As you may be aware, we are in the process of talking to our colleagues about some proposed changes to how we use our beds across our three main hospitals.
We want to be really clear - none of the proposed changes mean that we stop providing or reduce any services for patients. The only change would be where they are provided within the hospitals and / or the local community.
We appreciate the level of passion and support that our local communities have for our three hospitals and the services we offer. It is a sentiment that we all share.
We remain absolutely committed to the futures of our main hospitals and these proposed changes - developed by our clinical Care Groups - are not about downgrading or disinvesting in any of the sites or services.
These proposed changes will help us ensure our patients receive the right care, at the right time, in the right unit; and reduce the time stay in hospital. They also strongly support local and national NHS plans for patients to receive care at home or closer to home where appropriate with support from nurses, therapists, social carers, volunteers and doctors in the community.
It’s also important to say that the proposals will not mean that any of our dedicated and experienced colleagues lose their jobs or be required to work at another of the Trust’s sites.
These are proposals and no decisions have been made. As per Trust policy, it is important that we can consult with colleagues directly about any proposed changes to the way they work to give them the opportunity to shape future plans. That process has started, and colleagues have already raised some distinct themes that will be fed into the consultation going forward - including maintaining the privacy and dignity of patients, the provision of end-of-life care, and support available in the community.
As there will be no changes or reductions to the services provided, public consultation is not required, and this has been confirmed by Lancashire and South Cumbria Integrated Care Board - who hold the statutory responsibility for public engagement and consultation.
However, we understand how important local services are to our communities and in order to be as open and transparent as possible, we wanted to share the detail about the proposed changes which you can find below.
Further updates will be shared as the process is completed in the coming weeks.
Our ambition is to only admit patients to hospital when there is a clinical reason to do so, with no better alternatives. We also want to ensure that patients are admitted to the most appropriate unit and are cared for by the most appropriate clinical team, then discharged without delay when their acute care is complete.
We know from our data and feedback from patients and colleagues that while we most often get this right, it is not the case for every patient, every time. For that reason, we have reviewed how our hospitals are configured and what changes we could make to achieve our ambitions for patients more consistently.
Why do we need to change?
- We don’t currently admit all our patients to the right bed or the right clinical team, which impacts on patients and colleagues caring for them
- Inpatients are transferred between wards, sometimes more than once, for non-clinical reasons
- Colleague experience is not what we would wish, with colleagues telling us that they feel overstretched by having patients scattered across the hospital
- Patients suffer poorer outcomes, for example: increased length of stay, corridor care, and sometimes avoidable harm
- We’re not adhering to national guidance that states:
- Patients should be cared for by a single consultant-led team in a single ward
- There should be beds ringfenced for day surgery and elective surgical inpatients
The review of how beds are configured across our three main hospitals has shown that there are opportunities to improve how we use them which will lead to:
- Improved patient care and outcomes
- Improved colleague and patient experience
- Streamlined clinical pathways which will allow us to ensure our patients receive the right care, at the right time, in the right unit, and reduce inpatient length of stay
- Clinical colleagues being able to spend more time with patients by reducing the need to visit various wards to see patients who should all be in the same place
- Increased resilience over the winter period
Why now?
