Primary Care Trust Boards Reach Decisions

21/09/2006

‘Future of Healthcare in Gloucestershire’

Primary Care Trust Board members met today (Thursday 21 September) to reach decisions which they believe will help safeguard the range of health services provided in Gloucestershire into the future.

Board members considered the outcome report from the consultation on ‘The Future of Healthcare in Gloucestershire’ before reaching decisions. The report included feedback from the public, partners and staff.

Chair of Cheltenham and Tewkesbury Primary Care Trust and Chair designate of Gloucestershire Primary Care Trust, Ruth FitzJohn thanked everyone for taking part in the consultation and staff for their continuing commitment to patient care. She said:

“As promised at the beginning of this consultation, we have considered very carefully as we have gone along, the differing views and needs of our local communities including the views of local healthcare professionals.”

“First and foremost, our priority has been to safeguard the range and quality of services for the longer term, whilst seeking to establish a sound financial footing for the future.”

“This will continue to be our guiding principle and the views of the public, our partners and our staff have been very important in helping us to reach our decisions.”

“We have also taken into account the changing nature of the NHS which places less reliance on beds with more services provided in community facilities and the patient’s own home.”

All three Boards reached decisions on a number of county-wide proposals relating to planned care (centralisation of a number of low volume inpatient hospital surgical services), urgent and emergency care, maternity services, rehabilitation services (including proposals for Delancey Hospital) and Patient Transport Services.

Local PCTs also reached decisions on community based proposals for Berkeley Vale, North Cotswolds, Forest of Dean and Winchcombe.

Recommendations agreed by all PCT Boards

Planned Care

PCT Boards agreed to:

• Approve the centralisation of all inpatient services for oral maxillo-facial surgery, vascular surgery, gynaecology and urology
  
  
• Support the proposal to locate all inpatient services for maxillo-facial surgery at Gloucestershire Royal Hospital, to ensure effective links with ear, nose and throat services
  
  
• Support the proposal to locate all gynaecology inpatient services at Gloucestershire Royal Hospital (except for complex surgery for cancer) to link effectively with the obstetric service
  
  
• Support the preference which has emerged for urology and vascular inpatient surgery to be located at Cheltenham General Hospital, as long as the ongoing work on clinical links supports this
  
  
• IVF
  Endorse the cessation of routinely provided locally funded assisted fertility (IVF) services and clarify for patients which parts of the infertility service will still be funded
  
  
• Agree with local clinicians the implementation date which will be confirmed to the new PCT at the October Board meeting.
  

Urgent and Emergency Care Services

PCT Boards agreed to:

• Support the proposal set out in the public consultation document for a new model of urgent and emergency care
  
  
• Support the development of an implementation plan setting out where and when the new urgent and emergency services will be introduced, accompanied by a patient information and education campaign
  
  
• A programme for reporting back on progress being produced for discussion with the Health Overview and Scrutiny Committee (HOSC).

Note: Proposals in the consultation document for urgent and emergency care services include: integrating the way in which out of hours centres and A&E departments work, introducing weekday emergency outpatient clinics to ensure that patients are rapidly assessed and diagnosed before being treated in the most appropriate setting and introducing staff with different skills (e.g. emergency care practitioners) to avoid unnecessary hospital admissions.

Maternity Services

PCT Boards:

• Approved the proposal to centralise all consultant led births onto the Gloucestershire Royal Hospital site
  
  
• Considered the proposal to transfer all midwife-led births and other inpatient admissions to Gloucestershire Royal Hospital and decided to:
  
  Not proceed with the original proposal as set out above on the grounds that affordability is not seen as sufficient reason to centralise midwife-led services when taken alongside the view that the proposal runs contrary to current national direction for more local access to services.

Patient Transport Services

PCT Boards agreed to:

• Endorse the proposal to tighten the criteria for escorts
  
  
• Request further work to be undertaken on the practicalities of charging for some journeys and working through the Integrated Transport Unit with key partners (including Gloucestershire Hospitals NHS Foundation Trust, the Great Western Ambulance Service NHS Trust and the voluntary sector) to develop a more flexible and cost effective car transport service which meets patients’ needs
  
  
• Request that a timetable for the further work be shared with the Health Overview and Scrutiny Committee at their November meeting.
  
  

Rehabilitation and Delancey Hospital

PCT Boards:

• Agreed to proceed with the original proposal, part of which is already underway, to increase rehabilitation in patients’ homes and in community facilities leading to the closure of beds at Delancey Hospital and the transfer of the remaining specialist rehabilitation beds onto the Cheltenham General Hospital site by 2009 to complement those at Gloucestershire Royal Hospital
  
  
• Agreed to share implementation plans setting out where and when investment in community services will take place with the HOSC at their November and subsequent meetings.
  
