Building Better Hospitals 24 page summary document (html)

Building Better Hospitals for the future: University Hospitals of Leicester NHS Trust

Public consultation about proposed £450 million improvements to transform acute and maternity services at Leicester’s hospitals.

What this publication is about

This is a summary of the full consultation document about the proposed £450 million improvements to transform acute and maternity services at Leicester’s hospitals. The full consultation document and the Pre-consultation Business Case, which is a document describing in a lot of detail the proposals for improving services is available by emailing beinvolved@LeicesterCityCCG.nhs.uk. 

When we say ‘acute services’ we are talking about care for severe injury or illness, urgent medical conditions, or during recovery from surgery.

Introducing our 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.

It is vital we hear your views to enable us to take a final decision on the proposals to improve Leicester’s hospitals. We would be grateful if you could complete the questionnaire online. You will also find additional supporting information on this website. 

All surveys must be received by the closing date of Monday 21 December 2020.

What this consultation covers

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:

• Leicester Royal Infirmary (LRI)
• Glenfield Hospital (GH)
• Leicester General Hospital (LGH)

The consultation is also about services delivered at the midwifery-led unit at St Mary’s Hospital in Melton Mowbray.

This consultation does NOT include community hospitals, GP practices, mental health and other services provided in the community or in people’s homes, which have been discussed with the public through the Community Services Review. We will be continuing to engage with people about these services in the future. Irrespective of what proposals are developed to move peoples’ care closer to home, we believe that this proposal will deliver safe, high quality care to our patients.

"We want to spend £450 million to transform acute hospital and maternity services in Leicester, Leicestershire and Rutland."

What changes are being proposed?

The £450 million investment proposal includes:

• The first dedicated single-site children’s hospital in the East Midlands based in 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.
• Modernised wards, operating theatres and imaging facilities.
• Additional car parking.

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 recovery services 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 plans will enhance the care we provide to our patients, including those needing planned care and emergency care, and those who are critically unwell.

Why we need to make changes

1. Our population’s health and care needs are changing

Overall, people living in Leicester, Leicestershire and Rutland are living longer and there are fewer people dying from conditions such as cancer and heart disease. However, the number of people ageing with more than one health condition has increased and this puts pressure on health and social care services. People’s health varies greatly owing to the large differences in income and deprivation levels. We believe our plans to improve services will address some of the frustrations that people have told us about, respond to the health challenges and help improve the overall health and wellbeing of local people.

2. The need for services is set to increase

Leicester’s hospitals often struggle with the level of demand and do not have the capacity in the way services are currently set up to cope with the future predicted increase in the need for services. This increase in need is for both emergency and urgent care services as well as planned care.

In addition, the need for maternity facilities has increased. The maternity facilities at Leicester’s hospitals were designed for approximately 8,500 births a year, but the number of births is now about 10,500 per year.

3. We need to integrate health and care services

Health and social care organisations in Leicester, Leicestershire and Rutland are working hard to bring services closer together. Services will be focused around patients and their GP practice, with more care and support delivered in the community through teams of health and social care staff working together.

The aim is to reduce the need for people to travel into hospital for much of their care. The new way of providing care is designed to improve people’s health and wellbeing, improve patient, carer and staff satisfaction, and improve access to services, while making sure the NHS is making the best use of its money.

4. The standard of care patients receive is not as good as we want it to be

There are many examples of excellent quality care and patient safety, such as specialist heart services and children’s surgery. Leicester’s hospitals want to achieve the highest possible standards and quality of care across all of their services. Investment in buildings that are well designed for their purpose helps to ensure that services are provided more efficiently and effectively. This will help improve services such as emergency care and care for people living with cancer or other long-term conditions.

5. We need the right number of hospital beds

We have a growing local population and there will be more beds provided in Leicester’s hospitals in future with this investment. Leicester’s hospitals say there is a need for 139 more acute beds by 2023-24 - an increase of 7% on the current number. However, we know making patients better and keeping them healthy is not just about having beds in hospitals. We will work to establish a better way of providing care which means we will see more services located closer to where people live, at home or in the community.

6. Medical and nursing resources are spread too thinly

The current way that the hospitals are set up in Leicester means services are sometimes duplicated or triplicated. We have three intensive care units, one at each site but none big enough in their own right. Our doctors and nurses are spread too thinly. Employing more staff is not a feasible solution - there are staff shortages locally and nationally. Patients are regularly moved between the three hospital sites.

Many planned and outpatient services currently run alongside emergency services. When emergency pressures increase, the planned cases and outpatient appointments suffer delays and cancellations. We need to develop a different way of working that is affordable and improves patient experiences.

At present, mothers in labour are routinely transferred from one hospital site to another if there are too many births taking place in one of the units, or not enough staff are available on a unit to provide adequate care.

