Overview of our change proposals

All of our change proposals are based on:

National clinical evidence
What our clinical service leads believe is right for patients
What external clinical experts and advisors say is best practice
Feedback from our public and stakeholder engagement

In order to:

Deliver better outcomes and quality of care for patients
Make it easier for hospital staff to provide the best possible care to patients
Make services more attractive so they can recruit and retain great staff dedicated to high quality care

For each of the four NHS services within the scope of this consultation, the tables below set out the options considered at the shortlist stage, the preferred change proposal identified following the appraisal of the shortlist and a summary of the preferred change proposal.

Orthopaedic surgery

Options appraised at shortlist stage		Preferred option identified following appraisal
Consolidate planned orthopaedic surgery at Grantham and District Hospital Other options were considered initially, however these did not progress to the shortlist stage following the clinically led evaluation of the long list of options		Consolidate planned orthopaedic surgery at Grantham and District Hospital A dedicated day case centre at County Hospital Louth (developed through the pilot)
Overview of preferred option
A ‘centre of excellence’ in Lincolnshire for planned (only) orthopaedic surgery would be established at Grantham and District Hospital A dedicated day case centre at County Hospital Louth for planned orthopaedic surgery All unplanned orthopaedic surgery delivered by dedicated, specialist staff at ULHT will take place at Lincoln County Hospital and Pilgrim Hospital, Boston A pilot of these services has demonstrated: Reductions in the number of patients who have their planned orthopaedic surgery cancelled due to a lack of beds Care provided in line with national best practice and care standards A reduction in the amount of time patients wait for their planned orthopaedic surgery A reduction in the amount of time patients spend in hospital after their planned surgery An improvement in patient satisfaction and experience A reduction in the number of patients receiving their care in the private sector, funded by the NHS

Urgent and emergency care at Grantham and District Hospital

Options appraised at shortlist stage		Preferred option identified following appraisal
Grantham and District Hospital A&E department to become an Urgent Treatment Centre (UTC) Other options were considered initially, however these did not progress to the shortlist stage following the clinically led evaluation of the long list of option		Grantham and District Hospital A&E department to become an Urgent Treatment Centre (UTC)
Overview of preferred option
Feedback from the public received during Healthy Conversation 2019 engagement further developed this proposal into a 24/7 walk-in UTC 24/7 walk-in urgent care services at Grantham and District Hospital would be provided by a sustainable and permanent Urgent Treatment Centre (UTC) The vast majority (estimated to be around 97%) of patients currently seen by the A&E department at Grantham and District Hospital would continue to be treated by the proposed 24/7 Urgent Treatment Centre (UTC) Compared to the current Grantham and District Hospital A&E Department, access overall would increase as the UTC would be open 24/7. Greater access would also be provided for children The 24/7 UTC would be provided by a community health service provider, which will support better integration with primary care and community services and the provision of care closer to home For the small number of patients who wouldn’t be able to have their care needs met by the 24/7 UTC in Grantham, care would be received at an alternative site with the right facilities and expertise to ensure the best patient care The Mental Health Liaison Service currently provided at Grantham and District Hospital would not be impacted by the proposed service changes and would continue to provide services as it does now

Acute medical beds at Grantham and District Hospital

Options appraised at shortlist stage		Preferred option identified following appraisal
No acute medical beds at Grantham and District Hospital OR Integrated community/acute medical beds at Grantham and District Hospita		Integrated community/acute medical beds at Grantham and District Hospital
Overview of preferred option
Acute medical beds would be retained locally at Grantham and District Hospital in a sustainable way The majority (estimated to be around 90%) of patients currently receiving care in the acute medical beds at Grantham and District Hospital would continue to be treated in the integrated community/acute medical beds Compared to the current Grantham and District Hospital acute medical beds, a more comprehensive service would be delivered, particularly for frail people, which enables greater integration with community health and care services Maintaining a local service at Grantham and District Hospital would reduce pressure on Lincoln County Hospital, Pilgrim Hospital, Boston and Peterborough City Hospital For the small number of patients who would not be able to have their care needs met by the integrated community/acute medical beds in Grantham, care would be received at an alternative site with the right facilities and expertise to ensure the best patient care

Stroke services

Options appraised at shortlist stage		Preferred option identified following appraisal
Consolidate hyper-acute and acute stroke services on the Lincoln County Hospital site, supported by an enhanced community stroke rehabilitation service OR Provide hyper-acute and acute stroke services from Lincoln County Hospital and Pilgrim Hospital, Boston, supported by a combined medical on-call rota		Consolidate hyper-acute and acute stroke services on the Lincoln County Hospital site, supported by an enhanced community stroke rehabilitation service
Overview of preferred option
A ‘centre of excellence’ in Lincolnshire for hyper-acute and acute stroke services would be established at Lincoln County Hospital – Pilgrim Hospital, Boston would no longer provide hyper-acute and acute stroke services Hospital stroke service provision would be based on national clinical evidence, which has demonstrated stroke patients are more likely to survive, recover more quickly and spend less time in hospital Hospital stroke services in Lincolnshire would be in a stronger position to attract and retain talented staff through building a strong, high quality and successful service – making it sustainable for the long term More patients would benefit from hospital stroke services being located on the same hospital site as the highly successful Lincolnshire Heart Centre, with benefits including increased access to important time critical interventions and acute imaging services, further reducing time to treatment Stroke patients would spend the minimum time necessary in a hospital bed, by ensuring enhanced community services have the right skills and capacity to provide high quality rehabilitation to stroke patients as they return home, or as close to home as possible