Working together to deliver a health service for the 21st century

1. Introduction

The health investment plan is being drawn together by Peterborough Hospitals NHS Trust, North Peterborough, South Peterborough, SW Lincolnshire and Fenland Primary Care Trusts, and in consultation with Peterborough City Council through the Local Health Partnership Board.

The area has a higher than average annual population growth. The catchment population is forecast to exceed 310,000 in 2010 and 340,000 in 2020. (Source: Cambridge and Lincolnshire County Councils)

The Cambridgeshire county structure plan shows an additional 18,000 houses will be needed in the Peterborough and north Cambridgeshire area by 2016. An example of this expansion is the Hampton development in south Peterborough, one of the largest privately funded new townships in Europe.

Ø local GPs, health centres and community nurses;

Ø community hospitals in Stamford and Doddington;

Ø mental health facilities at the Gloucester Centre, Lucille Van Geest unit and The Gables in Peterborough;

Ø a NHS walk-in centre in Peterborough city centre; and

Ø the Peterborough District and Edith Cavell Hospitals.

· Establishing one of the first NHS walk-in centres in the country

· A one-stop cataract service with patients being referred from the optician direct to the eye specialist at the hospital

· Tests and results are transferred electronically between hospital and GPs

· GP involvement in developing hospital or community treatment for patients

· An award for quality for developments in urology and outpatient services

· The use of computer technology (telemedicine) to link hospital consultants and GPs

· GPs, rapid response teams, and social services working together to help patients avoid an unnecessary hospital admission by providing patients with the right care in the right setting at the right time - 24 hours a day.

· At peak times there are insufficient beds to accommodate all emergency and elective patients so planned operations have to be cancelled, leading to increased waiting times

· The lack of operating theatres leads to cancelled operations and longer waiting times

· Most hospital beds are occupied more than 90% of the time, at peak times this impacts on the quality of care

· Urgently needed beds are occupied for long periods by patients awaiting community care

· The fragmented system is wasteful, expensive and difficult to staff

· More medical staff are required at the hospitals for patient safety than would otherwise be necessary

· Our Royal Colleges’ training accreditation in some specialties is seriously threatened by our poor hospital facilities

· The combination of pressures mean NHS performance targets will shortly be unachievable.

· Many health care facilities are in poor condition, cramped and will not be able to expand to provide the new community services

· There is a problem recruiting GPs and other key health staff

· Patients have to be transported by ambulance between wards and hospital sites to accommodate emergencies

· Patients have to travel to hospital for services that could be easily provided in their local community

· There is a backlog maintenance bill for the Peterborough District Hospital and the maternity unit approaching £8 million

· An independent risk assessment concluded that the current split site arrangement of our hospitals represented the local service’s biggest single risk to patient safety.

1. The introduction of a new level of service that sits between primary care (GP surgeries and community services) and hospital services. This is called intermediate care.

It is proposed that this intermediate care will provide a wide range of services based in three health care centres operated by primary care trusts, each serving a population of approximately 100,000 people.

The range of intermediate care services provided in these health care centres may include:

· Beds for rehabilitation and short term emergency support for those who don’t need hospital care but who can’t be supported at home

· Diagnostic and therapy services

· GP surgeries

· Community services, including mental health services

· Minor injuries service or walk-in centre

· Outpatient clinics, and

· Palliative care.

2. The expansion and changes to primary care and hospital services to meet future demands and move non-urgent care closer to peoples’ homes.

The main developments will mean:

· Providing GPs and nurses with specialist training to undertake some routine work currently done in hospital to provide faster and more local access (eg. minor surgery, basic diagnostics and management of long-term illness)

· Increasing the 691 beds within the health system by about 100 while allowing space for future growth

· Increasing the number of surgical procedures carried out as day cases, thereby reducing the time patients need to spend in hospital, where this is safe and desirable for the patient

· Providing more clinics in GPs’ surgeries using new technology to book hospital appointments, order tests or report results

· Providing more consultant clinics in the community with greater use of computer technology and ‘telemedicine’

· Building in provision for Linear Accelerators (a highly specialised radiotherapy treatment) as part of an expanded radiotherapy service for cancer patients in Peterborough (currently patients have to travel to Addenbrooke’s Hospital, Cambridge).

3. The provision of new, modern facilities, located where there is space for future growth and easy access.

The building programme will cover:

· The three new health care centres and investment in other health care facilities

· A multi-professional training and education centre on the main hospital site with computer links to GPs and the new health care centres

· The merging of the city’s District Hospital and Edith Cavell Hospital on to the Edith Cavell site, and

· The development of a high-tech diagnostic and treatment centre on the Edith Cavell Hospital site providing fast, one-stop access to diagnostics and routine day surgery.

All the local NHS trusts, health authorities, primary care trusts, the Community Health Council and Peterborough City Council, believe the proposals set out in this document present a real opportunity for improved patient-centred care, providing a modern and efficient service fit for the 21st century.

· there will be better use of beds,

· a reduction in waiting times, and

· much more effective use of qualified specialist staff and equipment.

· The extra 25,000 patients the service will need to treat will account for a further £5 million

· The remaining £3.5 million will be spent on providing the new hospital services and maintaining all the new facilities.

