Specialist services

Specialist services2017-11-30T18:53:39+00:00

Proposal for specialist services

Certain more specialist services which need a hospital stay should be concentrated in one place, where this would improve your care and chances of making a good recovery.

Background

There is clinical evidence that where there are small numbers of patients requiring the care of highly trained specialists, there are benefits in concentrating these services in one place so that one team is able to treat the greatest number of patients each year.

This means:

  • A larger specialist team can make sure that the right number and level of skilled staff are available should you need specialist care at any time of the day or night, 365 days of the year, providing fast access to the highest quality care for patients.
  • By seeing more patients, specialists can further develop their knowledge and skills to achieve better results.
  • A larger team can develop as a centre of excellence and be in a better position to be involved in research and innovation.
  • A larger team has greater opportunities for development, training and career progression. This can improve our ability to attract and retain talented people and deliver the best care for you.

In each proposal, routine services, such as outpatient appointments, tests, and surgery and treatment that can be done in a day would continue at all three local hospitals. 

Our proposed changes are only concerned with specialist surgery and treatments that require a hospital stay.

Our proposed locations for bringing together specialist services are based on:

  • Where there are already established specialist teams, together with facilities and equipment
  • Where there are important links between different specialist services which require shared expertise and close relationships between expert teams.

We would like to know your views on bringing together in one place
the following specialist services that need a hospital stay:

Women requiring gynaecological surgery who need a hospital stay would be treated at Southend Hospital

Gynaecological surgery covers surgery on the female reproductive system. Most procedures are done in a day and this would continue at your local hospital. The proposed change is for more complex operations that would require a hospital stay of three to four days.

  • Currently, emergency and routine gynaecological services are offered from all three main hospitals.
  • Southend Hospital is developing a range of surgical expertise in cancer and some patients already travel from Basildon to Southend for gynaecological cancer treatment.
  • We propose to bring together specialist gynaecology expertise at Southend Hospital for all women who need a hospital stay of more than 48 hours.

What this means:

  • Routine outpatient, day case and short stay gynaecology services would continue to be available at all three main hospitals for both emergency and planned care.
  • The proposed change mainly affects women in mid Essex who need specialist gynaecological surgery who would go to Southend Hospital and not to Broomfield Hospital, as they do now
  • Southend is the proposed location because it makes sense to bring specialist gynaecology surgery together with the existing expertise in cancer treatments at Southend.

Patients requiring a hospital stay for complex lung problems would be treated at Basildon Hospital

Complex respiratory problems could include severely collapsed lung, disease of the lung lining or lung disease with complex oxygen requirements.

  • There are good standards of care for breathing problems in all three hospitals, but respiratory specialists are not always available 24 hours a day in all three hospitals.
  • A round-the-clock specialist inpatient service for patients with complex lung problems would improve care and recovery and help people to avoid long term problems, such as becoming immobile.
  • We propose to maintain the majority of services for respiratory care at all three hospital sites, with the addition of a specialist respiratory ward at Basildon Hospital.

What this means:

  • Routine outpatient, day case and short stay services would continue to be available at all three main hospitals for both emergency and planned care.
  • If you were very poorly as a result of breathing problems, you would be taken to your nearest hospital, where you would be seen and stabilised in A&E.
  • Following stabilisation, we would expect to be able to treat your condition within a day or with a short hospital stay of 24 or 48 hours.
  • Should you need more specialist care and a longer stay in hospital, then you would transfer to the specialist respiratory ward in Basildon.  Here you would receive treatment and a team of specialists would be able to plan your ongoing care.
  • The reason for choosing Basildon as the location is that we could maximise our expertise with links to the cardiothoracic centre in Basildon.

Patients with complex kidney problems who needed a hospital stay would be treated in Basildon

Complex kidney problems could include problems following a kidney transplant, or a serious kidney injury.

  • There are good standards of care for people with kidney problems in all three hospitals, but specialist care varies across the three hospitals.
  • One specialist team across all three hospitals would increase the availability of senior specialists for all patients and minimise the degree of kidney injury.
  • We propose to maintain the majority of kidney services at all three hospital sites, with the addition of a specialist ward at Basildon Hospital.

What this means:

  • Routine outpatient, day case and short stay services would continue to be available at all three main hospitals for both emergency and planned care including haemodialysis.
  • The specialist team at Basildon would be able to support clinicians in each local hospital, including the A&E team, to ensure consistently high quality local care.
  • If you needed a hospital stay and specialist treatment you would transfer to the specialist team at Basildon.
  • The reason for choosing Basildon as the proposed location is that there are strong links between kidney and cardiovascular services, so it makes sense to have specialist services on the same site as the cardiothoracic centre.
  • Very complex care such as kidney transplants would continue to be provided in the London and other specialist centres, as they are now.

Patients with diseased arteries or veins would be treated at Basildon

Vascular disease is caused by inflammation of the blood vessels, which can interfere with the blood flow to vital organs. Vascular disease is a common cause of strokes and blockages in arteries.

