Ideas for developing

neurology services in Gloucestershire

Engagement with service users, family members, carers and voluntary and community organisations

2

What is this about?What do we want to talk to people about?

In Gloucestershire we are aiming high. We want you and your family to benefit from the very best healthcare and to be in the best position to look after your own health in partnership with others involved in your care. We now want to talk with you about an opportunity to change the way neurology services are provided and explore what this could mean for you, your family and our staff. The ideas are based on the desire to make best use of our dedicated specialist staff like doctors, nurses and therapists, equipment and our two thriving hospital sites – Cheltenham General and Gloucestershire Royal. We are keen to hear your own ideas, including views on current services so that we are clear on the things that you value and would like to see preserved and built upon. The ideas for change relate specifically to inpatient neurology services, including the Brain Injury Team and the neurophysiology services and we describe what these services are on page 4.

The number of patients affected by these proposals would be relatively low as the vast majority of people with a long term neurological condition are treated as an outpatient.

However, if you are one of the 700 neurology patients who need a hospital stay every year, we think we could provide an even better specialist service in a centre more suited to meet your needs and the needs of staff who strive to provide the very best care.

Why are we talking about these ideas now?

Our vision for developing a centres of excellence approach to providing specialist hospital care across our two large hospital sites, has made us think about the range of services that could potentially benefit. The centres of excellence approach reflects the way a number of specialist services are already provided by the Trust, like children’s services, cancer care and trauma, where all the necessary expertise and equipment is on hand, on site, to meet the needs of patients. The development of further ideas for some specialist services at our two hospital sites, described in the recent Fit for the Future public

3

engagement (summer/autumn 2019), has helped us to consider how we could use our buildings (space), facilities and scarce specialist staff to best effect to improve advice, support and treatment for other patients.

We now have an opportunity to consider changing the way neurology services are delivered, and in doing so, the potential to bring forward benefits to you, your family and our staff. The main aim is to ensure that you, and patients from across the county, experience specialist neurology services that are comparable to those areas at the leading edge of care, treatment and outcomes. The sections below describe our ideas and the potential benefits that these ideas could bring.

Who are we involving in these discussions?

We want to talk with you, other people with neurological conditions who use local services, carers and people who work for voluntary and community organisations in the county.

This booklet sets out our ideas, but this conversation is about listening to your experiences, views and ideas too and making the right decisions going forward.

What is engagement?

Engagement is a conversation. It’s an opportunity to share ideas and views on these services and consider any alternative ideas and suggestions you may have.

It is also an opportunity to share views on the things that you feel should be taken into account when looking at possible options for change.

To support the engagement, we are arranging events and would be pleased to come along to existing events, meetings or sessions that we

are invited to. A short survey can be found at www.onegloucestershire.net/yoursay and at the back of this booklet.

What happens next?

The period of engagement with service users, carers and voluntary and community organisations will run to 1 March 2020.

A summary of the feedback, including key themes, will be published in an Output of Engagement Report, made available on the One Gloucestershire website.

The local NHS (NHS Gloucestershire Clinical Commissioning Group that plans and ‘buys’ services and Gloucestershire Hospitals NHS Foundation Trust that provide these hospital services in the county), will review the ideas and views they receive and consider them carefully. They will assess potential proposals for change, and the suitability of any alternative ideas for change they receive, using the criteria developed, and heavily influenced, by the Fit for the Future public engagement.

This includes important things like quality of care (including patient and carer experience and patient safety), access to care, impact on the workforce (staff) and value for money. You can see the full criteria at www.onegloucestershire.net/yoursay

Any significant proposals for change would form part of a public consultation later in the year.

4

What are the services and how are they currently organised?The section below describes the range of services that form part of this conversation and how they are currently organised across the two hospital sites – Cheltenham General Hospital (CGH) and Gloucestershire Royal Hospital (GRH).

Neurological inpatient (bed) care, including the Brain Injury Team

Inpatient care is where people need to stay in hospital for a period of time to receive medical treatment, nursing care and rehabilitation with the support of therapy services.

These specialist services are currently provided on the GRH site.

The services are for people with neurological conditions like Multiple Sclerosis, Parkinson’s Disease, Epilepsy and those who need rehabilitation following a head injury.

