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.
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.
Since the plans were launched in November 2024, we have been speaking to colleagues as part of the usual Trust management of change process - with formal consultation closing for all areas on or before 17 December 2024.
We want to say a huge thank you to all colleagues who took the time to attend briefing sessions and let us know their thoughts, concerns and feedback. We’ve also been listening to feedback from key stakeholders, patients and members of the public.
All the feedback received has been reviewed in full and considered alongside the proposed plans. As a result of all you have told us, we have made some important changes to the initial plans. The final plans (incorporating feedback) can be found below:
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:
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Improvement |
What does that mean? |
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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. |
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Sustained reduction of patients Not Meeting the Medical Criteria to Reside (NMC2R)
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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. |
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Opening of Park View Gardens in Barrow
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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. |
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Expanding portfolio of community services, including the increased use of virtual wards - particularly in Frailty and Respiratory
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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. |
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Approval of the Wellness Centre Project in Barrow
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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.
Revised proposed changes to Furness General Hospital (updated January 2025)
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.
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ORIGINAL PROPOSED PLAN |
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WE HEARD FEEDBACK ABOUT… |
RESOLUTION |
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Maintaining privacy and dignity of gynaecology service users - particularly those undergoing early pregnancy loss.
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The footprint on Ward 1 will be split as follows to ensure privacy and dignity:
Non-sensitive gynaecology patients who require admission will be placed in one of two ringfenced beds on Ward 5 (including one side room) following a risk assessment to ensure they will be placed in a suitable environment based on clinical need. Non-sensitive day cases would be routinely managed on the Day Surgery Unit as they are currently. |
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Provision of appropriate facilities to support service users and their partners - private rooms, en-suite toilets and showers, etc. |
As above. |
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Adherence to national requirements and guidance such as Pregnancy Loss Review. |
Those experiencing pregnancy loss will continue to be cared for on Ward 1 - ensuring all relevant guidance can be adhered to. |
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Access to ultrasound. |
EPAU, Gynaecology SDEC and sensitive gynaecology patients would remain on Ward 1 and maintain access to ultrasound within Gynaecology outpatients. |
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24/7 access to South Lakes Birth Centre (SLBC) for emergency teams to access from main hospital. |
24/7 access to SLBC will be maintained. Obstetric Gynaecologists will be in proximity to support service users if needed. |
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Safeguarding and security of women with resident babies. |
As per current guidance, if a patient needs to keep their baby with them whilst receiving care, this would be risk assessed on a case-by-case basis at the time as this is a situation that happens very infrequently and not just on Ward 1. |
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Link with Gynaecology clinical configuration / service redesign work.
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The clinical configuration process that is underway has identified a compelling case for change for both elective gynaecology and Trauma and Orthopaedic elective arthroplasty. The proposed models of care are currently being assessed but these final changes will not have a negative impact. |
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FINAL PLAN |
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AGREED TIMESCALES: A phased approach to the changes will take place as below:
All changes to be in place by 27 February 2025. |
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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.
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ORIGINAL PROPOSED PLAN |
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WE HEARD FEEDBACK ABOUT… |
RESOLUTION |
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The proposed timescales and anxieties about nursing medical patients rather than surgical patients.
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The change in time to the end of February 2025 will help mitigate these concerns together with the community therapy model (further information below) and the impact of the virtual wards. We will offer any training and clinical supervision required to support colleagues where required. |
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Appropriate medical capacity to support the surge capacity of 34 beds.
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This is being addressed within the Medicine Care Group to ensure there is appropriate medical cover.
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FINAL PLAN |
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AGREED TIMESCALE: Changes in place from 27 February 2025 (following change to Ward 1). |
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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. These 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.
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ORIGINAL PROPOSED PLAN |
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WE HEARD FEEDBACK ABOUT… |
RESOLUTION |
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Ward 5 colleagues were engaged in the process but did not undergo a formal consultation process as no substantial changes were proposed. The only issues expressed by colleagues were regarding the proposed changes to Ward 1. |
As above in Ward 1 section. |
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FINAL PLAN |
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AGREED TIMESCALES: A phased approach to the changes will take place as below:
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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.
