Frequently Asked Questions
On this page you will find answers to the frequently asked questions about the consultation. The questions have been grouped into sections. For ease of navigation, you can use the links below to jump to the relevant section:
The Consultation
When does the public consultation start and how long will it run for?
The public consultation runs from 28 September to 21 December 2020.
Who is running the consultation?
This consultation is being led by NHS Leicester City Clinical Commissioning Group (CCG), NHS West Leicestershire CCG, and NHS East Leicestershire and Rutland CCG, in partnership with regional and national health service organisations.
What is covered in the consultation?
This public consultation is about the services delivered at the three acute hospitals in Leicester, run by University Hospitals of Leicester NHS Trust (UHL). These hospitals are the Leicester Royal Infirmary, Glenfield Hospital, and Leicester General Hospital.
The consultation is also about services delivered at the midwifery-led unit at St Mary’s Hospital in Melton Mowbray.
Can we comment on changes to services in the community?
This consultation does not include community hospitals, GP practices, mental health and other services provided in the community or in people’s homes. We have undertaken engagement to understand what matters most to people about community services and will, in the future, engage on proposed changes to these services, particularly taking into account the impact of the temporary changes made during the coronavirus pandemic.
What happens after the consultation ends?
All the feedback we receive from the consultation will be independently analysed and evaluated by an external organisation. They will also undertake a review half-way through the consultation and advise the clinical commissioning groups if there are communities that are not being reached. If the review shows gaps then we can adjust our communication plan accordingly.
A final report of the consultation findings will be received by the three clinical commissioning groups’ governing bodies in public meetings in early 2021 and the public consultation will be considered and taken into account in any decisions they make.
We will promote the governing body meetings to enable people to attend and hear the discussions. All decisions will be made public after the governing board meetings and further engagement work will commence with people who use services provided by UHL. This work will include communicating the decision via local newspapers, social and broadcast media.
How is it real consultation if you already have the money agreed and there are not different options?
We are consulting on a proposal to transform acute and maternity services in Leicester, Leicestershire and Rutland. We genuinely want to hear people’s views on these proposals and the impact of the changes on people, their family and loved ones. We have funding lined up from the Government in principle so that they can see our ideas are affordable and realistic.
Will you change your plans through consultation if the public share ideas that could improve your plans?
All views obtained through consultation will be considered within the context of the proposal. At the end of consultation we will be developing a decision making business case which will articulate how we have taken account of the public’s views. It is really important to us that our plans reflect the needs of the local population, while taking account of the health economy.
When would the proposed changes start?
We cannot make any changes until we have consulted and listened to everyone’s views. The CCGs’ governing bodies will then need to review this feedback and make any decisions about the proposal.
We’ve heard all this before and nothing changed, so what is different this time?
The Government has now stated the funding is agreed, in principle. The proposals have been carefully worked up based on years of engagement with local people, staff and stakeholders. The public consultation will now allow us to hear people’s views on a clear set of proposals.
What’s plan B if this doesn’t work or happen?
We do not want to guess the outcome of the public consultation. Firstly, let’s hear the views of everyone with an interest in the future of health and care in Leicester, Leicestershire and Rutland, and, secondly, let’s then assess what people have told us. Once this process is complete, we will be in the best position to make decisions.
Why haven’t you consulted before on these proposals?
We were not allowed to consult until the Government had agreed to the funding in principle. Now that is in place, we can go out to public consultation. The time it has taken to get to full public consultation has allowed us to carry out significant public and patient, staff and stakeholder engagement to date in informing the proposals.
Where can I find out more information and have my say on the proposals?
There are a number of sources of information. Please visit our website www.betterhospitalsleicester.nhs.uk which has the full consultation document and summary versions, and details of consultation events and meetings. People can complete a questionnaire on the website, request a copy of the questionnaire to fill in at home, or can arrange to complete the questionnaire with a member of staff, telephone us on 0116 295 0750 or email beinvolved@LeicesterCityCCG.nhs.uk. To keep up to date with news of the consultation, follow us on social media via Facebook: @NHSLeicester and via Twitter: @NHSLeicester using the hashtag #BetterHospitalsLeicester
How accessible is the consultation information?
People can read the full consultation document and find a lot more information about what is being proposed and why at www.betterhospitalsleicester.nhs.uk. Versions of the consultation documents can be available in other languages and formats, including in easy read format, large print and video. These versions can also be accessed on our website.
Why are you consulting now during the Covid-19 pandemic?
In order to achieve the service change desired, we have a legal obligation to consult on the proposals. Furthermore, we know that public consultation will only improve the proposals being put forward. The longer we continue to deliver services in the way we are today, the more costly it becomes. Transforming services according to these proposals will result in a more cost-efficient and effective local health service.
In preparation our Communications and Engagement Plan has been revised and acknowledges that the consultation will be carried out during a period of significant change in the NHS. People are all learning to live in a world where Covid-19 is impacting on our day-to-day lives and as such our plan identifies activities showing less reliance on face-to-face communications and looks at more innovative methods to engage using our partnerships and digital capabilities.
In reaching the decision on the techniques and activities for involvement we sought advice from our external legal team – Brown Jacobson. We also sought advice from our external Equality and Diversity Team through Midlands and Lancashire Commissioning Support Unit (CSU), who reviewed the plan and strengthened our approach to address inequalities in our involvement. The plan has also been reviewed by the Regional Communications and Engagement Team at NHS England.
Why did it take so long to publish the pre-consultation business case?
The pre-consultation had to be approved at local, regional and national level before it could be made available to the public. The PCBC was shared as soon as possible after it was finally approved.
Who/where does the Business case have to go to for consideration, possible amendment and approval. Can you say something about the sources for the funding. Will the final plan be put out for additional consultation or comments from the public, stakeholder groups etc?
There is quite a complex approval process. Regional regulators such as NHS Improvement and NHS England sign off the business case at regional level. It then goes to NHS Improvement at national level, the Department of Health and then the Treasury.
The £450 million for this work is public dividend capital (from the government).
The consultation ends on 21st December 2020. There are lots of ways for the public to get involved during the next few months. We’re running some larger and smaller events so that the public can give their views on the proposals. These events are being promoted on the Better Care Together website.
Once the consultation has completed, an external company will evaluate the feedback from the public and produce a report. The CCG will consider the responses from the public to inform what is called a final decision-making business case. The CCG will need to approve this as the local commissioners. Once that has happened, we expect to be making a decision in the Spring of next year.
Where will the money to build these come from? How much is guaranteed from the Government and how much will reply on sale of the land? What will happen if these changes do not happen?
Our proposals have received a commitment of £450 million funding from the Government in principle – subject to the outcome of this consultation. Vacated land and buildings at Leicester General Hospital would be freed up and sold for affordable housing developments. Money from the sale of the land and buildings would be reinvested into the hospitals.
If we can’t bring these proposals to fruition, then we have missed a huge opportunity. This is the biggest investment Leicester has had since the Highcross was built.
Is there sufficient funding to deliver on this vision?
We have been looking at service development for a number of years and have begun transforming and moving services around the system. This has been done through recycling funds throughout the system. We will have to continue to do this to ensure sustainability and development.
Why wasn’t the recent ICU reconfiguration consulted on?
All the relevant documentation has been shared previously several years ago and discussed at length with the Joint Health Overview and Scrutiny Committee.
How soon will the public leaflet be delivered - at present much of the information is only available online?
The leaflets are currently being delivered. If you wish to have a summary and questionnaire delivered to your home address please call 0116 295 0750 and we will send you a printed version.
Some people are giving out flyers and posters suggesting that the plans are being proposed to balance NHS books and not about what people what/need in the future. Is this the case?
No, this is not the case. The purpose of the reconfiguration proposals is to address clinical configuration issues that have been going on for 20 years. The merge of the three hospitals was successful in 2000 but we haven’t yet sorted out the clinical configuration of our services. Cardio and vascular services are excellent services but are located separately which doesn’t support efficient service delivery. The location of many of our hospital services has happened by accident rather than design and we are trying to address this through our proposals. When we’re running hot on emergency care, elective care is affected. We need to get our hospital’s in a state where we can provide services fit for sale. Duplication and triplication of services across three sites makes it too expensive.
The proposals are clinically driven. The proposals have been scrutinised in great detail by the Clinical Senate and there is much support. This is our opportunity to address the issues that can currently stop us delivering.
What happens if you don’t get the support for the proposals through the consultation? Would the funding be lost?
It would be extraordinary if the government and the treasury withdrew the £450 million. The consultation is not a referendum. The purpose of the consultation is to see if there is anything we’ve missed or nuanced elements that require consideration. This is about checking our plans with the public and ensuring it makes sense to you.
How is the one year trial of the standalone midwifery-led unit being promoted?
It is promoted within the letter woman receive following their initial appointment with their GP. The second option within that letter is the St Mary’s Birthing Centre (after home birth). When the women first meet with their midwife, they’re given a lot of information including a leaflet including information about St Mary’s. There is also a website and a Facebook page. Before the COVID pandemic we used to hold open days which were advertised in the Melton Times but this still didn’t increase the number of women who give birth there.
If you close St Mary’s and after the one year trial the standalone unit at Leicester General doesn’t succeed, what will you do then?
We are anticipating that the standalone unit at Leicester General will succeed. People are just not using the St Mary’s Birthing Centre where it is currently located. We are anticipating that by locating it in a more central location, more people will use it. We’re proud advocates of midwifery-led care but we need to get more people to use it.
We wouldn’t be expecting 500 – 750 births in the trial year, that’s clearly not realistic. People aren’t using St Mary’s for two key reasons, distance and safety. We know from research that women prefer to be in midwifery-led units with access to medical support in case it is needed. We don’t know whether women are going to engage with the standalone unit at the Leicester General but it is more likely we will get more women wanting to use it because they won’t have so far to travel. Less than 10% of the 1800 pregnant women who live within 8-10 miles of St Mary’s each year chose to use the service.
Population of Rutland is older and people say ‘that’s great but how do we access those hospitals’. Need to find out more know it’s not an NHS issue. If patients don’t have car then they are stuffed even if you do have a car it’s a long journey?
We recognise there are issues for people who live in rural areas, which are serviced by public transport. We are working with Rutland, Leicestershire County Council and Leicester County Council and also working with an independent travel company. We are the NHS not County Council or Arriva, but the NHS does have a social responsibility to come up with something that suits most people. Not an NHS issue but it is if patients can’t get to their appointments. Patients from Oakham coming for an outpatient appointment which is routine might have 3 different bus journeys which is daft need to do some work so that this doesn’t happen. Consultant clinics in community hospitals and GP surgeries.
If I put consultation on Facebook I can tell you transport will be an issue and what people focus on. Not going to have answers?
People need to engage with this and tell us their thoughts so that we can address issues like transport.
Don’t have local newspaper, or radio, we have local newsletter, new radio station probably people don’t know about it. Will you actually sit down and say not getting anything from specific area. Found that not a lot of people knew about it as in Leicester Mercury. People say not know anything about it?
In terms on some radio stations Lutterworth falls into a black hole, working with Swift Flash to promote the consultation. Also radio advertisement conducted on Cross Counties radio station which covers Lutterworth and surrounding areas. Looking at data about who is participating in consultation where there is strong representation or particular areas of weakness and adapting areas of strategy to get to those areas. We want to work with councillors to help get this message out to your communities and how this might be possible. If you have an issue in an area come back to us. Swift Flash and Cross Counties radio station only thing we have.
People want clarity whether beds at Rutland Memorial Hospital will be maintained and that end of life care beds will stay?
It is not our intention to close Rutland Memorial hospital. We are developing a whole series of models that may change the way we want to use beds and the number of beds we need. These are decisions for Rutland as a place to make as a place decisions will be decided in the right place through the mechanisms that Rachna described. I think it to be honest it's one of the big strategic issues facing Rutland, we've already heard a suggestion that we need, potentially new facilities maybe to modernise or even maybe replace the existing hospital we need to look at that carefully. But it's a decision that will be made in Rutland, the plan is very clearly, to develop enhanced services here.
My question relates to timing of any changes. I understand why you wish to move services closer to home. Based upon the experience of Ashby following the closure of their community hospital in 2014 have still to see the promised services delivered as per the Leicestershire County Council Scrutiny Committee of 9th Sept 20. Should Rutland residents be concerned with your proposed changes?
Take your point entirely; there is no agenda here to diminish services in Rutland’. These decisions need to made in Rutland, shouldn’t be changing or standing services down unless there is a better alternative. This is a positive place development plan. The place is driving this you are in control of this. I agree with sentiment that you don’t get rid of something unless there is something better and that is correct.
To what extent is this development future-proofed? Is it just catching up with what we need now or will it provide what will be needed in 40 years?
A lot of work has been done with colleagues at the Local Authority to ensure future-proofing including looking at the demographics of the local population, taking into account the fact that people are living longer and many have multiple-morbidities. We have taken these things into account when developing our proposals.
An independent review showed that hospital food needs to be considered when future-proofing hospital care. The report recommended the use of digital menus and dining areas in wards. Has consideration been taken of this report?
This is an important element of patient care and recovery and we need to ensure we are offering patients the best we can. This is currently being looked at and we are still waiting for updates on this. Once received, we will update the frequently asked questions on the website.
There seems to be contradiction between the plans to increasingly centralise things on fewer sites and the direction that care seems to be wanting to take which is more spread out and more in the community and closer to where patients actually live?
What the NHS is trying to do is emergency and specialist services are coalescing into Centres of Excellence, where they're all together. But that's essentially what we're trying to deal with the emergency and specialist elements of the work that we do in the hospitals. The work that doesn't need to be done in hospitals, we're trying to export into community hospitals, GP surgeries, clinics so it’s closer to home.
The last 70 odd years of the NHS has been about is that hospitals have essentially been factories where people are made better. And frankly, too many people came to a hospital that could have been treated elsewhere, had the elsewhere existed or had we exported our staff and our specialist expertise to other places.
When we do the work in hospital that need to be done in hospital, and to coalesce that work into more concentrated environments where clinicians can feed off each other in terms of ideas and you don't move the patient's around, whereas the work that doesn't need to be done the hospital should move closer to home, and out into the community.
Do you have support from the Government of experienced personnel to ensure this project is managed correctly (cost, delivery on time, meeting regulations, taking residents views as the project runs)?
We need a blend of expertise to make this project a success. We have employed BDP as our architects who have a lot of experience in these kinds of projects and with Price Waterhouse Cooper for the governance. We also have skilled project managers working alongside our clinicians and across all other areas. Collectively, we do have the skills required.
Is £450m enough to complete the refurbishments across the 3 sites?
It is enough to achieve what is in the plans. But of course we could always do with more funds.
Is the funding really secure this time?
We are as confident as we can be. We are really positive about it and are planning to receive the money to get on with the changes.
How will these plans be handled? Will it be a phased approach?
Yes, we have to consider who gets what first and who follows so that we can have a streamlined approach. For example, at the LRI, when building the maternity hospital we would empty Kensington into the new build, then refurbish that into Children’s, then move them in before turning the old sites into adult sites. We will be engaging with our patients about the timescales months in advance and it will not be complete until 2024/25.
Time frame of consultation period?
The consultation period goes up to 21st December and this has been a 3 month period of engagement and communication messages to the public. I won’t cover all the activities of how we have reached 1.8 million people. It does mean that people via social media and off line have seen things a number of times people need to be reminded. Reach has been there. This is not a referendum it is not a ‘yes’ or ‘no’, key intention of the consultation was really to seek out to ask people what they think about the proposals and what impact it would have on them and their families, we will have a whole range of insights and data. Have 1,000’s of responses outside organisation and will work through all information which could take up to a couple of months due to the information received. Report will produced for the Clinical Commissioning Group and information will be in public domain so people across Leicester Leicestershire and Rutland can see what conclusions and what the information shows and how any decisions have been reached. Can’t give date for that at present.
Some risks of cost overruns are present in the risk register but some of them are not. Recent tenders have come in at higher than expected cost. Also, the proposals were costed before the pandemic so altering hospital design to allow for the greater space and flexibility needed in pandemic planning may also push costs up. Why is the possibility of cost overruns because of higher than expected construction and project management costs not reflected in your risk register?
The budget costs identified in the Pre-consultation Business Case at the stage we are at are based on our recent experience of letting schemes in UHL – for example the emergency floor scheme, the East Midlands Congenital Heart Centre scheme and the interim Incentive Care Unit scheme. These costs have been validated by the estates team at NHS England and Improvement. The risk register in the Pre-consultation Business Case is at a point in time. It is a live document that is continually updated and validated, with mitigations identified to help prevent the risk coming to fruition. The current risk register has been updated and is presented to the UHL Trust board on a monthly basis.
With regards to pandemic proofing, the current proposal will respond to a future pandemic. For example, this includes:
- A doubling of Intensive Care Unit capacity. During the peak of the Covid 19 pandemic we had to use some theatres, and move children’s heart intensive care to Birmingham for a period of time. We needed in excess of 70 Intensive Care beds at the peak; our scheme will provide over 100 Incentive Care beds.
- In addition, the development of the new treatment centre allows us to split a lot of planned care from the emergency care. This means that at times of peak emergency pressure we can maintain our planned activity.
- New buildings also have a more generous footprint. This will make it easier to separate flows of people and goods around the new buildings.
Will the Department of Health cover additional costs for pandemic planning and how will you address cost overruns from higher than planned construction costs?
We are working with our professional advisors and design team to ensure we deliver our scheme within the £450million budget allocated.
However, vacated land and buildings at Leicester General Hospital would be freed up and sold for affordable housing developments. This money from the sale of the land and buildings which would be over and above the £450million, would be reinvested into the hospitals.
What happens after 2024? A £450m capital expenditure on hospital services is a long-term investment, so what is the long-term plan for hospital expansion after 2024? I appreciate that bed modelling is difficult, but population increases are a certainty, so a plan for expansion is unavoidable. 2025 is not far off and at the least, we should see a plan till 2036, including where the funding for that plan is going to come from.
Our ambitious plans for investing £450million in modernising and improving Leicester’s hospitals is about much more than simply creating additional beds. Had it not have been it is unlikely our bid for Government funding would have been successful.
Instead our proposals are about correcting decades of capital under-investment in our hospitals. They address some of the clinical adjacency and co-location issues that all too often hinder our ability to deliver the kind of care and experiences we want for our patients.
Simply put services are currently organised in a way that is a legacy of history rather than design, often in buildings and facilities that are outdated and not fit for the delivery of modern healthcare.
