Why are you moving to this new way of working and creating a Green site at Grantham?
National guidance was recently issued requiring all NHS organisations to restore essential NHS non-COVID services. This includes elective activity such as chemotherapy, cancer surgery, urgent surgery and diagnostics. This is a result of reducing numbers of cases of COVID-19 in hospitals, and increasing numbers of patients waiting for appointments and treatment.
A recent study by Healthwatch Lincolnshire has revealed that more than 60% of people in the county have concerns about the safety of accessing hospital care due to the COVID-19 outbreak. We must act to ensure that people regain confidence in our services and the fact that we will protect them against transmission of COVID-19 in our hospitals.
Why have you put in place a UTC at Grantham hospital rather than an A&E?
As we are moving towards a green (COVID-free) site at Grantham we need to prevent patients and staff from crossing between green and blue (possible COVID) areas.
With an A&E, you need the ability to have unplanned admissions if necessary, and as such, patients cannot be COVID-19 tested in advance that would put the green patients and site at risk. The UTC will not be taking such admissions.
The conversion of the Grantham A&E to a UTC affords the option of having completely green diagnostics and inpatient services on the rest of the site to deal with the elective activity.
How long will these changes last?
This temporary change is part of the Trust’s response to the level 4 national emergency, and accordingly will be reviewed when the ‘Restore’ and ‘Recovery’ phases of the response nationally comes to an end. Based on current available information, this will run to the end of March 2021 but could be subject to change. It will be reviewed regularly throughout.
How will you be supporting staff through these changes?
The workforce will be supported by careful adherence to infection prevention and control. We will carry out screening by health assessment, including a temperature check, at the start and end of each shift. This will be supplemented by swabbing if a member of staff is symptomatic or for contact tracing. We are also seeking to put in place a programme of random staff swabbing to screen for asymptomatic carriers. We are developing a defined protocol for migration of staff between sites (especially surgical teams) to ensure no blue to green transfer on the same day.
If staff are asked to move base to another site, will they get travel time and mileage payments?
Where staff have moved from another site, then excess travel [excess to normal travel to current base] time will be counted as ‘paid time’. Mileage will be paid.
What services are you expecting to be able to re-introduce in the coming weeks?
The introduction of the Green site at Grantham will give us the capacity to deliver all cancer surgical activity for patients across Lincolnshire, including those that require level 1 post-operative critical care. Within two-three weeks there should be no waiting list for cancer surgery.
Chemotherapy for patients from across Lincolnshire will continue at Grantham and we expect to be able to carry out elective surgery for the following specialities at Grantham; colorectal, urology, gynaecology, cancer, ear, nose and throat and oral and maxillofacial.
Urgent diagnostics will also take place.
What does increasing planned care mean for testing capacity, PPE, and medicine supply?
We are confident that we have sufficient supply of testing kit, PPE and medicines in Lincolnshire to manage this increase in activity safely. As testing ramps up, and elective patients can increasingly be tested pre-admission, this should have a positive impact on the quantity of PPE that may be needed.
How many more patients will have to be diverted away from Grantham as a result of the change to the A&E?
Modelling shows that, of the 24,617 A&E attendances from April 2019 to March 2020, 4,611 attendances (13 per day) will be displaced, of which 1,187 (3 per day) will be displaced to other ULHT sites and 3,424 (10 per day) will be displaced to neighbouring Trusts.
Can neighbouring hospitals cope with the patients who will be diverted to them?
The daily displacement to neighbouring Trusts is at such low levels that there is every expectation that these Trusts have the capacity to manage this activity. This has been discussed with neighbouring Trusts.
If you are withdrawing the medical beds at Grantham, what will happen to those patients who would usually be admitted straight into them via GP or similar?
A total of 1,198 admissions (3 a day) were made to medical beds at Grantham from multiple non-emergency department routes between April 2019 and March 2020.
As medical beds will be withdrawn at Grantham, these 1,198 patients will be re-routed and admitted at Lincoln.
Don’t you need to formally consult to make this change?
This change would ordinarily constitute ‘significant service change’ and require consultation under the public involvement and consultation duties of commissioners as set out in s.13Q NHS Act 2006 (as amended by the Health and Social Care Act 2012) for NHS England and s.14Z2 NHS Act 2006 for CCGs, and require the subsequent service change assurance process as detailed in the ‘NHS Planning, assuring and delivering service change for patients’ 2018 guidance.