Care provided for babies born prematurely or ill is currently split across two sites. St Mary’s midwifery-led unit in Melton Mowbray is under-used despite efforts to promote services, with less than three births per week on average. By building a new £88 million maternity hospital we will improve the safety, efficiency and effectiveness of the service and provide better care for mothers and their babies.

7. We have tired buildings and a significant maintenance backlog

Some of the hospital buildings are old, tired and beyond their useful life. Over the last two decades there has been no significant investment into Leicester’s hospitals apart from the recent development of the new emergency department.

There are only a few facilities we can call state-of-the art and there is a backlog in repairs to the buildings, resulting in poorer conditions and buildings being no longer being fit-for-purpose. We want local facilities to enable us to deliver safe, high quality services to our patients and provide staff with a good working environment.

8. We need to spend our money in the best possible way

In 2020-21 the NHS in Leicester, Leicestershire and Rutland is forecast to spend around £2.2 billion on running local health services. The impact of Covid-19 could make this figure even higher. This includes paying staff, running our buildings, providing equipment and information technology, and funding treatments and drugs.

We are working hard to save money by cutting waste and finding better ways of doing things more efficiently. But we need to do more. We believe that changing how we reconfigure our services will help us to use our money in a much better way to support local people.

Has coronavirus changed our thinking?

The experience of managing health and care during Covid-19 has only strengthened the case for these proposals. The Covid-19 pandemic meant that non-urgent operations and procedures had to be cancelled in large numbers. This affected all services and all types of patients, even some with cancer. In our plans we propose to build a dedicated treatment centre at the Glenfield Hospital. This would help us separate emergency and planned procedures. This means that when we are busy with high numbers of emergencies, our patients needing planned care would still be able to receive it.

Our proposals would also help us more effectively staff our services. For example, had we had 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. From our experience during the pandemic, it is clear that our hospitals would have been better able to cope with Covid-19 in their reconfigured state.

Services we are consulting on

The proposed changes - at a glance

The proposed reconfiguration of services would mean new buildings built, existing buildings refurbished, services being retained and new services created.

Leicester Royal Infirmary

• Build a new maternity hospital with a doctor-led inpatient maternity service. A shared care unit with midwives and doctors and a midwifery centre provided alongside the obstetric (pregnancy) unit
• Refurbish the Kensington building to create a new children’s hospital including a consolidated children’s intensive care unit
• Create a new gynaecology (female reproductive health) inpatient day case and outpatient service through refurbishment
• Build a new expanded intensive care unit to create a ‘super’ intensive care unit
• Refurbish wards to relocate adult inpatient services
• Expand car parking facilities, for example, additional levels on the multi-storey car park
• Create a new welcome centre

Glenfield Hospital

• Build new premises to house a major new treatment centre for planned care, inpatient wards and theatres
• Expand the intensive care unit to create a ‘super’ intensive care unit
• Create a new surgical admissions unit
• Build a new car park
• Create a new welcome centre

Leicester General Hospital Campus

• Create a small campus that focuses on community health with some beds
• Retain the diabetes centre of excellence and stroke recovery service with inpatient beds
• Potentially relocate a midwifery-led unit from Melton Mowbray to Leicester General Hospital.
• Potentially retain Brandon Unit for administrative, education and training services
• Retain sufficient car parking
• Potentially create:
  • new GP access imaging facilities (to help with diagnosis)
  • non acute services – GP-led primary care urgent treatment centre
  • observation facilities
  • a diagnostic service
  • community outpatient service
  • new or additional GP capacity

Glenfield Hospital

"The core of our approach is to separate emergency and planned care so that one does not overwhelm the other."

Under our proposals Glenfield Hospital would expand by almost one-third - as services move over from Leicester General Hospital and Leicester Royal Infirmary. 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.

The treatment centre at Glenfield Hospital would provide outpatient facilities and day case surgery. The centre would offer state-of-the-art, purpose-built wards, theatres and imaging facilities – effectively a ‘one-stop-shop’ for clinics and investigations so that patients have their care and treatment in one day and in one place rather than being sent from site to site over a longer period of time.

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.

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.

This creates space for a dedicated children’s hospital and new maternity hospital and reduces congestion and parking problems.

Leicester Royal Infirmary

"Still the primary site for emergency care with significant investment in a new maternity hospital and a newly established children’s hospital."

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. Where more appropriate, they may be delivered as digital appointments rather than face-to-face. This will help to relieve pressure at the Royal Infirmary site and provide significant space to plan and create new developments.

One of two ‘super intensive care units’ are planned for this site, which will double intensive care capacity, with specially trained staff providing critical care, equipped and designed to closely monitor and treat patients with life-threatening conditions.

The rehabilitation unit for people with a brain injury or problem with their nervous system will relocate to Leicester Royal Infirmary from Leicester General Hospital.