If further capital developments are needed to meet growth in population or health need after 2024, then we do have flexibility in our existing estate to develop. We retain 33 acres of developable land – the equivalent to approximately 22 football pitches. This is located at the Glenfield Hospital. More than 25 acres of this land is already empty space.
If future developments are needed they would likely be funded from the Trust’s own capital budgets and, working with local NHS and local government partners, through access to section 106 funding and the community infrastructure levy to support services when housing growth puts pressure on them.
We will also continue to maximise space at the Leicester Royal Infirmary, with appropriate planning consent if necessary. We appreciate that it is essential to consider travel, access and car park when considering what services are provided on this site.
How can the public be expected to give an informed assessment of the proposals without details of the community services which, we are told, will be picking up more health care through new patient pathways? The interdependence of community and hospital services is well established in whole systems thinking but community services have been bracketed off from this consultation.
The plans to build better hospitals for the future for Leicester, Leicestershire and Rutland stand independently of other proposals. Even if we were planning to do nothing to improve and expand on the services provided in the community closer to where people live, these plans are the right ones and the reason why we have undertaken the consultation at this time.
However, during 2018 and 2019 we undertook separate engagement to understand what matters most to people about community services. The feedback from this work aligns with the central tenet of our overall clinical strategy for health and care services which is delivering as much care as we can as close to where patients live as is practically possible.
We have already started discussions in some local areas as the first step to developing plans for what local health and care services should look in communities across Leicester, Leicestershire and Rutland. These plans would include discussions relating to GP provision and the usage of local infrastructure, such as the community hospital, to deliver a greater range of services locally.
We are committed to continuing these conversations over the coming months. Our focus will be on working with the local community to identify services that can and should be delivered locally.
You state in the PCBC and in your response to an October 2020 JHOSC representation that the consultation does not include proposals for community services. You then make proposals for community services on the site of the Leicester General Hospital and consult the public on these, despite the fact that, as you admit, they are not funded in the £450m scheme. Do you agree that consulting the public on these possible, one-day-in-the-future ‘potential’ services alongside services you are committed to retaining on the site of the General Hospital is likely to confuse the public? I note that one of the prominent images on the website, in the brochures and in videos circulated on Twitter is an image of ‘The Leicester General Hospital Community Hub’ – which is unfunded - sometimes alongside the planned Treatment Centre and the planned Maternity Hospital - both of which are funded?
The consultation is about the three acute hospital sites in Leicester and the services that will be provided from these in the future It also covers the future of the midwife-led unit at St Mary’s in Melton Mowbray. It is therefore entirely appropriate that the consultation should ask for views about what services could be provided from at the Leicester General Hospital campus given its proposed changed remit.
How likely do you think it is that the Building Better Hospitals consultation will fulfil the requirements of a lawful public consultation?
With regard to the opinions expressed above, these have been responded to in previous reports and communications. The Better Hospitals consultation has fulfilled the statutory duties and common law obligations placed on the CCGs. The consultation provides sufficient information to understand what is being proposed from acute and maternity services provided by UHL.
It has been accepted that additional work will always be required after any consultation to understand what services could replace those moved from a particular NHS site. Ideas are being generated by people who are responding to this Better Hospitals consultation. It is normal in those instances to seek to co-produce future service provision with the relevant communities and that is all that is being proposed. This we feel further supports the fact that the CCGs are undertaking an open and transparent process which meets their statutory duties and common law obligations. Consulting during a pandemic has shown us how technology can be used to involve and engage the public on a range of issues. In the context of health service reconfiguration, we adapted and adopted new ways of working to exercise our statutory functions.
The use of technology to hold meetings, share information and recordings of meetings, and enable a wider reach across communities has provided additional methods and opportunities to consult or provide information to individuals to whom the services are being or may be provided.
This is in addition to off-line communications and engagement activities in order to reach people who may not be digitally enabled or active.
The only restricting factor experienced during the consultation has been the inability to undertake public face-to face events and public outreach. However, the public face-to-face events have been replaced by many more virtual online events than would have been practically possible using off-line mechanisms.
We have undertaken extensive online and offline activities which we are able to measure confidently. This demonstrates that the vast majority of adults across Leicester, Leicestershire and Rutland will have had the opportunity to be aware of the proposals, often through multiple channels and participate in the consultation process if they wish.
Can we have a breakdown of consultation responses with where the response originated from, when will this breakdown be supplied?
All the consultation responses we receive from the consultation will be independently analysed and evaluated by Midlands and Lancashire Commissioning Support Unit (CSU).
The responses provided by the public are anonymous. However, the questionnaire does ask people to provide socio-demographic and equality data. This is optional. Where people have provided this information, the CSU will include a full breakdown of this data in their Consultation Report.
The final Consultation Report of Findings will be received by the three CCG governing bodies and discussed in a public meeting in the first half of 2021. The public consultation feedback will be considered and taken into account in any decisions they make.
The papers for this meeting will be publicly available including the Consultation Report of Findings. We will promote the governing body meetings to enable people to attend and hear the discussions. All decisions will be made public after the governing board meetings and further engagement work will commence with people who use services provided by UHL. This work will include communicating the decision via local newspapers, social and broadcast media. We would also expect to present this information to Scrutiny Committee.
In light of the Covid pandemic and limited awareness among the general public of the Better Hospitals for the Future consultation and that no community provision assurances have been given do you not think an extension of the consultation period should be considered?
When looking at the current circumstances the world finds itself in, then in order to fulfil our duty and to continue to exercise our functions we have adapted our processes to achieve that objective. The use of technology to hold meetings, share information and promote the consultation has enabled a wider reach across communities. This activity has been combined with off-line activities to reach communities not digitally enabled. We are able to measure the majority of our activities confidently. This demonstrates that the vast majority of adults across Leicester, Leicestershire and Rutland will have had the opportunity to be aware of the proposals, often through multiple channels, and participate in the consultation process if they wish.
We are confident that our activities to date and the approach we have taken has allowed us to meet both our statutory and common law duties. Therefore we see no reason to extend the consultation period, which will close on 21 December 2020.
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Should we just keep the current services as they are?
There are three hospitals in Leicester as a result of history, rather than design. For the last decade our clinical teams have been telling us that it’s almost impossible to run effective services when people and equipment are duplicated and triplicated across three hospitals. Staff and patients are bounced between the three hospitals; clinical services that ought to be next to one another are separated which hinders team working; and it’s clearly expensive to run.
What are the reasons behind the proposals?
There are many reasons why we need to change how our hospitals provide services. These reasons include the fact that our population is generally living longer and people’s health and care needs are changing. The demand for healthcare services is going up. We need to better join up health and social care services so that they make sense for patients and are less confusing. We want to improve the quality of care provided to patients. Our existing staff are spread too thinly across services at the three hospitals, meaning there are times when some services cannot be staffed as needed. We have some tired, old buildings that need a lot of maintaining because of their age - these are very costly and inefficient to run. Furthermore, we need to spend NHS money in the most efficient way. The way our hospitals are currently set up does not support this.
Has dealing with the Covid-19 pandemic changed the need for these proposals?
The Covid-19 pandemic meant that operations and procedures were cancelled in large numbers. This affected all services and all types of patients, even some with cancer. In our plans we are going to build a standalone treatment centre at the Glenfield Hospital. This will help us separate emergency and planned procedures. This means that when we are busy with high numbers of emergencies, our patients due to receive planned care still receive their care. Our proposals will help us more effectively staff our services. For example, with two super intensive care units rather than the current three smaller ones we would have been able to consolidate our staffing, making it easier to cover absences. The experience of managing health and care services during Covid-19 has only strengthened the case for these proposals.
What changes are actually being proposed?
As a quick overview, the proposal is to re-shape acute and maternity services by moving all acute care to the Leicester Royal Infirmary (in the city centre) and to Glenfield Hospital (on the outskirts of Leicester on Groby Road). We propose to retain some non-acute services on the site of Leicester General Hospital, in Evington (three miles east of Leicester city centre on Gwendolen Road). The services that we propose to have at Leicester General include a diabetes centre of excellence, imaging facilities to help with diagnosing conditions, and stroke rehabilitation including inpatient beds.
A midwifery-led unit may be re-located to Leicester General Hospital. This is an option which will be informed by the views of the public expressed during this consultation. We are also asking people for their views on other services that might be located at the Leicester General Hospital site in the future. This could include a primary care urgent treatment centre, observation beds (keeping an eye on people who might be poorly enough to be admitted into hospital), community outpatient services and potentially a new GP practice or increased primary care services.
Overall our proposals will enhance the care provided to critically ill patients and will see the doubling of intensive care capacity for the most unwell patients.
Is the reason these changes are needed because the NHS is underfunded by Government austerity?
These proposals are driven by a desire to offer really great environments for care and clinical services with a quality element which is important. The financial issue is important to make sure get best value from the resource investment, it's not driven by desire to save money. The main driver is high quality sustainable services.
Can you outline how plans have changed in light of lessons identified from Covid?
The pandemic has helped us to focus on infection and prevention. We have learnt that the ventilation at Leicester General Hospital is not good; the nightingale style wards have made this more difficult. We have also learnt that we need to increase number of side rooms available. We are learning about how we separate services and staff. Doubling Intensive Care Unit capacity will give us the ability to have a super clean hospital.
Are all the changes being made now going to reflect how the set up needs to be with regards to future potential outbreaks?
The Covid-19 pandemic meant that operations and procedures were cancelled in large numbers. This affected all services and all types of patients, even some with cancer. In our plans we are going to build a standalone treatment centre at the Glenfield Hospital. This will help us separate emergency and planned procedures. This means that when we are busy with high numbers of emergencies, our patients due to receive planned care still receive their care. Our proposals will help us more effectively staff our services. For example, with two super intensive care units rather than the current three smaller ones we would have been able to consolidate our staffing, making it easier to cover absences. The experience of managing health and care services during Covid-19 has only strengthened the case for these proposals.
Are you looking at other countries where this is working really well and taking on board some of their initiatives?
We will be working with an architect company who has built a number of hospitals. We have also looked at other children’s hospitals in this country and have been working with others who are also developing their sites to discuss learnings.
Is the IT infrastructure in place or planned to cope with this development and innovation in terms of cross-site visibility and communication?
We are working with NHS Digital as well as an in-house team about the digital programmes to try and modernise healthcare. We will be implementing a lot of new technology, systems and processes and making our buildings more digital proof. We are also involving clinicians in designing our programmes and technologies. We have very strong digital aspirations and are currently working to pilot systems such as the electronic prescribing system.
With the move to virtual by default, will there still be an option for physical appointments, particularly for those who struggle digitally?
Virtual appointments will only happen when appropriate. We will absolutely continue to offer face to face appointments. However, we have learnt a lot from Covid-19 whereby we can see the importance of only brining people to hospital when it adds value to patient care. Sometimes this will mean face to face but sometimes this will mean virtual appointments are most appropriate.
The IT systems are a long way off from being integrated, particularly with primary care. Will you be addressing this within the plans or will this have to wait until after the building work is completed?
No, the development of our IT structure needs to run alongside our reconfiguration plans. We are very proud of our e-hospital board and the fantastic staff leading the board. Work has already started on developing e-patient records. This enables us to capture the whole, holistic view of the patient.
Are there any targets or timescales for the completion of the IT work?
There is a digital road map on the University Hospitals of Leicester website which you are welcome to view. It shows the key changes we expect to see with timescales. Some work already happening for example, the e-patient records. These should be in place by 2022. The development of the new Treatment Centre at the Glenfield will enable us to use technology for the benefit of patients. For example, we are planning to create a digital system where patients can sign in at the Welcome Centre to register their arrival on site. They will then be called up to the appropriate waiting room 5 minutes before their appointment. This will avoid the clustering of lots of patients in waiting rooms outside clinics for long periods of time. This would support better infection prevention in situations such as the COVID pandemic.
Housing development, 24,000 new homes in Leicester are we sure we have got enough growth
We have taken into account population growth, plans are sufficiently roomy ‘yes’, is that a guarantee ‘no’. Reason I say no is because predicting in NHS what service are likely to be is a bit of a fools errand. The reality is we plan 10 years in advance population growth is 10% how many beds, bed base growth is 300 beds by making some pathways more efficient. If there seems a theme the work of hospital should be emergencies and specialist care. Care can be provided in GP surgeries, community hubs and in the community. This will give more room to expand if we need to. Any resource this frees up should be spent on prevention, public health and mental health. I can’t give guarantees.
From CCG point of view we are planning with UHL, LPT with regard to the changes Mark has described which are place and locality based plans. Contingency for significant growth at Glenfield. There is a degree of future proofing. It wouldn’t be prudent to say at this time but we can review in medium to longer term.
Wanted to know if there would be a possibility to have the eye clinic in one building?
We have the eye casualty which is next to A&E. We have eye clinics in LRI Balmoral building which where people get their outpatient clinics done and then we have the retinal screening and retinopathy which looks kind of picking up things like diabetes so it depends what you mean by the Eye Clinic.
At the moment, I think it's likely to stay in one place, place with the Royal Infirmary but we don't know which is which will work out where the best fits most important thing I'd say. A lot of the work that take place around ophthalmology is screening properly that takes place in the hospital. So, High Street ophthalmologists High Street optometrist an awful lot of the kids, we have in hospital, and an awful lot of the skills we have in hospital, and can do an awful lot the work we do in hospital, without having to make the journey possible first. So my strategy team, the ophthalmologists in the clinical team and the commissioning group, looking at how we better export some of our eye services back onto the high street so patients don't need to kind of make a trek in the hospital, it's not absolutely necessary.
Mental health and educating about breast cancer, having the relevant professionals visiting community centres and have workshops, could this be something?
That's something I'm going to take away and pick up with some of the teams in the CCG that are working on the redesign of those areas because I really do think that that's an excellent idea and we need to use community facilities I think to do that I think we need to come to women as opposed to women coming towards so I'll take that away with me.
The General Hospital is known for its excellent renal service. Where is this moving to and can we have some reassurance that the new service will be as good or better?
The renal service will move to the Glenfield hospital however dialysis will move to a new unit in the east of the city. The service is currently too small, and we would like to put it in a more modern building.
Would providing more/additional training for staff be more cost effective than employing 400+ shortfall of staff from overseas?
We need an overall approach so we need to consider both approaches.
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The consultation is about changes to acute and maternity services – what do you mean by ‘acute’ services?
When we say ‘acute services’ we are talking about the care when patients receive treatment for severe injury or illness, urgent medical conditions, or during recovery from surgery.
If Leicester General is no longer going to be an acute hospital, does this mean that the General will eventually be closed?
No. Under our proposals the General has a key role to play in people’s future health and care needs by becoming a ‘community health campus’. Rather than being an acute hospital caring for the sickest patients, it would become a smaller centre that focuses on community health, with some inpatient beds. The community health campus at Leicester General would tend to serve people living in the east side of the city and county. It would include a range of facilities such as the diabetes centre of excellence, a dedicated imaging hub to help GPs diagnose patients’ conditions quicker and a stroke recovery service with inpatient beds (in the Evington Centre). There would be the potential development of a primary care urgent treatment centre, observation facilities, community outpatient facilities for a range of mental and physical conditions and additional primary care services. The consultation will also consider greater use of hydrotherapy pools in the community, replacing use of the hydrotherapy pool at Leicester General Hospital.
If you are closing the General what happens to the dialysis unit there? Will that be closed too?
We are consulting on the dialysis unit in terms of the best location for this service. There is currently a dialysis unit on the Leicester General Site and also at the Hamilton centre which is 2 miles from Leicester General Hospital. The renal team want to provide better access for patients and propose moving the renal unit moves from Leicester General Hospital to two additional facilities, one at Glenfield along with acute services and another unit towards Wigston where there is a lack of facilities and this would improve access for patients who use this service.
What will you do if people say they do not want to lose the Leicester General Hospital and St Mary’s centre?
This is an issue for the Clinical Commissioning Group as part of the consultation exercise. An independent organisation has been commissioned to review the messages and what this tells us. We may not get a consensus, we will then need to decide if safe to continue with proposals or if there is a need to modify.
What would be some of the big changes at the Leicester Royal Infirmary and Glenfield Hospital?
It is proposed that all acute care is moved to the Leicester Royal Infirmary and to Glenfield Hospital. The proposals would see the creation of the first dedicated single-site children’s hospital in the East Midlands based in the Kensington Building, Leicester Royal Infirmary, a new maternity hospital at the Leicester Royal Infirmary, two ‘super’ intensive care units with 100 beds in total (almost double the current number), a major planned care treatment centre at Glenfield Hospital, modern wards, operating theatres and imaging facilities, as well as additional car parking.
These changes would enable us to separate emergency and planned care (care which is arranged in advance), helping to prevent treatment being delayed or cancelled when emergency services are busy. More than half a million planned appointments a year will move away from the city centre site, creating room for the new maternity hospital and improve and enhance services at the newly established children’s hospital.
Why do all the planned care procedures need to be at Glenfield Hospital? Could they not be split between the two acute sites?
The treatment centre is an important part of our plans and enables the separation of planned care from emergency care. At the moment, our emergency care services and planned care services sit side-by-side. This means that at times of pressure, patients waiting for planned surgery often have their operations cancelled because an emergency patient needs the bed, is in theatre or intensive care is full. Locating the treatment centre at Glenfield Hospital away from emergency care predominantly provided at Leicester Royal Infirmary, would help to protect planned care procedures. It would also help to relieve pressure on the Royal Infirmary site and provide significant space to plan and create new developments.
We know that Leicester Royal Infirmary tends to be ‘full’ with traffic and parking is a significant issue for patients, visitors and staff. Moving the majority of planned care from Leicester Royal Infirmary – which currently sees more than 100,000 patients for day-case procedures and approximately 600,000 for follow-up appointments a year – frees up capacity at Leicester Royal Infirmary to manage emergency demand.
What would happen to emergency care?
Leicester Royal Infirmary will continue to be the main site for emergency care. To make way for the new hospitals and services on this site, the majority of planned care and outpatient appointments would move to the new Treatment Centre at Glenfield Hospital or to a community hospital or general practice setting.
What are some of the services moving into Glenfield Hospital?
A ‘super intensive care unit’ would be developed to support the growth in demand generated from all services. Planned orthopaedics (bones and joints), liver medicine, kidney medicine and urology services would relocate from Leicester General Hospital to create a special surgical hub with a supporting admissions unit. It would double the size of the intensive care services, improving the care of our most ill patients with conditions including strokes, heart attacks and breathing problems.