We know that these proposed changes are the right thing to do for our patients and colleagues, and we are only able to start talking to colleagues about them now because several other pieces of improvement work that have started to make an impact. These include:
|
Improvement |
What does that mean? |
|---|---|
|
Improved use of same day emergency care pathways |
Patients are receiving the care they need and going home on the same day rather than being admitted. |
|
Sustained reduction of patients Not Meeting the Medical Criteria to Reside (NMC2R)
|
These patients no longer require hospital care but do need some further support to safely return to their place of residence. Being in hospital is not the best place for these patients. They do not need acute medical care - they need rehabilitation support to promote their independence and wellbeing, and this is better provided in the community. This time last year, we had an average of 150 patients NMC2R in our hospitals - approx. 100 at the RLI and 50 at FGH. That is up to 20% of our hospital beds. Working hard with our partners in primary care and local authority, these numbers have reduced to around 120 as of September and closer to 100 in October. Further reduction of these numbers will ensure patients are cared for in the right place and free up around 95 beds across the Trust. |
|
Opening of Park View Gardens in Barrow
|
Park View Gardens is now providing 16 intermediate care beds in the community with plans to extend to 24 beds in the coming weeks. This environment is much better to support patients in their rehabilitation and promote their independence and wellbeing. |
|
Expanding portfolio of community services, including the increased use of virtual wards - particularly in Frailty and Respiratory
|
Virtual wards allow patients to get hospital-level care at home safely and in familiar surroundings, helping speed up their recovery while freeing up hospital beds for patients that need them most. Just as in hospital, people on a virtual ward are cared for by a multidisciplinary team who can provide a range of tests and treatments. This could include blood tests, prescribing medication or administering fluids through an intravenous drip. Patients are reviewed daily by the clinical team and the ‘ward round’ may involve a home visit or take place through video technology. |
|
Approval of the Wellness Centre Project in Barrow
|
The Wellness Centre model is an integrated health, social and voluntary sector approach to supporting citizens to ‘live well’. It will identify those at high risk of readmission and intervene early to reduce the risk of future readmissions, focusing on areas such as: - Bespoke support at home: combining health care, carer support, therapy, and equipment to prevent falls - Medicines management: ensuring appropriate medication use Social care and connectedness: addressing social isolation and providing carer support to enhance overall wellbeing. |
We are focusing the changes at FGH initially as the sustained reduction to patients NMC2R has happened quicker in South Lakes than in other areas of the Trust. Once we start to see the same sustained reduction in north Lancashire, we can start to talk to colleagues there about the proposed changes for the RLI.
News and updates
As you will be aware, we have been in the process of consulting with colleagues about several proposed changes to bed configuration within our three main hospitals.
The first of those consultation processes (Ward 6 at WGH) is now complete and we wanted to notify you of the end of the consultation, its outcome and the next steps.
To recap, Ward 6 at WGH is a 16 bedded inpatient rehabilitation ward which primarily supports not meeting the medical criteria to reside (NMC2R) patients. On average, there were two to four patients on the ward at any one time. The closure of the ward would not only ensure that patients receive the care they need in the most appropriate place but also provide an opportunity to use the vacant space to increase the number of patients receiving day case surgery and support the aim of WGH becoming an accredited surgical hub.
The ward currently has no patients - those who would have been cared for on the ward previously are now receiving their rehabilitation care in the most appropriate place in the community.
No concerns about the plan to close the ward were raised by colleagues during the consultation process. There were some concerns regarding individual circumstances but not related to the overall direction of the proposed change. All colleagues who worked on the ward have agreed suitable redeployment opportunities within other services at WGH and will continue to be supported in their new roles.
As you will be aware, the next step in the process is for us to approach Lancashire and South Cumbria Integrated Care Board (ICB) as commissioners for their final consideration before taking action. This notification took place on Friday 6 December 2024, and the ICB will now work with NHS England and the Trust to determine the appropriate process and the requirements for public consultation.
Update on FGH proposals
The consultations with colleagues regarding proposed changes at FGH are still ongoing and due to complete in the next two weeks. Due to the amount of feedback we have received, we are going to take the necessary time following the completion of consultation to review and amend the plans to ensure we have listened and responded to all concerns. We will then go back out to colleagues for a short period with the revised plans to get final views.
The planned timetable for this is as follows:
-
Colleague consultation for Wards 1 and 4 and Abbey View: Closes 17 December 2024
-
Review of feedback / development of revised proposals: 17-23 December 2024
-
Review / approval of revised proposals by Executive team: 24 December 2024
-
Conversations with colleagues re revised proposals: 27 December 2024 - 8 January 2025
-
Plans submitted to ICB for analysis and decision re public consultation: 9 January 2025
-
Update to key stakeholders: w/c 13 January 2025
These timings may change but we will keep you updated. Please note that no changes will be made to the current arrangements at FGH until the process has completed.
We will update you further as soon as we know more.
