Download Urology - South Tyneside Council

DRAFT
Consultation on a proposal for a
County Durham
South Tyneside and
Wearside
Urology service
NHS lozenge
Durham and Chester-le-Street Primary Care Trust
Durham Dales Primary Care Trust
Derwentside Primary Care Trust
Easington Primary Care Trust
Sedgefield Primary Care Trust
South Tyneside Primary Care Trust
Sunderland Teaching Primary Care Trust
(Note – draft for comment. Please note sections where additional figures are
required for each site.)
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Executive Summary
Between x October 2004 and X January 2005, local NHS organisations are
consulting on plans to change urology services in County Durham, South Tyneside
and Wearside.
What is urology?
Urology is a medical word for problems with the kidney, bladder and other related
organs.
Which services would be affected?
These plans would affect services at
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University Hospital of North Durham (including Shotley Bridge and other
community hospitals)
Bishop Auckland General Hospital
South Tyneside General Hospital
Sunderland Royal Hospital
How would services be affected?
If the plans get the go-ahead, there would be a wider range of urology treatments
available for local people.
If you need urology treatment, you would still be treated at their local hospital most of
the time.
Specialists – called urologists - would travel between hospitals for:
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outpatient appointments
day surgery (operations which don’t usually mean an overnight hospital stay)
follow up appointments
If you need an operation which needs an inpatient stay, then you would go to a new
specialist centre for urology surgery. This would be at Sunderland Royal Hospital.
This would affect about 1,500 patients each year.
We are looking at ways to make travel to the specialist centre easier for patients and
their carers.
Why change?
We need to change to offer better care for patients.
At the moment some services aren’t available in the area at all, or aren’t available to
everyone.
For example:
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The new specialist centre would be able to invest in state of the art equipment
– for example, the latest laser technology for treating problems like kidney
stones.
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At the moment some keyhole surgery is carried out in Sunderland but not in
Durham. We want up to date surgical techniques for ALL patients.
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At the moment, some South Tyneside patients travel to Sunderland for day
surgery. We want all day surgery to be at your local hospital.
Setting up a specialist centre for County Durham, South Tyneside and Wearside
would also help us bring together a team of highly skilled surgeons.
This would mean that, if you need a major operation, you would know your surgeon
is an expert with lots of experience in treating patients with the same problem.
Improving Cancer treatment
We need to offer the best care for people with urological cancers.
The National Institute for Clinical Excellence (known as NICE) has issued guidance
on how care for people with a urological cancer should be organised, based on “best
practice”.
NICE recommends that local teams based in cancer units at local general hospitals
diagnose most urological cancers, provide treatment for some types of cancer, and
refer people on to the specialist urological cancer teams if necessary. These
specialist teams are based at specialist cancer centers, usually at major hospitals,
which might be some distance from the patient’s home and local hospital.
How can I get involved?
Durham and Chester-le-Street Primary Care Trust is co-ordinating public consultation
on behalf of local NHS organisations.
Details of how you can comment on these proposals are given in Section 6.
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1.
Introduction
NHS organisations in County Durham (not including Darlington), South Tyneside and
Sunderland have been looking at the way we provide urology services and how to
get the best care for patients in the future.
Urology is a specialism which deals with the kidney, bladder and associated organs.
National guidelines have been published for making sure that patients with urological
cancers get the best treatment.
Following a review of services across County Durham, South Tyneside and
Wearside, a proposal has been developed to meet the cancer guidelines and
improve the standard of service available to patients.
This proposal would affect services currently provided at
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University Hospital of North Durham (including Shotley Bridge and other
community hospitals)
Bishop Auckland General Hospital
South Tyneside General Hospital
Sunderland Royal Hospital
Under this proposal, most patients would still be treated at their local hospital most of
the time.
Specialist urological surgeons – called urologists - would travel between hospitals so
that outpatient clinics, day case surgery and follow up appointments remained at all
local hospitals.
Patients needing inpatient surgery would be treated in a new specialist urology
inpatient centre, for County Durham, South Tyneside and Wearside, based at
Sunderland Royal Hospital.
Between X October 2004 and X January 2005, Durham and Chester-le-Street
Primary Care Trust is co-ordinating a three month period of public consultation on
this proposal, on behalf of local Primary Care Trusts.
