11.20
The Gynaecology Service at the Horton General Hospital (HGH) delivers elective and emergency care to the local population north of Oxfordshire and the surrounding counties. The Oxford Radcliffe Hospitals Trust recently announced a number of changes to the service. This is one of a number of developments that have taken place since the Independent Reconfiguration Panel (IRP) report in 2008. Further developments are planned.
The purpose of this item is to provide an update on the gynaecology service changes and to consider a major item for the November agenda aimed at reviewing what has happened at the HGH since 2008 and whether the recommendations of the IRP are being met.
Minutes:
The Gynaecology Service at the Horton General Hospital (HGH) delivers elective and emergency care to the local population north of Oxfordshire and the surrounding counties. The Oxford Radcliffe Hospitals Trust recently announced a number of changes to the service.
This is a complex issue that relates not just to change in gynaecology services but also to the much wider issues of reducing activity in acute hospitals, cutting down on numbers of beds, developing day services and/or outpatients for procedures that previously would have required hospital admissions and providing services closer to home.
The Trust has stated that the aim is to create a dedicated gynaecological Day Surgery and Diagnostic Suite that will ensure the following:
· Fewer women living in Banbury and surrounding areas having to travel to the John Radcliffe Hospital due to the expanded and improved volume of services provided locally at the Horton General Hospital
· The creation of new outpatient clinics, including tertiary level services.
· Performing less invasive laparoscopic surgery.
· Avoiding or minimising the need for admission to hospital unless clinically necessary.
· Improving the quality of care for women needing treatment
Service structure
· Inpatient and day case surgery will continue to be performed at the Horton General Hospital.
· New diagnostic services will be set up at the Horton General Hospital, including outpatient hysteroscopy clinics, mirroring those running at the John Radcliffe Hospital. This represents an expansion of the existing services provided at the Horton General Hospital and will avoid the need for women to travel to the Women’s Centre in Oxford as is currently the case for such procedures, minimises in-patient stay and reduces waiting time for surgery.
· Clinics such as the hysteroscopy clinic will enable procedures to be performed on an outpatient basis as opposed to having to go to theatres and in some instances, avoid the need for an anaesthetic.
· New urodynamic clinics will be set up at the Horton General Hospital. These will match those running at the John Radcliffe Hospital and will benefit women living in Banbury and the surrounding areas, who also currently have to travel to Oxford for this diagnostic service.
· Specialised tertiary clinics such as Reproductive Medicine will commence on the Horton site, strengthening the relationship between the Horton and the University and enabling local access to highly specialised skills.
· Late terminations of pregnancy due to foetal abnormality will be performed under the care of maternity services at the Horton General or John Radcliffe Hospitals in line with agreed clinical pathways.
· There will be no reduction in the budgeted number of medical staff or changes to their working hours. It is anticipated that the creation of new services will help to recruit medical staff into long-term vacancies, thereby minimising the need for agency staff and improving the continuity and quality of medical support.
Inpatient beds
· Advancements in surgical techniques mean that many procedures, which previously necessitated an inpatient admission, can be performed as a day case or outpatient procedure. This has reduced the overall need for inpatient admissions and therefore the number of beds required for the service.
· Gynaecology patients requiring admission will have access to 6 beds on an inpatient ward. These beds can be ‘flexed’ up or down dependent on clinical need, in line with current practice adopted by all specialities across the Oxford Radcliffe Hospitals.
· It would not be possible for these beds to be ring fenced to the detriment of emergency admissions as this could compromise clinical safety at the Horton General Hospital. As is currently the case, this is managed on the basis of clinical risk, patient need and overall demand for particular specialties. This may mean that emergency cases are on occasions managed between the John Radcliffe Hospital and Horton General Hospital. This is normal practice currently and does not reflect a change in service provision.
· The inpatient beds identified at the Horton General Hospital have three side rooms which have en-suite facilities. This is the same number as on G Ward. Every endeavour will be made to accommodate patients undergoing sensitive procedures i.e. miscarriage into a side room as is current practice across Women’s Services.
Women’s Day Surgery and Diagnostic Suite
· The Women’s Day Surgery and Diagnostic Suite will initially be open between 7:30am and 8:00pm.
· There will be 9 day case trolleys and 3 treatment rooms on the unit.
· Patients who require admission to an inpatient bed following day surgery will have their admission organised by the Duty Operational Manager for the Horton General Hospital as is current practice.
· It is not anticipated that patients will travel during rush hour times, as per current practice, and therefore patient travel times will be kept to a minimum. If a patient chooses to have their procedure performed at the Horton General Hospital and their travel time is over 1 hour this will be considered by the listing surgeon when assessing an individual suitability for day surgery.
· The Horton General Hospital currently performs day surgical procedures for patients as far afield as Swindon who choose to attend the Horton General Hospital.
Emergency Gynaecology patients and clinic
· The Urgent Gynaecology Clinic will be open between 8:30am and 4:00pm, with the last booked appointment at 2:00pm. This is in line with the hours of service of the clinic at the John Radcliffe Hospital.
· Emergency patients admitted outside of the scheduled opening hours will be seen and assessed in the Emergency Department following discussion between the GP and the Registrar/Consultant. This is in line with the current emergency patient pathway.
· If patients are discharged and require a follow up, an appointment can be made in the Urgent Gynaecology Clinic for the following day.
· Any patient requiring admission to hospital following assessment by the gynaecology medical team will be admitted into an inpatient bed, in line with current practice.
· Hyperemesis (extreme morning sickness) patients requiring admission will be admitted to either a gynaecology inpatient bed or the maternity unit in line with clinical policy, as is current practice.
Outpatient diagnostic clinics
· Urodynamic (how the bladder and urethra perform their job of storing and releasing urine) and Menstrual Disorder clinics will be run from the Women’s Day Surgery and Diagnostic Suite at the Horton General Hospital. This will expand on the range of service offered at the Horton General Hospital. Patients currently requiring urodynamic assessment have to travel to the John Radcliffe Hospital to have this specialist service performed.
· The new hysteroscopy (the inspection of the uterine cavity by endoscopy) clinic will allow patients to be assessed and treated in an outpatient setting, improving patient experience and matching the service offered at the John Radcliffe Hospital. Patients are currently undergoing this procedure in theatre.
· By treating patients in an outpatient setting as opposed to theatre, patients will benefit and it is anticipated this will assist in reducing surgical waiting times for other gynaecology patients.
Staff and local residents question whether it is all good news. They have raised a number of doubts and queries around the loss of beds throughout the hospital and whether the proposals take sufficient account of knock-on effects elsewhere.
In order for the HOSC to be seen to be acting openly and fairly in this matter the Chairman proposed that a toolkit meeting should take place to ascertain whether there should be full public consultation. It was proposed and agreed that a group of members of the HOSC should be delegated to meet ORH managers and clinicians, staff representatives, members of the Community Partnership Forum from Banbury and the LINk in order to come to a conclusion. No changes would take place at the Horton until after the meeting.
The meeting would take place on October 4th at the John Radcliffe Hospital and the outcome would be made public and reported to HOSC members.