Local hospitals - Q&A

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How will this be different from a district general hospital?

Better surgical safeguards for emergency surgery

Evidence shows that surgery should not be carried out at night unless a patient’s life or limb is threatened. Under these proposals local hospitals will carry out onsite emergency surgery between 12 and 16 hours a day, with emergency surgery for life-threatening conditions outside these hours provided by a wider clinical network.

This means a dedicated emergency service could be provided around the clock through a network of two or more hospitals, run by senior doctors with a skilled level of expertise.

This will ultimately improve clinical outcomes and save lives.

Separating emergency and elective surgery

To further improve surgical outcomes, the report proposes that elective (planned) surgery is separated from emergency surgery.

This will benefit patients as elective surgery is less likely to be disrupted by the arrival of emergency cases. And healthcare associated infections could be further prevented if patients are separated and all elective cases are screened before admission.

Getting the right diagnosis from a senior doctor

It should be a key objective of a local hospital to ensure that senior doctors are available to see patients at an early stage.

Patients will benefit from more appropriate treatment, plus it will ultimately reduce patients’ length of stay.

Senior doctors should also be more available during weekends and out-of-hours, including an increased consultant presence in A&E and the paediatric assessment unit.

This improvement will be supported by increased consultant numbers over the coming years. The workforce development strategy, produced by NHS London, will look closely at what staff training and development is needed.

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Establishing clinical networks to underpin improvements

Clinical networks will help ensure Londoners are seen by the right person, in the right place, at the right time and will be critical to how local hospitals evolve.

These networks will be developed between hospitals and partner organisations, such as a nearby major acute hospital with a specialist stroke or major trauma unit, as well as other clinical specialties such as emergency surgery and paediatrics. Patients will benefit from an expert opinion earlier in their diagnosis and treatment.

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Introducing urgent care centres and polyclinics

For the treatment of minor injuries and illnesses, a local hospital could also include an urgent care centre, integrated with the A&E department.

Patients will receive a faster diagnosis and be transferred to the most appropriate place of care, freeing-up A&E staff to concentrate on the most serious cases. An urgent care centre could be based in a polyclinic within, or next to, a local hospital.

The polyclinic will also offer GP appointments, with access to a wide range of health and community services.

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Improved maternity and children’s services

It is intended that all local hospitals will include a paediatric assessment unit (PAU), staffed by senior doctors who can quickly assess children and minimise the need to wait in A&E departments. The units will operate as part of a wider network of paediatric services.

This could include local hospitals linking together to offer a paediatric inpatient ward on one site in addition to a PAU, or alternatively partnering with a nearby major acute (large hospital). A seriously ill child who requires specialist care or complex surgery will be treated at a specialist centre.

Maternity services will also be retained in a local hospital. The service will be supported by a special care baby unit (level one) and will manage women who are not classified as high-risk. Both paediatric and maternity services are the focus of more detailed work in the Healthcare for London programme.

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Dignity in end-of-life care

There is strong evidence to show that hospitals do not always manage end-of-life care as well as they could. More than half of all complaints received by NHS trusts relate to patients who have died.

The complaints are predominantly about poor communication, lack of basic comfort, privacy and psychological care.

Work is underway as part of a national strategy on end-of-life care. While this highlights the need to offer more support to those who choose to die at home, it is clear that the many people who will still die in hospital deserve better care.

There is an opportunity to develop a more hospice-style environment in local hospitals.

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Will the plans mean closures of existing local hospitals?

The local hospitals report does not propose any hospital closures. The plans involve developing local hospitals in order to create opportunities to improve the quality of care available to all Londoners.

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What will the financial impact be of the changes?

Changes to how and where patients receive care will impact on where and how money is spent.

Healthcare for London has examined the financial impact of implementing its 10-year programme. It was concluded that the overall effect of the changes proposed in the strategy could result in around a 15 per cent reduction in income for the local hospital over the next five years. This reduction in income could be partially offset by increased demand for services.

However, these changes will be challenging and will require dedication, resources and excellent skills to achieve them.

There are opportunities for trusts to broaden the range of services they offer to meet local needs; and to develop services that link closely with general practice and community services, as well as with specialist hospitals.

Opportunities could include:

  • extending rehabilitation and intermediate care services;
  • provision of an onsite polyclinic;
  • developing local niche services; and
  • the movement of some elective surgery from major acutes to local hospitals.

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