  • Emergency specialist vascular services are not always available on all three hospital sites. Specialist emergency care rotates between the three sites, which means that patients currently go to whichever hospital is providing specialist vascular expertise on that day.
  • There is evidence nationally that a joined-up vascular team from several hospital sites improves care quality and patient outcomes, because of the greater number of patients they treat.
  • Given the important links between cardiac care and complex vascular services, we propose that a specialist vascular hub should be located near the cardiothoracic centre for heart and lung operations in Basildon. This would also be close to interventional radiology, a type of camera-guided surgical technique, which avoids the need for open surgery.

What this means:

  • Routine outpatient, day case and short stay services would continue to be available at all three main hospitals for both emergency and planned care.
  • If you needed a complex vascular operation that required a hospital stay, your GP would refer you to the proposed vascular hub in Basildon.
  • In an emergency situation, you would go to your local A&E for assessment and stabilisation, and then transfer to the vascular hub for specialist surgery.
  • Your surgery in the vascular hub would usually require only a short stay of up to 48 hours, after which you would return home or to your local hospital for further support and recovery.
  • Routine operations, such as treatment of veins in the legs, would continue at all three hospitals as day cases and short stay operations.

Patients who needed a hospital stay for specialist treatment of complex heart problems would be treated at Basildon

  • Currently, all three main hospitals offer outpatients and short stay heart treatments.
  • The Essex Cardiothoracic Centre in Basildon has been established for over 10 years as the specialist centre for heart and lung problems. Patients from all over Essex have been going to the centre for both emergency and planned operations, and this has improved outcomes.
  • Patients who experience a serious heart attack are already taken to Basildon, usually direct by ambulance for life-saving care.
  • We propose to build on the expertise of the Cardiothoracic Centre to give you quicker access to this specialist service.

What this means:

  • Outpatients and short stay treatments would continue to be available locally. For example, treatments for chest pain and erratic heartbeat would be at your local hospital.
  • For more complex problems, such as needing a pacemaker or unblocking arteries, you would in future be referred quicker than now to the Essex Cardiothoracic Centre in Basildon.
  • Patents who experience a serious heart attack would continue to go to the cardiothoracic centre, either via your local A&E or direct by ambulance as they do now.
  • The cardiothoracic centre would continue to provide complex planned operations, such as coronary artery bypass as it does now.
  • Most people would stay only two to three days in the cardiothoracic centre, after which they would go home or back to their local hospital for further care and cardiac rehabilitation.

Patients with complex gastroenterology problems who needed a hospital stay would be treated at Broomfield Hospital near Chelmsford

Complex gastroenterology problems could include severe liver failure, intestinal failure requiring nutritional support or pancreatitis.

  • There are good standards of care in all three hospitals for people with gastroenterology problems, but specialist care varies across the three hospitals.
  • One specialist team across all three hospitals would increase the availability of senior specialists for all patients.
  • We propose to maintain the majority of gastroenterology services at all three hospital sites, with the addition of a specialist ward at Broomfield Hospital, near Chelmsford.

What this means:

  • Routine outpatient, day case and short stay services would continue to be available at all three main hospitals for both emergency and planned care, including endoscopy.
  • A specialist team, potentially at Broomfield, would be able to support clinicians in each local hospital, including the A&E team to ensure consistent high quality local care.
  • If you needed a hospital stay and specialist treatment, you would transfer to the specialist ward at Broomfield.
  • Very complex care, such as liver transplants, would continue to be provided in the London specialist centres, as they are now.

Proposals for a dedicated service at Broomfield Hospital for emergency general surgery that requires a hospital stay

General surgery that requires a hospital stay would include major operations on the abdomen.

  • All three sites currently offer a wide range of inpatient, outpatient and daycase general surgery services and this will continue.
  • There are sometimes delays for people who need complex emergency surgery, which could be avoided if there was a single dedicated emergency surgical team and theatre facilities in one place.
  • In order to separate some emergency from planned surgery, we propose that some complex emergency operations should be provided from a dedicated emergency general surgical team at Broomfield Hospital, which already leads on some complex general surgery.
  • Some complex surgery is already provided at Broomfield as the lead for all three main hospitals. This includes:
    • Ear nose and throat and facial surgery which needs a hospital stay
    • Upper gastro-intestinal surgery which needs a hospital stay
  • We propose to add to this arrangement, for example, complex surgery for bowel problems (except for cancer which would continue at Southend).
  • Routine planned and emergency surgery which could be performed as a day case, with no requirement for hospital stay would continue at all three hospitals.

What this means:

  • If you had severe stomach pains, for example, you would go to your local hospital via A&E for assessment and treatment.
  • If you needed an abdominal operation that required a hospital stay, you would transfer to Broomfield Hospital in Chelmsford.
  • Two to three days after your operation, ideally you would go home if you had made a good recovery, or you might return to your local hospital for further care.