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ORIGINAL PROPOSED PLAN |
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WE HEARD FEEDBACK ABOUT… |
RESOLUTION |
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The impact on palliative / end of life (EOL) care:
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Abbey View provides excellent care to a small number of EOL patients, but it is not a specialist palliative care ward. EOL care is delivered across all acute wards at FGH - for example, Ward 9 encompasses the Maple Suite which has Platinum GSF (Gold Standards Framework) accreditation. Inpatient community beds are also available at Millom hospital. Within the community, there are excellent services provided 24/7 via our own community teams, primary care, regulated care and hospices. Our district nursing services consistently deliver care within the two-hour urgent response times required - which helps to ensure that patients receive timely EOL care. In addition, the teams will focus on strengthening existing relationships with the hospice, and work alongside hospital teams to support appropriate and timely fast track for patients requiring end of life care. Discussions are also ongoing regarding potential further spaces for EOL care within the hospital. The ‘old PPU’ space is not suitable as it is dedicated for surge beds during winter. |
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Social care availability.
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We continue to work closely with adult social care colleagues to support timely discharges which has seen a consistent reduction in patients not meeting criteria to reside. They have assured us that they are not aware of any issues with patients accessing the care packages they require. |
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Patient flow through the hospital without Abbey View. |
Timings have been revised to start the phased closure later (April 2025) to support flow during winter pressures. |
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Whether Parkview Gardens has the skill set to manage the same number of patients as Abbey View (20) - including orthogeriatric patients.
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Park View Gardens has 24 beds - 6 respite beds, 6 Discharge to Assess beds, 6 Intermediate Care beds and 6 flexible beds. All the beds have dedicated Primary Care medical support. The unit is currently only taking step down patients from UHMBT, but we are working towards developing a step-up model. Early feedback regarding patients who have gone there is very positive - including around length-of-stay and early mobilisation. |
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Rehabilitation capacity.
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The community therapy model is due to go live in February 2025. It is an amalgamation of Discharge to Assess, supported discharge and community therapy and will operate 7 days a week providing an urgent / same day response to support step up and step down patients requiring non bed-based rehabilitation. |
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A general lack of understanding about the Wellness Centre model. |
All colleague briefing held to demonstrate the model and answer any questions. |
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Access to equipment and support in the community - currently not rapid enough to support discharges.
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For EOL patients, our District Nurses consistently meet the urgent response Key Performance Indicators. The equipment store (for therapy equipment) has an urgent request response and basic equipment can be provided from therapy stock. |
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FINAL PLAN |
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INDICATIVE TIMESCALE:
Implementation dates are dependent on the outcome of consideration by the ICB as commissioners, NHS England and the local Health Adult Scrutiny Committee. |
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There were other areas of specific feedback that were received about the proposed changes to FGH as detailed below:
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WE HEARD FEEDBACK ABOUT… |
RESOLUTION |
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How adequate infection prevention and control (IP&C) will be possible with a reduction of 19 side-rooms (7 in Ward 1 and 12 in Abbey View).
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It is acknowledged that during seasonal winter, the demand for side-rooms for IP&C rises. Therefore, a number of actions will be carried out to underway to ensure the safety of patients and colleagues:
It is also worth noting that we expect there to be a reduction in the requirement for inpatient side rooms due to less of our frailest patient population needing hospital admission because of the Wellness Service model. |
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How will adequate bariatric care be provided should the appropriate space not be available in Ward 1 and Abbey View, including what will happen should fire evacuation be required.
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This concern relates only to those patients who are both immobile and of a weight whereby specialist equipment is required. The number of these patients is very small - thought to be less than three per year. In this case, these patients would remain on the Acute Medical Unit (AMU). A daily report of all patients with a high BMI is sent to fire officers, emergency planning and clinical site management. When requested, the fire officer reviews these patients on the ground floor and specialist equipment is required before transfer to the upper floors to ensure patient safety. Our Health and Safety team has procured specialist equipment for evacuation of patients relevant to this risk and deliver an ongoing training programme at FGH. On this basis, we have no concerns in relation to the care of bariatric patients and fire evacuation. |
Revised proposed changes to Westmorland General Hospital (updated January 2025)
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.
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ORIGINAL PROPOSED PLAN |
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WE HEARD FEEDBACK ABOUT… |
RESOLUTION |
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No concerns about the proposed plan to close the ward were raised by colleagues during the consultation process.
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None required as no concerns raised.
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FINAL PLAN |
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AGREED TIMESCALE: Ward to formally close on Friday 31 January 2025. |
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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.