  

Community Based Proposals – Recommendations agreed by local Primary Care Trusts:

North Cotswolds (Cotswold and Vale Primary Care Trust)

The PCT Board agreed to:

• Endorse the proposal to develop a new health campus in Moreton–in–Marsh and redevelop the Moore Cottage Hospital site at Bourton–on–the-Water.
  
  
• Hand over the Business Case to the new Gloucestershire PCT to take forward.

Note: Broad support has been received on the proposal to develop a new health campus in Moreton–in–Marsh and redevelop the Moore Cottage Hospital site at Bourton–on–the-Water, with the accompanying development of community based services, multi–disciplinary teams and local outpatient services.

Dr Hywel Furn-Davies, GP from the North Cotswolds said:

“After many months of uncertainty, we are delighted that a decision has been made regarding the Community Hospitals in the North Cotswolds. This has been a very difficult process for our local community. The transfer of resources from hospital to community services is vital if the proposed plans are to be successfully implemented. We now need to work closely with our caring and dedicated staff who are involved in this change to remove further uncertainty.”

Berkeley Vale (Cotswold and Vale Primary Care Trust)

The PCT Board:

• Endorsed the proposal to develop the new service model for the locality
  
  
• Agreed to hand over the Business Case to the new Gloucestershire PCT to take forward
  
  
• Supported the change in opening hours of the Berkeley Hospital Minor Injuries Unit with opening hours from 8am to 8pm from 1st November 2006.

Note: There is broad support for the proposed new service model for the locality based on building a new health and social care facility at Dursley and the development of primary care and social care teams clustered round local populations. Based on these proposals, Berkeley Hospital, Sandpitts Clinic in Dursley and the Symn Lane Clinic in Wotton-under-Edge would close when the new health and social care facility in Dursley is developed. In the case of Symn Lane clinic, the same services would be provided in nearby alternative accommodation.

The proposal concerning the opening hours of the Minor Injuries Unit at Berkeley Hospital is based on the limited use made of this facility between 8pm and 8am.

Chief Executive of Cotswold and Vale Primary Care Trust, Richard James said:

“We recognise that a change in service model and location is hard for local communities and for local staff and we welcome the Health Overview and Scrutiny Committee’s response given the changing needs of the population.”

“We are confident that these proposals reflect the way the NHS is changing and will result in increased local access to services including many more outpatient clinics and the provision of state of the art new facilities. I am delighted so many clinical staff have worked so hard to develop this proposal.”

Forest of Dean (West Gloucestershire Primary Care Trust)

The PCT Board agreed:

• Not to proceed on the basis of the original proposal, but to undertake further detailed work with the GP Commissioning Cluster, in conjunction with key stakeholders, to develop an affordable service model for the Forest of Dean which meets patients’ needs
  
  
• To require details of the next steps to be shared with local stakeholders as soon as possible and with the Health Overview and Scrutiny Committee at the next meeting in November 2006
  
  
• To require the GP Commissioning Cluster to complete the commissioning plan in time for full consideration at the October meeting of the Gloucestershire PCT Board.

Chief Executive of West Gloucestershire Primary Care Trust, Stephen Golledge said:

“We are absolutely committed to ensuring that patients continue to receive the highest standards of patient care.”

“The NHS locally will continue to dedicate time and resources to support the work of the GP Commissioning Cluster, who are working to develop an alternative plan for the provision of future health services for the Forest of Dean, and Forest Health Future who are developing proposals for a Social Enterprise Trust.”

Tewkesbury and Winchcombe (Cheltenham and Tewkesbury Primary Care Trust)

The PCT Board agreed:

• Not to proceed on the basis of the original proposal, but to undertake further work with the key stakeholders, including local clinicians, to develop an affordable service model for the Winchcombe locality which meets patients’ needs.
  
  
• Require details of the next steps to be shared with local stakeholders and the HOSC at their November meeting
  
  
• Support the change in opening hours of the Tewkesbury Hospital Minor Injuries Unit with opening hours from 8am to 8pm from 1st November 2006.

Note: The original proposal set out plans to provide services in an alternative way in the Winchcombe area based on a number of factors including the condition of the current hospital building, increased opportunities to provide more rehabilitation and support in the home and plans to relocate outpatient and therapy services within Winchcombe.

Chief Executive of Cheltenham and Tewkesbury Primary Care Trust, Caroline Fowles said:

“We understand the strength of feeling locally and recognise the high standards of patient care provided by our staff at Winchcombe Hospital.”

“The NHS locally remains committed to providing services in the Winchcombe area. We believe that there is now an acceptance that the current hospital is not suitable for redevelopment. The PCT will put in the time and effort needed to support the steering group which has been established to develop an alternative and affordable plan for Winchcombe.”

*The Primary Care Trust Boards are: Cheltenham and Tewkesbury, Cotswold and Vale, West Gloucestershire.