The renal service (looking after people with kidney disease) and haemodialysis service (cleaning of the blood) would move from Leicester General Hospital to Glenfield Hospital as part of the proposals. There would also be a haemodialysis unit located to the south of Leicester.
Will the development of the Glenfield site help to reduce waiting times for appointments and treatments?
The key to this is the separation of elective (planned) and non-elective care. Acute care always takes priority as it is more life-threatening. The proposals will support the separation of these two types of care to support delivery of both and will mean diagnostic testing will be separated too.
This will improve efficiency. Currently, patients have to visit different sites for different tests and procedures during their patient journey. The purpose of the Treatment Centre at the Glenfield Hospital is to provide a one-stop-shop. This should be better for people travelling from further afield and will help us tackle our waiting lists. Demand is growing and our estate if working against us. The proposals will offer real benefits to patients.
Will it not be more difficult for people to find their way around in such large buildings?
A welcome centre would improve the experience of people getting around a very busy and complex building. Facilities developed through the building would improve access and make it easier to get around. This welcoming environment when people first enter the hospital would particularly assist those less physically or mentally able, providing assurance and assistance to help them get to their appointment.
How will we know where all the individual services are going to be based in the future?
The full consultation document details a total of 99 day case and outpatient services, setting out where the service is currently based, and where it will be based under the proposals. This document is available on the website www.betterhospitalsleicester.nhs.uk
Are you taking beds away?
No. Our proposals will see an increase in beds – on our wards and in our intensive care units. Overall, there will be another 139 acute beds by 2023-24. This would be an increase of 7% on the current total of 2,033 beds.
How confident are you that is enough?
Yes we do have enough beds, these bed numbers can fluctuate year by year, so there needs to be the ability to moth ball wards or bring in extra beds if required.
We keep being told that the population is living longer and as a result have more health care requirements. If that's true surely we need more new beds than are planned under these proposals?
There has been drive to reduce the bed stay in acute hospitals by 30-40%; this has not been a cost saving exercise, clinical practice has changed. Modern medicine doesn’t necessarily mean bringing people into hospital, especially frail elderly people. The bed model says we require 139 extra beds but we have the option to build more if required.
How many Stroke Rehabilitation beds will be moved from the UHL section of the General into the Evington Centre and how many beds will therefore be lost to community hospital use?
We will be moving 16 beds from Leicester General Hospital to the Evington Centre. These beds will move into empty wards at present and spaces being used as offices for staff. It is important to keep Stroke Rehabilitation beds on Leicester General as this is within the city boundary and stroke patients are mainly from the City and are therefore accessible.
What are the proposals for hydrotherapy?
There is currently one hydrotherapy pool at Leicester General Hospital. We are proposing using hydrotherapy pools already located in community settings in schools and community centre. This would provide care closer to home and improve access to hydrotherapy pools for our population.
The consultation mentions possible GP imaging facilities at the General. Are these actually budgeted for in the business case or are they a 'wish list'?
The Leicester General site does have imaging facilities and the proposal is to keep these on site so GP’s can refer directly into this service.
How are you going to staff these new hospitals when there is a national shortage of nurses and other key staff?
Our experience of building new facilities (the emergency department) shows that it is easier to attract staff to work in modern, purpose-built buildings, so we are confident that this will help us to not only recruit staff, but to also keep them. Furthermore, by getting the right services in the right place, we will be able to make better use of our staff resources, rather than having to duplicate or sometimes triplicate staffing rotas across different sites.
What are the staffing levels now across the three sites and what staffing levels are anticipated upon completion?
We currently have 16,000 staff working across the three sites and that number won’t significantly change. However, we are trying to reduce duplication and triplication (doubling/tripling) of services and to ensure there is better clinical adjacency (services being located next to each other so they can work together). Therefore, staffing models will be more robust and staff won’t be stretched so thinly across the sites.
How will the facilities and environment be better as a consequence of the changes?
The services we relocate will be provided from either new buildings, or from refurbished accommodation. They will be designed to be fit-for-purpose, bright and airy - healthcare fit for the 21st Century.
How environmentally friendly will this be? Will you have solar panels on the roofs, electric charging points for cars ground source heating?
Sustainability is a huge issue and is on everyone’s minds. We will take cognisance of latest technologies and latest development in sustainability using a system called Building Research Environment Assessment (BREAM). Modern methods of construction will be used i.e. construction materials from sustainable sources. Car parking and travel are a big issue for patients and estates are looking to build new car parks with electrical charging points as a minimum standard.
How are you funding these changes and is public estate land being sold to help pay for them?
Our proposals have received a commitment of £450 million funding from the Government in principle – subject to the outcome of this consultation. Vacated land and buildings at Leicester General Hospital would be freed up and sold for affordable housing developments. Money from the sale of the land and buildings would be reinvested into the hospitals.
Is it a good idea to sell off land when the needs are rising for more health services?
Land will only be disposed of when it has been declared surplus and is planned through a comprehensive estates strategy. The Trust has more developable land at the Glenfield Hospital.
Why has my area (for example, east Leicestershire or Rutland) been forgotten about in these proposals?
No area has been forgotten about. We have considered the needs of all people across Leicester, Leicestershire and Rutland. We need to ensure that we can serve the needs of all our population, now and in the future, and these proposals will, we believe, provide the optimum solution for acute and maternity services. The proposals provide the basis for the most cost-effective, efficient, high quality and safe services, a local NHS fit for the 21st Century.
What period of time would the whole project take from start to finish?
The project would run until 2027. It will involve a complex series and sequencing of moves. We need to create space to build the maternity hospital and vacate some clinical areas first. It will be a couple of years before we can start construction. It is likely to be the latter part of 2024 for the major building work outlined in the consultation.
The public perception regarding the sale of land at the General Hospital site is negative. How can you counteract this perception?
We are aware that there has been a mixed public reaction regarding this. As you may be aware, there is a housing shortage across Leicester, Leicestershire and Rutland. Part of the planning guidelines for this consultation required us to consider how our work will contribute to the current housing crisis. As such, the land at the General Hospital site is unused, we therefore deemed it beneficial to sell this land for local housing and use the funds raised to reinvest into the local NHS. As part of this, a percentage of the houses developed on this land will be reserved for NHS key workers. Whilst we appreciate the concerns that this land may be required by the NHS in the future, we would like to highlight that we have more unused land available for future development at both the General Hospital and Leicester Royal Infirmary sites.
Where are we with the proposed changes to Hinckley and Bosworth Community Hospital?
Covid-19 has affected our progress with the plans for Hinckley and Bosworth Community Hospital. We are looking at the learning from wave 1 of Covid-19 and considering how this will impact plans for the hospital. We will then come back out to talk to patients and the public about our plans for the hospital. Further, we will look to roll out this process to all community hospitals across Leicester, Leicestershire and Rutland through the development of ‘placed based’ plans.
How are the new buildings and refurbishments to be protected against surface water flooding, which is a risk particularly at the Leicester Royal Infirmary site? How do these proposals help towards reduction in carbon footprint of health services?
Leicester Royal Infirmary is flood risk site. We will be working with planners at the council and will be required to conduct a survey and produce a drainage strategy. Carbon is a very important issue. The NHS have a strategy to take hospitals to a carbon neutral position. Carbon neutral is much more possible to achieve in new builds than in older buildings.
What size will the new wards be?
We are planning for 28 bed wards - 4 bed bays with 2 side rooms. The side rooms will be either 16 or 20 beds. It is important that we look at the flow of people through the ward. We will be doing this with the architects with detailed mapping post consultation.
What happens after that time with the population growing, some people saying need more. Supported discussions around options 1-3 the disadvantage of option 3 is the ICU at LRI as this site has been described as landlocked with expansion limited. The issue is about putting everything at LRI, very restricted in terms of land, and may be possible to re-design. When look at calculations for options 1-3 net present cost not full cost benefit. Difference between options 1-3 is not very great. Welcome and appreciate services together. Maternity is an example, understand not wanting to move people if having difficulty in birth?
To put more services on landlocked site wouldn’t be correct. Putting the treatment centre at Glenfield will take roughly 50% of patients off the LRI site. 730,000 patients current attend the LRI and this will drop to under 400,000. We have a bed model which says over next 3 years have 300 new beds, based on disease profile epidemiology. Look at history of healthcare, acute beds have halved, not for cost savings, it’s because long stays are long gone, use more keyhole surgery which reduces the need for long stays in hospital. We are essentially creating capacity of 15% more beds the population growth is 3.4% up to 2024 and for 2030 just shy of 10% this is more than population growth. If necessary we will be able to create more beds on the Glenfield site.
Anxiety in periphery of community hospitals, with regard to Rutland memorial hospital people are worried that it will close?
There have been a number of discussions in Rutland and we are working with the local council and population to ally some of the fears. This consultation is not talking about community hospitals. We are working through what we need to be able to provide from local hospitals to have services closer to home which is important to us. Post COVID care is in people’s homes, lots of virtual processes are in place, telephone and Microsoft consultations. We are undertaking a parallel piece of work and will come out to engagement with people about what this means. We will keep you updated on plans for community hospitals.
Too much work comes into big hospitals in the City as a result of COVID we are pushing more into community hospitals and long may that continue. We need our community hospitals to be doing other work.
The city centre is over run with facilities. I am greatly encouraged by the Treatment Centre at Glenfield 40-50% work go there. Working closer with GP surgeries whole system better co-ordinated. Glenfield large centre. There is a lack of communication between surgeries and the hospital system itself?
Couldn’t agree more, it is a focus for us on all aspects of care, communities, acute and GP’s. Right skill set in community. We are working out what services might be delivered in primary care and exciting mechanisms there are for urgent emergency services to enable keeping people at home as long as possible. Communication to support GP’s to deliver that care in peoples own homes.
Reconfiguration is not all around the building, underpinned by changes to the way we do things. Truly put the patient at the centre, what care, where and right people in right place to deliver that care. Home best place quite often, increase prevention to stop bringing people into UHL only bring people in when it adds clinical value to the patient. We need to do this transformation irrespective of the reconfiguration.
Talk about getting message out to community with regard to the consultation, worried how to get to elderly people in the community, in Lutterworth advert taken out to do this, again these people will miss what happens. Fielding Palmer closed to beds and been under closure for a number of years. Step down beds from Oadby, Wigston, in bed capacity planning ahead. In mainstream hospital that can’t get out (bed blockers), no support in community for services to support them, growing environment, does it account the loss of these community beds, reliant on better care together. Elderly population routed to Loughborough, Ashby, some of those were minor things done at cottage hospital level. This pulls people away from network of limited support. Having fantastic building in centre Leicester great but others get pushed out?
Model of care for the community is Home First, and these community services are coming on-line. Long term strategy is to put more investment into community services not only healthcare but social services, with more preventative care. If people do need to go into hospital discharging them as soon as possible when medically fit for discharge, and having service in place to receive this patients. We do know need set number of beds, this has been changed by knowledge of COVID. The bed modelling isn’t done in isolation, done with system ambition to keep people home. Concerns are raised are that people not able to get out of hospital as services not set up at the moment.
Getting the communications right is vitally important. It is difficult to reach 1.1million people but we are using many different techniques/tools to reach as many people as possible so that they feel able to take part if they wish to. They can phone us and be taken through the survey. We have commissioned 8 voluntary & community services to work on our behalf to reach out to seldom heard communities to ensure we cover the 9 protected characteristics as these are people who often find it difficult to access healthcare. Council of faith is working with to get messages across to those who might not have English as first language. We have paid and organic social media advertising, 4 full page advertorials Leicester Mercury, Loughborough Echo, Hinckley Times, Ashby, Coalville and Swadlincote Times, Rutland Times, Harborough Mail and Melton Times. Also, extensive radio activities with Sabras Sound, EAVA, Kohinoor, Sanskar, Seer. Capital FM, Fosseway, 103 The Eye, Hermitage FM, Harbourgh FM, GHR Stamford and Rutland, Cross Counties Radio and Leicester Community Radio. Also local newsletters and magazines i.e. Swift Flash, Hinckley Roundabout, Groby Spotlight, The Herald, MaHa Magazine and Age UK magazine.
Targeted TV advertising aged at the over 55’s who may be less likely to use social media across Leicester, Leicestershire and Rutland. We are extensively utilising social media, snapchat, Facebook. Posters provided to 100’s of shops across LLR.
Leafletting of households is part of the strategy. Mixed results as 7% of all responses are from people who received leaflet. There have been 2 separate deliveries of leaflets to give greatest level of assurance that people have seen the consultation. Leaflet just one part of overall communications package.
We should introduce neurology to Leicester as currently we have to travel to Nottingham for this service?
In Leicester, we have a large adult neurology department. This department provides both inpatient and outpatient care, with general and specialist clinics in Parkinson’s disease and movement disorders, epilepsy, neuro-ophthalmology, dystonia and multiple sclerosis. We also have a neurorehabilitation department which provides Level 1 and Level 2 neurorehabilitation for the whole of the East Midlands region.
However, Leicester does not provide neurosurgery and interventional neuroradiology services. These services are provided at Queens Medical Centre Nottingham for the whole of the East Midlands region - Nottingham is also the regions major trauma centre. We do have local clinics with two visiting consultants in neurosurgery in Leicester.
What is planned care? With reference to the Planned Care Centre at Glenfield Hospital; how many new theatres will there be and what are the planned care treatments that will be in this new building?
Planned care is care that is relatively planned and that you can wait a period of time to have as opposed to urgent or emergency care. This is care such as hip and knee replacements. A substantial building will be built onto the front of the current Glenfield Hospital. Whilst it will be a separate building, the buildings will be linked. The new building will contain things such as outpatient services, day case surgeries, 23 hour surgeries, inpatient service theatres and wards.
What are day cases? I noted that day case areas are said to have chairs instead of beds, could you please expand on this?
Day case treatment usually sees patients arrive at hospital in either the morning or afternoon and receive their procedures. This is usually procedures such as key hole camera surgery. Patients are then discharged early evening to recover at home. We have also developed 23 hour surgery. This sees patients arrive in the morning and returning home the following morning post procedure.
This facility will have a combination of beds and chair. Day case procedures sometimes just need recovery from local anaesthetics, therefore in these cases sometimes chairs are most appropriate. Too many beds mean people stay in hospital longer than they need to.
What plans have been put in place to maintain patient pathways through the transition build?
A detailed plan has been developed. This involves moving services and buildings whilst delivering high quality care. We will make the transition in phases, starting with the demolishing and building of sites taking place first. This will provide the space to move existing services, to then go on and refurbish remaining services and areas. We hope to have the new buildings ready to take services by 2024 with the view to have the entire project complete by 2027/8. We have also worked in collaboration with our construction company to ensure clear and timely public messages regarding changes to services and locations through construction.
Was the General Hospital site considered as an option for the proposed Treatment Centre and Maternity Unit? What consultation has been done with residents in the East of Leicester and users of services at the General Hospital site?
Leicester’s hospitals merged in 2000 to become UHL. However, services were not configured in a way that made clinical sense and sometimes had duplication and triplication of services. So resources, staff and technology are often stretched. Concerns have been raised about the sustainability of our services because of this.
Our clinical strategy looks at how best to configure services. Whilst considering budget, we thought about separating services where it made clinical sense. It became clear that we needed two acute sites. Given this we needed to consider which sites we would. Leicester Royal Infirmary would have proved extremely disruptive and expensive to move. Therefore, when considering Leicester General and Glenfield Hospital sites it was decided that Glenfield Hospital was most appropriate as our second site. The General Hospital site is significantly older and less fit for purpose. Further, the nature of the services at Glenfield would have meant moving these services would be extremely costly.
How will you ensure that the proposed hospital buildings are inclusive in terms of religious and cultural needs? Have you taken advice from people working within BAME sectors?
We have done lots of work with local community groups, both online and offline. We have also worked closely with our GP Patient Participation Groups and local Voluntary and Community Sector organisations.
How and where will you be able to expand future hospital plans after this time?
At the end of this project, there is still a substantial amount of land remaining at the Glenfield Hospital site that could be utilised for future development. We are creating flexible spaces going forwards to future proof our designs and have modified our design standards in order to do so.
Is the building work being contracted directly through the NHS or privately?
We can assure you that this will not be delivered through a Private Finance Initiative. The project will be funded through public dividend capital. We will also work to utilise local companies through NHS supply chains.
Hospital food. It is recommended that patient areas and upgraded kitchens be considered as part of any reconfiguration. I know there are limited kitchens at the moment, I just wondered if I could have response to that please?
We are fully aware of the new blueprint for better hospital food and are in support of providing our patients with tastier, more nutritious food, as high-quality hospital food can aid patient recovery, improve patient morale and encourage patients to eat well at home.
On any new build wards, built as part of the reconfiguration programme, we will be providing new ward kitchens. We will also be working with the architects to provide the most appropriate patient dining spaces within the rooms or bays.
The capital allocated for the reconfiguration programme is for new buildings on existing hospital sites, so we are not planning to refurbish the current kitchens as part of this programme. However, we have an ongoing ward kitchen refurbishment programme, as part of our Trust’s maintenance programme. This work is being undertaken with the support of key stakeholders, including our external Environmental Health Officers from Leicester City Council’s Food Safety Team as part of our backlog maintenance programme.
What plans are there for the extra space at the Leicester Royal Infirmary. For example, the eye clinic that is currently straddled across the site?
The aspiration is to keep emergency and elective care separate. The eye clinic is included within our plans and these are still being reviewed. We won’t know until after the consultation is finished what will be done with the extra space as we are currently hearing different views from patients and members of the public. The eye clinic is a particularly busy area and we will be looking at this. There are currently no firm plans for space and we will need to look at this in a consultative way.
It can be confusing finding your way around and knowing which reception area to use at Leicester Royal Infirmary (e.g. Balmoral Reception or Windsor Reception)?
We currently have too many entrances; there are 20 different ways to access Leicester Royal Infirmary at the moment. The building of the new maternity hospital will enable us to create a proper entrance to the hospital in the form of a Welcome Centre. We are mindful about improving the way-finding experience for patients and are listening to patient and public feedback.
Will you ensure that signage will be useful in supporting way-finding? There were some issues with signage not being kept up to date when the new Emergency Department was built?
We have learnt lessons from the experience we had with the Emergency Department so when we were completing the developments at Glenfield Hospital we did better with signage. The proposals for Leicester Royal Infirmary will mean a really big development. A lot more planning will go into signage and way-finding including the use of the website. Public feedback in relation to signage will be logged as part of the consultation.