However, these proposed changes are being made as part of the level 4 incident response and are deployed in response to COVID-19, as such, they are not subject to the usual legislative process.
The changes proposed are temporary in nature as part of the level 4 incident response. Any process to make permanent significant changes to services would be led by the NHS Lincolnshire Clinical Commissioning Group and is within their authority as the commissioner of services, not ours.
What is the difference between the services offered at a UTC and Grantham A&E?
The vast majority of patients who are treated at Grantham Hospital A&E will be able to receive the same care in the Grantham Urgent Treatment Centre (UTC). In fact, there is very little difference in the service which has been available in the Grantham A&E department in recent years to that of a UTC.
UTCs provide urgent care for people whose conditions are not life threatening.
Examples of conditions which may be treated at a UTC include:
Sprains and strains
Suspected broken limbs
Minor head injuries
Cuts and grazes
Bites and stings
Minor scalds and burns
Ear and throat infections
Skin infections and rashes
Coughs and colds
Feverish illness in adults
Feverish illness in children
Vomiting and diarrhoea
Why have you opted for Grantham instead of Lincoln or Pilgrim as the green site?
A full options appraisal process has been carried out to determine the best location for the Green site, looking at the options that will best deliver IPC excellence, delivery at scale in terms of staffing, theatres and estates and future service resilience. Grantham was the only site that passed all of these tests. Full details on the options appraisal can be found in the Board paper.
How long is temporary?
This temporary change is part of our response to the level 4 national incident, and accordingly will be reviewed when the ‘Restore’ and ‘Recovery’ phases of the response nationally comes to an end. Based on current available information, this will run to the end of March 2021 but could be subject to change. It will be reviewed regularly throughout.
Can EMAS cope?
We have engaged with East Midlands Ambulance Service around this change and are confident that they will be able to support this change.
Won’t you be putting patients at a disadvantage as they now have to travel further for care?
To mitigate the impact of displacement on patients, particularly those on the East Coast, ULHT is working with its partners to provide effective transport solutions. This is not expected to be a constraint on the deliverability of the model.
What is the long term future of Grantham hospital?
These changes are temporary. The long term future of Grantham hospital is subject to the Acute Services Review process and was discussed during the Healthy Conversation 2019. It is the responsibility of Lincolnshire Clinical Commissioning Group to formally consult on any permanent change to hospital services.
Why can’t the elective surgery be carried out in the private sector?
We will be using the private sector for some elective surgery, however capacity in the private sector in Lincolnshire is not sufficient to meet all of the demand.
Will you be prepared in the event of another surge in COVID-19 cases?
We have comprehensive plans in place to respond in the event of a further surge in COVID-19 cases. This could result in us having to once again reduce our elective surgery offer, should capacity be required for COVID-19 purposes.
Lincoln and Boston are going to operate separate Green and Blue Pathways whilst retaining their A&E – why can’t you do the same at Grantham?
It is important that COVID-positive and COVID-free patients are separated where possible, and a Green site achieves this in a more effective way than Green pathways within a Blue site. This is particularly important for patients who are immunocompromised. Therefore, it is preferable to create a Green site wherever possible, and is a model that has been used by a number of trusts nationally.
Will this mean junior doctors are withdrawn from Grantham?
We have an agreement with Health Education England that trainees will remain on the Grantham site for this rotation (until the end of August). We are working on producing satisfactory evidence that trainees can be suitably trained at Grantham for the next rotation.
As a patient, do I need to get a test before I come to hospital? If so how do I access a test?
If you are being admitted for planned care (including day surgery) you will be asked to isolate for 14 days before coming to hospital to reduce risk. Where possible, you may be asked to have a test within 72 hours of coming to hospital, which will be arranged locally.
How quickly will I get my results? How do I find out my results?
Results are usually available 48 hours after being tested. For patients who are being tested pre-admission, the important thing is that results are available prior to admission.
Do I need to isolate after my surgery / procedure / appointment?
Your clinician will advise what steps you may need to take post-surgery or admission, but this will not normally be required.
Will I be eligible / sent for support while isolating before planned care?
Anyone who is booked in for planned care and needs to isolate prior can self-refer for support from the NHS volunteer programme. They can do this by calling the NHS Volunteer Responders helpline Tel: 0808 196 3646 between 8am and 8pm. You can also find more information about the programme at www.nhsvolunteerresponders.org.uk.