The Committee received a presentation from
Professor Andy Hardy, Chief Executive and Justine Richards, Chief
Strategy and Transformation Officer of UHCW. There had been
reported concerns regarding the closure of the Hoskyn ward at the
St Cross Hospital, Rugby and the presentation informed members of
the service developments taking place at this hospital. The slides
covered the following areas:
- Transforming services at the
Hospital of St Cross, Rugby.
- The vision for the hospital, with
context on how this had been developed, the aims for some services
to be delivered in communities and in partnership, with a focus on
elective surgical procedures at this hospital:
- ‘More than a
Hospital’ committed to transform the Hospital of St
Cross, build modern facilities and improve staff and patient
experience.
- Regional leader for elective care
– GIRFT (get it right first time). The hospital was one of
only 36 sites nationally to be accredited as a surgical hub.
- To deliver expanded and modern
elective services to meet the needs of a growing population in
Rugby. Evidence of the high proportion of orthopaedic services
already delivered at this hospital.
- Separating emergency and planned
care onto two distinct sites, with less disruption to planned
procedures and driving down waiting lists.
- ‘Health on the High
Street’ development for some outpatient services to improve
accessibility. The former Wilko retail premises was being leased.
Reference also to the better transport links to the town centre and
economic benefits of increasing footfall from the use of such
premises.
- Multi-phase 10-year plan with a
Strategic Partner – Development Control Plan.
- Investing in the Hospital of St
Cross since 2021:
- Modular build of two new theatres
– expanding surgical capacity.
- £1 million Haematology and
Oncology Maple Unit opened in 2021 - increasing outpatient
appointments numbers for local people.
- A specialist breast care unit
offering surgical and nurse-led clinics, reconstruction, plastic
surgery and breast surgery physiotherapy.
- New ultrasound unit in outpatients.
An extra scanner doing 4000 more procedures each year.
- New modular endoscopy unit, with a
dedicated two-storey unit, delivering 30% more tests for patients
with potentially life-threatening conditions. This had resulted in
73,000 additional tests from Rugby since the start of the
diagnostics programme.
- Investment in wayfinding and
signage, with a new site map and plans for a single entrance to the
hospital.
- An Urgent Treatment Centre (UTC),
which currently was adjacent to the out of hours GP service. This
formed part of a C&W wide review by the ICB. The expectation
was for a doctor-led UTC at this location. There had been
investment in a virtual consultant link to UHCW.
- Over £4 million in
energy-saving measures. It was one of greenest hospitals in the
country, utilising air source heat pumps and solar panels which
would contribute to becoming to carbon neutral by 2045.
Andy Hardy concluded that the St Cross
Hospital was central to the UHCW vision, with significant
investment being made.
In response to this part of the presentation,
more detail was sought on surgical hubs, what impact they had for
other hospitals, the planned services in Rugby town centre and
whether this was based on models elsewhere. Many of these aspects
would be covered by the rest of the presentation. ‘Health on
the High Street’ was being advocated as the way forward for
NHS services and Rugby would be a frontrunner. Mr Hardy explained
the challenges at hospital sites which provided both emergency and
elective services, deemed as ‘hot’ and
‘cold’ sites. Emergencies would always take priority
impacting on elective work. By separating the services at a
‘cold’ surgical hub for elective procedures, patients
were not affected by emergencies. This meant that 60-80 percent of
procedures (other than cases which might require intensive care)
could be delivered from the St Cross Hospital, reducing travel
distances for many Warwickshire residents.
Justine Richards continued the
presentation:
- Listening to our population –
research in 2021/22 to inform the strategy and identify emerging
themes. There was good engagement with over 1200 people responding,
many of whom were from Rugby. Justine
highlighted some of the staff feedback, which included proactive
work both before and after the elective procedure, and linking to
other NHS services involved in the pathways. Many of the public
themes were similar, key issues being integrated patient records
and expanding the range of services at St Cross. UHCW was stretched
and therefore more development at St Cross was a key aspect of the
ten-year strategy.
- Urgent Treatment Centre (UTC):
- Service available 24 hours a day,
seven days a week.
- Over 27,000 attendances per year
with an average of 75 patient attendances per day and 4 patients
attending at night.
- A direct digital connection to UHCW
was in place, meaning emergency medicine consultant advice was
available.
- Patients over the age of five with
minor injuries and illnesses could attend the UTC where trained
nursing staff undertook an assessment and gave advice and
treatment.