Would the proposed increase in ITC beds help if we had another pandemic
Yes it would have helped us cope with the pandemic better. At the peak of the pandemic we required 73-74 ITC beds when we only have 50, that meant we had to spill over into theatres and the children’s ITC at Glenfield which had knock on effect, that required us stopping operations and children had to go to Birmingham. In the reconfiguration we would have 100 beds and therefore would have been better able to cope. ITC for children will move to the LRI. In terms of Infection Control looked at this for new build. Basically taken pandemic as a wake-up call.
Is Balmoral to become extended A&E, emergency care for children, incorporated into children’s hospital?
Balmoral has an extensive emergency care area. In terms of moving clinics off Leicester Royal Infirmary, this will not necessarily mean moving A&E into those clinic areas. Going to outpatient Treatment centre at Glenfield, will improve care and patient experience. Children’s ED is staying where it is.
Will the current children’s A&E be moved to the Kensington building? And the pathway for children, if stays where it is, how be admitted to children’s hospital?
It will not be very different from now, we have not nailed this at the moment with regard to design. There is a wide service passage way from the new children’s emergency department to the Kensington building and this will be re-designed so that we can take children under the building to the children’s hospital. We have been working with children and families on this, what we have spotted is that underground corridors can be scary for children and their families and we are working on how we can make it a welcoming environment. We will make journey from children’s A&E to the Kensington building fun for kids.
Digestive disease centre, where will that be placed?
Outpatients will be on the Glenfield site with planned endoscopy in new build, inpatient gastro-entomology and bowel surgery will be on Leicester Royal Infirmary site.
Future of community Hospital Fielding Palmer Lutterworth, plans in east Lutterworth with an increase in population and Rutland Memorial Hospital
We are working with local political leader, communities and community interest groups with regard to services and working together to provide a joint statement on how work is progressing. Depends on what happens with Lutterworth East, Clear commitment to increase and develop these services eg Rutland Memorial Hospital, Hinckley. What we do about physical facilities will depend if get funding from the East Lutterworth development, we are working on plans for service delivery over coming months.
Active process in Rutland to talk about developments to increase range of services, given commitment to delivery of services. Place based decision through partnership working, PCN’s and community, to develop and enhance services, replace with new facilities if required. Not closing hospital, it is a land locked site. Commitment given that decisions will be made in Rutland by Rutlanders. Make same commitment to other places i.e. Lutterworth, Hinckley.
Would it would it be possible to have an education centre as well. Most women don't know how to examine their breast so somewhere where they can be educated on how to look after themselves, and the importance of, you know, the different types of screening diabetes, I know we've got the diabetes centre there, but it can be incorporated with this?
We might want to do more of those sorts of things in communities, in health centres or in GP practices or in, facilities that people use too. We come out to women as opposed to women coming to us.
Will this have an impact on the urgent release of the disease because of where the mortar is going to be, and because of the different sites? The General hospital won’t be there anymore and the mortuary won’t be there too?
We are probably are likely to reach a mortuary at the general because we've got a really great building there, which we refer to as PPD which we've actually expanded significantly. Unfortunately, driven by recent events through to COVID and one of our clinical directors at the moment is working on what we refer to as a kind of business case internally to expand that function to become a regional function, and with, with a plethora of other elements to it as well. So, it probably is likely that we will have a bigger facility than what we've had historically and that will help us in terms of a speedy release of the deceased as quickly as possible. We are likely to retain that as part of our current thinking around the site.
COVID sadly has highlighted further inequalities for people with learning disabilities, in terms of environments particularly for people from that cohort and people with autism. Is there a plan to increase in terms of staffing or nurses as they are really critical to making sure that people are comfortable and receive the treatment that need?
We have local group who is a local Action Group around kids with autism and learning difficult, difficult learning difficulties and long, we were talking about how we can use some of their experience in the interior design in the Children's Hospital to make it LD / autism friendly.
Currently there are excellent prayer facilities at the LRI. Are there plans to replicate this at the other sites too?
We will have a Spiritual Care Centre at the LRI. We fully intend to review the, what we provide a multi faith prayer perspective across as part of this process across all of our sites and, and try and provide the best, the best facilities we can. We've made that commitment I think previously, when we built the new ED department, and we fully intend to see that through and to honour commitments that we've made.
We work closely with all the different groups to try and get something that satisfies the needs of as many people as possible.
We do with everything we want this to be somewhere that we're all proud of our NHS and I want to replicate that in each and everything that we do have something.
What support will the patients receive after they have been sent home early from hospital after major surgery and will this continue until they have been discharged?
Patients are only discharged from hospital when they're deemed to be medically fit by their medical team but increasingly, as medicines advanced and has advanced over the last few, the reduction in the length of stay in hospitals, you can recuperate more and more at home with the right support. So alongside the changes that we're proposing structurally to the hospital to the hospital, we are working on our community services offer, and particularly about how do we support people at home, particularly the elderly and frail when they when they've been in hospital for a period of time and how do we get them back to the optimum independence that we can do as possible. So we are developing integrated care teams in your communities, including the city that will support people at home, whether that be either to stop them going into hospital when there isn't a need for them to go into hospital and also to help them recuperate when they come out. So that's things like district nurses support rehabilitation support dietitian support, and just general support with things like getting a home ready for them for them coming home.
We work with a volunteer sector as well, to make sure that people have got the right food and medicines and things for them to go home with. So, it is a complete package around supporting people at home. Our aim is to make sure that there are a minimum number of people that go back into hospital after being discharged. I think we would all feel that as a bit of a failure if they've been discharged and then had to go into hospital without a medical reason to do so, necessarily. So, we are working on that collective collectively across the patch.
Are there any plans to make changes to the chaplaincy services or will that be remaining the same and how would that work over the three sites?
Chaplaincy services, is a multi-faith chaplaincy including people who believe in nothing but want some support and that's led by Mark Burley I head of chaplaincy with a kind of a team of 21 people in his team of all different faiths. The chaplaincy service will be a lot easier to run, not trying to spread him across the three sites which is what he's doing at the moment. So I don't think there's any good getting any denigration of the chaplaincy service.
What will happen with the mental health facility at GGH during the reconfiguration, Bennion Centre?
There would be no access problems for the mental health hospitals that are on either of the Glenfield or the General site. No direct impact.
The royal infirmary is hard to navigate already for some people- considering the size of the royal going forward what plans are there to make signage, supporting patients moving around the hospitals etc.?
We want to change the main entrance to the Royal Infirmary site. At the moment we've got 24 instances to the site. So, when you get in there, like the rabbit Warren is in terms of navigating through the different corridors and everything else and when you do that you're quite likely to come across people pushing waste through the through the corridors and everything as well so part of what we're planning to do certainly not just in the new buildings but in existing buildings is to try and reduce the amount of access that we've got into the buildings to make it easier for people to navigate around.
We are going to be looking at Digital's called Digital standardisation part of this as well. We are identified as one of the sort of digital exemplar sites where we can use modern technology, so that when people turn on the platform, a smartphone can actually direct you through the building where you can look at it and follow a map that will be that will be on your phone, Where it's a lot easier to navigate your way around so digital technologies. How we avoid having to look at signs, and also signs that sometimes really change your way if English isn't your first your first language was we try and do much more language changes we can use internationally recognised symbols.
A lot of money has already been spent on the development of the LRI over recent years, and now there is a new plan. Why do we keep changing it and how can we be assured that it will be better in the end?
This is a one-off investment of capital money. Our plans have not changed for 10 years. Previously, money has been released to us in small amounts to make improvements. It will take a long time to make all of the changes as we will be doing it alongside running the hospitals. It is a long process with take us to 2027/28.
We have seen many plans to change the General over the years but nothing seems to change. Will it happen this time?
Yes, we are confident that it will.
Will the proposals affect the safeguarding team in anyway and how will you be able to incorporate this into the new design of the children’s hospital?
Firstly, it will be a better environment for children. We have a new lead for safeguarding in the trust and also a consultant with a particular interest in this area. Safeguarding is embedded in everything that we do, including the new plans. We take it very seriously. For maternity services, we consider safeguarding right at the start of pregnancy, with new mothers and those who have children already who may be using our other services.
There have been some concerns about the move of the renal services to the Glenfield. The General is accessible for the South Asian population in particular who live that side of the city?
Dialysis will be staying in the east of the city, either in the General or nearby but it will be a better service. However cardiac, renal and vascular services do need to be co-located.
We have heard that staff at the General will be losing their jobs but you are building accommodation for staff.
No one will lose their job as a result of these proposals. We plan to sell some of it for housing and the money will come back into the NHS for patient care. It is part of the local delivery plan and it fits in with what the Leicester City Council plan to do. NHS staff will have some of this housing.
There has been a lot of taxpayers money spent on the General over the years. Isn’t this wasted money?
The General is actually our most under-invested site, apart from the Diabetes Centre for Excellence.
As a deaf service user communications is a barrier. We don’t know where to go. Pictorial information would be good and more information on signs.
We will certainly consider this.
People suffering with mental health issues aren’t aware of how these changes may affect them. We still have children going out of the region for acute beds which hinders recovery and has an impact on families and carers?
We have been working to eliminate these issues and there will be times when we do need specialist services for children from elsewhere. These proposals are not the totality of everything that is going on locally at the moment, and there are other developments and improvements being made in our mental health services.
Move to close re-hab wards not stroke, have re-hab for older population to avoid bed blocking those relocated to Evington Centre, does that represent overall reduction in re-hab beds, create more space at Evington Building, what are the figures for this?
General principle no reduction in beds if moved away from lgh plans to be re-provided. Is an expectation make all services better, commitment and trust will not be making things worse. Pool at LGH which will be going won’t be expecting to put new pool at Glenfield, plan to use community based services which are underused. Good question can’t give specific answer. We will respond in due course fully. Why potential loss of service these will be addressed to make as good or even better.
Does Leicester General Hospital count as sufficiently alongside and will there be dedicated ambulances?
There won’t be dedicated ambulances at the Leicester General Hospital. Stand-alone is midwife staffed in the community away from services. If there are complications women would need to be transferred by ambulance to the Leicester Royal Infirmary. At the moment 160 babies are delivered at St Mary’s, some people believe we are not telling people about St Mary’s, it is not our job to encourage people to have babies at home or St Mary’s, it is our job to give them an informed choice. St Mary’s is difficult to access unless you live nearby. A large proportion of women still want to have access to a labour suite. Default to offer birthing centre at Leicester Royal Infirmary and Leicester General Hospital. Distance won’t be as far.
Will UHL please confirm the new buildings will be designed and built to the highest of the five BREEAM ratings available to the 'Outstanding' rating Star 5 and the capital funding is available to achieve this?
Any buildings that are new build will be designed to BREEAM excellent rating. This will be delivered within the capital funding allocated.
Can a detail description of how the change of 28 Hampton Suite beds to other uses will be handled?
As part of winter and Covid-19 there was an urgent clinical need to convert the Hampton Suite to an acute medical ward from the beginning of November. Therefore there was a need to pull forward proposed changes because of the operational changes result from Covid-19. Patients that would previously have gone to Hampton Suite, if at all possible go home with Home First care. If they need tests at the hospital this is done whilst on a medical ward. They then either go to a community bed if they need inpatient rehabilitation or they go home with Home First care for continued rehabilitation.
In line with its change of role over the winter we have increased funding to increase medical and nursing cover to the same level of an acute medical ward. We had set up a system to monitor the outcome for this to be pulled from nerve centre to assess with this change should be maintained in the long term.
How does the loss of Leicester General Hospital impact the city and counties resilience in terms of “Clean Sites” during the current or future pandemics?
The change of use of Leicester General Hospital will not impact on the availability of clean sites within UHL. Leicester General Hospital was not a clean site in the current pandemic; it had less COVID cases than the other 2 sites but that was/is a reflection of the case mix admitted there – there are no emergency medical or respiratory patient admissions to that site, only surgical and urological patients. The new build on the Glenfield Hospital site essentially provides us with a “hospital within a hospital” which will cater for elective work and that will be our “clean site”, putting us in a far better position than we are in now.
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What facilities would a new maternity hospital at the Leicester Royal Infirmary have?
Our proposals include creating a new dedicated maternity hospital at the Leicester Royal Infirmary providing a safe and sustainable environment for maternity and neonatal services with more personalised care provided by a named midwife, alongside a dedicated children’s hospital. This will allow obstetric-led births (specialist care of women during pregnancy, labour and after birth) and a co-located midwife-led unit to be with neonatal services (care for premature or ill babies) all in the same building. This means that women could choose a less ‘medical’ delivery, but be close to the staff and equipment that can support them if circumstances make this necessary. It also means that skilled staff and expensive equipment are in one place resulting in a less fragile service when demand is high.
In addition, the facilities will support partners staying overnight and provide a 14-bed facility to help prevent mums being separated from their babies and avoid long term admissions. There would be better use of staff resources to support continuity and one-to-one care. There would be access to neonatal unit facilities for babies that require it, reducing risks associated with transferring premature babies, improving outcomes for premature infants.
Why are you proposing to relocate the midwifery-led unit at St Mary’s Hospital in Melton Mowbray?
Reviews of maternity services identified that the standalone birthing centre at St Mary’s Hospital in Melton Mowbray is not accessible for the majority of women in Leicester, Leicestershire and Rutland. It is also under-used with just one birth taking place every three days. While the proposal is to relocate the midwifery-led unit at St Mary’s to Leicester, we would maintain community maternity services in Melton Mowbray. We would ensure that there is support for home births and care before and after the baby is born in the local community. If someone has a complicated pregnancy, care afterwards would be provided in an outpatient service located at Leicester Royal Infirmary or in remote/virtual clinics.
As part of the consultation we would want to test if a new standalone midwifery-led centre would be used by expectant mothers, if appropriate to their individual circumstances. If the consultation shows support for a standalone midwifery-led unit run entirely by midwives, it would need to be located in a place that would be chosen by enough women as a preferred place of birth and ensure fair access for all women regardless of where they live in Leicester, Leicestershire and Rutland. It would also need to be sufficiently close to more medical and specialist services should the need arise. It is proposed that for a trial period the centre would be located at Leicester General Hospital, where it would be much quicker to transfer a patient by ambulance to the maternity hospital in an emergency situation. For a standalone unit to be viable it must have a minimum of 500 births each year.
Why is St Mary’s Midwifery-led unit under utilised?
Due to its locality, this unit is not accessible for the majority of women in LLR and is underutilised, with an average of 141 deliveries per year (this is an average of 3 births per week). We believe this underutilisation is also due to concerns regarding proximity to emergency care and acute support, making the service no longer viable. There are also women who planned to have their baby at Melton, but due to complications are rushed to Leicester to have their baby, which is very traumatic. The new maternity hospital, and potentially the midwifery-led unit at the General, would allow for women to be closer to support services should it be needed.
Why does a unit need at least 500 births a year to be viable?
In a bigger unit midwives have more opportunity to maintain skills and students will receive a more meaningful learning experience. There is a gap nationally in midwifery-led birthing units between capacity (the number of births that can take place) and actual use, all of which are under-utilised. If we can care for 500-plus women then the cost per birth, with the staffing models to support this, will prove more cost-effective and sustainable.
How do the new reconfiguration plans support Better Births?
There will still be the same choices for women available; choice is about pathway of care not venue. We know that continuity of care is important to women and it is something we plan on developing further, and many of the continuity pathways are not affected by estate, it is however more likely to be successful with the single site as staff will be on one site and more available to see the women in their team.
People are concerned they will lose community care including breastfeeding support. Will this happen?
We will still be providing community care. We have a lot of passionate midwives who want to deliver community care. We have breastfeeding hubs at Leicester General Hospital and want to roll these out into the community. We will be training support staff too so that patients can have home visits or drop in to see professional.
What's the increase in the number of people that would want to use the community midwifery unit if it moves to the General hospital? Have time factors in terms of getting to the LRI been considered because although it's in the centre there is a lot of traffic?
We don't know how many women will want to go to a standalone birth centre on the Leicester General Hospital site, but to make it sustainable we would hope it is around 400 to 500 people
There has been a lot of work done looking at traffic in and around the hospitals and we're confident this the traffic around the Leicester Royal Infirmary will improve as the footfall will be less with a lot of activity being redirected towards Glenfield. We have also considered this for the increase at Glenfield hospital. We are also doing further intensive work on a Travel Plan in partnership with a range of organisations including councils and Healthwatch organisations. We are using the feedback from the consultation to inform this plan.
In Rutland new mums are going to want to be at a hospital that they can get to quickly?
The service at Melton Mowbray is a Midwifery Led Unit, which is a non-medical. To have access to obstetric doctors, we have to transfer women to Leicester General Hospital or Leicester Royal Infirmary. Our proposal is to relocate the standalone maternity unit from Melton Mowbray to the site of the Leicester General Hospital. It will still be a standalone unit, but closer to obstetrics at Leicester Royal Infirmary if this is needed.
Women living in the east side of Leicester may feel that getting to Leicester is more difficult for them and may choose to go to Peterborough instead. However, the safety consequences of trying to sustain two obstetric units on two separate sites (Leicester Royal Infirmary and Leicester General Hospital) for the longer term, and the safety of women has to be our primary responsibility.
I have personally used maternity services at Leicester General Hospital and had a very good experience and I know a lot of people who were very pleased with the service. Now all maternity services are moving to Leicester Royal Infirmary. What will this mean for patients?
The complexity of modern maternity care means that it is becoming really difficult to staff the service at Leicester General and keep it safe. This is because we have to provide 24/7 rotas of medical and midwifery staff across both sites. There are times when we have concerns about the safety of the services, more often at the Leicester General Hospital site. Therefore, we have to make compromises to make sure the services are as safe as possible. We used to have a neonatal unit at the Leicester General Hospital site but unfortunately we had to reduce it as we weren’t able to staff it effectively. Therefore, if babies need intensive care they now need to be transferred to the Royal. The pressures on NHS services mean that we have to redistribute support services from the Leicester General to Leicester Royal Infirmary including the support services that ensure safe maternity care. Given the reality of our current circumstances, it appears we will have to locate our services on one site though it would be better to have two.
However, it is a good thing that we have an exciting opportunity to spend a lot of money of a new women’s hospital where we can design services which are bespoke for the women in Leicester, Leicestershire and Rutland. It is likely that this new service would be sustainable for the next 40-50 years. We are conscious that we need to be careful in terms of how we design it to ensure we retain a personal component to the way we provide care as it will be very large. We’re aiming to achieve really good, properly designed maternity services for all the women we look after and having a Women’s Hospital in Leicester would be fantastic.
