Agenda item

In attendance for this item were:

Worcestershire Acute Hospitals NHS Trust – Paul Brennan, Chief Operating Officer and Deputy Chief Executive and Richard Haynes, Director of Communications and Engagement

NHS Herefordshire and Worcestershire Clinical Commissioning Group – Simon Trickett, Chief Executive

Richard Haynes, Director of Communications and Engagement explained that the Committee had already been updated on the impact of Covid at Worcestershire Acute Hospitals NHS Trust (the Trust) as part of the previous Agenda item. The aim of this report was to start discussions with members before the forthcoming County Council elections, about work to restore services and how future services might be configurated and to discuss the issues involved. There were significant challenges ahead including the ongoing need to protect patients from Covid.

Since publication of the Agenda, the Trust had been able to publicise the proposed development of Worcestershire Royal Hospital’s (WRH) Urgent Care and Emergency Department (ED) following a national review of the size and attendance at emergency departments which identified WRH as one of three trusts with an ED of disproportionate size. The Trust had been allocated £15m to improve the size and flow of the ED, and following evaluation of the site, the preferred option was to use the two unoccupied floors of the Aconbury building, with an additional ground floor extension. Plans also included a separate children’s ED, new helipad funded by the Air Ambulance, and a same day emergency care assessment facility. This development would release the existing ED building, and options for its use were being considered.

The Chief Operating Officer (COO) set out the set out immediate next steps to restore and restart services as part of work to address increased waiting lists, through looking at ways to safely increase capacity of surgery and ambulatory care – proposals were being worked through and would start at different stages from 15 March and over the next few months, including:

·         use of Kidderminster for elective day case and short stay activity

·         increased elective capacity for confirmed non-Covid patients at the Alexandra Hospital (the Alex)

·         increased capacity for more complex elective care for confirmed non-Covid patients at the Alex with high care provision in designated Covid-secure wards – this would allow continued focus on elective orthopaedic and urology services as well as transfer of more planned elective and cancer surgery from WRH to the Alex

·         transfer of activity from WRH to the Alex which would be balanced by moving some urgent surgery back to WRH. For non-Covid patients requiring urgent or complex surgery which could only be provided at WRH, one ward had already been designated as a Covid-secure ward.

Longer term plans also included further expansion of elective capacity at the Alex through development of a business case to improve the operating theatre on that site.  It was emphasised that there was no debate about the ED at the Alex, which was a key asset and would definitely remain.  The operating theatre at the Alex would be important in increasing capacity, since virtually no routine elective surgery had been carried out during the pandemic and the COO’s view was that it could take 2-3 years to tackle waiting lists.

Some temporary service changes had been necessary during the pandemic, and further conversations would be needed with HOSC members about those which may be proposed as permanent, a particular example being the relocation of the Ambulatory Chemotherapy Care Unit from the Alex to  Kidderminster Hospital to ensure continuation of services for cancer patients whilst protecting them from the risk of Covid-19 infection.

The Chairman invited discussion, and the following main points were made:

·         HOSC members welcomed the exciting new plans.

·         regarding the revenue consequences of the ambitious plans, for example running costs, the Trust’s COO explained that some changes had been relatively cost neutral, for example refurbishment of the chemotherapy unit at Kidderminster due to funding from the STP and Covid allocation. However, in order to get the Alex fully functional for more complex elective care, he envisaged some additional costs in extra consultants and nursing, which the Trust would look to minimise. It would be important to maximise and reprioritise existing resources because of national budget constraints.

·         This year, because of nationally determined finances, all systems would be in a break-even position. Nonetheless for the year prior to the pandemic, the hospital had a deficit of £79m. Current arrangements during the pandemic would be replicated for quarter one and possibly quarter two but there remained uncertainty on the financial arrangements for 2021/22 and the deficit issued pre-pandemic of £79m.

·         When asked when opening hours of Minor Injuries Units (MIUs) be restored for example to 24 hour/seven days a week at Kidderminster, it was explained that this was under review, however given the reduced demand for the service for the full 24 hour period (before the pandemic), the longer term view may be that current hours were more appropriate, however consideration of any permanent changes would be consulted on.

·         It was explained that staff from MIUs had been redeployed to the community teams during Covid to facilitate people being able to leave acute hospitals, however with services now being restored, it was envisaged that MIUs would reopen by the end of the month providing staffing was available. 

·         In terms of timescale and coping with demand in the meantime, it was hoped to start work in April, to open the first part of the development in February 2022, and the main ED in around August 2022. Temporary additional capacity had been created in cubicles adjacent to Worcester A&E, along with reopening of the same day emergency facility.

·         A HOSC member pointed out that the Committee may be able to influence the Trust’s access to additional funding and asked what would be helpful, and the COO explained that further capacity (alongside the existing facilities at Evesham) for endoscopies would be a very helpful investment, which could be available through converting the old maternity unit at Kidderminster Hospital.

·         The Trust representatives were asked their views on the impact of growing waiting lists and explained that prior to the pandemic the Trust had been able to drive down long waits, however following the pandemic, at the end of January over 9000 had been waiting over 40 weeks. The Trust was now able to start addressing this, and initial modelling suggested it would take around 3 years to tackle, however more work was being done which could be shared with the Committee in future.

·         The Trust COO acknowledged that the issue of waiting lists may need to be addressed in public health messages, but he also explained that the clinical triage and guidance put in place demonstrated that some health concerns could be dealt with in non-acute environments.

·         HOSC members from the Redditch and Bromsgrove areas referred to extensive housing development plans for north Worcestershire and made a case for more services being delivered from The Alex, such as maternity. The Trust representatives advised they were committed to enhanced facilities at the Alex, however this was part of the wider hospital trust and county-wide service and it was also important to look at the roles of primary care and community based services. When asked whether developers were being asked to contribute to hospital services, it was acknowledged that demand would increase with population growth although from experience housing development had not led to significant increases since often the population moved within the area – a key issue remained provision of services in community rather than acute settings and the Trust intended to ensure services could meet demand but in the right place.