- Background to Healthy Weston and the case for change
- The proposals for decision
- Your feedback
- How we have listened to feedback
- Next steps
A case for change
What is Healthy Weston?
Healthy Weston is the name of the work Bristol, North Somerset and South Gloucestershire Clinical Commissioning Group has been leading since October 2017 together with a range of health and care organisations to deliver high quality, safe and sustainable NHS services that meet local people’s needs now and in the future. It is part of Healthier Together – our Bristol, North Somerset and South Gloucestershire Sustainability and Transformation Partnership.
Since October 2017, the Healthy Weston programme has been looking at how to change and improve local services in Weston-super-Mare, Worle, Winscombe and the surrounding areas including North Sedgemoor.
This includes the future of services at Weston Hospital. Specifically, Healthy Weston has been looking at how healthcare services are organised and delivered, and how they could work better together to provide joined-up care for patients, now and in the future.
In October 2018 we published a Case for Change setting out the reasoning behind the project and why we needed to adapt and re organise the way services are provided.
In Feb 2019 we launched a consultation on a series of proposals. Over 3,000 people responded to this and we published an independent analysis of the responses in August.
A detailed business case was then developed taking into account the feedback received during the consultation. Its recommendations were agreed by the Governing Body on 1st October.Read the Healthy Weston Decision-Making Business Case
Why do services need to change?
We are facing significant challenges which we need to address as a priority:
- Our population is growing, getting older, living with more long-term conditions, and there are significant inequalities in health amongst our local communities – people have changing health needs we need to meet.
- There is variation in the way GPs, primary and community care teams currently provide care across the area, with some patients finding it more difficult than others to access the right care.
- Some of our hospital-based services at Weston Hospital are not able to consistently meet national clinical quality standards because of low volumes of particular cases and specialist staffing shortages.
- There is a growing financial gap between rising costs and available funding. We must live within our means, get best value and make sure we use our available financial resources most effectively to meet the needs of the whole population.
You can read more about these challenges and the case for change – why we need to change how we organise and provide healthcare across primary and community services as well as at Weston Hospital – in the Healthy Weston: why our local health services need to change document, published in October 2018. This is also available to download in our easy read format.
What are the services Healthy Weston has been looking at?
Services include those provided by GP practices, community healthcare services, mental health, the voluntary sector, social care as well as services provided at Weston Hospital and neighbouring hospitals. We think we already have most of the right services available in our area but we could make them work better together to deliver more effective and efficient care for local people.
Who has been involved in this work?
The organisations involved in Healthy Weston are: Bristol, North Somerset, South Gloucestershire Clinical Commissioning Group; Somerset Clinical Commissioning Group; Weston Area Health NHS Trust, North Bristol NHS Trust, North Somerset Community Partnership, South Western Ambulance Service NHS Foundation Trust, Taunton and Somerset NHS Foundation Trust, Avon and Wiltshire Mental Health Partnership NHS Trust, University Hospitals Bristol NHS Foundation Trust; North Somerset Council.
The work to identify the proposals we recommended for consultation, and the other changes to services we are planning, has been led by doctors and other health professionals from across our area. Patients and the public have been included at every stage of the work. Read more detail on the process that was followed.
Why is Healthy Weston important for people living in Weston?
The number of people living in Weston and nearby villages is rising, particularly old people and children, as well as people living with long-term health conditions.
Our population includes vulnerable people, for example, those who are homeless, and people living with mental health problems. This means that the demands on local health and care services are changing and we need to take steps to respond to this so that our services continue to meet the health needs of the local population.
Additionally, Weston Hospital has long-standing challenges in recruiting enough specialist staff to run some services – resulting in the temporary overnight closure of the hospital’s A&E department in July 2017 on the grounds of patient safety.
NHS services in the area are also under significant financial pressure, so it’s important that the future shape of services is organised to work better for patients, while using all NHS resources in the best way possible.
In order to deliver the best, most effective and efficient care for local people, we know that we need to work differently in the future, working in a more joined-up way across different services and organisations.
Healthy Weston sets out how we could go about doing this. This will also help ensure our services are both clinically and financially sustainable by making sure they can deliver to national quality standards and are affordable within the available funding.
What will a Healthy Weston look like?
We want NHS services in Weston-super-Mare, Worle and the surrounding area to be the very best they can be. Patients will benefit from being better supported to stay well, with more people treated in the community and closer to home.
We want to keep people well and independent, deliver day-to-day services locally, and when specialist hospital treatment is required, make sure it is of the highest quality – working to get patients home as soon as they are well enough.
