We want you to tell us what you think about our preferred change proposal to develop:
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.
Lincoln County Hospital |
A&E • Operates 24/7 • Services: full A&E Acute medical beds • Same day emergency care • Medical emergency assessment unit • Medical emergency short stay • Acute medical short stay ward |
Pilgrim Hospital, Boston |
A&E • Operates 24/7 • Services: full A&E Acute medical beds • Integrated assessment centre • Acute medical short stay ward |
Grantham and District Hospital |
A&E • Operates 08:00-18:30 Services: not full A&E Acute medical beds • Emergency assessment unit • Acute medical short stay ward |
This section sets out the challenges and opportunities for acute medical beds and what we hope to achieve by making changes.
Challenges
Opportunities
By making changes, we can look to ensure:
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:
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:
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.
Support for change proposals for acute medical bed services at Grantham and District Hospital |
||
Support for change proposal |
Stakeholder Workshop |
Public Workshops |
Integrated community/ acute beds at Grantham hospital |
85% |
81% |
No acute medical beds at Grantham hospital |
9% |
11% |
No preference |
6% |
8% |
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
Potential adverse impacts