Second Public Meeting – 23 January 2002
Neale-Wade Community College, March.

A No, option appraisal had to be included in the Strategic Outline Case document. Costings for ECH were already known but for the PDH option, some assumptions had to be made based on building improvements. Less money would be spent on PDH; therefore running costs would be lower. In reality, once the appraisal is taken to the next, more detailed stage, the costs will probably rise. Cost issues include difficulties in expansion due to the city location, and providing extra facilities for patients whilst the build takes place. ECH would seem to be the better option in terms of patient quality and even if the costs are high, improved healthcare is preferable.

A Main benefits for private sector in PFI schemes are profit, a cash flow and income stream over a 30-year contract period.

A Under PFI, after a 30-year contract, the property returns to NHS ownership. It has been bought and paid for and is NHS responsibility. During the course of the contract, there would be potentially break points for market testing or re-tendering of services, to demonstrate VFM.

A Current NHS rules state that significant land disposal (over £1m) go back to central government. PNHST is a 3* trust. Alan Milburn gave a recent speech which indicated that 3* trusts will have greater freedom in the future, including retaining 10% proceeds from sale of land.

A This is an issue for the South Fenland area both logistically and in terms of availability of site. Both are potentially problematic. The range of services that locals require has to be considered as this will influence location. Services are already provided at Doddington Hospital, and this may be a good site for one of the local facilities. GP services are being linked into the centres to provide access, backup, diagnostic support and cover during the out-of-hours period.

A Patient percentages show that Fenland area only produces about 14 % of patients so the bulk of the capital will inevitably be around the development area. Good opportunity to make PHNHST a showcase for the rest of the NHS and PCT views are very important in assessing the needs of the whole community. Activity from Fenland is between Peterborough, Hinchingbrooke and King’s Lynn, which makes it harder for the PCT to consider resourcing a local facility.

A Service provision has to start immediately to address this issue. GPs agreed at the Clinical Conferences that a refocus is needed and changes are necessary. This will include consultant appointments, telemedicine in local practices and more one-stop services like the cataract service. The Transformation Project at PHNHST will look at delivery and streamlining of services. Anti-coagulation services and specialist nurses are seeking to move into the community to improve access to patients.

A 2 practices are located in Marylebone currently but there are plans for one of the practices to relocate in March. The remaining practice can then expand its workforce to relieve pressure and also improve their services to potentially provide x-ray facilities, pathology testing and beds. There are currently no minor injury unit centres in March and this would be a good reason for locating a bigger facility in the area if that is what the locals wish to see.

A Resource centres could relieve the pressure on the PHNHST redevelopment, so the idea is that these sites would be up and running before the main building starts.

A Training accommodation only is provided at the hospital. Part of the reason for trying to make the development a showcase is to attract staff and try and encourage people to come and live in the area. Discussions with housing associations and the district council are a possibility to work together to provide housing that will attract staff.

A After the consultation process is complete, the Fenland situation will be investigated. If insufficient money is available the major stakeholders would have to be consulted. PFI is different from traditional procurement schemes in that the Trust pays off the costs gradually from the revenue stream. If Fenland people state that they want a centre in March, then PHNHST would support this and would attempt to organise funding accordingly.

Janet Feary

A It is more the later, but the service will also concentrate on women’s specialties like breast surgery, with pre-care and counselling.

Q There was fundraising by Jimmy Saville some years ago for a children’s hospital, will there be some facility like this planned?

A Not a stand-alone unit. Derby opened a children’s hospital that was closed down shortly afterwards. The children’s services will be made more of a unit, to reflect children’s needs in the future and will be closely linked with women’s services.

A PHNHST is looking to increase service provision in March and Stamford. The challenge for the NHS is that the NHS Plan needs to be delivered, so services will have to be modernised i.e. electronic patient records.

A Figures are purely based on patients using the hospital and the data comes from postcodes. Local authority population growth assumptions have been looked at for each of the districts and the fastest growth comes from March, South Lincolnshire area. The growth in planned services is based on our growth in emergency (about 3% a year), whereas population grows at about 1% a year.

A Doddington is a valued facility but logistically are the services in the right place – this is the problem we are trying to resolve at the moment. Public transport situation is very bad also.

Emphasis so far in the debate has been resolving Peterborough issues if the one-site option goes ahead, but there is a real opportunity now to improve facilities for the March/Fenland area, allied to this scheme. We must now encourage locals that this needs to be given serious consideration by the new Strategic HA.