The proposals for decision
So what are the detailed proposals?
The Healthy Weston Programme recommended making the following change to services at Weston Hospital. The change has multiple components which need to be implemented together.
Proposals for Urgent and Emergency Care and A&E
To keep A&E at Weston Hospital open 8am to 10pm, seven days per week, making the temporary overnight closure of the A&E permanent. The A&E would be staffed by a multi- disciplinary team of hospital and primary care clinicians working together. The overnight closure of A&E would be supported by 24/7 direct admissions to the hospital via referrals from GPs, paramedics and other healthcare professionals.
Proposals for Critical Care
- Provide up to Level 3 critical care for people who need support for a single organ at Weston Hospital. This includes short stay post-operative recovery at Level 3 and longer term incubation, where the lungs are the organ requiring
- Transfer people requiring critical care for two or more organs at Level 2 or 3 or people who would benefit from proximity to UHB’s specialist clinical services via dedicated transfer team to UHB.
- Establish a critical care service that is digitally linked to UHB to provide oversight and monitoring from the larger unit of the people who remain at Weston
- Repatriate people following treatment in UHB when care needs can be met at Weston Hospital.
Proposals for Emergency Surgery
- Provide emergency surgery in the daytime only at Weston Hospital. Theatres will close overnight from 8pm-8am.
- People requiring an emergency operation overnight (those who deteriorate on the ward or present to A&E in the evening) will be stabilised and transferred to Bristol for surgery.
- A small number of people who require more complex surgery will also be transferred to Bristol to receive support from specialists unavailable at Weston Hospital.
- Ambulatory pathways for emergency surgery, including rapid access to daily clinics Monday to Friday and a dedicated afternoon emergency theatre session, will be established to improve the quality and responsiveness of the surgical service.
Proposals for Acute Paediatrics (as part of wider supporting changes)
- Specialist children’s staff will be available at Weston Hospital seven days a week from 8am- 10pm.
- This includes extending the hours of opening of the Seashore Centre from 8am to 10pm, Monday to Friday and supplementing the A&E in Weston with paediatric expertise over the duration of its opening hours on Saturday and Sunday.
Are these changes supported by clinicians?
The recommended change has the full support of senior clinicians and health providers across Bristol, North Somerset and South Gloucestershire including Weston Area Health Trust and University Hospitals Bristol NHS Foundation Trust. The South West Clinical Senate encouraged progress “as soon as possible as it considers the current model to be potentially unsafe.”
Does this mean an end to 24/7 care at Weston Hospital?
No it doesn’t. Weston Hospital will still provide 24/7 urgent and emergency care but it will be delivered in a different way through direct referral from GPs and the ambulance service.
The hospital will continue to provide most hospital care for local people and will be able to offer more of the services local people use on a regular basis, such as chemotherapy treatment, delivering much more planned surgery such as knee, hip and cataract operations, as well as continuing to provide access to urgent care services seven days a week.
On any one day, over 80% of Weston Hospital’s beds are being used by patients over the age of 65. It’s important that we meet the needs of our population in the most effective way, and so we also want to develop Weston as a centre of excellence for frailty.
Our ambition is for Weston Hospital to be an exemplar locally and nationally for how smaller hospitals can deliver excellent, sustainable, high quality care for their local populations.
Will people still be admitted to Weston Hospital overnight?
Yes. GPs, paramedics and others will be able to make arrangements for patients to be admitted directly to a Weston Hospital ward if that is the best treatment plan for them.
Will more people have to go to Bristol or Taunton as a result of closing A&E?
No. We estimate that fewer people will need to travel to Taunton or Bristol overnight than was previously the case as a result of the new arrangements for direct admission.
Do these proposals meet the Case for Change?
The proposals do not fully address the challenges outlined in the Case for Change but they are a crucial first step in ensuring that Weston Hospital is able to meet national clinical quality standards in the near future In the long term, these changes will mean the local NHS is better able to deliver value for money and sustainable, high quality services for everyone in Weston.
When was the public consultation?
The public consultation was agreed at the February meeting of Bristol, North Somerset and South Gloucestershire CCG’s Governing Body. It started on 13 February and ran until 14 June 2019.
Where can I read more about the consultation and the long-term vision?
Read more about the long-term vision and work that has been happening over the last 18 months.
Why was it important that local people got involved and gave their views?
We endeavoured to run a robust consultation that everyone could take part in. It was vitally important that we heard the views of local people on our proposals to make sure that they have access to the very best health and care services that meet their needs.