- Patient could have X-rays, blood
tests and a pharmacy was available.
- A review was underway led by the ICB
and Care Collaboratives, to design an integrated urgent care
model. Adjacent to the UTC, there was
another NHS centre which provided doctor-led out of hours services.
This was confusing for patients and work was ongoing to look at
providing such doctor led services at the UTC. Recently a workshop
was held with the ICB and a range of service providers to discuss
the redesign of a new model of care.
- Phase 1: ward and theatre complex.
This would provide four theatres and two wards each with 24 beds.
Justine Richards provided an outline of the stages completed and
those still to be undertaken. It included the planning process,
feedback from agencies, and the investment in a design partner.
This should reduce waiting times for regular elective procedures
including cataracts, hernias, breast surgery and urology. It should
be a catalyst for research and training opportunities. She
emphasised the patient and staff engagement throughout this
process, to design services with the patient in mind, ensuring a
good flow through the services and to maximise efficiency.
- ‘Health on the High
Street’. An integral aspect of the service redesign was to
replace some aging property. This would require demolition and new
building at the hospital site. Additional spaces would be located
in Rugby town centre, with an economic benefit for the town and
better public transport links. It would deliver services for
patients with diabetes and for children and young people including
maternity services. The Trust was now moving to the design phase of
this project which would be in the former Wilkinson store in
Rugby.
- Improving Lives Programme –
Coventry pilot:
- Justine Richards provided background
on this multi-year transformation programme in Coventry. The
‘Improving Lives’initiative involved three local
integrated teams which supported patients in or near to their home
following hospital discharge.
- The programme included a front door
admission avoidance model and improved hospital processes across
wards.
- Since going live in July 2024, the
programme had demonstrated improved outcomes for patients with a
reduction in lengths of stay in the hospital. Justine emphasised
the public, patient and staff engagement, the reduced reliance on
step-down care beds and bed occupation rates had reduced.
- Fewer elderly inpatients from
Coventry were being transferred to Rugby due to the new model (from
5.1 to 3.1 patients per day).
- There was an opportunity to further
progress the elective surgical hub development.
- Impact of the ‘Improving
Lives’ pilot:
- From 4 December, the Hoskyn Ward
would close with the number of medical beds reducing by 25. As
context, there were 69 medical beds at St Cross Hospital, with
about 50% being used for Coventry patients.
- This reflected the reduction in
Coventry patients requiring transfer to St Cross. These beds were
empty across the medical base.
- There would be no change in access
to medical inpatient beds for Rugby and Warwickshire’s
population at the Hospital of St Cross.
- For Coventry residents the Improving
Lives model avoided patients being away from families with extended
stays in hospital.
- Work was underway with partners for
the adoption of the Improving Livesmodel for Rugby. This included
both social care and South Warwickshire Foundation Trust
(SWFT).
- This aligned to the priorities of
the new government moving services from hospital to community, from
treating sickness to preventing it.
- Investing for future generations.
This slide showed the revisions to the site and the location of:
- New theatres.
- New wards.
- The main entrance development with
retail offer and improved facilities.
- Relocation of the mortuary
unit.
- More green spaces.
- Dedicated staff car parking.
- Development of an education campus
to facilitate research.
- Next Steps and summary:
- The planning application had been
submitted.
- The innovative ‘Health on the
High Street’ development was at the detailed design
phase.
- Ongoing collaboration with partners
across Rugby.
- C&W urgent and emergency care
review.
- Delivery of the vision over next
decade for the Hospital of St Cross.
Andy Hardy closed the presentation summarising
the aim to move services from UHCW to localities in Warwick,
Coventry and Nuneaton. Often NHS projects didn’t totally
fulfil their aspirations. ‘Improving Lives’ had
delivered the aspiration, with better community services and
integrated work with social care. There was an aim to replicate
this in Warwickshire. He spoke about reduced timescales for
community services and the financial savings achieved in Coventry
through reduced packages of care being needed. He commented on the negative view of the closure
of the beds at the Hospital, but this was due to Coventry people
not needing this step in their patient journey, waiting for a
community care package.
Members submitted questions and comments with
responses provided as indicated:
- Further information was sought on
the redeployment of staff. Andy Hardy confirmed that NHS processes
were being followed for the management of change. There were no job
losses resulting from the ward closure and staff wanting to stay at
St Cross Hospital were doing so.
