programmes of work that are specifically focused on reducing waste.  Examples of such programmes are reducing temporary staffing costs, getting best value out of medicines, reducing avoidable demand for emergency care through prevention and self-care, and reducing delayed transfers of care in inpatient settings. For further information please visit www.england.nhs.uk.