We have not been able to develop a deliverable, sustainable model that would enable there to be a 24 hour A&E in Grantham, because of proven issues sustainably staffing three A&Es in a county with a population size of Lincolnshire, and because the supporting services are not available in Grantham to make an A&E a safe and realistic option.
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 proposal 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 an UTC service.
If you walk in to an UTC and have a condition that requires emergency care, you would be assessed and cared for by skilled clinical staff. If needed, you would be safely transferred by ambulance to the A&£ at the nearest available specialist emergency care hospital, as is the case now at Grantham A&E given its exclusion criteria.
We aren’t. Across the NHS, including our colleagues in the ambulance service, one of our key objectives is getting patients to the best possible care as soon as possible. The clinical criteria for conveyance to Grantham by East Midlands Ambulance Service have been reviewed against the planned clinical acuity for the Grantham Hospital site. Ambulance crews fully understand the scope of service available at Grantham. They will assess the patient and will decide, or in some cases seek advice from specialist units, as to where best to take that patient to ensure they receive the right treatment as soon as possible.
In Lincolnshire, paramedics are able to take advice by phone, talking with clinicians either in the county’s successful Clinical Assessment Service or a consultant in an A&E, to assist in making this decision. This happens now.
One of the options for care will be taking low acuity patients to Grantham Hospital at night and directly admitting the patient (with prior agreement with night teams). Treating patients locally and within the Grantham community is important, as is keeping people out of hospital whenever that is possible.
The proposed model incorporates a ‘walk in’ aspect, which was included in response to the public feedback we heard during Healthy Conversation 2019. An estimated 97% of patients who do arrive at Grantham, can be seen and treated at a the proposed UTC model for Grantham hospital.
For those who ‘walk in’ that fall in the 3% (approximately 15 people per week) who require more acute services than the UTC can offer, they will be stabilised by the qualified team at Grantham until they are transferred to a more specialist unit to receive the best possible care for them. Due to the type of illness or injury concerned in this situation, it is expected that the majority of patients who do require specialist A&E services will be in an ambulance and taken directly to the appropriate centre.
Given the exclusion criteria that currently exists at Grantham hospitals’s UEC services, many people from Grantham are already travelling to A&Es elsewhere, particularly Lincoln’s. Being seen by the right team at the right time will improve patient outcomes and reduce stays in hospital, and we believe the right, specialist care is the priority.
For those families who will have to travel to another site to visit, we understand the issues with road networks and public transport and are working with Lincolnshire County Council, who are responsible for both these matters, to support their aspiration of continuous improvement.
It is estimated that around 3% of patients, equating to an average of 15 per week, will be transferred to Lincoln, transfers that are already occurring due to the exclusion criteria currently in place at Grantham hospital’s UEC services. These are patients who require acute, specialist care and would not be expected to be discharged directly after being assessed or treated.
Patients who arrive at any urgent or emergency setting are triaged and prioritised according to need. Because this proposal would result in only patients that need acute, specialist care being transferred to Lincoln, it is probable that those patients would be high priority and seen and treated quickly. Patients from the Grantham area whose need is not acute, will be able to access the appropriate services at Grantham UTC.
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 understand the type of injuries and illnesses that have been presented at Grantham for many years now and believe these proposals provide the most sustainable and appropriate urgent and emergency care service for Grantham now and in the future.
We are currently preparing a paper which will go to the NHS Lincolnshire Integrated Care Board executive team, to inform a decision about the appropriate route to agree a provider for the service. We expect this process to occur in April 2023 and will update once complete.