- In response to a question on the
timescales for the new services becoming available, he referred to
the planning consent submitted in April. It had been hoped this
would have been determined by now and any assistance which could be
brought would be welcome.
- On resourcing, the funding was in
place through a private finance initiative. For ‘health on
the high street’ this was in the final stages for completing
the lease and the funding was in place. Staff would be involved in
the design of the new centre with a workshop planned for January.
This could potentially be completed within a calendar year. The
service delivery model would be flexible, allowing for other
specialist services. The larger projects had a build timescale of
two to three years, and this was dependent on the planning
consent.
- Justine Richards referred to the ICB
work on the UTC, with a procurement decision anticipated in June
2025 and mobilisation thereafter.
- Questions were submitted by
Councillor Rolfe on behalf of County Councillor Roodhouse, a member
for the Rugby area. There appeared to have been some confusion,
that the NHS staff had not been aware of the changes, and this had
been stressful for them. Some councillors had been approached by
staff fearful of losing their jobs. Andy Hardy confirmed that NHS
change management processes had been followed and that staff
received written confirmation of their new roles the previous
Wednesday. He said that Rugby Borough (RB) Councillors had not
helped this process, causing confusion. The presentation had shown
the investments into St Cross already and those planned for the
future. This information had also been shared with RB Councillors
but they had not shared it with their communities which was
frustrating. Councillor Rolfe responded that councillors worked on
behalf of their residents and passed on information heard from
them. They would not intentionally seek to cause
confusion.
- Councillor Timms commented that if
people had been adequately informed there would not have been the
recent march in Rugby. At a Rugby Borough Council meeting, it was
evident that all councillors had heard from staff who were
concerned, not knowing about their jobs. It was hoped that prior to
receiving the letters the previous week, there had been discussions
with the staff. As the Rugby Borough Councillor on this committee,
she stated she was not aware of the ward closure before reading it
in the newspaper. St Cross was central to Rugby, which had been the
fastest growing town in the Midlands for a number of years. She
considered the reaction to the population growth had been quite
slow. She did not want to be insulted being told that councillors
had not helped the process. If they had been informed, the
councillors would have helped the process. If staff had been
confused, then the members were also likely to be confused. Moving
forward she urged a constructive consultation.
- Andy Hardy confirmed the aim for a
constructive discussion. He referred to a recent meeting with the
RB Council and the local Member of Parliament. The staff were the
first people to be informed on the Monday with stakeholder
communications a day later. It had appeared on social media during
the Monday evening. The timeline was provided to staff, with
meetings held in groups and individually, giving time for them to
consider options, before communicating the outcome. He considered
there had been too many voices on this. Andy Hardy mentioned the
march in Rugby, which had referred to the downgrading of St Cross.
In fact, there had been significant investment in the site with
future multimillion pound investment plans. St Cross was crucial to
UHCW and to NHS services across Coventry and Warwickshire.
- Justine Richards spoke about social
media aspects. Change processes were difficult, and feelings were
often played out on social media platforms. The Trust Board
decision was to inform staff first and then to inform stakeholders
immediately afterwards, to avoid staff hearing about this from
other sources. For the Trust it was frustrating that it had played
out in this way. UHCW employed 11,000 people of which 40 were
affected by this review. She confirmed the staff engagement which
had taken place through individual and group meetings, listening
sessions and briefings.
- Justine Richards referred to the
engagement with the Rugby Health and Wellbeing Partnership (RHWP),
which reported to the Health and Wellbeing Board (HWBB). She
attended the RHWP meetings and had presented the development plans
on multiple occasions. The development of St Cross was a key
strategic priority for the partnership. Every endeavour was being
made to share the plans through the available channels. A similar
presentation to that heard today had been made at the RHWP. Help
from partners was needed to ensure the correct and consistent
messages were provided to the community.
- It was questioned why the proposals
had not previously been submitted to this scrutiny committee.
Justine Richards confirmed that this had been reported to the RHWP,
which reported to the HWBB. It was also noted that Councillor Timms
had only just been appointed to this committee as the Rugby BC
representative.
- A question on the bed capacity. Once
the first phase of development had been completed, there would be
48 beds for elective surgical procedures. With surgical advances,
the period of inpatient care needed was shortening. In time this
would mean that more surgical procedures and specialities could be
delivered from St Cross using broadly the same numbers of beds.
This would be in addition to the existing bed numbers on the
site.