I have some concerns about the proposals for the location of maternity services at Leicester Royal Infirmary due to the road structure going into Leicester. I’m from Blaby and it can take 45 minutes to travel to Leicester Royal Infirmary whereas travel to Glenfield Hospital takes 15 mins. I’m concerned about getting to Leicester Royal Infirmary in a timely manner when I’m in labour ?
When we conducted our options appraisal to identify the best site to locate the maternity service on, Leicester Royal Infirmary was clearly the most suitable site due to the location of the additional support services that are needed to support maternity. I do understand how the Leicester Royal Infirmary may seem a long way from you and how it may feel a bit scary that it may take some time to get to the delivery suite however, 45 minutes may not feel so long when women are often in labour for hours and hours. The reality is you will probably not need to get to the hospital in a hurry and our midwives are very good at talking with you over the phone and advising you when you need to come in so that you have time to get to the hospital in time. From a clinical perspective, you probably shouldn’t be quite so concerned.
In addition, we are working with City Council and County Council in relation to road networks and are looking at using new technologies such as electric rapid transport park and ride. We anticipate that journey times for the majority of patients should be reduced considering what we are planning. We will be working on our travel plans with patient groups and health partners to ensure their views are heard.
A family member recently had a seizure and we had to wait 1 hour for an ambulance. This might be too late if I was to deliver at speed?
The ambulance service categorise maternity cases as ‘Category 1’ calls which have a very quick response time and they legally have to attend you very quickly due to the risk to the life of the mother and the baby.
I have some concerns about no longer providing post-natal care at St Mary’s. Midwives sit with mothers through the night at St Mary’s to provide support with breastfeeding. I would imagine community teams of midwives won’t be able to provide this level of support will they?
The community midwives will visit mothers and babies every day and we have a breast feeding team of support staff and peer supporters. If women have the right support during the day they should have the confidence to feed at night. We also have videos available online to show women how to attach the baby and a 24 hour telephone service so that midwives can talk women through night feeding. St Mary’s is wonderful as you say, women appreciate the extra support however, only 360 women per year actually use the service so we’re maintaining a 24 hour service that is not very well utilised. Most people are choosing to go home and be looked after by their partner or family.
I am very concerned about the whole situation for mothers and babies in the future. I don’t understand why you can’t separate maternity services from Leicester Royal Infirmary and build it on the Leicester General Hospital site. However, my main point is about distance – you responded to an earlier question saying that women would be brought in more quickly if they lived further away, however; it is my understanding that if women are brought in early, there is a higher risk of interventions taking place and this is not always good. I’m concerned that you are going to close the St Mary’s Birthing Unit and set one up at Leicester General Hospital in an unrealistic way only giving it a year to prove itself. Midwife-led units can be closer to where people live and can give them confidence which is preferable to risks of coming in too early and getting stuck in traffic. Commitment from the organisation and publicising of the midwifery-led service is vital?
The reason we are re-locating St Mary’s to Leicester General is purely because of location. It’s a wonderful service and I’m very proud of the service we offer to women. Sadly, not enough women use it. 52% of the women we serve are from Asian, black and other ethnic minority groups and they tend to live in the city. When we’ve done reports on how women deliver and how quickly they deliver, a lot of these women deliver quickly but don’t want to give birth at home. Therefore, if we had a birth centre in the city that is accessible to people who haven’t got much money or access to transport they would find it much easier to use. We have to prove its worth and there is not a lot of money available for public services. Many women are saying that they’d like to know the midwife who delivers them so we are looking at ensuring continuity of care. A midwife that the women know will go with them whether they birth at Leicester Royal Infirmary or in the standalone unit at Leicester General Hospital. It is imperative that midwives support the standalone unit and encourage women to use it. We are very much focussed on giving women choice and women want that. We want to give more people the opportunities.
We want to give low-risk women more choice however, we can only do this if there are enough deliveries to make it cost effective and at the moment it costs the NHS twice as much to deliver a baby at Melton than it does at the Leicester Royal Infirmary and so this is something that is not sustainable and wouldn’t work in the long term.
Emerging evidence highlights the fact that there are disproportionate BAME maternal/infant deaths and complications in pregnancy and childbirth. Will specialist screening services for women from racial minority communities to identify issues such as, health and wellbeing, high blood pressure, diabetes, cardiovascular disease, genetic (sickle cell) etc. be available in pre-pregnancy and during pregnancy though the new hospital to reduce this?
We have recognised this, the 10 year plan and advice from NHS England is that 75% of women from minority groups are encouraged to have continuity of care because we know that this reduces poor outcomes. We’ve currently got a pilot group called the LOTUS team. It’s in the Highfields area and it has a group of six midwives who give care to women who are disproportionately disadvantaged. The pilot is working really well and we are looking at expanding it.
I know of a lady who didn’t receive the leaflets and their midwife didn’t mention St Mary’s as an option. If St Mary’s Birthing Unit was promoted properly, I think numbers would increase. Why are more mothers being given the opportunity to go to Leicester General Hospital rather than St Mary’s Birthing Centre?
We recognise that the St Mary’s Birthing Centre works really well but we want to offer this service to more people. We are relocating it to an area that is more accessible to more people. I understand how you feel living in Melton but I’m sure the people in Market Harborough and Market Bosworth would like a standalone Birthing Centre too. The realism is that funds are limited and we need to be serving as many people as we can.
Closing St Mary’s and producing one maternity unit across the whole of Leicestershire drastically limits the ability of a pregnant woman to choose her birth centre. The argument put forward is that having one centre of excellence will give better outcomes but isn’t this really just a large cost cutting exercise ?
Cost cutting nothing to do with plans, what we want for most women is for them have the most options. At the moment limited number of women have babies at St Mary’s 150-170 per year. What we want is for women to have the option of 4 settings and a better opportunity for far for women to access a standalone birthing centre if that’s what they would prefer. Increases choice for women across Leicester Leicestershire Rutland.
Can the midwife lead unit at the General have water-birthing facilities available in every suite? St Marys currently offers pools in each room, and sees a 68% uptake?
The suites available with a birthing pool for labour and delivery would be inherent and present in all rooms, will be having a lot of rooms in the stand alone birthing centre at LRI.
Please would you answer what the feedback from Mothers in the eastern side of the county is regarding the likelihood of having to be moved by ambulance to Leicester only when birth complications have arisen?
This is not a cost cutting exercise and why closing St Mary’s. The short answer is how many women transferred in labour, depends on how many women who are having babies are away from hospital. 20-25% from St Mary’s low risk if had babies before, having your first baby risk may be 40%. Women transferred to hospital can have poorer outcomes both for the women and babies. A lot of that is about selecting right place for the right women. This is not about saving money. The fact is that we can’t be running small number of birth centres around the country, we have defined public purse, women will have all the options, this is the best way to reconfigure services.
Feeding services, support breastfeeding regardless of choice, extent to which design of midwifery services has been led by midwifery team.
They link. We don’t have a detailed design of the birth centre at the Leicester General Hospital, we are 4 years away from completing the work. I don’t think about the building this is about the care of women, many people will have heard of the better births national programme, to increase choice and personalised care for women with uncomplicated births, increasing continuity of carer. the model of midwifery care, is 6-8 midwifes providing all care for women from the start of their pregnancy, to the birth of their baby and post-natal care. Breastfeeding is likely to be best, we would emphasise that women should not be forced to breastfeed it needs to be right for mother and baby and having the right support.
I expect midwifery teams to play a substantial role in the design and layout of the unit and we really want to use the expertise of the Melton team that are responsible for the birthing centre at Melton.
I think potential advantages to put together for county and be identified nationally as an exemplar for home births, birthing centre and care along-side a birthing centre. I think there is a real opportunity to do something innovative and different.
Has midwifery leadership been involved in this process?
Yes at all stages. We have explained process when there have been different option appraisals, there has been wide contribution for various teams, midwives from all persuasions ie community midwives, anti-natal and birthing suite midwives. Midwives who now work in CCG have contributed to midwifery care. Models of care taken into account the different pathways people have. Midwives have been central and integral to this to provide best service for either complicated or non-complicated pregnancies. The Women’s hospitals project board have been part of peer review with other trusts, we have spoken with Manchester who had similar approach and with Dublin who are also pursuing similar approach. Part of those conversations had midwifery contribution.
There is an issue with maternity being moved from away from Melton Mowbray and an issue that was mentioned with the plans for Glenfield where they talked about, not just the operation being done there, but clinics and tests too. Clinics and tests are some of the things that perhaps will be better done in the community, not in a centralised place and then with the general hospital with the idea that it becomes a sort of slightly bigger version of a community hospital, but doesn't that then, again, take away from the direction of travel that where things ought to be spreading out rather than coming in?
The midwife led birthing Centre in Melton running out of St Mary's currently has about one baby born every three or four days. There are no doctors present on the site it's just midwives. Although it is a really good facility, one baby every three or four days doesn't make it sustainable. Part of the reason for that is it’s in Melton. So, people from other parts of Leicester Leicestershire and Rutland are unwilling to travel out towards the east of the county to use the service. The reason we want to bring it into the last General Hospital is it's got better transport and access for more people from across the whole patch, we figure that way more people will want to use it and it's more equitable in terms of access for those people who might want to use it.
Thing that is most important is how the re-organisation will support baby friendly facilities in hospital and the community to increase the breastfeeding rate. Women at St Mary’s get enhanced breast feeding support and this experience may be lost in the reconfiguration. If breastfeeding increases by 1 month the first years saving would be £400,000 for Leicestershire and I am keen to make sure what changes are in support of breastfeeding and the success and savings would be passed through system?
I hope I can reassure you that BFI accreditation is important to UHL, St Mary’s has a gold standard working towards LRI becoming gold standard in the bigger of the 2 units. We don’t just put a lot of time and money into accreditation if not going to maintain, being baby friendly is very dear to us. Moving forward we will be working in different ways; better births continuity of care an aspect will be that mums will know their midwife Anti-Nataly and Post-Nataly and this is part of the NHS 10 year plan. Ww will need 75% of women to be looked after in this way, which improves breastfeeding rates also women will not get conflicting advice, rather than one thing being said by one midwife and something else by another. Peer support will be available.
St Mary’s not as busy so women get 1:1 support. We know when women get named midwife the golden hour of skin to skin between mothers and babies is important; midwives concentrating on this 1:! Continuity of care will know the families, how all family fit in. I envisage have post-natal element of St Mary’s will be rolled out to all women with regard to breastfeeding.
We would like Detail of how these facilities will be breastfeeding friendly?
It’s a brand new unit and this is being looked at by clinicians who all have experience. Leicester General will have a community hub and can meet midwives there or where ever is appropriate for them. Will have more provision than we do currently. Moving forward will have provision for partners to stay with mothers see as a positive.
The consultation document is about the detail eg mentioned peer support, where is this coming from and who is providing this, where is it in consultation document, community support already exists. If we are providing peer support perhaps you should have asked us. Expanding services not asked if volunteer if we can expand services?
Done fantastic work in City we have peer support from health visitor teams who need extra support, we want to grow this.
Infant feeding suite, tongue tied, excess weight loss, jaundice rather than going to children hospital, really helpful for feeding for mums and babies to be together?
Infant feeding team will be looking at this. So many things going on, may not be written in document.
I am a members of mummer’s who are not trained peer supporters. Came though LRI experience, my breastfeeding was complicated and I was worried about post-natal care. Struggled with getting baby to feed straight after having him it was a complex birth. I had problems with feeding had asked the feeding nurse to come and see me she was very quick and dismissive it didn’t solve problems. Had to go and do my own research, health visitor gave leaflet. Not a great support system I was on ward for 2 nights, it was not great continuity, I was left out in the wild, didn’t have any signposting from team in hospital. I was able to google a better way to help him latch and it solved a lot of problems. Information was poor and felt like left on my own.
Continuity midwife would be good, worry about period just after baby after a C-Section couldn’t get out of the house to go to community hub. Good opportunity to make changes and make sure first time mums are supported?
Sorry not brilliant experience, people like you who have had this experience will help to improve it, no illusions it’s not perfect, continuity of carer would have helped you. Your community midwife would have been with you and come to you on the ward after C-section. We do work in silos, community midwife, health visitor and staff at the hospital say things different. Want to join the dots.
Have support worker band 2 or 3, specifically trained to support breastfeeding mums. Midwives in short supply one of good things of transformation plans is people want to come and work in a nice environment. Hoping this will help to improve recruitment process so we have more midwives to help you. Support workers trained to give more breastfeeding support in their home.
Community hubs adds accessibility barrier, breastfeeding hard to take up?
We will offer support to everyone, some women may want an appointment at the community hub some may want this in a home environment.
Strong advocate for co-production this is absolutely vital as the maternity and hospital services move forward to make sure they meet the needs of communities they represent. Is there a plan to use co-production for maternity suite? Some of positive elements of St Marys’ might be lost, have they already fed in?
Working with maternity voices partnership, women from all walks of life, young mums older mums and partners, they will help model how services look in future. Every single guideline is sent to them to make sure they are user friendly and people affected will understand.
Opinion post-natal care not enough, We have run Charnwood bras on virtually no funding, I have watched peer supports come and go, can’t get good breastfeeding support for free, public health say hospital issue, hospital say public health issue its everyone’s issue. Need a proper peer support system it doesn’t come for free?
We are working towards this, trying to work with partners and moving forward work more closely and give input and let us know where we can improve, need to work together as partners.
Charnwood Bra before pandemic couldn’t go into hospital; to go into Leicester hospital have to have special UHL volunteer training, people don’t have money or time to do that?
Continuity of carer is part of better births and there are positive changes will take place regardless, there are prescriptive timescales for this, by 2022 we need to have 75% of women with continuity of carer we are working with national team and they are supporting us. We very much want to do this as improves outcomes for women and breastfeeding. Change where we work.
How will you run to site alongside each other?
Designing a unit to be staffing women rather than staffing the unit. Main midwife will have small team of midwives 6.8 working in pairs, every 2 teams will have dedicated support worker for anti- natal and post-natal care. Get this in place first before we build the units.
Undertaken surveys with university of Leicester, looking at infant feeding in pandemic and found simple changes that we can feed back to you to put in place during planning. Leicester Royal Infirmary 77% mums wanted to breastfeed, Leicester General Hospital 88%, skin to skin 60% improves breastfeeding. Build into structure of hospital. Chance to build properly and put things in to improve infant feeding. Pre-mature babies, mum discharged while babies remain in hospital, have to us a breast pump at hospital. If just had C-section mums have to come in and out of the hospital 8 times a day and they can’t manage that, donor milk is not available so they go onto formula?
There will be a transitional care unit so mums and babies don’t have to be separated, this is definitely in the plans so that mums and babies to get things off to a good start. We will take that on board.
To manage expectations the consultation document has the high level detail on the proposals and why we want to do this. The things we are talking about are important, we won’t be building for at least 2 years. Basic principles of what we want to achieve, this is important when creating a new maternity unit at the Royal; what does it look like to provide the things that we are talking about. I think we are in the foot hills and we need lot more face to face meetings. What I am trying to say is don’t be disheartened that we are not engaging as we are not miles away from getting into detail of the hospitals and we will be engaging with people during this process.
Building first children’s hospital in East Midlands don’t want the design to be by 50 years olds we want the design to be for children; need to change design with children and mums so that the hospital is a non-fear inducing children’s hospital. Co-production is the right thing to do to ask people who use the facilitates how it should feel and what it should look like. You will be hearing a lot more when we get into design and build.
Mums Director since 2018 and I have been volunteering at maternity wards supporting breastfeeding. I've felt non-English speaking mothers are unable to get support they need. This is not just for maternity but for elderly patients in other wards. How will you overcome language barriers for all patients
Thank you for question, this is very important and dear to my heart as I have BME background and we are trying to address health inequalities and will be looking at offering extra level of support. Have new Lotus team to support the BME community, providing all care for women, have midwives who can speak Guajarati and Hindi. If women doesn’t speak English the midwife can contact an interpreter. The Lotus team are working on an app which will be in different languages for breastfeeding. We are trying to support mothers as best we can, we know we can improve service.
Will the hospital be planning to include a milk bank? So are there plans to include space for a breastmilk bank in the new facilities? Will the plans include space for a specialist infant feeding clinic including tongue tie services?
We need to gather contact details please so that we can wire our community colleagues into design stage. Need to make this better. We will be looking at breast feeding bank. Need your support and all get on board and think about what is essential for women. The consultation is just the start of journey real work will start in new year, its right thing to do.
Looking at maps wondering if small amount of births at St Mary’s . Asking a lot of mothers to travel extra miles in labour to centralised maternity/birthing units. Understand gives lots of other women opportunities. Are they looking at Kettering, Grantham etc, deletion of service? Rural community with differing needs?
Hoping women will choose to deliver at birth centre, travel is an issue for all women, for women who have no transport an ambulance will be required. To get in perspective 1,800 women in Oakham give birth, 123 deliver at Melton and other women choose to go elsewhere i.e. Grantham, Peterborough and Nottingham. Transport issues we can overcome.
If midwives are looking after women in Rutland and a lady in other area goes into labour. How will they manage this will there be higher level of midwife cover in that area, don’t want to see any midwives under any unnecessary stress. I know the journey from St Mary’s Melton takes a long time if a women’s birth turns into high risk it’s the longest journey in the world. Health and safety of midwives trying to get into Leicester from Melton in the middle of the night?
Going to be working in totally different way at present there are 200 women on the midwives list. Going forward midwives will have 36 women a year with a buddy. Midwives will not have to work long shifts when 12 hours is up they will call partner and they come in and look after the women and they will be known to them. Midwives will know months in advance when a women is due, they won’t book annual leave, won’t have women in Rutland left without a midwife. Hopefully those issues won’t be an issue and midwives will be safer. I can assure you this benefits everyone.
We have 10,000 births there would be half a million pounds saved in terms of overall healthcare costs if increase breastfeeding by one month, opportunity to work in partnership, peer supporters welcome. Very difficult to meet you at present but doesn’t mean don’t want to meet you due to home and work life.
Recent report by Donna Ockerdan regarding the Royal Shrewsbury hospital, noticed one of recommendations identify non-exec director should be appointed with specific remit that women and family voices are heard at board level. I don’t know if UHL has anything like that in place. Trial of stand-alone mid-wife centre, is a consultation panel being sent up, what plans there are for the future?
