SUMMARY CLINICAL STRATEGY AND PROPOSALS FOR CHANGE
INTRODUCTION
The recent review by Sir Bruce Keogh, Medical Director for the NHS in England, has summarised the key
challenges facing the NHS in delivering high quality urgent and emergency care across England. His vision is
that people with urgent but non-life threatening needs should be able to access care as close to home as
possible; people with serious or life threatening emergency needs should be treated in centres with the
very best expertise and facilities to reduce risk and maximise their chances of survival. Implementing this
vision is crucial for the residents of Hampshire. The opportunities posed by the national policy to develop
integrated services across health and social care are well-timed and supportive. Implementing integrated
services at the same time will facilitate us delivering better services for urgent and emergency care.
HHFT has been working closely with commissioners on plans to ensure we continue to deliver the highquality services our population requires and deserves, particularly for urgent and emergency care.
The joint work undertaken by commissioners and HHFT has involved very detailed analysis of each hospital
specialty with review by hospital consultants, other hospital clinical staff and local GPs to ensure any
proposed change has clinical support. The review has taken account of workforce issues, clinical evidence
on best quality care and patient outcomes, as well as the need to ensure long-term financial sustainability
for the local health economy.
This detailed review of the evidence indicates that there are real benefits in providing some services closer
to patients’ homes whilst providing some of the most complex emergency services in just one place for our
region. These benefits include:
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Guaranteeing consultant-delivered care for the sickest and most at risk patients 24 hours a day, 7
days a week. This will lead to safer care and better outcomes for all.
Delivering care in the most appropriate facility and facilitating integration with community and
social care services.
Providing local services for communities outside Winchester and Basingstoke such as Eastleigh,
Andover, and Alton. This will reduce travelling distances and provide a better experience for patients.
PROPOSALS FOR CHANGE
The key proposals for change are as follows:
To centralise some aspects of our services
It is proposed to centralise and co-locate the elements of hospital services that are required for the sickest
and most at risk hospital patients (about 15% of our patients). This will include, for example, services for
heart attacks, acute strokes, trauma, emergency surgery, critical care and care for very sick children. It will
also be where obstetric-led care is provided. There is a strong relationship between these services in that
they all have the same potential need for life-saving support services including critical care (ITU) and
specialist interventional radiology. There is also strong evidence to show that these services should be
delivered by fully-trained specialist consultants 24 hours a day, 7 days per week. In addition, there will be a
midwife-led birthing centre alongside the central obstetric unit, recognizing that women who do not need
obstetric-led care or anesthetics will be able to choose a home environment with rapid access to medical
support if it is needed.
To deliver two local general hospitals in Basingstoke and Winchester
The majority of patients (approx. 85%) do not require the life-saving interventions and support outlined
above. The remaining patients require urgent access to walk-in front of house services (eg with a broken
arm), rapid assessment service (eg following GP referral), outpatient consultation, diagnostic services (x-ray
scanning and pathology), planned medical and surgical interventions (eg endoscopy, surgery), rehabilitation
or maternity services (including midwife led birthing centres for delivery). These patients can be much
better cared for in the appropriate environment of their local general hospital where relevant partner
organisations work together to deliver appropriate services. Partners include HHFT, local GPs, community
providers including Southern NHSFT and HCC Adult Services. The majority of patients would be treated in
these hospitals where we are investing in the services to further develop them.
To expand the services delivered in other localities including Andover, Eastleigh and Alton
For patients who do not live close to the hospitals in Winchester and Basingstoke, a large proportion of
their care needs can be met closer to home in community facilities. Again working with partners, HHFT is
developing a range of services in the other main towns using fixed and mobile services to deliver walk-in
urgent care, outpatient consultation, diagnostic services and some planned medical and surgical
interventions including MRI scanning and chemotherapy.
Some services also reach into patients’ homes, for example maternity and community children’s services.
Role of the General Hospital in the Future
Much of patients’ care and treatment will continue to be delivered from our two general hospitals in
Basingstoke and Winchester (Basingstoke and North Hampshire Hospital and the Royal Hampshire County
Hospital). This will be where approximately 85% of care will be provided. This will include:
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A&E 24 hours a day urgent care for self-presenting patients,
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Medical assessment for patients referred by local GPs,
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Paediatric rapid assessment facilities for sick children needing assessment,
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Midwife led birthing centre and outpatient maternity facilities,
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Most planned surgery, day case and short-stay inpatient beds,
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Medical beds including care of the elderly, rehabilitation and medical specialty facilities. This will
include on-going care and treatment for patients returning to the general hospital closest to home
once stabilised by the critical treatment hospital,
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Outpatient and diagnostic facilities (e.g. blood tests, scans, x-rays).
4 December 2014