- A follow up question concerned the
removal of beds from the Hoskyn ward. It was clarified that these
beds were previously used for patients from Coventry, who were now
receiving alternate support elsewhere. The surgical hub was
creating additional capacity. The vision was to make more efficient
use of these beds and a reduced medical footprint so people could
go home, not wait in hospital whilst a package of onward care was
arranged.
- The impact of the new surgical hub
for other acute hospitals in Warwickshire was explored. This would
not impact negatively on those other hospitals. Many patients who
would have attended UHCW for their procedure could now attend St
Cross instead, unless there may be a need for intensive care
post-surgery.
- Discussion took place on improving
communication between different parts of the NHS. The Chair
considered the patient should have all their medical records and
take them to every appointment. Andy Hardy confirmed they could
already do this via the NHS mobile telephone application. He knew
the concerns of patients needing to repeatedly advise clinicians of
their condition/treatment. In June this year, UHCW went live with
an electronic patient record system (EPRS), meaning that
information was all held in one place for any service at UHCW. Both
George Eliot Hospital (GEH) and Warwick hospitals had agreed to use
the same EPRS, with an estimated commencement in the summer of
2026. This would make a significant difference. He made an offer
for the committee to visit UHCW to see the EPRS.
- At the Queens Hospital in
Burton-on-Trent, Staffordshire a cold hub for elective procedures
had been opened. Councillor Humphreys explained the efficient way
staff coordinated all the services required for each person’s
treatment leading to assessments before discharge with an ongoing
package of care the following day.
- Councillor Holland reminded of the
roles of elected members and revisited the concerns raised by Rugby
residents, leading to the protest march. He asked what had been
changed to meet the requirements of local people. Andy Hardy
outlined some of the services introduced at Rugby in the last three
years including chemotherapy, endoscopy, ultrasound scans, sleep
studies and the new modern theatre facilities. A key concern was
the UTC, which was dependent on the ICB review, due to complete in
June 2025. He considered that UHCW had been responsive where it was
able to do so. There were now more services available at St Cross
than five years ago.
- It was stated that one in ten people
nationally were on an NHS waiting list. Councillor Holland asked
what strategies UHCW had to address such waiting lists. In reply,
Andy Hardy gave an outline of UHCW achievements and strategies. It
was the first specialist hospital to eradicate two-year waits
post-pandemic. It had worked on removing waits longer than 65
weeks, there being only five cases currently. The aim was to reduce
waiting times to the levels prior to the pandemic (52 weeks), with
UHCW setting its own target to achieve a reduction by March 2025.
Currently, this cohort was estimated to be 3,250 patients and the
aim was to reduce it to 800 patients by March, which would be the
shortest waiting time for specialist services in the country. Some
people were unable to work whilst awaiting a procedure. Delays of
the non-urgent procedures impacted upon their lives. The surgical
hub would help to reduce the delays and waiting lists for such
procedures significantly. Many people were waiting for their first
outpatient appointment. UHCW aimed by March that no person would be
waiting for their first outpatient appointment for more than six
months. Many people may not need ongoing health support. Following
the initial assessment, it would give more accuracy of the overall
health service needs.
- A discussion on discharge planning
aspects and the arrangements in Coventry. There were known
challenges for adult social care, so more information was sought on
how this worked in practice. Justine Richards outlined the previous
position in Coventry. A high number of patients were requiring an
onward package of care. Through an effective partnership with the
City Council’s Social Care team and the Community Services
Trust, the system moved to a ‘One Coventry Integrated
Team’. This shift utilised the knowledge of community staff
and those in social care via three community integrated teams. The
teams provided a range of services tailored to the needs of each
patient. The teams were responsible for the discharge process,
meeting three times each week and coordinating visits to patients
together. It had streamlined processes and created capacity with
staff working under a collaboration agreement. There was praise for
the staff involved and the care support staff. Through
re-procurement of services, key principles had been embedded and it
included a training element on achieving better outcomes. Andy
Hardy added that other systems were looking at this model,
including the ICBs for the cities of Liverpool and Manchester. It
was an aim to replicate this in Warwickshire, with recent visits
from Becky Hale, GEH and SWFT. The
Councillor commented on the challenges of recruiting carers in the
community. Justine Richards explained that no additional staff or
running costs had been incurred in moving to this model. She added
that the caseload was higher than anticipated and the times
involved in providing care packages had reduced from seven to four
weeks. Data had been gathered over a six-month period to show that
the beds at the Hoskyn Ward were no longer needed.