This is in interim report haven’t had chance to digest yet as it was published on Thursday, need to look at carefully over next few days. We will do a gap analysis of the themes in the report and compare how we provide services. This report will be taken seriously and recommendations are applied to our own services this will be the same for the CQC report of Nottingham hospital which was an interim inspection and identified areas of concern. We will analyse both of these reports and incorporate any recommendations feel we need to going forward.
Understand from the Shrewsbury report there were concerns with working relations and the stand- alone midwifery unit because of the way it was run and the concerns about the reluctance to move women who required a C-section, we need to look at this carefully.
We have had a non-executive within our service for over 12 months who has a background in public health and is independent of the trust; she is a safety maternity champion. We would like role to be broader at the moment her role is of assuring representative of families at service level and at board level; if that is what the Shrewsbury report says we will enable and encourage her to take that role and responsibility. Locally through the LMS we have maternity and neo-natal group and we have been working collaboratively across Leicester Leicestershire & Rutland and also regionally. We knew this was the right thing and have been doing this for a long time through the LMS activity maternity voices partnership. This group is working with service users and it would be fairly easy to join this with executive director as highlighted in the interim report.
I think this is a very important report and the information needs to be assimilated properly to see lesson learned; we do have a non-exec director, and this is consistent with transformation and would be relatively straightforward to include service users and people at board level.
If proposals go through for a mid-wife led set up, will you be taking learning from other areas?
We know important with use of midwifery led unit over to LGH we don’t just look at health perspective look at the community perspective. Looked at other areas and where they had success. We will set up a multi-disciplinary panel over 10-12 months to look at use and see what needs to be done to encourage more women to use service. Will be looking to see if some groups are using the service more than others. There will be independent community representatives and professionals looking at the use of the service. We met with federation group of Muslim mothers they were positive about idea of this service being located at General as they wouldn’t go to Melton and saw this as an opportunity not to go to the Royal. Panel will look at usage. This service won’t happen until after the maternity hospital has been built at the Leicester Royal Infirmary it will be 2024-25 at earliest.
The group I am referring to we had a conversation with them the other evening, they can’t go to Melton and are pleased to have option of this service on the Leicester General Hospital site, this is precisely why having this. Difficult to engage with this group and need to engage with them on their terms and encourage them to make an informed choice, may decide they don’t want to use services but at the moment they don’t have a choice.
Not opposed to having unit at the Leicester General that looks good. Don’t get impression good dialogue has taken place with people in Melton or information been given to people in Melton. Just bland generalisation given in response and no factual information. Both sides need to listen and know all facts?
In terms of reach and activity not only for all proposals looking at activity across the whole of Leicester Leicestershire and Rutland. I Know for Melton needed to do additional work to ensure people knew of the proposals and have an opportunity to come to events and visit our website. Tried to embed into on-going community groups in Melton and surrounding area. We have also used newspapers and radio stations that are advertising the opportunity for people to give their views. Members of the public could have telephone interviews with the CCG and members of UHL. Reached out to various parish council and City and County Council to pass on information and also to local MP’s who have supported getting information out to people. On-line digital is not for everybody, we have also used traditional ways of communication with colleague giving out banner stands and leaflets, for a presence in various communities across Leicester Leicestershire & Rutland.
Have had consultation meetings twice with staff. This process has been on-going since 2018, we were holding meetings across the whole of Leicester Leicestershire and Rutland. Held a meeting in Melton where lots of councillors and members of public attended. Midwives have been posting about closure and save St Mary’s have been involved. This is not new we have been talking about this since 1990.
Costs more to have a baby at St Mary’s as there needs to be midwives, support workers, students and the birth rate is not as high as we would like it to be. I went to St Mary’s on Monday there was no one in labour and there was only one lady in an 8 bedded ward with 3 members of staff and support worker, the numbers seem difficult to digest. Those midwives could have been giving people breastfeeding advice. We would not want to take the service away if it was being used efficiently. We want to reach out to more women, home births will still be available. Women who haven’t go transport that’s where ambulance service comes in if required.
Flo gave a good example of the difficulties of running the service, we have been honest over decades, Melton has been challenged for a long time as other birth centres closed. Group representing ‘save St Mary’s’ have tried hard to encourage women to have babies there.
Shrewsbury report highlights risk if having babies in peripheral units that we need need to tell women the risks; This may discourage people to have babies in a stand-alone birth centre. Have to point out something that women need to consider. My be criticised for giving this information but if we don’t women can’t make an informed decision.
In September 14 babies and in October 9 babies were delivered at St Mary’s. At the peak of the pandemic in May 24 babies were delivered at St Mary’s, COVID did make a difference as women thought they might be exposed to virus at the Leicester Royal Infirmary. It costs £4,000 for a birth at St Mary’s, Leicester Royal Infirmary or the Leicester General costs £2,000 those should be more expensive to run but at the moment it currently costs twice as much at Melton. We are conscious of the fantastic service for women in Melton, if they want to access this service it will be at Leicester General Hospital and they will have to travel some distance. Not accepted by particular group of people who value this service.
This is also a listening exercise for us, with colleagues assisting from Leicester Mercury newspaper live events, Facebook live 500 people at peak, numbers are still rising for this event it has had 30,000 views.
Put women off choosing to have baby at Melton due to the threat of closure. Threat of closure of birthing unit at Leicester General after a year will also put a lot of people off. It was Interesting to hear about the costs?
Obviously as said at previous meetings 4 years is a long way off and we may be working in a different way; continuity of care will look after mums in the community during pregnancy through to labour and post-nataly. Mums can have a virtual tour of the facilities and we encourage people to come and have a look and see what we have to offer. We talk through the reasons why they might have to be transferred so that they can make an informed decision. Women are very involved in the whole process and they decide where they want to go.
We want a stand-alone unit, women may choose not have babies at home but want to deliver in a low tech environment. One of reasons St Mary’s costs so much is that there are 8 members of staff and 1 patient. Also a night there is one trained midwife and support worker. That’s why expensive to run there is not much activity but have to provide heating, electricity and staff.
What are the advantages and disadvantages of midwifery led units?
Midwifery led units there are 2 types, alongside units and stand-alone units. Alongside unit will be staffed by midwives no monitoring of babies, no epidurals, basic pain relief but will have access to obstetrics. Pools in rooms that are women friendly they are like home from home. If there are complication or problems with baby or lady needs extra pain relief in order to cope with labour, would be transferred to environment for better monitoring. One of problems might have low threshold, in obstetrics unit some elements safety. People interfere when not really needed and GP’s and midwives will take advantage of anaesthetics which they might do if not in that environment.
Overall population of women the best birth placed study looked at comparing outcomes for women who selected in different environments. If look at women who have babies at home, outcomes are at least as good as those ladies in obstetrics unit. If in stand-alone unit which is not next door and have problems and issues they would need to be transferred to obstetrics units by ambulance and there may be some delays to addressing issues. If not next door can’t do that without making significant plans. Outcomes for babies and mums do become a bit worse in terms of long term issues. Not really understood that St Mary’s does not offer anything different. Having baby in birth centre is just another location that could be supervised at home, has same facilities and equipment this will be the same as the birth centre at Leicester General Hospital. It is confusing, the bottom line is to give women choice and options in any of the 4 environments and it is right thing to give them choice, there is no significant risk in doing that. First baby does carry some sort of risk and if there are problems and complications better to be close to birthing unit with obstetrics close by.
If this is a 12 month pilot, after 3 months won’t get women booking in
We are working with St Mary’s midwife teams, to work at the stand-alone birth centre. 12 months no rigid, what we will be doing during the first 12 months is encouraging women to use the Leicester General Hospital birthing centre. At 12 months we will need to review this and see if it has a long term solution. If we are in that position it should be sustainable. Not slamming door shut at 12 months.
Taking learning from other areas and setting up a review group when the service opens with mums dads, families and staff to look at how service is being used. This will be an independent group to support the NHS going forward in delivery of that service.
I have given birth 4 times locally, clinically its very different, understood what deciding the why and how. Walked out of birthing suite, don’t go into this naively. People know exactly what they are doing. On the whole we are excited about these proposals not being moaning minis welcome an awful lot on what being proposed. Proposals do disproportionally impact on this area. We are concerned and alarmed not more outreach into rural areas?
Global pandemic and consulting, hardly anyone has had leaflets. Why timing is the timing as it is, why hasn’t more been done to talk to residents in Melton Mowbray. We are losing services alarmed not more done, sacrificing services to benefit women in City. Why are you not doing more to make us informed and re-assured. Whilst welcome provision in City Centre, we are losing ours to make it happen. Don’t feel this is acceptable, make more of an effort to explain to people in Melton and not patronise women, Home birth and birthing centre is not the same its rubbish. Reduction in choice is happening, laying it on the line and be honest with people?
I appreciated Helen’s issues, sorry if it comes across as patronising, I am being honest and straight when answering these questions. We can only run one community based birthing centre, envelope of money for providing these services, and we need to use resources in the best way we can for the women we provide care for. There have been three reviews and we have engaged with women regarding home birth, birthing centre and an alongside birth centre. An a stand-alone is not everybody’s choice, it is the case of what most women prefer and is a perception have more confidence with an alongside birthing suite, if that’s women tell us that’s what we have to believe. Want to give women opportunity for stand-alone birthing centre.
Looked at what we could do to provide multiple birthing centres, talked nationally at one point very keen on providing multiple birth centres, eg Loughborough, Hinckley, Lutterworth, Market Harborough, Melton, but unfortunately were not going to get the sort of numbers required to make this sustainable. Delivery at St Mary’s costs twice as much as Leicester Royal Infirmary and Leicester General Hospital, I think being very honest we want a stand-alone birthing centre, there is a group of women who want to access this in Melton but it is not sustainable at 160 births per year we want to build a birthing centre in a place where we think more people will use it. Does mean people from Melton will have to travel to Leicester General Hospital. Being very honest want to provide this service as an option, from a clinical perspective it’s the same as a home birth. St Mary’s is a fantastic service, the midwives are brilliant, and because it’s such a good service we want to offer this at the Leicester General Hospital site but it does mean some women will have to travel a bit further.
We have been determined from outset to make this the most accessible consultation ever run. We are using a wide range of tactics and tools to give as many people as possible the opportunity to take part in the process. I think have we have achieved this well.
The only thing we have not able to do is face to face meetings, but that has been more than off-set by these sort of on-line events. We have provided people without internet access the opportunity to dial in. Face to face events get a small group of individuals. On-line events have attracted those that would not normally attend. Facebook has drawn more people.
There have been a lot of activity taking place, paid for social media attracted half million people we have taken out advertorials in the Leicester Mercury and local papers. We have undertaken extensive radio campaign as well as those that cater for Black Minority Ethics that has reached half a million people. Direct TV advertising to the over 55’s has reached 756,000 households. Advertorials via local parish councils has reach 1000,000 people, we have also promoted the consultation on 100 community websites i.e. spotted, Facebook etc which has reach 350,000 people. We are also working with 18 voluntary community sector organisations, focusing on protective characteristics both in the city and county. Information has been promoted into more than 200 locations across Leicester Leicestershire and Rutland. Idea that people don’t know about the consultation I frankly don’t buy into. There have been 80,000 unique visitors to the web site, which is a staggering proportion of people.
I am personally pleased with work being done and we have given people every opportunity to take part. What we can’t control is if people do not take part in the survey. People have said they have seen the proposals and they look great and therefore have nothing they want to say.
When we look at responses received so far, certain areas of city and county are higher where these changes impact i.e. Rutland and Melton have seen .
We are seeing an overwhelming number of people coming forward having their say and things they are worried about and these will be taken into consideration when making any final decisions.
Why are the risks of placing all 11,000 births in one maternity building not on the risk register? What do you think these risks are and how will you address them?
The proposals we are making to improve maternity services represent the culmination of extensive work over a number of years across many national, regional and local stakeholders. We believe they represent the most sustainable configuration of maternity service for the entire population of Leicester, Leicestershire and Rutland - delivering both equity of service and access.
Our proposals include creating a new dedicated maternity hospital to be located at the Leicester Royal Infirmary. It would provide a safe and sustainable environment for maternity and neonatal services with more personalised care provided by a named midwife.
This would allow obstetric-led births (specialist care of women during pregnancy, labour and after birth) and a co-located midwife-led unit to be with neonatal services (care for premature or ill babies) all in the same building.
We believe that this proposal is about reducing risks that have been highlighted in a number of maternity reviews. It was noted in NHS RightCare data for Leicester, Leicestershire and Rutland. Although outcomes in our early years pathway are promising the trends for maternity show that there is considerable room for improvement.
One of the key drivers of reconfiguration of the maternity model of care is to enable these clinical factors to be managed in the most effective way possible. For example, increasing the presence of consultant obstetricians in delivery suites has been shown to reduce caesarean section rates and complications of deliveries. Unfortunately UHL struggle to deliver this on the current multiple site model but would be able to if it was to move to the proposed reconfigured state.
With continuous oversight and scrutiny from our LLR Local Maternity and Neonatal System, the current Maternity Transformation Programme (Better Births) has seen significant work undertaken locally in relation to improving and maintaining quality to ensure a safe and sustainable maternity service. This has resulted in investment in midwifery, neonatal and obstetric services. However, services still face demographic challenges, especially in Leicester City, in relation to the capacity of services to cope with increasing complexity. The current split-site working has caused difficulties for both neonatal and obstetric services, sometimes leading to temporary unit closures and we know that this is unsustainable.
In addition, clinical safety issues potentially could arise as a consequence of multiple site provision as seen in various neonatal services where service reviews over time have highlighted that there remains a significant risk that a baby will come to harm should consultant presence be required simultaneously on both units. This risk is compounded by significant rota gaps in junior doctor rotas, highlighted by both the East Midlands Operational Delivery Neonatal Network and the Care Quality Commission (CQC).
Inefficiencies are also reported in specialities such as Gynaecology as a consequence of split site working. Geography adds further to these clinical challenges. Currently there is an inefficient configuration of Gynaecology services e.g. day case activity is undertaken in main theatres, geographically separated from the ward base. There is also a conflict between Gynaecology emergency theatre use and the elective Obstetric pathway.
The maternity facilities in UHL were designed to cater for approximately 8,500 deliveries per year but deliveries now total approximately 9,895 (revised 2019). The local health community agreed as far back as 2010, through the Next Stage Review, that the solution would be to have a single site maternity and neonatal service based at the LRI site, with the option of community birthing facilities. However, due to financial constraints at that time, an interim solution was adopted. The interim solution has been successful at maintaining the current provision, but progression to the single site option is imperative to sustain the safety of maternity services.
Your proposals dramatically reduce choice for expectant mothers. Why won't you commit to the provision of a free-standing midwifery unit for low risk mothers? Offering one is part of NICE's quality statement but you are offering only a possible 12 month trial of a free-standing midwifery unit on the site of the General Hospital, with no associated capital investment. Requiring 300-500 births (the numbers keep changing) in a 12 month period, the trial looks as if it is set up to fail.
Our priority for women and families across Leicester, Leicestershire and Rutland is to provide maximum choice of ‘place of birth’. This includes options such as a home birth as well as shared care arrangements between an obstetric-led unit (co-located with neonatal services) alongside a midwifery-led unit at the Leicester Royal Infirmary. In addition, the option of a birth in a standalone midwifery-led unit is also proposed.
We are proposing to relocate the existing midwife-led unit from St Mary’s hospital in Melton Mowbray to the Leicester General Hospital. The existing facility is significantly underused, with fewer than three births taking place there a week which isn’t clinically or financially sustainable. We believe that moving it to Leicester would make it accessible to many more women.
The consultation document describes the proposed unit as running as a pilot for 12 months to test public appetite for this service with an indicative target of 500 births per year. To be clear, this is not a hard target that must be achieved in year one. Instead we are looking for evidence that a clear trajectory for 500 births in subsequent years is likely to be achieved.
If the consultation shows that there is support for the Midwifery Led Unit at Leicester General Hospital then we are fully committed to developing this service and making it work, as we believe that it is a good option for mums. If the proposal is implemented and the centre is open, a review body would be established comprising of midwifes, parents and other stakeholders who will co-produce the service with UHL.
Can you explain why the removal of the postnatal facility along with the trial of the LGH birth centre is not specifically mentioned in the consultation documents, using misleading language of "relocation", instead of closure, which prevents people from understanding fully the impact of the proposals being consulted on?
Our proposal and the consultation documents do include the relocation of the midwifery-led unit at St Mary’s Hospital to Leicester General Hospital, where it will be accessible to many more women. While we are proposing to move the midwifery-led unit, we would maintain community maternity services in Melton Mowbray. We would ensure that there is support for home births and care before and after the baby is born in the local community. If someone has a complicated pregnancy, antenatal care would be provided in an outpatient service located at Leicester Royal Infirmary or in remote/virtual clinics.
If the consultation shows support for a standalone midwifery-led unit run entirely by midwives, it would need to be located in a place that would be chosen by enough women as a preferred place of birth and ensures fair access for all women regardless of where they live in Leicester, Leicestershire and Rutland. It would also need to be sufficiently close to more medical and specialist services should the need arise.
This is important since it will provide more reassurance to women who may need to be transferred to an acute setting during or after birth. Transfer rates in labour and immediately after birth, according to the Birth Place Study, is currently 45% for first time mums and 10% for 2nd, 3rd or 4th babies.
The consultation document describes the proposed unit as running as a pilot for 12 months to test public appetite for this service with an indicative target of 500 births per year. To be clear, this is not a hard target that must be achieved in year one. Instead we are looking for evidence that a clear trajectory for 500 births in subsequent years is likely to be achieved.
If the consultation shows support for the Midwifery Led Unit at Leicester General Hospital and the proposal is implemented and the centre is open, a review body would be established comprising of midwifes, parents and other stakeholders who will co-produce the service with UHL.
I stayed at St Mary's from the 28th September to 1st October, during this time the staff at St Mary's literally helped me to keep my baby alive through breastfeeding. I required hourly face to face support from the staff in St Mary's and would not have been able to feed my baby had I not been receiving post-natal support on the ward. How can you claim that mothers will be able to access the same level of post-natal support through community care and watching online videos after the closure of St Mary's? In the same situation would I be able to call a mid-wife to my house every hour during the night to help me feed?
