We want you to tell us what you think about our preferred change proposal to develop:
The primary role of an Accident and Emergency (A&E) department is to assess and treat people with major trauma, serious injuries and those in need of emergency treatment.
United Lincolnshire Hospitals NHS Trust (ULHT) currently provides A&E departments at Lincoln County Hospital, Pilgrim Hospital, Boston and Grantham and District Hospital.
The A&E departments at Lincoln County Hospital and Pilgrim Hospital, Boston are consultant-led 24 hour services that provide the full range of accident and emergency care, with support from 24/7 diagnostics and access to critical care.
However, the Grantham and District Hospital A&E department has for some time (since 2007/8) only dealt with a limited range of presenting emergency conditions. This is because of its small size, limited availability of specialist staff and limited range of 24/7 support services to support very ill patients after they leave the A&E department.
This means the majority of patients treated at Grantham and District Hospital A&E department arrive with injuries or illnesses that can be safely treated at an Urgent Treatment Centre (UTC). As the service is supported by a skilled range of doctors, GPs, practitioners and nursing staff, it is able to provide an extensive range of assessment and treatment that meets the needs of the local population.
The service available at 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.
If patients do present at Grantham and District Hospital A&E department with conditions that the hospital is not able to deal with, the skills and experience are there to manage the patient whilst transfer is quickly arranged to a more specialist unit for the appropriate treatment.
Prior to 2016 the A&E department at Grantham and District Hospital was operating 24/7 (dealing with a limited range of presenting emergency conditions).
Since 2016 it has been operating on reduced hours (currently closed between 6.30pm and 8.00am) due to difficulties faced by ULHT in safely staffing its A&E
departments. This change did not impact on the limited range of emergency conditions the service could deal with.
A summary of the current provision at ULHT’s A&E departments is set out below
Lincoln County Hospital |
• Operates 24/7 • Services: Full A&E • Consultants: 24/7 • Doctors: 24/7 • Nurses: 24/7 |
Pilgrim Hospital, Boston |
• Operates 24/7 • Services: Full A&E • Consultants: 24/7 • Doctors: 24/7 • Nurses 24/7 |
Grantham and District Hospital |
• Operates 08:00-18:30 • Services: Not full A&E • Consultants: 14/7 • Doctors: 14/7 • Nurses: 14/7 |
In addition to the three A&E departments currently provided by ULHT, six Urgent Treatment Centres (UTC) are provided by Lincolnshire Community Health Services NHS Trust (LCHS). These are located at:
Lincoln located with A&E
Boston located with A&E
Louth
Skegness
Gainsborough
Spalding
These urgent care services can treat a wide range of conditions which are not critical or life threatening such as sprains and strains, suspected broken limbs and feverish illness in adults and children. They play a significant role in protecting A&E departments for those patients who really need them.
The Minor Injuries Unit service at Stamford Hospital (which is currently provided by North West Anglia NHS Foundation Trust) is available to people in and around the Stamford area in the south of the county.
This section sets out the challenges and opportunities for urgent and emergency care 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 urgent and emergency care 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.
In light of the feedback received in relation to urgent and emergency care we have considered how we can deliver a sustainable 24/7 walk in service at Grantham and District Hospital.
Our proposal for change is to establish a 24/7 walk in Urgent Treatment Centre (UTC) at Grantham and District Hospital, in place of the current Accident and Emergency (A&E) department.
The UTC would be provided by a community health care provider, with existing doctors retained as part of the team and consultant (senior doctor) oversight provided to the unit. The multi-disciplinary workforce would have the ability to manage all presentations, including those requiring stabilisation and transfer to an alternative hospital with the right skills and expertise.
It is anticipated this change would affect around 3% of those patients currently attending the Grantham and District Hospital A&E. This is equivalent to 2 patients a day, on average. These are patients who require onward transfer for immediate specialist care.
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 urgent and emergency care, where only one solution remained following the shortlisting of options, attendees at these workshops were asked whether they agreed or disagreed that the changes proposed would help to improve the current situation and meet the challenges identified.
The table opposite summarises the level of stakeholder and public support for the change proposal.
Support for change proposal to establish a UTC at Grantham and District Hospital in place of the A&E department |
||
Support for change proposal |
Stakeholder Workshop |
Public Workshops |
Agree (strongly/ tend to) |
98% |
84% |
Disagree (strongly/ tend to) |
2% |
11% |
Neither agree nor disagree |
0% |
5% |
As we have developed our proposals we have considered the quality and equality impact of the preferred option for urgent and emergency care at Grantham and District Hospital.
Through our equality impact assessment we identified three groups of people, two of which can be defined by protected characteristics, which may be more likely to be impacted, positively or adversely, by this proposal.
These three groups are age, disability 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