Our proposals include creating a new dedicated maternity hospital 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 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. 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.

The proposal would create a newly established children’s hospital in the current Kensington building. Hospital can be a daunting place for children as they are away from their friends and family in an environment they are not used to.

The creation of a new standalone hospital for children and young people would focus on creating a more comfortable environment, a place to play and where they can feel at home. Parents would be able to feel more relaxed knowing that the newly established hospital environment has been designed for children, giving them a much better experience and easing some of their worries.

The quality of the patient environment within the Leicester Royal Infirmary would be welcoming and suitable for patients, visitors and staff. This would start when people arrive, with additional accessible car parking being created.

A welcome centre would improve the experience of people getting around a very busy and complex building.

An improved patient environment would also benefit staff in their day-to-day work, delivering high quality care, from cleaners to consultants and porters to nurses. It is expected that staff will be retained for longer and more skilled staff will be attracted to work at Leicester’s hospitals.

Leicester General Hospital

"No longer an acute hospital - instead Leicester General Hospital would be developed into a smaller campus that focuses on community health with some inpatient beds."

We are proposing to create a community campus at Leicester General which would serve people living in the east side of the city and county with:

• A dedicated building for the Leicester diabetes centre of excellence
• A dedicated GP access imaging hub (to help with diagnosis)
• Stroke recovery centre with inpatient beds at the Evington Centre
• A midwifery-led unit - dependent on the outcome of public consultation - within the existing Coleman Centre
• Administrative, education and training services in the Brandon Unit.

  In addition, we want to explore through this consultation potentially developing other services at this site, including:

• A GP-led primary care urgent treatment centre, open at least 12 hours a day, every day, offering appointments that could be booked through NHS 111, a GP practice or referred by the ambulance service. There would also be a walk-in access option
• Observation facility located alongside the primary care urgent treatment centre for patients where admission is not necessary, but where they need to be cared for and monitored for up to eight hours by suitably trained staff
• Community outpatients service providing additional care for people referred for treatment in the community
• Additional primary care capacity to provide family health care to people living in the east of the city.

Options for maternity and midwifery-led unit

Reviews of maternity services identified that the standalone midwifery led unit 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.

Options 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.

Support services

Support services such as expansion to the mortuaries, pathology and pharmacy form part of the proposals. Also included is an expansion of the information technology (IT) services across the sites. In addition, administrative support functions will be reviewed to ensure the right services are in the right location, and the buildings are used efficiently.

How do the proposals affect transport, travel and parking?

Our proposal takes into consideration travel times for people to reach hospital and the ease of getting to each site, including parking. The proposal for how services should be provided in the future means that 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.

However, the proposal does potentially create an increased travel journey for approximately 30% of patients living in Leicester, Leicestershire and Rutland who need acute hospital care. This 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.

The relocation of significant numbers of planned care services and outpatient clinics to the Glenfield Treatment Centre would also mean that traffic and congestion around the Royal Infirmary would be less of an issue. The creation of new car parks at both the Royal and Glenfield would help ease current parking difficulties.

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.

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 we propose to fund the improvements

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.

How we arrived at the proposal

The NHS has been listening 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.

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.

Summary of the key points of our proposals

• These proposals will improve patient care and enable Leicester, Leicestershire and Rutland to have NHS services fit for the 21st Century
• Certain services will be located together on one site to improve patient safety and deliver better results
• Bringing together certain services on certain sites will reduce confusion for patients as they will have all their appointments in the same location and environment
• For the majority of patients, the new location of services will be more accessible
• Providing more day-case surgery in a dedicated treatment centre will mean more patients will be able to have a procedure and go home the same day.
• Separating emergency patients from planned care patients will reduce the likelihood of planned care procedures being cancelled due to emergency pressures
• The new way of providing services will improve working conditions for staff and make more effective use of support staff
• Providing more non-acute services at the Leicester General Hospital site, with some inpatient beds, including additional GP services will improve access for patients, particularly those living in the east of the city and the county

Get involved - and have your say

This consultation will run from 28 September to the 21 December 2020. We want to know what you think about our proposals for changing acute and maternity services. You can tell us by:

• Attending one of our public events or workshops.
• Completing our questionnaire online
• Emailing us your views at beinvolved@LeicesterCityCCG.nhs.uk
  
• Phone us on 0116 295 0750 or emailing beinvolved@LeicesterCityCCG.nhs.uk to arrange to complete the questionnaire with a member of staff.

To keep up to date with news of the consultation, follow us on social media:

• Facebook: @NHSLeicester
• Twitter: @NHSLeicester #BetterHospitalsLeicester

Online events

Two question and answer sessions will be held online on Monday 12th October 2020 and Monday 7th December 2020.

A series of workshop will also be held throughout the consultation. Find out more information on all our events and workshops here.