There is the full expectation that short term postnatal stays for uncomplicated pregnancies and births will be provided in both the proposed standalone midwifery led unit and in the birth centre running alongside the proposed new Maternity Hospital at Leicester Royal Infirmary. Taking this into account, and from looking at the details of patients using the facility, it is clear that in the overwhelming majority of cases it is more appropriate for those new mums to be recovering at home, away from the risks, including from infection, of being in a communal inpatient areas. From there they will be able to access support including from family and experience the essential mother and family bonding in familiar surroundings. Access to care can either be delivered in that home setting or through community-based drop-in type services.
Of course, we recognise that some mums require additional inpatient postnatal care for clinical reasons, either maternal or neonatal and, where this is the case, it is important that they are cared for in an appropriate medical environment. Under our proposals this would be provided from the new maternity hospital at Leicester Royal Infirmary.
Sadly we do not believe that it would be possible to provide this kind of service from a community location. Most significantly this is because of the requirement for around-the-clock 24/7 medical cover
Has the Clinical Commissioning Group seen or asked for any evidence to support UHL’s assertion that St Mary’s Birth Centre is not cost-effective? If there is evidence can the Joint Committee request the CCG/UHL to publish it?
How can UHL justify the 500 births a year requirement for the midwifery unit at the General to be considered viable?
The Clinical Commissioning Groups have worked closely with UHL to develop these plans and supports the Pre-consultation Business Case, which was approved by the Clinical Commissioning Group Governing Body. The plans have also been independently reviewed by NHS England, as well as clinicians locally and regionally to test their appropriateness.
When considering the financial viability and sustainability, looking at births alone is not reflective of the wider value. The model of providing 24 hour cover for 130 births as opposed to 500 is more expensive per birth. In a bigger unit midwives have more opportunity to maintain skills and students will receive a more meaningful learning experience. There is a gap nationally in Midwifery Led Birthing Unit’s nationally between capacity (the number of births that can take place) and actual use, all of which are underutilised. If we can care for 500+ women then costs per birth with the staffing models to support this will prove cost effective and sustainable.
The consultation document describes the proposed unit as running as a pilot for 12 months to test public appetite for this service with an indicative target of 500 births per year. To be clear, this is not a hard target that must be achieved in year one. Instead we are looking for evidence that a clear trajectory for 500 births in subsequent years is likely to be achieved.
If the consultation shows support for the Midwifery Led Unit at Leicester General Hospital and the proposal is implemented and the centre is open, a review body would be established comprising of midwifes, parents and other stakeholders who will co-produce the service with UHL.
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Where’s the voice of public and patients in all this?
The NHS has been talking to people about changes to the three hospitals in Leicester for 20 years. All this feedback has helped shape the proposal. Our engagement in recent years has included hosting nine public events, attending 15 community meetings, running stakeholder meetings, meeting MPs and councillors, and an online video. Engagement on the local strategic plan for health and social care in Leicester, Leicestershire and Rutland, which included consideration of Leicester’s hospitals, reached more than 10,000 people. We continue to engage with patients, carers, staff and stakeholders through events, meetings, outreach work and printed publications.
How have you ensured that you have taken into account the needs of a diverse population?
As both a legal requirement, but also as a moral duty, we have ensured that engagement since 2014 has reached out to everyone who has an interest in the proposal and encouraged them to get involved. An initial equality impact assessment was undertaken to ensure that there would be fair access for everyone, avoiding inadvertently excluding any particular groups of people.
What about people who cannot access the internet how will they be consulted with?
The COVID-19 pandemic means that we need to consult in different ways with a much greater reliance on technology than we would have done previously. We recognize and understand how important it is that people who haven't got access to the internet are also able to take part.
Therefore, we are supporting a door drop of information through every residential property in Leicester, Leicestershire and Rutland. This is quite a short document, which sets out the fact that this consultation has now started and sets out what some of the key proposals are. The leaflet will signpost people to how they can take part in the consultation that doesn't necessarily require them to go online. There is a telephone number members of the public can call for a telephone interview with somebody who will literally walk through the consultation survey with them.
Similarly, we are working with the voluntary and community sector and faith leaders, recognising the important role that they play in liaising with their local communities to make sure as many people as possible are able to take part in the consultation process and in a range of ways.
Can I ask when the door drop will be done, my family and friends haven't had anything yet.
Will the Trust involve the public in some type of co-production around the new buildings?
The leaflets started to be distributed to coincide with the start of the consultation on 28th September. We originally hoped that distribution would be completed within three weeks but it now looks as if it's going to run a little beyond that. Clearly, this is quite a complex process, delivering material to nearly half a million properties across Leicester, Leicestershire and Rutland but we're hopeful that the vast majority of properties across the city and the two counties will have received their information by the end of next week. We are currently in discussions with our distribution partners to ensure that this is what happens.
Yes. Depending on the outcome of the consultation, we would involve the public in taking our proposals forward to reality.
Have you consulted Members of Parliament (MPs) on your plans?
We have, since 2015, shared our long term plans with local MPs. We will continue to do that and hope to gain their full support for the proposals we have developed to improve local health services and hospitals for local people.
Our PPG has not heard anything from our GP Practice regarding the consultation, nor is there any information on display within the patient waiting area. Could you please address this?
We are working closely with our partners and stakeholders. We had hoped that practices would be able to communicate with their own patients via text message to promote the consultation. Unfortunately we have run in to some GDPR consent issues. We are however asking practices to display content in the practice where they can - though understandably practices are working differently due to covid-19 and in some cases have removed all display materials from the premises.
We have asked local GP practices to promote and share the consultation with their patient populations. We also ask that our PPG members also promote the consultation to local communities and patients. We want to ensure that the consultation is shared widely across Leicester, Leicestershire and Rutland to ensure that all patients have the opportunity to have their voices heard.
How are you going to communicate the consultation with the public given the restrictions of Covid-19?
In our preparation for the consultation we have considered carefully all the circumstances, not only the impact of Covid-19, but also the greater use of digital technology by the general public over the last few months.
What has become apparent is that there are now multiple mediums which we can use to communicate and engage that do not require physical meetings or physical contact with people. Although we have to be very mindful and make provision for people and communities that are not digitally enabled or perhaps comfortable with using online resources. However, on balance we have putt in place arrangements that allow us to obtain views from a much wider group of the public, 24/7, that may not have previously happened through face-to-face events such as public meetings. In our approach we have updated our profiling of our population which now includes recognition of digital capabilities. The consultation activities include:
- Online focus groups with existing patient groups and the voluntary and community sector, building on relationships enhance during Covid-19
- Virtual public events with presentations and question and answers sessions (1 to 2 per week including evenings and weekends)
- Virtual outreach talking to different communities, particularly established groups and the voluntary sector to have in depth conversations will be undertaken.
- Displays, where possible, in NHS and public venues
- Online briefings – including with local authorities, councillors (county, city, district and parish), MPs, GPs and Primary Care Networks.
- Articles in e-newsletters, magazines and community newsletters
- Mail drop to all households across Leicester, Leicestershire and Rutland
- Distribution of hard copy summary document and questionnaire if people do not have online facilities
- Email communications to networks and contacts
- Digital including social media (e.g. Facebook, Twitter, You Tube) and websites
- Offline advertising to profile to people the consultation, the proposal and ways to get involved including community radio.
- Engagement of broadcast media including newspapers, TV and radio
- Engage of staff at different levels – as employees of the NHS, as patients and as people who have direct contact every day with patients and could highlight the consultation, but also have the potential to champion the transformation.
We are also working with a number of voluntary organisations who we have commissioned ito engage directly with communities, including some of those who tend to be seldom heard or often overlooked. We'd also like practices and PPGs to share information with their own groups and networks.
What about energy saving options?
Yes, for the new builds we have a whole workstream looking at how to make our hospital smarter. We are also working to the BREEAM measure of excellence. BREEAM is an international scheme that provides independent third party certification of the assessment of the sustainability performance of individual buildings, communities and infrastructure projects.
Carers are given appointment times which are impossible to get to. How will others cope as logistically this is an issue?
The Coronavirus pandemic has helped us to look at how we can deliver care closer to home and using technology, so that people only come into hospital when it really adds value to their care. We are working on a more efficient system, which is not just about reconfiguration.
There needs to be more recognition of carers. What is your pledge?
As a Trust, we have the Family, Carers and Friends Charter, found by visiting www.leicestershospitals.nhs.uk/patients/patient-welfare/carer-information, which supports carers who come into Leicester’s Hospitals with their loved one. The Charter takes into account that not all family members who have a caring responsibility wish to be labelled as a carer - they should, however, receive the same level of support. A sign called 'The person supporting me is...', which has the carers/family members name written on it, can also be placed in the patient's bed space to help staff recognise that the patient has a carer/family member supporting them. The Trust actively seeks feedback to help us make improvements in the future, and value any that is received.
What is the CCG’s response to the paper published by the University of Leicester supporting the continued use of the Birthing Centre? The author says that you are not going to have the facilities at Leicester to do this?
The paper is not necessarily about keeping the St Mary’s Birthing Centre but refers to the benefits of having a standalone birthing unit and we’re going to do this we’re just relocating it.
I would suggest reading papers produced by non-clinical academics on this with caution. It isn’t the case that we would not be able to cope. I do think it is important to understand that these proposals have been effectively thought through and have been through three separate options appraisals.
Dr Walsh who wrote the research and is also an ex-midwife is of the view that with 11,000 births at Leicester Royal Infirmary caesareans will increase if these proposals go ahead for the single Women’s Hospital and that mega units like these are more expensive to run?
We are at approximately 10,000 births per year. Dr Walsh is talking about birth centres and we will still be offering this at the General and low-risk women will be offered other options. We want to enhance what we currently have an make it better.
Understanding of how messages are being picked up by different age groups?
Keen to make sure by the end of the consultation process we have something as representative of population as can be. We are monitoring responses on a daily basis from both the City and County from diverse community and right way across all age brackets. We have adapted and used this if figures low. What saw early on in process, response spike for Facebook in the 20-50 age bracket. Not seeing responses from older people on Facebook. Media has doubled with advertorials in newspapers and working with local radio stations in communities along with TV advertising. We are also working with the Voluntary and Community sector and have 18 partners working with us and each of these organisations have a different remit which covers all protected characteristics. Hopeful when look at responses received this will look and feel like it represents the population that makes up LLR.
Timetable for considering comments made, whether re-consult in light of any changes?
Consultation concludes on 21st December 2020. It will take time to work through responses at the end of the process. We expect this will take a couple of months, Findings will be taken to CCG governing bodies with feedback and making a final set of recommendations. At that point unless proposing anything that is very different would not go out to consult again. The report will demonstrate how we have listened to what people have said and how this has been reflected in the final decision.
How much research and engagement with the community has been done to find out why it wasn't being used so much, or is it just an assumption that if it's moved to the general they'll be a better actor?
A lot has been done, but the facts are of the effects are of the 1000s of women who give birth who could possibly use the Melton centre. Most of them don't choose to.
Example: So if you are a mom, especially if you're a mom with a first time baby, you are faced essentially with the choice of, If you live locally, is a good option, but ultimately it comes down to what if something does go wrong. Do you want to be faced with a 45 minute ambulance journey into an intensive care unit or an accident, emergency unit?
If something does go wrong and for lots of mums although they like the idea of a low risk birth in a low risk environment that isn't obstetric or medically LED, decide they would you like a birth that is midwife led but with an obstetric unit next door.
If the co- production and co design hasn't started yet, then its starting too late. It should have been happening even before this consultation?
Engagement has been happening since 2017/2018 involving communities and talking with people. We have a maternity voices group, which comprises of women who are pregnant, women who've given birth so we've had been having these conversations for a long time with them, so this point that we've come up to now is more around the consultation, so that journey will continue so we won't be just be starting co production and co design after the consultation, it will be a continuation of the journey.
Has there been a consistent group of people involved?
Yes. We have something called Maternity Voices Partnership, which was established some time ago and it comprises of both staff and also women and families who have either gone through pregnancy or are all connected to maternity services in general, Like an advisory group or a discussion group, talking through how these proposals might look.
How do you address health inequalities amongst the community of Leicester in a new improved hospital? During COVID we have noticed a huge gap. Sometimes it’s not about the buildings it’s about the experience and the quality of care that is fair for everyone?
They have been absolutely highlighted in a huge amount of detail in relation to COVID as a result of COVID. It's actually led us to have a really radical rethink about how we approach this subject, within health across LLR. We are developing an action plan around health inequalities, at this moment in time around what we do. There's a there's a few nuances to this about access to care, and the quality of that care.
How do we put interventions in that close that gap, particularly around health interventions around prevention, particularly those large those areas where we know that there's a large differential in health outcomes in life expectancy in different populations in different groups across the city. For example, CVD cancer outcomes, respiratory outcomes and then also around what we class as the wider determinants of health so actually only 20% of what we do in health will have an impact on your health outcome. The rest comes from your, you know how your education, your work status your community in which you live your housing. We want to work together and we started to work to go with the wider public sector across LLR to address some of those things collectively So what can we do about workforce, how can we offer opportunities for apprenticeships and work experience, what can we do to reduce carbon emissions in our city and those sorts of things.
We ought not to fall into the trap of just saying that inequality is around ethnicity and demographics, it isn't. Lots of inequality in health is most linked to levels of deprivation, and we've been doing some work recently, looking at for example, the likelihood of a person from a deprived background or neighbourhood. Ending access to a hip or knee replacement that you could apply to any number of different surgeries and procedures, versus a person from a better off background and actually the two figures nationally are pretty disparaging. So if you're coming from a background you four times less likely to have your hip or knee replacement than if you're from a wealthier that actually looks at the way and it's kind of the inverse wall of health because actually you'd think with people who live in more deprived communities have more health conditions, generally, and yet their access to health is not a level playing field.
The challenge for the service and for our communities actually is what are we prepared to do about it and I think we need to be held to account for what we are going to do about it, both in terms of the health service, local councils and all the other agency bodies and voluntary bodies that have a role to play in this thing.
Our plans for maternity and because we've obviously got the building as well so we have recognised for our health on the policies and especially for the childbearing population, know that if you're from Asian background you'll resolve more likely to die in other than, you know, white British person, and that black people are five times more likely to die. Also the rates of stillbirth or miscarriage are much higher. So, one of the things that the NHS England has looked at is whether or not, continuity of care or where the same midwife that books you in the beginning of your pregnancy provides for you care through your antenatal period, and looks after you in labour and sees you at home post baby, is a great start with feeding your baby and the spouse, family, helps and we know that it does we've looked at all the research and we know that it does help, and it breaks down all the carriers with problems with safeguarding concerns, and, you know, people with mental health issues.
In Leicester what we've done is we've formed a team called the Lotus team, basically, a team of 6.8 midwives, and they work on surgery on Melbourne road, it's Dr Saunders, and they provide total continuity for women so they're looking after women from the very beginning, right through until they discharged the and we know that that's going to help to improve that.
It's not just about buildings, it what goes on around buildings, and our plans are to use both new maternity hospital at the Leicester Royal Infirmary, and the planned birth centre the Leicester general in that way so we're not going to be staffing buildings, because we staffing women. So when the women go into labour they're not going to be seen by herds of midwifes they are going to be seen by two or three midwifes they know who are going to look after them when they go into labour. There will be their named midwife, and their partner, when they go into hospital the midwife goes with the looks after woman labour and then if they stay in hospital the midwife will visit them every day while they're in hospital and provide all the care and if they choose to go home midwife sees them at home and that's purely because of all the research that's been done that says there are health inequalities and we're trying our best to address that.
We're going to make sure that we have interpreters with us every clinic so that there's no problems with in communication and we're also looking at getting an app together, we're trying to encourage women who are diabetic to book, early. We're trying to get health and wellbeing connected prevent women from getting diabetes in pregnancy, because we know that Asian women are more likely to become diabetic so a lot of it is about prevention rather than cure.
Mental health, wellbeing of parents, children and our general community, if you'd have a section where, say for instance there's a person who's an art teacher. There's so they're believed in the actual session and other people have come to attend. And this this idea that I think I'm thinking of would also bring revenue back into the hospital in the sense, with regards to this art idea for example everybody would have one of those painting boards ready they'd come in, the teacher would lead the session. Everyone will copy the painting and they'll be taught how to do a painting which they take home with them. Now, this could also be including for children to do, arts and crafts where the teacher is leading the session they're coming in, and parents, not all parents in the community speak English as a general language. So you could call them in either phonics sessions or call them into practice sessions, because they could be having some sort of treatment going on, and help them to meet like minded people who have in the treatment done. Also, and this could also help people who do musical or dance, to bring in communities in this is helping the race and inequality, you'd have interpreters there. People are getting to know each other they're helping each other, but through avenues that are making them have to, with regards to their mental well being?
That’s a really good idea. We need to have a bit more of an in depth discussion about that idea. We are really interested in how we can use the arts as a way of engaging with communities but also giving communities something back. We often go out to communities and find out what they think about our hospitals, but we don't always give an awful lot back and I think it's a much more reciprocal way of engaging with communities
There is a secret garden at the Glenfield. there is a bit of building there, adjacent to it which would lend itself beautifully to the to what you're suggesting, and we are looking at ways with which we can utilise that and that is a garden that we brought back into use that was neglected. Previously, and as a sensory area for people was, and has been used a lot through this COVID period by staff from the Glenfield, it's a great example of something that we can do with a community. The whole idea of that area is that it becomes a community asset.
How are you marketing to the community with the new changes that are happening? How are you reaching out to them?
The consultation is a formal consultation it's something that we have to do because we're making major changes to the way that we organise our services across the city so we haven't heard her for consultation. That started on the 21st of September and it goes through to the 21st of December. During that period of time we've done quite a lot of different things, events like this one, some open question and answer sessions. We've also done some workshop sessions.
We issued a leaflet explaining our proposals to most well all households it's across LLR and we're doing various things for voluntary and community sector to reach groups that are not traditional that we don't traditionally reach well. We've also gone a lot of work with. We've got a survey that's on our website so we've got a website, if you want to have a look at the various different videos about our proposals, and it's got a lot of questions and answers on it that we have gathered and, responded to join the consultation phase. Also on there is our survey so we would encourage people to complete the survey on their which your opinions on our proposals and then what's going to happen next.
We have an independent organisation that's bringing together all of the statement and consultation results that we've had and what people have said about our proposals, and they'll present that in a report to the CCG, and then we will look at that and and develop a final business case for decisions, probably in the spring of next year. And once we've considered all of the responses for the from the consultation.
We have done a lot of community radio as well so I think we've done an awful lot when it comes to working with people in communities.