We have worked closely with doctors, partners and the local community in the design of our ambitions for the future and wanted to test them further through the consultation before making any firm decisions on the future shape of services.
Why did you hold a public consultation to ask for views and feedback and not just make the changes you are proposing?
The proposed changes to acute hospital services at Weston General Hospital that have been identified through the work led by clinicians represent a ‘substantial variation’ to current services which means they require formal public consultation before a final decision is taken on any changes.
The purpose of a public consultation is to ensure we have considered the views of local people on our proposals before we make a final decision on what changes to make to local health services.
The consultation also sought to identify any information or evidence that we haven’t already considered, that could impact on the proposals. To note, a public consultation is not a vote or referendum but an opportunity to gather a range of insights, views and feedback on proposals before decisions to make changes are made.
The public consultation is now closed and a final decision about changes to services has been made by the Governing Body of Bristol, North Somerset and South Gloucestershire Clinical Commissioning Group based on all the evidence and information available, including feedback from the public consultation.
Who decides what constitutes a significant enough service change to warrant a consultation?
The local health overview and scrutiny committee for each of the relevant local authorities considers whether the proposals for changes to local health services represent a ‘substantial variation’ requiring formal public consultation (relevant local authorities are those that have residents that are potentially affected by the proposed changes – in this case North Somerset and Somerset respectively).
The Bristol, North Somerset and South Gloucestershire Clinical Commissioning Group Governing Body took the decision to consult at its meeting on 5 February 2019.
Who ran the public consultation?
The consultation was led by Bristol, North Somerset and South Gloucestershire Clinical Commissioning Group (CCG).
Bristol, North Somerset and South Gloucestershire CCG is the organisation responsible for planning and securing healthcare for our area.
What has happened to all the consultation responses?
How we have listened to feedback
What changed as a result of the consultation?
The Healthy Weston Programme revised and enhanced the proposals for change after listening to the views of local people, clinicians and partner organisations. Revisions included changes to how the A&E would be staffed, enabling paramedics and other healthcare professionals to make direct admissions to Weston Hospital overnight, changing which people are able to receive critical care, having a dedicated transfer team for critical care and having rapid access clinics for emergency surgery. The changes made due to the consultation mean that over 2,000 more people will receive care at Weston Hospital each year, whilst still making the immediate essential improvements needed to quality and safety.
What changed as a result of the consultation?
Travel Issues: This included whether it is safe to travel to another hospital, the inconvenience and expense of travel for patients and their family and visitors, difficulties returning home from another hospital, the environmental impact of increased ambulance and car journeys and the lack of public transport to and from other hospitals.
What Healthy Weston did as a result:
- Developed recommendations to increase awareness of the support available for people travelling to and from hospital, particularly for vulnerable groups and people with difficulties travelling.
- Changed the model so that time spent in another hospital would be limited, with transfer back to Weston at the earliest clinically appropriate opportunity.
- Added a new dedicated critical care transfer service to help transport people to and from Weston Hospital.
- Clinically reviewed records and found that overnight closure was safe and did not result in any adverse health effects.
- Explored ways of expanding and locating out-of-hours primary care and access to diagnostics at the hospital, which could prevent people from transferring out of area.
- Looked at digital solutions between the A&E department and primary care to help people access the care that they need in the best location for them.
Capacity of other services: People were concerned about the capacity of other services to cope with the proposals including the ambulance service, other hospitals, transport services and primary care.
What Healthy Weston did as a result:
- Worked with the ambulance service and GPs to identify people who can be directly admitted to the hospital overnight without needing to go through A&E.
- As part of the temporary overnight closure, funding has been provided to the ambulance service for an extra double crewed vehicle, plus £12m more funding has been provided to the ambulance service as part of wider work.
- Supported teams at Weston Hospital to consider new ways that the specialist workforce could work with the A&E department to streamline services.
- Changed proposals for critical care so that people would be transferred on clinical grounds rather than after a certain time, so fewer people would transfer.
- Proposed a new transfer team for critical care with its own staff and equipment so as not to deplete either hospital or affect the ambulance service.
- Worked with local GPs to strengthen primary care, improving access to GP appointments and other specialists.
Population Demographic: We had feedback about local population demographic including size, growth, age and rural location and the number of holiday makers.
What Healthy Weston did as a result:
- Used the most up to date population information from the local authority including house building projections. These are the same projections that are used by local authorities to plan for other services like school places.
- Supported changes to primary care and community services to address the needs of older people, vulnerable groups and those with long-term conditions.
Accuracy and feasibility of evidence and statistics.
What Healthy Weston did as a result:
- Reviewed all of the assumptions to make sure they were accurate.