The neurophysiology services

Neurophysiology is a support service that provides investigations and information to help with the diagnosis (identification of the nature of an illness or problem by examination of the symptoms) of patients with neurological conditions, such as epilepsy and nerve damage.

This is currently provided for both inpatients (see above) and outpatients (see below) at dedicated clinics based at the GRH site. The service is carried out by therapists who are specifically trained in neurophysiology. There is currently no facility to provide neurophysiology tests for outpatients at CGH. Any tests for inpatients that are needed at CGH are provided through a visiting service from the GRH site.

5

‘Acute’ head injury and stroke care

This is when patients arrive at hospital with an ‘acute’ (serious and sudden) condition such as a traumatic head injury or stroke. This treatment and care is currently provided at GRH and we are not proposing to change this service. Our doctors, nurses and therapists do not believe that our ideas to change neurology services would have any negative impact on stroke care.

Outpatient services

This is when a patient is seen by a doctor, nurse or therapist in the daytime on an appointment basis and does not need to stay in hospital overnight. The vast majority of patients with a long term neurological condition are treated as an outpatient and the services would remain largely the same and continue to be provided at both hospital sites.

The only change would be the introduction of neurophysiology outpatient appointments at the CGH site.

What are our ideas for services?The idea is to bring together neurological inpatient care (where people need to stay in hospital for a spell) into a single, specialist centre at CGH and the section on page 6 describes what we think the benefits would be. The crucial neurophysiology services, supporting the diagnosis and treatment of patients with neurological symptoms or conditions, would be improved with greater provision at CGH through the development of an ‘enhanced hub and spoke model.’

This means that the neurophysiology service would be able to build on the current service at GRH by adding a separate smaller service (‘spoke’) at CGH.

The following section describes the potential impact of these possible changes.

6

What are the potential impacts?Summary

An initial impact analysis relating to the ideas in this booklet is available from www.onegloucestershire.net/yoursay and on request. The section below sets out some of the key potential benefits, drawbacks and mitigations (things that could minimise or reduce any negative impact).

What are the potential benefits?

By moving the specialist centre for neurological inpatient care to CGH, we would be able to provide a much improved care environment for you and your family.

It would mean:

z You would benefit from a dedicated ward supporting your specific care and rehabilitation needs. This means that you would not be sharing the ward with other patients who often require emergency or acute medical support. We think that the nature and type of medical care provided there can have a big impact on how it ‘feels’ to be on the ward.

z The proposed ward, Woodmancote, was designed as a rehabilitation ward, and as such, unlike the current inpatient ward at GRH, it would provide an environment much more suited to your rehabilitation needs from the moment your hospital stay begins. We think that the quality of the ward environment is of particular importance to neurology patients as they tend to have a longer hospital stay compared to many other patients.

z A new and significant neurology presence on the Cheltenham site would also enable enhanced support to patients with serious conditions such as Guillain-Barre syndrome who are cared for in the critical care unit at CGH on occasions.

By developing our specialist centre for neurological inpatient care at CGH in an improved environment and space, we would be able to make the most of the benefits of caring for you on a single site.

This includes:

z The availability – around the clock – of specialist staff to ensure you get high quality and timely care.

z Staff – doctors, nurses and therapists – able to share, and further develop, their expertise and skills in this specialist area of care. The evidence shows us that the best staff are attracted to (and stay in) specialist centres where they can provide the very best care, where they become involved in teaching and research in their chosen field and have access to equipment and technology that makes it easier to do their job.

Under our ideas, the neurophysiology service would be enhanced with the addition of a ‘spoke’ service at CGH.

This means:

z The service would be able to offer neurophysiology outpatient appointments at Cheltenham too, which would benefit you if you live in the east of the county.

z Therapists would also be on hand to provide a more responsive service for inpatients at CGH.

z More patients with neurological conditions would find it easier to access these services, including more services at Cheltenham. It would reduce the need for you to travel to GRH if you live in the east of the county.

7

What are the potential drawbacks?