Aaron Cummins, Chief Executive
Tabetha Darmon, Chief Nursing Officer
Miss Jane McNicholas, Chief Medical Officer
Scott McLean, Chief Operating Officer
Proposed changes to Furness General Hospital (FGH)
Ward 1 is currently our Gynaecology ward that provides Gynaecology Assessment Unit (GAU) and Early Pregnancy Assessment Unit (EPAU) activity, and 15 overnight beds.
Most of the Gynaecology activity at FGH is day case and is carried out on the Day Surgery Unit. The overnight beds are predominantly filled with medical patients who should be on a medical ward, not Ward 1. This means patients are being cared for in the wrong place and this often leads to an increased length of stay as they are not able to be reviewed by a medical doctor each day which delays discharges.
The current set up also means that patients in the GAU or EPAU are being assessed and treated in an inpatient area which is not the best experience for them or their loved ones.
The proposed change would close the 15 overnight beds and make the unit a dedicated assessment unit for GAU and EPAU and the Surgical Emergency Assessment Care Unit (SEAC) - which would move to the area from its current location on Ward 5.
Any Gynaecology patients requiring an overnight stay would be cared for in a dedicated area on Ward 5. This area would be set up to always maintain the privacy and dignity of patients.
Gynaecology and surgical colleagues would be blended into one team to maintain skill set / speciality expertise to ensure no detriment to patient care.
Proposed timings
- Admissions to stop on 2 December 2024 with beds being closed as patients are discharged
- Beds to close on 16 December 2024 (might be earlier dependent on discharges)
- SEAC to move to Ward 1 from Ward 5: between 17 and 23 December 2024
Ward 4 is currently a 24 bedded surgical ward; however, the beds are predominantly filled with medical patients who should be on a medical ward, not a surgical ward. This means patients are being cared for in the wrong place and this often leads to an increased length of stay as they are not able to be reviewed by a medical doctor each day which delays discharges.
We know that we need more medical beds and less surgical beds at FGH due to the makeup of our patient activity. We also know that mixing medical and surgical patients increases the risk of patient harm.
Therefore, the proposed change would see the ward become a 24 bedded medical ward with the ability to increase the number of beds to 34 at times of pressure, such as seasonal winter, etc.
The surgical patients that would currently be cared for on Ward 4 would be cared for on Ward 5 - facilitated by the move of SEAC to Ward 1.
Proposed timings
- Stop admitting surgical patients to the ward as soon as SEAC moves from Ward 5 to Ward 1 between 17 and 23 December 2024
Ward 5 is currently an 18 bedded surgical ward plus the SEAC unit. We know that national guidance states hospitals should have beds ringfenced for day surgery and elective surgical inpatients as it is proven to improve patient safety and reduce risk.
We currently cannot provide that, but the proposed changes would see surgical inpatient activity centralised into a single ward and enable the bed base to be increased by six to 24 beds in total. Thes 24 beds would be ringfenced for surgical inpatients meaning no non-surgical patients would be admitted into them.
This would be facilitated by the move of SEAC to Ward 1.
Proposed timings
- Changes in place from 17 to 23 December 2024
It is important to note that whilst Abbey View does provide excellent palliative care to a small number of patients, it is not a palliative care ward. It is a 20 bedded community rehabilitation ward that primarily supports patients who are Not Meeting the Medical Criteria to Reside (NMC2R). These patients no longer require hospital care but do need some further support to safely return to their place of residence.
Being in hospital is not the best place for these patients. They do not need acute medical care - they need rehabilitation support to promote their independence and wellbeing, and this is better provided in the community. A good example of this is the recently opened intermediate care beds at Parkview Gardens in Barrow which has already seen some fantastic results getting patients home within weeks whereas they would have previously spent months in a hospital bed.
The proposed changes are in two phases. Phase one will see the number of beds on the unit reduce to eight, with a view to closing those eight beds at a later date following a full review.
The proposed changes will support the realignment of community teams in close partnership with the South Cumbria Place Team as well as Adult Social Care, Primary Care and Voluntary sector teams to develop an integrated, community-based model of care to prevent admissions to hospital and extended hospital stays for those patients at highest risk.
