The centralisation of acute services at either the Lister or QEII

1. The centralisation of acute services at either the Lister or QEII Mr John Saetta – Associate Medical Director & A&E Consultant Sarah Brierley – Deputy Director, Strategic Development East and North Hertfordshire NHS Trust

2. Strategic principles for the NHS in Hertfordshire Agreed in 2003 during the Investing in your Health consultation: • Invest in and develop community services • Concentrate acute hospital services – a single acute site in east and north Hertfordshire

3. Overwhelming evidence • Larger hospital units save more lives • Specialist doctors save more lives • New technologies, used by specialist staff, save more lives • Better availability of consultants saves more lives • Improving paramedic skills saves more lives

4. Patient benefits • Better clinical outcome for patients who need treatment for complex medical or surgical problems in an acute hospital • Continuation of locally-based care for less complex problems (local general hospital & primary care) where clinically appropriate • Increased consultant availability to care for patients, particularly those needing emergency care • Hospital doctors and nurses would be more able to retain and develop specialist skills and expertise • Clinical services would be sustainable in the long term • More efficient in the long term

5. Key themes within consultation responses • Questionnaires: • Access to care • Clinical quality • Sustainability • Retention of the status quo • Comments from letters, events and other sources: • Hatfield • Cancer Centre services • Impact on out of county hospitals

6. Access to care • Majority of respondents tended to prefer site closest to their home • Concern about travel times, especially at peak periods • Recognition of public transport limitations • Desire for more integrated transport to support access • Recognition that Lister has better road access and is closer to A1(M) than QEII • Health equality impact – slightly favours Lister on balance • Transport and access are not significant discriminating factors between options but marginally favour Lister

7. Clinical quality • Overwhelming clinical support for consolidating acute care on a single site • Site must be fit for purpose • Public tended to equate proximity to acute site and clinical quality/safety • Recognise public will require ongoing reassurance and information • Lister preferred as offers better potential clinical adjacencies – majority of NHS respondents preferred Lister • QEII site more challenging: financially would only be able to offer limited ongoing investment in services and quality

8. Sustainability • Recognition of the need for sustainable acute services in the future • Need for acute site to have sufficient capacity • Capacity for the future: space and flexibility for efficient expansion • Lister > QEII by 9 acres; site layout lends itself more easily to development of future services

9. Retention of two acute sites • IIYH agreed clinical model of consolidation • Consolidation strongly supported by clinicians locally and nationally • Key to improving quality and sustainability • Population growth will not negate the need for a single acute site - has much greater impact on demand for primary care • Maintaining two acute sites likely to cause deteriorating clinical quality and unsustainable services

10. Hatfield • Disappointment at lost opportunity to develop this new hospital • Preferred option non-financially • Not affordable – would lead to recurrent deficit and inability to meet statutory duty to break even • Not possible to make scheme affordable without making it too small and unfit for purpose • Assessment confirmed by NPV - revealed Lister to be best value • Lister option offers greatest scope for ongoing investment in service quality and development

11. Cancer Centre services • Important issue for Hertfordshire • 10% cancer patients undergo treatment at Mount Vernon Cancer Centre (MVCC) • MVCC serves wider population than just Hertfordshire • Cancer Reform Strategy (December 2007) • Commissioner-led review in 2008 • MVCC response supports consolidation of acute services on Lister site

12. Impact on out of county hospitals • Patients’ choices will not be impeded by acute site consolidation • Patients can continue to choose to travel out of Hertfordshire for care • Current activity flows incorporated onto modelling • Commissioners linking into out of county hospitals’ planning • Proposals designed to improve clinical outcomes in Hertfordshire • Emergency access complemented by Urgent Care Centres

13. Conclusions of the health equality impact assessment • Impact on minority ethnic communities, young children, older people, particularly the very old • None of the options have distinctly different potential effects on such groups but Lister slightly better placed for access • Any option would need to ensure that the services are adequately accessible for these groups in terms of transport and communication

14. Summary • Access • – most frequently cited issue, Lister site marginally more accessible • continued access to local services at local general hospital and in primary care • Sustainability • – scope for future growth • - Lister site 9 acres larger than QEII site

15. Summary • Clinical quality – Lister site has greater potential for optimal flexibility and clinical adjacencies • Financial – both options would potentially enable the trust to meet its statutory duty - Lister site offers greater surplus for ongoing investment in services + buffer against adverse movement in costs or income

16. Summary • Public views – questionnaires 60:40 in favour of QEII • respondents tended to support nearest site • concern about safety • ongoing need for reassurance and information. • Clinical views – strong support for acute consolidation - NHS staff responses tended to favour the Lister site

17. Conclusion • Healthcare will continue to be provided across a range of locations • Proposals designed to achieve the best possible clinical outcomes for our patients • Future locations will include local general hospitals, primary care and acute sites • On balance, the Lister option is better placed to deliver the Committee’s five principles: • Capacity • Requisite investment • General clinician support • Reasonable access • Affordability