- Chris Bain advised that HWW would
monitor the impact for patients and the experiences for the public
following the Hoskyn ward closure. He suggested the lesson to learn
was to talk to other organisations before issues were raised on
social media. HWW could have been helpful in communication of the
messages. People who campaigned often felt excluded and it was
useful to ask people why they felt excluded. He urged that in
future UHCW talked to local government early and had a genuine
commitment to two-way communication in a way that people felt was
accessible for them. St Cross was part of the Rugby health and care
system which was under pressure. This included primary care
services in general practice, dentistry and pharmacy. There were
challenges in mental health provision, services for children and
young people and Social Care. Communications about St Cross needed
to placed in that context. The people who worked as part of this
system could be helpful allies. The main impact was for Coventry
people, but he considered this item should have been brought to
this Committee to air these issues at an earlier date. He
considered that both this Committee and HWW would be useful allies.
The Chair endorsed this and hoped going forward to work in
partnership and assist with messaging.
- Reference was made to the
‘More than a hospital’ strategy published in 2022. It
had a ten-year project for the site. Questions were submitted on
the funding and timescales for the projects, given the change of
government and delays with the planning consent. Finally, it was
questioned if there would be a reduction in surgical procedures or
pressures elsewhere in the local system as the site was
reconfigured.
- Andy Hardy responded that this
project was not reliant on public funding. He referred to NHS
funding more broadly, speaking about the recent government
settlements both for revenue and an increase in capital funding.
This included a specific allocation for surgical and diagnostic
hubs. In terms of timescales, this was dependent on when planning
permission was secured and on commencement of development, if any
issues were identified at the site. He spoke on service pressures
during the site development. By creating the additional town centre
services first, this would enable a phased approach, where each
aspect was completed and the service relocated, before commencing
the next development phase. The strategy was on a rolling basis,
with periodic reviews.
- Councillor Timms would encourage
fellow Rugby Councillors to watch the recording of this meeting and
view the presentation slides. Councillors could be helpful and
improved communication would be welcome. She was pleased that
step-down beds would still be available for Rugby patients at St
Cross, and this was a key message. She asked whether the new
provision on the high street may impact on existing community
services such as the Orchard Centre. On the UTC she sought a
timescale on when the two adjacent services would be amalgamated.
Clear communication on accessing emergency services for children
under five years of age was needed.
- Justine Richards reiterated that
there was no change to step-down care for Rugby residents. UHCW
would welcome any help in communicating this to the public. The
Trust recognised members’ role; it was here to listen and
wanted to work together. She hoped the number of meetings held over
recent weeks demonstrated that. Regarding the Orchard Centre, there
was a multi-agency estates forum for Rugby, which was trying to
bring together a local plan, to understand the assets available and
make the best use of those assets.
- Andy Hardy apologised for expressing
his frustrations earlier in the meeting. There was a need to work
together and had been miscommunication. On the UTC if the Trust
received approval, it could make this work from January. The
outcome of the ICB’s review was not expected until
June.
- Councillor Rolfe considered the
‘health on the high street’ scheme to be innovative.
She asked if UHCW could address a future committee to talk through
the proposals for this site in more detail. Then, once it was
established to report on the success of the scheme. If this proved
to be exemplary it should provide a model for services elsewhere.
Andy Hardy welcomed this. It was an exciting development for Rugby
and was the way that NHS services would be developed. There was an
aspiration to bring neighbourhood health to all areas of the
county. It was helpful for children and their families, avoiding
the stress of appointments at hospital and creating a new mindset
on where/how health services were delivered.
- The Chair asked about transfer times
to UHCW if the patient subsequently needed intensive care. Andy
Hardy said this hadn’t been an issue over the last five
years. As the St Cross plans developed there may be scope for an
enhanced care unit with additional services to respond to any
unforeseen risks. If a patient did need transfer to UHCW this could
be achieved by blue light service in twenty minutes, with the
patient accompanied by a specialist.
- The Chair commended the plans for a
dementia nurse in the health space. Justine Richards confirmed this
was an important aspect and would be built into the design of
future projects. The Chair added it was an important area for
hospice services too.
- Andy Hardy asked for guidance going
forward to ensure UHCW attended the correct forum.
The Chair brought this item to a close,
thanking Andy Hardy and Justine Richards for their presentation and
for responding to questions from the Committee.