The Wellness Centre model is an integrated health, social and voluntary sector approach to supporting citizens to ‘live well’. It will identify those at high risk of readmission and intervene early to reduce the risk of future readmissions, focusing on areas such as:
- Bespoke support at home: combining health care, carer support, therapy, and equipment to prevent falls
- Medicines management: ensuring appropriate medication use
- Social care and connectedness: addressing social isolation and providing carer support to enhance overall wellbeing
In relation to palliative care, we understand how important this service is to our colleagues, patients and families at an incredibly difficult time in their lives. It is vital that we continue to offer this service to our patients where appropriate and we are working with our lead clinicians in end of life care to ensure that there are robust arrangements in place for patients who previously may have end of life care in Abbey View to have quality end of life care elsewhere in the FGH estate.
Proposed timings
- Stop admitting to full bed base on 9 December 2024 with beds being closed as patients are discharged
- 12 beds to close on 6 January 2025 with eight beds remaining
- Review to take place before closing remaining eight beds in August 2025
Proposed changes to Westmorland General Hospital (WGH)
Ward 6 is currently a 16 inpatient rehabilitation ward which primarily supports patients who are Not Meeting the Medical Criteria to Reside (NMC2R) - usually from the Royal Lancaster Infirmary. These patients no longer require hospital care but do need some further support to safely return to their place of residence.
Being in hospital is not the best place for these patients. They do not need acute medical care - they need rehabilitation support to promote their independence and wellbeing, and this is better provided in the community.
On average, there are two to four patients on the ward at any one time. We know that the length of stay increases because of the move to WGH which puts patients at an increased risk of a negative impact on their recovery. We also know that because of our work with partners, the number of NMC2R patients in our hospitals is continuing to reduce and stay at a lower level which means these beds are no longer required.
The proposals would see the ward closed. This provides an opportunity to use the vacant space to increase the number of patients receiving day case surgery and support the aim of WGH becoming an accredited surgical hub.
Proposed timings
- Admissions to stop on 25 November 2024 with beds being closed as patients are discharged
Proposed changes to the Royal Lancaster Infirmary (RLI)
Both Ward 22 and Ward 23 are 22 bedded elderly care wards (44 beds in total). These wards care for a variety of patients, including patients who are Not Meeting the Medical Criteria to Reside (NMC2R). These patients no longer require hospital care but do need some further support to safely return to their place of residence.
Where this is not possible and they are required to stay in hospital, a care plan focused on rehabilitation is essential to promote their independence and wellbeing and decrease the risk of an increased length of stay and negative impact on their recovery. This is not possible with the current configuration where patients are cared for under a medically led model.
The proposed changes would see these wards used to cohort all patients who are NMC2R with a move away from a medically led model of care to one focused on rehabilitation. This would enable us to develop a dedicated unit for this group of patients - providing the right care in the right place at the right time.
Proposed timings
- February / March 2025 - dependent on sustained reduction of NMC2R numbers across the RLI.
Ward 16 is currently our Gynaecology ward that provides Gynaecology Assessment Unit (GAU) and Early Pregnancy Assessment Unit (EPAU) activity, and 16 overnight beds.
Most of the Gynaecology activity at the RLI is day case and is carried out on the Day Surgery Unit. The overnight beds are predominantly filled with surgical patients who should be on a surgical ward, not Ward 16. This means patients are being cared for in the wrong place and this often leads to an increased length of stay as they are not able to be reviewed by an appropriate doctor each day which delays discharges.
The current set up also means that patients in the GAU or EPAU are being assessed and treated in an inpatient area which is not the best experience for them or their loved ones.
The proposed change would close the 16 overnight beds and make the unit a dedicated assessment unit for GAU and EPAU.
Any Gynaecology patients requiring an overnight stay would be cared for in a dedicated area within the existing surgical footprint. This area would be set up to always maintain the privacy and dignity of patients.
Gynaecology and surgical colleagues would be blended into one team to maintain skill set / speciality expertise to ensure no detriment to patient care.
Proposed timings
- Timings TBC - dependent on sustained reduction of NMC2R numbers across the RLI.