Acute medical beds at Grantham and District Hospital

We want you to tell us what you think about our preferred change proposal to develop:

• Integrated community/acute medical beds at Grantham and District Hospital

Acute medical beds work alongside, but are separate from, Accident and Emergency (A&E) departments.

The primary role of these services is to provide assessment, investigation and treatment for patients with particular medical (i.e. not surgical) conditions such as severe headache, chest pain, pneumonia, asthma or chronic obstructive pulmonary disease (COPD), who are referred by their GP or come via the A&E department.

In these services the care is provided by a multi- disciplinary team of doctors, nurses, therapists and support staff.

The acute medical beds team is responsible for coordinating initial medical care for all the patients they see, whether they need a hospital stay or are able to return home after assessment and treatment in one of the walk in (ambulatory) units.

If patients do need a hospital stay they will either be admitted to an acute medical assessment bed or transferred to another specialist ward or department. This can sometimes involve patients being transferred between hospital sites to ensure they get to the team that provide the right care and treatment.

United Lincolnshire Hospitals NHS Trust (ULHT) currently provides acute medical beds at Lincoln County Hospital, Pilgrim Hospital, Boston and Grantham and District Hospital.

In line with the limited range of presenting emergency conditions (as highlighted in the urgent and emergency care section) that Grantham and District Hospital A&E department can deal with, the level of care and complexity of patients seen by the acute medical beds service at this hospital is lower than that at Lincoln County Hospital and Pilgrim Hospital, Boston.

The reduced service available at the Grantham and District Hospital is well understood by the local healthcare system, including the ambulance service. If they assess a patient local to Grantham as having a care need greater than can be dealt with at Grantham and District Hospital, they will take them to the next closest hospital with the right facilities and skills to care for them.

A summary of the current acute medical beds provision at ULHT’s hospital sites is set out below.

This section sets out the challenges and opportunities for acute medical beds and what we hope to achieve by making changes.

Challenges

• There is a rising demand for acute medical beds services and more patients have complex needs
• Our local acute medical beds services struggle to recruit enough doctors and nurses, which means:
  • We cannot consistently provide the level of service quality we aspire to
  • We need to fill vacancies with temporary staff, which itself is not always possible
  • There are increased service and patient safety concerns
  • In addition, Grantham and District Hospital faces further staffing challenges in this area as:
    • Its Accident and Emergency (A&E) department sees a limited range of presenting emergency conditions because of its small size and limited availability of specialist staff; which in turn means
    • Its acute medical beds service treats fewer patients with a lower level of care needs compared to Lincoln County Hospital and Pilgrim Hospital, Boston

Opportunities

 By making changes, we can look to ensure:

• High quality acute medical services are delivered locally in a sustainable way for the long term
  • The volume and complexity of presenting emergency conditions at hospitals in Lincolnshire is matched to the level of acute medical beds service provided at each site
  • Improving the ability of services to attract and retain talented and substantive staff through building a strong, high quality and successful service
• Patients who require specialist care are identified early and attend the right service, first time and receive the best possible care
• Patient health and the overall patient experience are improved
• Better integration and collaboration with patients’ GP surgeries and community teams

There has been ongoing engagement with the public throughout the Lincolnshire Acute Services Review programme, particularly through the ‘Healthy Conversation 2019’ engagement exercise.

Some consistent themes in relation to acute medical beds, a number of which specifically relate to Grantham and District Hospital, have been shared by the public and stakeholders throughout our engagement to date:

• A need to keep mcal treatment as local and easy to access as possible
• Concerns around distance and accessibility, poor public transport and access for patients or family who cannot afford the travel costs
• The ability of the ambulance service to transfer patients safely when required
• Specific to Grantham and District Hospital:
  • Acute medical beds at Grantham and District Hospital might take pressure off Lincoln County Hospital and Pilgrim Hospital, Boston
  • Concerns around how any proposed changes might affect other wards and services at Grantham and District Hospital

We have consistently taken into account all public and stakeholder feedback throughout our work.

Our preferred proposal for change is to establish integrated community/acute medical beds at Grantham and District Hospital, in place of the current acute medical beds.

The integrated community/acute medical beds would be delivered through a partnership model between a community health care provider and United Lincolnshire Hospitals NHS Trust. The care of patients would still be led by consultants (senior doctors) and their team of doctors, practitioners, therapists and nursing staff.

It is anticipated this change would affect around 10% of those patients currently receiving care in the acute medical beds at Grantham and District Hospital. This is equivalent to 1 patient a day, on average. These patients would receive care at an alternative hospital with the right skills and facilities to ensure the best possible outcome. We envisage the number of medical beds required at Grantham in this new model will not be reduced.

A key part of our process to evaluate options to tackle the challenges we face was to hold a clinically led health system stakeholder workshop and four workshops with randomly selected members of the public.

For acute medical beds two solutions remained following the shortlisting of options:

• No provision of acute medical beds at Grantham and District Hospital
• Provision of integrated community/acute medical beds at Grantham and District Hospital

Attendees at the workshop were asked to think about the advantages and disadvantages of the two options against agreed criteria.

The following table summarises the level of stakeholder and public support for each change proposal.

As we have developed our proposals we have considered the quality and equality impact of the preferred change proposal for acute medical beds.

Through our equality impact assessment we identified two groups of people, one of which is defined by a protected characteristic, which may be more likely to be impacted positively or adversely by this proposal. These groups are age and those who are economically disadvantaged.

Our observations from these assessments are set out below. We will continue to review and develop these, including the impact on different groups of people within our population, with independent support, through our public consultation in light of the feedback we receive.

Potential positive impacts

• Acute medical beds provision would continue to be delivered at Grantham and District Hospital through a high quality service delivered in a sustainable way for the long term – including a more sustainable medical and nursing workforce
• The majority of patients (estimated to be around 90%) cared for in the acute medical beds at Grantham and District Hospital would continue to be cared for in the integrated community/acute medical beds
• The preferred proposal for change would deliver a more comprehensive local service provision at Grantham hospital, specifically in relation to the ‘frail’ population, thereby reducing pressure on acute hospital sites at Lincoln and Boston
• ​​​​​The preferred proposal for change would enable Grantham and District Hospital to build a centre of excellence for integrated multi-disciplinary care (particularly for frail patients), which supports both improved community-based management of long term conditions and reduced lengths of stay in hospital beds
• An estimated 10% of patients (equivalent to 1 a day on average) currently cared for in the acute medical beds at Grantham and District Hospital would not be able to have their care needs met in the integrated community/ acute medical beds. Instead, they would receive their care at an alternative site with the right facilities and expertise to ensure the best outcomes

Potential adverse impacts

• ​​​​​​​​​​​​​​For the small number of patients (estimated to be around 1 a day) with higher acuity needs who wouldn’t be able to have their care needs met by the integrated community/ acute medical beds, treatment will be received at an alternative site with the facilities and skills to look after the most seriously ill patients
• Of those patients seen at an alternative site, it is estimated that there would be no increase in the number of patients travelling more than 60 minutes by car, the threshold set by the local health system for this type of activity. However, given the serious nature of the conditions these patients are expected to have, most are likely to travel by ambulance
• Of those attending an alternative site, it is estimated around 40% would attend Lincoln County Hospital. The remainder would attend hospitals closer to them, but outside of the county, with the majority going to Peterborough City Hospital.
• The friends and family of those patients receiving treatment at an alternative hospital, which better meets the patients care needs, may have to travel further to see them
• ​​​​​These patients would get the specialist input they require at the right time and receive the best possible care. However, it is acknowledged that needing to travel further for this care may be seen as an adverse impact by some people.