A The public transport issue is not part of PHT’s remit, however one of the proposals is that a dedicated hospital bus will pick up passengers/visitors from Queensgate and the railway station and take them to the hospital. The service will work on a regular loop, every 15 or 20 minutes.

Intermediate health care centres will reduce travel to the acute site for residents in this area as well as south of Peterborough, i.e. Whittlesey, Yaxley. Diagnostics and minor treatments can be undertaken. Another challenge is to recall services from Cambridge, i.e. haemodialysis for kidney patients is now available at PHT. A plan is being put together for radiotherapy services on the new development, as currently only palliative care can be offered.

Stamford Hospital facilities will be retained and expanded upon. There is a planed investment for this site.

A 20 years ago an operating theatre was built and a local anaesthetic theatre. It is now quite old and needs replacing. Our plans are now to build 2 new operating theatres in Stamford.

A The new hospital should be ready by the end of 2007. Beds in local care centres should be available before this date. We are hoping to attract staff to a new super hospital. However, Stamford does not have the same ageing GP problem that Peterborough experiences. Co-ops have produced a huge impact on the working lives of GPs and will attract them to areas like Stamford. Lincolnshire has just been designated a teaching PCT, which is a positive step in attracting nurses, midwives, GPs. NPCT has also received teaching status. There is currently a project running in Peterborough to discuss a reorganisation of the out-of-hours service for the future.

A The Government have set up a body called the Commission for Architecture in the Built Environment to look at new hospital schemes and require planners to pass certain architectural criteria. The hospital corridors are very long at present but new designs mean that the hospital will be divided up more into sections. The main entrance will be nearer to the car parks, as will the bus stop. This is possible because of the surrounding land at ECH, this would not be possible in the land-locked site at PDH.

A Stroke services around the country are poor, some hospitals still do not have an acute stroke unit. A national service framework for older people is trying to address this issue. The HIP plan is to have an acute element as well as a rehabilitative element in the community – which is a strong function for the intermediate care centres.

A PHT is slowly becoming a teaching hospital, and will supply teaching services to Cambridge and Leicester. PHT can now be described as an associated hospital of Leicester Warwick Medical School. PHT does attract consultants for the very reason that it is not a teaching hospital.

A Cost of transport is a serious worry that PHT is trying to address. Intermediate health centres will mean patients do not have to travel so much in the future. Issue of shifts are being tackled. IZ has been upgraded but is still a cramped area because there is not much room for expansion in PDH.

A The plan focuses mainly on hospital care and primary care but angiography services are developing at PHNHST so that cardiology work can now be carried out locally. All 3 options are being costed, with growth in population, funding is increased and enough additional income will be available to fund the planned services.

A Presentations have been delivered to local groups, i.e. Parkinson’s disease and this issue was raised. The number of specialist nurses is to increase due to demand, as the role develops, funding is sometimes taken over by PCTs. However, if charities assist, more services can be offered.

A Compulsory purchase is little used today and would present immense difficulties with this option. A proposal has been made to put on a dedicated bus service to pick up hospital passengers on a permanent loop system from Queensgate and the railway station and then on to ECH. This would run regularly (every 15 mins). Another problem is that the local bus services are inadequate in the evening, but unfortunately this is not the remit of PHNHST.

PHNHST’s sentiment is that, although transport remains a problem, plans for a new hospital and local care centres in Peterborough should not be compromised.

A 3 options are being considered. From a clinical viewpoint, a one-site option is preferred. Each option is being thoroughly explored but PDH is a problem in terms of expansion. The site is land-locked as opposed to ECH, on a green-field site.

A Patient’s health problems 30 years ago are very different to patients of today. More is dealt with in the community and hospital inpatients are usually more seriously ill, with more complex needs. When there are split sets of medical and nursing staff, it is very difficult to provide a coordinated package of care. We need to look at one site to provide the best care for the patient.

A Maternity, SCBU, children’s’ outpatients and wards, children’s A&E will all be together in one unit. In the Women’s Unit, obstetrics and gynaecology patients can be housed in adjacent units and breast cancer patients can be cared and counselled in a separate area.

A Termination of pregnancy patients will also to be considered in this. The unit reflects where clinical services are sited but segregation will occur. Maternity would stay a separate unit.

A 690 beds are currently available across both sites. 100 extra beds have been envisaged in the SOC. This takes into account population of growth. These would be divided between the acute site (60) and community care centres (40). Numbers are based on a formula from the National Beds Inquiry. The occupancy of beds currently is very high and it is hoped in the future that beds will run on 82% occupancy. This would reduce pressure and enable staff to use beds more effectively.