Neurological inpatient care

Potential drawbacks include:

z Increased travel for service users, families and carers in the west of the county by centralising services in Cheltenham and not being able to provide dedicated inpatient facilities on two sites. We recognise that fully staffed and equipped inpatient services on two sites would provide a more equitable service in terms of distance to travel for you, your family and carers.

However, this is not possible or sustainable given the current number of specialist staff in post and the limited pool of available staff to recruit from nationally. We therefore believe that the ideas in this booklet would offer the best service possible with our current staffing. We also think that the inpatient service would be moving to the best location with services tailor-made for people with neurological needs.

The neurophysiology service

Potential drawbacks include:

z Splitting a team in order to provide a two site service.

However, this would improve access to neurophysiology outpatient services. The impact would also be reduced by the recruitment of additional staff, including a new specialist Consultant. This would result in the growth of the service and an improved offer to both the Cheltenham General and Gloucestershire Royal sites.

8

What are we asking people to consider?We would really appreciate your views and ideas on what you have read, including the ideas for neurological inpatient care and neurophysiology services.

3 If you have identified any potentially negative impacts above, what could we do to reduce these?

4 If change happens, what improvements should we consider making?

5Do you have any alternative ideas or suggestions about how services could be developed that we should consider?

Please complete the short survey below. You can also do this at:

www.onegloucestershire.net/yoursay

1Do you have any thoughts on what you have read about the ideas for developing neurology services in Gloucestershire – good and bad?

Good: Bad:

6Is there anything else you would like to tell us in relation to developing neurology services in Gloucestershire?

2

Based on these ideas, do you think there could be any potential impact on you, your family, someone you care for or someone who works within the service? We would like to hear about both potential positive and negative impacts.

Positive: Negative:

9

About YouCompleting the “About You” section is optional, but the information you give us helps us to ensure that we hear from people with a wide range of experiences and circumstances. Your support with this is really appreciated.

1What is the first part of your postcode? e.g. GL1, GL20

3 Are you:

A service user

A family member and/or carer

A community partner e.g. voluntary or community group

A health or social care professional

4 Do you consider yourself to have a disability? (Tick all that apply)

No

Mental health problem

Visual Impairment

Learning difficulties

Hearing Impairment

Long term condition

Physical disability

Prefer not to say

6 Which best describes your ethnicity?

White British

White Other

Asian or Asian British

Black or Black British

Chinese

Mixed

Prefer not to say

7 Which, if any, of the following best describes your religion or belief?

No religion

Buddhist

Christian

Hindu

Jewish

Muslim

Sikh

Other

Prefer not to say

(including Church of England, Catholic, Methodist and other denominations)

2 Which age group are you?

Under 18

46-55

18-25

56-65

26-35

66-75

36-45

over 75

Prefer not to say

5

Do you look after, or give any help or support to family members, friends, neighbours or others because of either a long term physical or mental ill health need or problems related to old age? Please do not count anything you do as part of your paid employment.

Yes No Prefer not to say

10

Male

Female

Transgender

Prefer not to say

8 Are you:

10 Which of the following best describes how you think of yourself?

Heterosexual or straight

Gay or lesbian

Bisexual

Other

Prefer not to say

Yes

No

9Do you identify with your gender as registered at birth?

Prefer not to say

11 Are you currently pregnant or have given birth in the last year?

Yes

No

Not applicable

Prefer not to say

Thank you for taking the time to tell us what matters to you. Your feedback is important to us.

Please return your completed survey to the freepost address (no stamp required) by:1 March 2020

FREEPOST RRYY-KSGT-AGBR Ideas for developing neurology services in Gloucestershire,NHS Gloucestershire Clinical Commissioning Group, 5220 Valiant Court, Gloucester Business Park, Brockworth, GL3 4FE

A short survey can be found in this booklet and at www.onegloucestershire.net/yoursay. We have also arranged events for service users to meet with clinicians to share views, ideas and find out more. Alternatively, if you would like a member of the team to attend an existing event, meeting or session, please contact GLCCG.participation@nhs.net

Getting involved To discuss receiving this information in large print or Braille please ring 0800 015 1548.

To discuss receiving this information in other formats please contact:

Ak si želáte získat túto informáciu v inom formáte, kontaktujte prosím

0800 015 1548Publication Date: February 2020 GDH3807