Agenda item

To consider the report of the Director of Transformation and Governance on proposals from the NHS or providers of health services to vary or develop health services in the area of the Committee.

Items for Monitoring

a.    Orthopaedic Trauma Modernization Pilot (Hampshire Hospitals Foundation Trust)

b.    Spinal Surgery Service Implementation Update (University Hospital Southampton)

Items for Monitoring 

a. Orthopaedic Trauma Modernization Pilot (Hampshire Hospitals Foundation Trust) 

Representatives from Hampshire Hospitals Foundation Trust confirmed that the pilot is 12 weeks into the changes and reported on progress to date from the 2 December reconfiguration due to end in March 2020.  

Members heard:

The Trust is working closely with South Central Ambulance Service (SCAS) for transporting patients safely to sites.  

There have been changes to processes and pathways to cope with additional demand and capacity.  Models have been successful in predicting bed capacity.  

Consultation exercises with staff highlighted concerns such as disruptions or changes to work location which have been addressed.  The feedback now is positive with good working conditions, as well as supervision and training opportunities for junior work force.  Successful recruiting of new staff has led to the highest staff in post for trauma staff.  

A comprehensive dedicated system with specialist nurses, Hampshire County Council community partners, and Integrated Intermediate Care services has allowed for moving patients who need supported discharge and improvements have been noticeable.  

The general election purdah effect was taken into consideration during the consultation.  Outcomes of further consultation and engagement surveys will continue to be considered alongside collaboration with Healthwatch.

Transport was a concern and actions taken on that front, making sure up to date information is available to patients, carers, and families regarding changes in travel between Winchester and Basingstoke with clear signposting and robust ambulance coverage. 

Previously, the quality of trauma and orthopaedic care and fatality rate was higher than the national average.  There were long wait time issues, longer stays in hospitals, and cancellations during winter pressure periods.

Centralization was undertaken to address these issues.  People can be treated quickly with access to the right surgeon for the right, timely treatment with better outcomes.  A dedicated rehabilitation unit provides further benefits returning patients to pre-trauma condition with reduced time in hospital. 

Those in pain have not had planned operations cancelled as those beds have been ring-fenced.  Emergency departments continue to carry on and only a small number of people need to be moved.  

Looking at patient outcomes, times, and quality of care, data for the test period has been collated and reviewed with partners.  The Trust is grateful for the support of patients, staff, and partner organizations.   

RESOLVED -

That the Health and Adult Social Care Select Committee:

a.    Noted the implementation update, engagement data, and current challenges as well as any recorded issues addressed and/or resolved 

b.    Requested a further update on outcomes in September 2020

b. Spinal Surgery Service Implementation Update (University Hospital Southampton)

Representatives from University Hospital Southampton provided an update on the transfer of elective spinal services from Portsmouth Hospital Trust in December 2018 and changes in the pathway.  

In response to questions, Members heard:

Access to operation theatres remain a problem and one additional theatre has been added to manage the volume.  Trauma has doubled since December and affects getting elective cases into the theatre.  More work remains to be done.

Out of hours scanning allows more timely movement and care of patients but is not universal.  Scans to confirm diagnoses are not always accessible or affordable.

Centres of excellence providing better care outweighs the distance travelled for care.  

A new surgical colleague coming on board in March will help alleviate workload pressures and help address surgical capacity.  Less complex cases will be directed to Salisbury.

GPs are the first call and have guidelines of service recommendations.  While accessible services like physiotherapy would be a useful investment in prevention to reduce the need of operations, time with therapist is short but the patient must do the exercises.  An education program is ideal, but many patients don not use the exercises.  There are first lines of treatment available and people are told if they do no need operations.  

Recruitment and retention of surgeons are not currently issues, but balancing nursing staff across departments can be.  There is a level of autonomy with running a spinal practice and recruitment and retention are positive but varies in other parts of the organization.  Overseas hiring, other incentives, valuing staff, and maintaining the education budget have had a positive impact. 

Audits are considered business as usual and the staff score high on sending their friends and family to the hospital.

RESOLVED -

That the Health and Adult Social Care Select Committee:

a.    Noted the progress update and current operational challenges as well as any recorded issues addressed and/or resolved   

b.    Requested a written update on outcomes in September 2020

A 10-minute comfort break was taken at this time.