Suggesting perhaps that the communication might be more direct and more effective coming via their local GPs surgeries?
We have to be really careful about using using data that GPS have got for all purposes that aren't direct patient care and we're not allowed to. What we have been doing is we have been encouraging GP surgeries to put the information about the consultation engagement on their websites and to promote it that way through their PPG’s etc. but we will take that away and see if there's anything else we can do.
How will patients and communities be engaged in ongoing co-production and co-design through the developments?
We are currently actively engaging and we will continue to have dialogue and seek input from people. As an example, in the first phase of building the children’s hospital we are already involving children, their parents, stakeholders and charities. The hospitals are public spaces and we need to make sure our hospitals feel comfortable for the people who use them by involving them in the decisions we make.
How are you reaching out to informal carers? They need recognition for what they do and are often not appreciated.
We have been engaging with a wide range of carers from different backgrounds throughout the consultation by holding separate discussions and meetings through our voluntary and community services.
Can you work with our disabled colleagues on the planning of the builds on areas such as parking, signage, lighting etc?
Yes, when we reach the design stage we will be drawing on the specialist skills of individuals who can help us. Our architects will be looking a patient flows for all needs.
What steps have been taken to ensure information has been adequately provided in these population groups, about which exact services are going to be lost, especially with those who are not able to access online meeting facilities or use the internet frequently?
We have undertaken solus door drops of an information leaflet to residential properties 440,000 residential properties across Leicester, Leicestershire and Rutland. In addition, rural communities in Rutland were sent a leaflet via Royal Mail as solus was not an option.
Whilst many people have told us that they have received this leaflet, we are also aware that some believe they have not. Solus delivery is not an exact science and is dependent on many key factors.
This includes the attitude of recipients to unsolicited deliveries, with some people simply disposing of leaflets immediately upon receipt. Other issues include the volume of marketing material being received by households, which can reduce the impact and recall of specific items, as well as the exposure of different people within the household to the material following delivery.
We have raised concerns from residents with our delivery partners who have provided us with GPS tracking information for their agents. This is in addition to feedback from telephone calls to a sample of homes within each of the postcode areas to validate delivery, which is undertaken by an organisation called DLM.
However, it is important to recognise that the door-drop is only one small part of the overall awareness activities we have undertaken, details of which can be found elsewhere in the papers for this meeting
At 22 weeks pregnant I had to travel by car to Leicester General Hospital as I was suspected of going into early labour- the journey took me over an hour. Please can you explain to me, if it’s not acceptable for women in the city to travel to Melton Mowbray, why is it acceptable for women in Melton Mowbray to travel to the city, where there is increased traffic, surely this will add to the congestion?
Reviews of maternity services have identified that the standalone birthing centre at St Mary’s Hospital in Melton Mowbray is not accessible for the majority of women in Leicester, Leicestershire and Rutland. It is also under-used with just one birth taking place approximately every three days, despite attempts to increase this number. This means the unit is unsustainable, both clinically and financially.
We believe underutilisation of the unit may, at least in part, be due to concerns over the length of journey from Melton Mowbray to Leicester should mum or baby experience complications during the birth, as well as its relative inaccessibility to the majority.
Our proposal would see the relocation of the midwifery-led unit at St Mary’s Hospital to Leicester General Hospital, subject to the outcome of the consultation. While we are proposing to move the midwifery-led unit, we would maintain community maternity services in Melton Mowbray. We would ensure that there is support for home births and care before and after the baby is born in the local community. If someone has a complicated pregnancy, antenatal care would be provided in an outpatient service located at Leicester Royal Infirmary or in remote/virtual clinics.
Access at Leicester Royal Infirmary site where we are proposing to develop the new Maternity Hospital would actually be easier in future. This is because we propose to provide approximately 100,000-day case procedures and 600,000 follow up appointments done each year in a different way e.g., done closer to home in the community which is what patients say they want. More appointments will also be done remotely, over the phone and via the internet. Others will move to the new Treatment Centre at Glenfield Hospital
We are also creating extra parking spaces on site at both Glenfield and the Royal Infirmary so access and parking would be easier.
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How will the proposals affect people’s journeys to hospital?
Our proposal takes into consideration travel times for people to reach hospital and the ease of getting to each site, including parking.
Journey times for the majority (around 70%) of patients would not increase and would reduce for many given the location of the proposed Treatment Centre at the Glenfield Hospital and its relative accessibility compared to the city centre location of Leicester Royal Infirmary. In addition, the need to transfer patients between three acute sites would reduce considerably with proposals to have two acute sites.
The proposal for how services should be provided in the future potentially creates an increased travel journey for approximately 30% of patients living in Leicester, Leicestershire and Rutland who need acute hospital care, but will decrease travel time for others. This increase is mainly for those patients living in the east of the area and who use services that would move from the General Hospital to Leicester Royal Infirmary or Glenfield Hospital.
The impact would be offset in part by the proposed increase in outpatient and follow-up appointments being undertaken in the community closer to where patients live, and through the increased use of technology. This will have the additional benefit of helping to reduce the NHS’ carbon footprint.
Are we just shifting congestion to the Glenfield Site by condensing activity from 3 sites to two?
Traffic in City is where congestion is worse and the road links into Glenfield hospital are much better. Plans would shift where activity takes place reducing the need for face to face consultations, between 300,00-400,00 outpatient appointments which have taken place face to face historically now don’t need to take place, this will reduce the burden on travel.
We will continue to work with travel consultant company and the local authorities for travel and access solutions.
How are you going to accommodate more parking?
The creation of new car parks at both the Royal and Glenfield will help ease current parking difficulties.
Our reconfiguration plans include a large Treatment Centre at the Glenfield Hospital. Once this is operational a significant amount of the activity that previously took place at the Royal Infirmary will take place at the Glenfield Hospital. This means that we will free up parking space at the Royal.
Given the significant increase in use of cycling during the Covid19 pandemic, is the Travel Plan going to be reviewed to get a better balance between supporting sustainable travel and ensuring appropriate amounts of car parking for those who need it?
We are developing a comprehensive sustainability strategy that uses established world-wide techniques set out by BREEAM, Building Research Establishment Environment Assessment Method. BREEAM is one of the world's leading sustainability assessment methods which using a 1 – 6 star rating and considers a range of factors such as energy, emissions, waste, sustainable care and social values . We are aiming for a minimum of 5 stars which is an ‘excellent’ rating.
Travel is such an important factor for us. We will be looking at park and ride services, travel hubs, storage for cycling and changing facilities. We want to look at the potential social benefits to help revitalise the economy such as apprenticeship programmes and how we can get more people working from within the city. This is such a fantastic opportunity for us to get patient care across the city to the level we want it to be and we're going to do everything we can to create the most sustainable services for our patients.
What about public transport considerations?
In terms of public transport, all three hospital sites are served by a multi-site bus service. This is a minimal-stop shuttle service and is free to use by staff at all times and those with concessionary passes in off-peak hours. Journey times between sites are between 20 and 30 minutes, with the shuttle stop coinciding with other local bus stops. A travel plan looking at wider travel options to support the proposal is being developed and will include options for improved public transport and use of park and ride facilities. We recognise that transport is a very important consideration for our patients and staff and we will use feedback from the consultation to help us with our plans.
How will you address the parking issues at the Leicester Royal Infirmary site? Long queues often mean people can be waiting up to an hour for access to the hospital site.
We recognise that parking is an issue. One of the things we would like to do to address this is to reduce the footfall of those attending the Leicester Royal Infirmary site. The treatment centre planned for the General Hospital site will dramatically help towards this, with a projected reduction of footfall by 50%. The Glenfield Hospital site will also have increased parking provisions. Furthermore, increasing services in the community and increasing the use of virtual consultations will further reduce the amount of footfall on the hospital site.
We are working closely with Go Travel Solutions and the public to look at the best travel opportunities for patients and the public to access the hospital sites. Healthwatch Leicester and Leicestershire and Healthwatch Rutland are an integral part of this work. We are also looking at our local travel plan. We are working with the local authorities to improve bus routes and other transport opportunities across Leicester, Leicestershire and Rutland. We are also investing in new technologies such as digital parking barriers to make access to car parks easier and avoid issues such as queuing.
People in Melton Mowbray are concerned that there is a move of all major services to Leicester. What are the plans for transport from outlying districts to the City for hospital appointments and visiting?
Where appropriate and safe to do so we will be moving more services into the community, closer to where people live. In doing so, we will enhance some of the services at Melton Mowbray Community Hospital. Part of our strategy is to try and maintain local services and only bring people into the city where they need more specialist services.
Please refer to the above question for more information on travel enhancements to ensure patients can access all three hospital sites.
I am disabled. Getting parking at the LRI is a problem. It can make it very inaccessible for me?
We are very aware of the issues about access to the Leicester Royal Infirmary and one of the problems at the moment is there are multiple access points.
For example, the maternity hospital would be designed adjacent to the multi-story car park which is going to be extended. You would also be able to drop people off at the front doors before parking close by. There is a lot of work going on with a city wide travel plan, because the footfall is going to change on the various sites and we need to fully understand this impact.
What will be happening with the spare spaces at the General? If it is sold off how will the money be spent?
Some of the land will be sold for affordable housing which will include homes for key workers. Money from the sale of the land and buildings would be reinvested into the hospitals.
I have checked Google maps and travel time from my house to Leicester Royal Infirmary is 47 minutes and in rush hour raises to well over an hour. When I was in labour with my second baby, I chose to birth at St Mary’s. It took me 30 minutes to get to St Mary’s and my baby was born 10 minutes after I arrived. If I had been travelling to the Royal, my baby would have been born in the car on the A6. Can anyone advise me what I would do if I was in that same situation again?
We would usually encourage women who deliver at speed to consider a home birth because that would be the safest option. If women don’t want a home birth you could still go to one of the maternity units though the midwives would advise you over the phone during labour whether it was safe for the women to come in. The midwives would talk you through what to do on the phone to ensure you deliver safely.
What is making the CCG think women will choose a birthing centre at Leicester General Hospital if safety is the determining factor? There are a lot of people in the County who actually live closer to Kettering Hospital so I think they would rather go there than Leicester General?
It would take approximately seven minutes to be transferred in an ambulance from Leicester General to Leicester Royal Infirmary if something went wrong. Whereas it could take 45 mins from St Mary’s so from a safety perspective, it is safer to locate at Leicester General. We are talking about 140 – 170 people accessing St Mary’s out of a population of 1.1 Billion so we do need to consider that given the challenges the NHS is currently facing.
I represent Castle Donnington on northern fringe of Leicestershire, patients tend to use services in Derby & Nottingham. Difficult with cross border services, how help us as care outside of county?
Looking at working across system footprint and working with partner providers, to ensure there is an offer to the total population. Arrangements for cross border working with Community Trusts when discharging patients not relying on passive approach, pulling people from those hospitals as we would with the hospitals of Leicester. We work as a system without boundaries; offer is the same for post hospital care. The services offered are a general offer, patients can go where they choose and we want to make sure this offer is still there. Work at more regional level for the more specialised services, work on regional footprint. Not a huge amount of impact if patients go out of county, it’s to make sure not these patients are not forgotten if go out of county.
5-10 years ago put hospitals in competition with each other, this has now changed. Much better to work together and look at a regional offer.
Can you make patients exempt from paying for parking?
University Hospitals of Leicester do not currently offer free parking to our patients. Car parks are expensive to run and maintain, and the revenue generated is used to maintain facilities to ensure they are safe for patients and staff. Any extra revenue is reinvested in care for patients. Abolishing car parking charges entirely would cost the Trust and would mean the funding would have to come from the hospital’s budget that is used to provide healthcare services to our patients.
However, we do provide a variety of saver tickets that are available to the patient or prime carer. These tickets are detailed below:
| Patient and prime carer saver tickets |
| Daily | £6.10 |
| Weekly | £17.00 |
| Monthly | £56.40 |
| Saver (only available at the LRI) | £25.00 (for £50 of parking credit) |
| Inpatients for over 6 weeks | FREE parking (for prime carer) |
In addition to the saver tickets, we adhere to the governments scheme for certain benefits, see below: Reimbursement for patients on qualifying benefits
Patients receiving qualifying benefits can have their parking charges reimbursed. The qualifying benefits are notified by the Department of Social Security and you will require proof of entitlement to the benefit and proof of hospital attendance from an appointment card or letter.
The current qualifying benefits are:
- Income Support Letter – valid for six months from the date in the top right hand corner
- NHS Tax Credit Exemption Certificate Card
- Income Based Job Seekers Allowance Letter - valid for six months from the date in the top right hand corner
- HC2 Exemption Certificate
- Income Related Employment and Support Allowance
- Pension Credit Guarantee Credit
In addition to the above, if you are named on a HC3 Exemption Certificate, contact cashiers for advice as you may qualify for some help.
For further parking information for our individual sites, please visit our website by clicking on the relevant link below:
Leicester Royal Infirmary
Leicester General Hospital
Glenfield Hospital
The proposals for spending 450 million on Leicester hospitals have become very emotive for some people, regarding travelling for appointments, I have heard nothing about travel?
We recognise there is a travel is problem, even for those within city it is not easy to navigate. We do think plans will in main be easier for the majority of patients but there will be challenges for people across Rutland. Janet was involved in a transport meeting on 25th November 2020 about the development being planned across Leicester Leicestershire and Rutland to improve travel plans. Where people need to use a car we are looking at the car parking, electric car charging points. There have been discussions about improved bus services from park and ride. We are working with a company called Travel Solution to assist with these issues. This is a really good question that we are conscious of. The £450 is not about just building hospital, it also brings social and economic investment across LLR.
Please would the team update on what progress is taking place to address the issue of people from the eastern side of the County and Rutland attending appointments /treatment. Public transport is sparse after office hours.?
We understand if you live near a hospital it is easier to get to. The issue is it’s important that people who come into hospital really need to. Rutland Memorial Hospital should negate the need for people to come in from Rutland. If need to come in by ambulance as an emergency to provide care. Key thing is as much of peoples care will be delivered closer to home. If you live in Oakham there are problems due to the lack of transport. Working with Rutland and Leicestershire County Council to make travel access that little bit easier. If care is needed at a hospital we are making car parking better, and looking at the buses and trains to work out how to improve travel for Oakham, Manton and Rutland. Encourage as part of the consultation for you to make sure we do understand all the nuances, so please complete questionnaire so we can understand needs.
Having attended a number of meetings at County Hall there has always been some concerns over the availability of ambulances and response times. How would you see these stats changing if there are greater distances to be travelled?
NHS plans for the acute sector are not planned in isolation of other partners, the numbers of crews held up at A&E’s due to winter pressures and COVID. EMAS are good at deciding where to take patients. Response times is about making options simpler for ambulances, won’t be using emergency vehicles to transfer patients across sites. Cardiac patients will have to be moved from Leicester Royal Infirmary to Glenfield. We have been talking to EMAS colleagues and they are enthusiastic about the plans.
There will be a cleaner separation between emergency and planned care and patient experience will improve as a consequence.
Travel time from Oakham to A&E is unchanged. Developing proposals for Rutland, that might help with some circumstances.
Improvements to roads and travel around site and access?
Separating Emergency and elective care, will take half of patients who are seen at Leicester Royal Infirmary to Glenfield, LRI see about 750,000 patients and this will fall to 400,000 that’s biggest thing to improve travel and access it will declutter the site as there won’t be as many patients and car journeys.
Working with Leicestershire County Council and Leicester City Council with regard to travel plans eg bikes, tram systems. The ground floor car park and multi- storey car park which was built 4-5 years ago is already full at times. The Leicester Royal Infirmary will no longer be the busiest site. The Glenfield site is much a wider flatter site, for parking and road access.
Doesn't mean that when similar tests need to be done, but not immediately, for an operation, they're also centralised?
Example: So the discussion we're having with people in Oakham, is what staff can work out of Rutland Memorial Hospital? If somebody needs an X ray, Do they really have to travel into the centre of Leicester or the other place they use; the centre of Peterborough for that X ray. We would prefer them to be able to have that locally because it's a 45 minute journey at the very least to come into the city and rather than have it locally rather than come it to the city hospital
Many people I speak to are concerned with the parking at the hospitals. It needs to be adequate and affordable. How will this be addressed?
We are building a new multi-storey carpark at the LRI. We will also be working with Leicester City Council on local bus routing. The LRI will have more of a campus feel to it.
People with disabilities can’t manage the distance from getting from the car park into the buildings. Once the buggy service finishes how do we get into the hospital?
We currently have around 20 entrances into the hospital. We will be having a new welcome centre which will offer clear access to all services and improve navigation. We are also looking a the buggy service that we offer.
Mentioned Go Travel solutions, involved with travelling public and visit all 3 main hospitals, never lower themselves to talk to public?
Currently getting feedback from public, through consultation process there is a huge amount of insights and we will extract information around access, travel transport etc. We have fed through these insights to Go Travel on a regular basis so get indication of what matters to people on travel and transport. Encourage as many as people to complete questionnaire.
Have regular meetings with Healthwatch across Leicester Leicestershire & Rutland. Feeding information into Go Travel, this will go long into the future. There are opportunities through the CCG and PPG networks to feedback information. These are the two key ways at the moment.
In response to public questions NHS leads have spoken about the removal of services from the Royal Infirmary to Glenfield as an example of how traffic on the LRI site will reduce. However, it has not spoken about how the new services on the LRI site, including a Maternity Hospital supporting 11,000 births, will affect traffic within the site and parking. Can it be more specific? Also it has ignored the issue of the congested nature of the roads around LRI and the impact that will have on access to LRI. Are there plans to improve traffic flow in the area?
The new maternity centre would be created at Leicester Royal Infirmary, bringing together the existing units there and at Leicester General Hospital. But to make way for these, more than half a million outpatient appointments and 100,000 day case procedures would be done differently – reducing expected traffic and footfall at the site by approximately 45%. This would include reducing the amount of first referrals and follow-up visits by an anticipated 30%. Technology would help to provide certain aspect of care differently in the future. This could include telephone conversations, Skype calls or other forms of virtual online appointments if it was appropriate. It would also involve having more appointments, where appropriate to the condition, in community settings close to home.
Travel, transport and access are important issues for us. We have commissioned a specialist company called Go Travel Solutions to work with us. They are taking all the insights collected through the consultation and working with a range of partners including the local authority and Healthwatch organisations to develop a travel plan to improve traffic flow and access and develop long term sustainable solutions.
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