Used the most up to date information from the local authorities and NHS England.
- Worked with some Weston Hospital consultants to evaluate an alternative proposal for A&E opening hours. When this was evaluated by clinicians as being less feasible, further work was undertaken to incorporate the ideas that the consultants had and improve the proposed changes.
- Sought more external advice from national advisors and Health Education England, the organisation responsible for educating health professionals.
What other changes to services are you making as part of this?
- Introduce a new integrated frailty service that will keep people healthy, well and independent in their community, and reduce unnecessary admissions to hospital.
- Commission a Mental Health Crisis and Recovery Centre in Weston Town centre, open in the evening that will meet the needs of people experiencing extreme emotional distress associated with a mental health problem and reduce the demand on acute hospitals.
Have you taken the proposals from the Weston Hospital consultants into account?
We have had several constructive meetings with the Weston Hospital consultants about the future of services at the hospital and will continue to work closely together.
The alternative proposal put forward by a group of consultants from the hospital has been reviewed against the same set of Evaluation Criteria against which all other potential models had been tested in the process to date.
This evaluation that was done by senior clinicians from across the region was an important step in the process ahead of receiving feedback from the public consultation.
- The hospital consultants who had developed the Alternative Model attended and fully participated in the meeting to evaluate their proposal. The consensus conclusion was that the proposal that was consulted on evaluated more favourably than the Alternative Model and this was mainly because the Alternative Model was too similar to the status quo and so would not sufficiently address the case for change. However, further work was undertaken to incorporate the ideas that the consultants had and improve the proposed changes.
The CSDDG came to the following conclusions:
- There were many similarities between the Alternative Model and the Consultation Model – for example an increase in 24/7 direct admissions via GP referrals and ambulances.
- There were a number of elements of the Alternative Model that improve the Consultation Model – for example the integration of A&E front door team with medical, surgical and trauma & orthopaedic teams, which is not detailed in the consultation proposals.
- There were other elements of the Alternative Model that – upon closer examination – were not deliverable. For example, it was unanimously agreed (including by the doctors that had worked up the Alternative Model) that the proposal to return to a “traditional” 24/7 A&E was not feasible. The key reason for this was on the grounds of patient safety – particularly around the care of children in an urgent care setting, for which national standards have been published since the temporary overnight closure of Weston A&E.
What about travel? Some people are worried about the additional travel requirements.
We estimate that fewer people will need to travel to Bristol and Taunton overnight when A&E is closed as a result of the new approach to direct admissions. However, we know that travel remains a key issue for many people.
We will increase access to information by:
- Promoting the support available for the local population to access healthcare including the Healthcare Travel Costs Scheme, patient transport services and community transport services.
- Providing information at hospitals, GP surgeries and other sites about local transport links.
- Providing training to hospital reception staff to support people to travel from hospital.
- Ensuring compliance with Accessible Information Standards.
For hospital services we will:
- Work with providers to minimise discharge from hospitals at night especially for vulnerable people.
- Provide a safe place for people to wait following discharge from A&E until appropriate transport becomes available.
- Provide preferred parking sites for community transport providers.
And we will also develop an Integrated Transport Programme to improve access to healthcare across the region. The intention is to achieve this objective by joining-up transport planning, commissioning and service delivery between Local Transport Authorities (LTAs) and healthcare system.
What happens next?
Indicative timelines for implementation
Proposals for Urgent and Emergency Care and A&E:
- A&E opening hours can be implemented Oct 2019
- Commence recruitment to enable implementation of GP at Front Door Model
- Increased overnight admission pathways established Apr 2020
- Commence alignment of operating policies and planning for workforce integration through Clinical Practice Groups Oct 2019
- Implementation of operating policies Oct 2019
- Digital monitoring solution between the two departments implemented Apr – Jul 2020
Proposals for Critical Care:
- Estate changes are required at UHB to enable implementation of the proposals, 18 month lead in from decision anticipated Apr 2021
- Dedicated transfer team established to support implementation of the critical care activity changes.
- Initiate implementation of ambulatory emergency surgery model
- Ambulatory emergency surgery model operational Apr 2020
- Phased implementation of changes to overnight theatre access and the GI bleed rota Apr 2020 – Oct 2020
Proposals for Emergency Surgery
- Commence alignment of operating policies through the general surgery and gastroenterology clinical practice groups Apr 2020
- Implementation of operating policies Oct 2020
- Changes in complex emergency surgery
Proposals for Acute Paediatrics
- Implementation (allowing for recruitment lead in times) Apr 2020