How these four NHS services are currently organised and how they could look in the future

Each of the tables below outline how the services which are part of this public consultation are currently organised (pre COVID-19 temporary changes). They also outline how services have temporarily been changed in response to COVID-19, changes which were necessary for multiple reasons during the pandemic, such as staff isolating, and the need to separate patients with COVID-19 from other patients. And finally, they outline how services would be organised in the future if our change proposals are agreed and implemented.

It can be seen in some areas there are similarities between the temporary COVID-19 changes and the preferred proposals for change. These temporary changes have therefore provided the Lincolnshire health system with additional insights into the proposed change.

Orthopaedic surgery

	Services pre COVID-19 (after the pilot changes in August 2018)	Temporary changes in response to COVID-19 *(in place between March* *2020 and May/June 2021)*	Preferred option for change proposal
Lincoln County Hospital	Planned surgery Day case high risk patients Inpatient high risk patients Unplanned surgery	Planned surgery Day case based on priority level Inpatient based on priority level Unplanned surgery	Planned surgery Day case high risk patients Inpatient high risk patients Unplanned surgery
Pilgrim Hospital, Boston	Planned surgery Day case* high risk patients Inpatient high risk patients Unplanned surgery some non-high risk patients also seen to manage day to day* operational demands	Unplanned surgery	Planned surgery Day case high risk patients Inpatient high risk patients Unplanned surgery
Grantham and District Hospital	Planned surgery Day case non-high risk patients Inpatient non-high risk patients	No service provision	Planned surgery Day case non-high risk patients Inpatient non-high risk patients
County Hospital Louth	Planned surgery Focused on day cases non-high risk patients	No service provision	Planned surgery Focused on day cases non-high risk patients

Urgent and emergency care at Grantham and District Hospital

	Services pre COVID-19	Temporary changes in response to COVID-19 (in place between June 2020 and July 2021)	Preferred option for change proposal
Lincoln County Hospital	24/7 full A&E department Co-located Urgent Treatment Centre (UTC)	24/7 full A&E department Co-located Urgent Treatment Centre (UTC)	24/7 full A&E department Co-located Urgent Treatment Centre (UTC)
Pilgrim Hospital, Boston	24/7 full A&E department Co-located Urgent Treatment Centre (UTC)	24/7 full A&E department Co-located Urgent Treatment Centre (UTC)	24/7 full A&E department Co-located Urgent Treatment Centre (UTC)
Grantham and District Hospital A&E operating reduced hours since 2016	A&E department (08.00-18.30 since 2016) Limited range of presenting conditions dealt with by A&E department since 2007/8	24/7 Urgent Treatment Centre (UTC)	24/7 ‘walk in’ Urgent Treatment Centre (UTC) (full range of services)

Acute medical beds at Grantham and District Hospital

	Services pre COVID-19	Temporary changes in response to COVID-19 (in place between June 2020 and July 2021)	Preferred option for change proposal
Lincoln County Hospital	Acute medical beds	Acute medical beds	Acute medical beds
Pilgrim Hospital, Boston	Acute medical beds	Acute medical beds	Acute medical beds
Grantham and District Hospital	Acute medical beds – level of provision reflective of the specified range of presenting emergency conditions	No acute medical beds	Integrated community/ acute medical beds – level of provision reflective of specified range of presenting conditions

Stroke services

	Services pre COVID-19	Temporary changes in response to COVID-19 (commenced April 2020, still in place)	Preferred option for change proposal
Lincoln County Hospital	Hyper-acute stroke service including thrombolysis Acute stroke service Transient Ischaemic Attack (TIA) clinics	Hyper-acute stroke service including thrombolysis Acute stroke service TIA clinics	Hyper-acute stroke service including thrombolysis Acute stroke service TIA clinics
Pilgrim Hospital, Boston	Hyper-acute stroke service including thrombolysis Acute stroke service TIA clinics	Acute stroke service TIA clinics	TIA clinics