A Both views have been expressed. 50% single rooms are proposed following NHS Government guidelines. We are required to produce a plan to produce up to 50% single rooms and to formulate whether or not it is achievable. There is more flexibility with gender separation with a larger number of single rooms.

A This is useful feedback.

A The focus in the local health centres will be on care. This is more of a Social Services issue though and needs to be addressed separately.

A There is an on-going process with these services. PHT is hoping to provide radiotherapy services in the acute site. Kidney dialysis services have already been relocated from Cambridge.

A A travel study has been performed to gauge travel patterns. A green travel plan has to be created now for the town planners. We will try to go for as many parking spaces as possible. The argument about fees has been noted.

A The document is the first cast of headline numbers. There are more options for a new building on ECH, to provide a better health service in Peterborough, though it is the more expensive option. The ‘do minimum’ option is cheaper because it involves less building but it delivers the least in terms of the NHS Plan and quality improvements. A decision will be taken on the basis of feedback from the public consultation, castings and quality assessments and the benefits that each option can deliver.

Mary Cooke

A The government’s target is to attempt to recruit 2/3 thousand more GPs over the next few years but even these figures are not high enough. The reality is that GPs are training and then disappearing into more specialised roles as a more attractive option. Primary care work will be a more appealing role in the future if changes are made to the ways in which GPs work. Early retirement needs be addressed also. GPs treat too many minor illnesses that nurses could treat, instead of concentrating on chronic illness. One vision for the future is that GPs will not necessarily be the first point of contact for a patient, a trained individual could triage patients and direct them to the most appropriate person to treat them; be it a nurse, physiotherapist or doctor.

Intermediate care will provide up to 40 inpatient beds for some elderly patients (e.g. recovering from a major operation), and they will remain under the care of the GP, supported by nursing staff. Some patients, who occupy acute beds at present, are there for social reasons, these admissions can be reduced by more use of rapid response. Hospital-at-home can also be expanded by providing medical facilities in the patient’s home. These facilities are better for the recovering patient and need to be expanded.

A Treating patients in the community also pertains to those with long-term conditions. Specialist services do need to be put in place to free up GPs where their time is used inappropriately. There are a range of specialist nurses, i.e. Parkinson’s nurses, MS nurses, nurse consultants, whose services are recognised and will be more so in the new model of care in the future.

Q Will neurology services be catered for more in the new hospital?

Negotiations are ongoing to expand support funding for specialist nursing.

A PFI is a matter of government policy and the mandate is to execute this policy. For projects of this size, PFI is the only realistic option. The issue then is, should no changes be contemplated, or should numerous minor projects be publicly funded, as an alternative of the idea of a super hospital. Staffing is also mandated by government policy. If experiments in the retained employer model are successful, it is possible we will be directed to execute the PFI scheme with the retained employer model. Government and unions are currently examining 3 pilot sites where proposals have been invited from the private sector about staff remaining within the NHS.

A The aim of the project is to provide services centrally, i.e. outpatients and diagnostics in the care centres. One proposal in the plans is to bring in a dedicated hospital service, to loop between ECH, Queensgate and the railway station. Local bus companies will be lobbied to provide additional transport. A meeting has already been held with ethnic minority leaders to make sure the plans are fully understood by the community.

Peterborough Pensioner’s chairman

A These comments have been noted.

A Norfolk and Norwich was in the first wave of PFI schemes, 5 years ago. PFI contracting process has vastly improved since then and is a much slicker process. Fenland Wing had building problems when it first opened many years ago as a publicly funded scheme and this can happen to any new building, however it is funded.

A All 3 options will be considered. Developing PDH would be very disruptive and services would need to be relocated.

A Cost of services will need to be estimated, it will not be a free service.

A If we cannot secure a PFI deal, it is very unlikely that we could secure public funding.

A Patient transport services are of a high quality and are regularly assessed for quality of care, this would continue into the future. Community care centres are consulted on the level of service. In terms of emergency transport, this continues to improve.

A Follow-up head injury clinics are starting to form through A&E dept, this will be developed in the future. The neurology rehabilitation team will be re-housed in one of the new intermediate care centres. National plans for head injury patients are being considered and services will be provided if we have professionals with the appropriate level of skills in the area.

A All comments are taken on board.

A Thank you for your comments.

A 100 more beds.

A This is opening a very wide debate, which needs addressing.