§ Clinically safe and of high quality

§ Operationally viable and usable by patients, staff and the public

§ Acceptable to all the NHS partners, social services and other interested parties

§ Affordable without draining money from other local health services

§ Able to meet current and future workloads and sustainable in the long term

· Where the new health care centres should be located

· Which option for the hospital development will provide the best solution, and

· How we can ensure our health services are accessible for everyone.

 

1 - New local services - minor injury/health care centres

The aim of the health investment plan is to make the local NHS more accessible and responsive by moving care out of hospital and nearer to patients’ homes.

This involves the redevelopment of our existing community services and the provision of three new health care centres. The suggested locations are:

Ø One could be somewhere in the Peterborough city centre

Ø A second centre could be located south of the river Nene to serve the population covering the Ortons to Whittlesey

Ø A third centre could be located in the south Fenland area in March, Doddington or Chatteris

These three health care centres will cost between £2 and £6 million each, depending on the range of services they provide.

 

2 - The options for the hospital development

We have identified three options that come close to meeting the needs of patients. These are:

Option 1: Do minimum

This option would cost an initial £56.3 million and £85.8 million a year to run. It is the minimum investment necessary to meet the needs of local people and the governments NHS Plan standards. It includes a general upgrading of existing facilities, eliminating the maintenance backlog, providing single-sex facilities, duplicating some high-tech diagnostic equipment and staffing on each hospital site and some minor changes to patient services.

Hospital services would remain split across the three sites, maternity services would remain separate to the children’s services at the District Hospital. In areas currently below standard there would be limited improvement.

This option does not include the new health care centres and only limited investment in community services.

Option 2: One hospital at the Edith Cavell Hospital

This option would cost £135.1 million to build and £88.7 million a year to run. All hospital services would be on the Edith Cavell site, including emergency services, patients waiting for surgery, maternity, children’s services and a diagnostic and treatment centre.

Option 3: One hospital at the District Hospital

This would be the most disruptive and expensive option. The site is already overcrowded and there is no room for expansion. It would cost £142.2 million to build and £87.9 million a year to run. All hospital services would be on one site, including emergency services, patients waiting for surgery, maternity, children’s services and a diagnostic and treatment centre.

However the existing buildings, and particularly the tower block, are not easily adaptable and so many services would continue to be provided in cramped accommodation. Patients’ journeys around the hospital would remain complicated.

An analysis of the options by local health professionals showed that having one hospital at the Edith Cavell Hospital was the most preferable option based on:

· The greatest level of patient benefits

· A significant level of investment and services switched to GP and community services

· A shorter building time than the District Hospital option and much less disruptive to patients and staff

· Meeting all the requirements of the NHS Plan and local health improvement plan

· A service level the NHS can afford

 

3 - Access for patients

Although more community-based services will reduce the need for a hospital visit, this will be unavoidable for patients needing operations or more specialist treatment. Therefore local access to hospital services is important.

Access to Peterborough District Hospital (PDH)

The District Hospital is near Peterborough city centre and close to the public transport hub. However, a very recent transport study showed that only 7% of patients came to hospital by bus. The vast majority, 86%, travelled by car, motorbike or taxi. The remaining 7% travelled by train, cycled or walked. (WS Atkins Travel Survey, June 2001)

This presents a major problem for parking at the PDH. The hospital generates large volumes of traffic and adds to city centre congestion. The travel pattern also reflects the rural nature of the population that is growing fastest in out-of-town locations around Peterborough and in south Lincolnshire

Access to Edith Cavell Hospital (ECH)

The Edith Cavell site is two miles from the PDH, well situated on the parkway system and A47 at Bretton Gate. The location of the hospital fulfils a major requirement for fast access to the accident and emergency department by ambulances. There is more room for parking and the excellent network of major roads makes the site more readily accessible for the majority of people. (WS Atkins Travel Survey, June 2001)

Service planning, transport and the environment

In the wider context of the environment, pollution and road congestion, local authorities, businesses and public services will have to encourage a change away from reliance on the car to greater use of buses and other forms of public transport.

Therefore any change in service must consider the wider impact on the environment. Peterborough Hospitals NHS Trust is working with the Peterborough City Council to develop a travel plan for the Edith Cavell Hospital site.

The travel plan will also focus on the need to provide the fastest possible access to the city’s accident and emergency department.

Case Study South Derby Hospital Trust faced a similar problem to that in Peterborough. The preferred location for the new hospital was less well served by public transport. The problem was overcome by introducing a health hopper shuttle bus service. This is a solution the Trust is actively exploring to solve the access problem at ECH and to help meet the travel plan targets. The health hopper would run frequent services between the Queensgate Centre, the train station and the Edith Cavell Hospital.

The local health services, including the ambulance service, believe the Edith Cavell Hospital site, with a direct link from the A47, will provide the fastest possible access for patients who need emergency care. The introduction of a health hopper bus can provide an acceptable solution to the problem of bus access to the hospital.

 

· What services should the health care centres provide and where should they be located?

· Which option for our new hospital will provide the best service?

· How can we ensure everyone has easy access to healthcare services?

Although the timetable can only be provisional at this early stage, completion of the new hospital is unlikely to be before autumn 2007, although the mental health development and the intermediate care facilities should be open well before then.