This consultation document aims to provide you with background information and to
offer you the opportunity to comment on this proposal. Details of how to contact us
with your views are given on page X.
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Where we are now – the service today
2.
(MAP OF COUNTY DURHAM, SOUTH TYNESIDE AND WEARSIDE TO BE
INSERTED)
At the moment, there are three separate urology services operating from four
hospitals:
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University Hospital of North Durham (including Shotley Bridge and other
community hospitals)
Bishop Auckland General Hospital
South Tyneside General Hospital
Sunderland Royal Hospital
At Bishop Auckland, outpatient and day case urological services are provided by a
consultant urologist who is based at University Hospital of North Durham. Patients
travel to University Hospital of North Durham for inpatient surgery..
Consultants at University Hospital of North Durham also hold outpatient clinics at
Community Hospitals, including Shotley Bridge, Chester-le-Street and South Moor.
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3. Why we need to change – keeping high quality
services
The key reasons why we need to change are:
To meet national cancer standards (see Section 4 for more details)
We need to make sure that the local NHS is providing the best quality care to
patients.
That means keeping pace with changes in treatment which offer the best results in
line with national guidance.
Cancer Improving Outcomes guidance (2002) recommends that larger units covering
larger populations are needed to achieve the best results for patients.
This is because units covering a larger area will see more patients and will therefore
be able to develop expertise in a wide range of urological conditions.
None of our local urology services has a big enough population on its own to offer a
service which meets this guidance.
The recommended population base for a urological cancer service is 1,000,000
people. The three services together cover a population of 860,000. The Northern
Cancer network has said that this will be large enough to support a urology cancer
centre.
Offering a wider range of services
At the moment, the full range of urology services is not available to patients in all of
our local hospitals.
For example, some keyhole surgery is carried out in Sunderland, but not in Durham,
while some South Tyneside patients have to travel to Sunderland for day surgery.
In a larger unit other specialist services can be developed, such as laser technology
for kidney stones, which are impracticable for smaller units.
More specialist doctors and surgeons
In modern urology, as in many other specialties, there is a demand for greater
‘specialisation’.
In urology that might mean one specialist treating patients with prostate cancer, while
another specialist treats patients with bladder problems.
Greater specialisation means improvements in clinical quality, survival rates and
better outcomes for patients.
However, greater specialisation also increases the number of consultant urologists
needed to provide a full urology service. This means that there is pressure for
services to become more centralised with urologists working in larger teams.
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Attracting the staff we need
The current position makes it very difficult to recruit top quality consultant urologists
to any of our local hospitals.
Over a number of years, it has become increasingly clear that smaller urology
services, like those in Sunderland Royal Hospital, South Tyneside Hospital,
University Hospital of North Durham and Bishop Auckland Hospital find it far more
difficult to attract highly skilled surgeons.
We need to attract more consultant urologists to the area so that there are a wider
range of experts available to care for patients.
Junior doctors’ working hours
In August 2004, the European Working Time Directive came in to force, limiting junior
doctors’ working time to a maximum of 58 hours a week.
Doctors in training used to work long hours to make sure medical cover is available
on every ward 24 hours a day. Modern standards make such long hours illegal.
Larger more centralised teams are more able to provide 24 hour cover for patients.
Training for doctors
If junior doctors work fewer hours, they need to see and treat more patients during
their working hours in order to gain the necessary experience.
Hospitals need to take action to make sure their junior doctors gain the experience
they need. In many cases this can only be achieved by centralising services.
Otherwise, the Royal Colleges could withdraw their support for training of doctors,
and hospitals would then be unable to offer safe cover for patients.
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4.
Improving Outcomes in Urological Cancers
This section is a shortened version of a patient information leaflet, produced by the
National Institute of Clinical Excellence “Healthcare services for urological cancers”
to support the Improving Outcomes Guidance. More details are available at
www.nice.org.uk.
Following consultation, the National Institute for Clinical Excellence (known as NICE)
has issued guidance on the organisation of healthcare for people with a urological
cancer. The guidance recommends which healthcare professionals should be
involved in treatment and care, and the types of hospital or cancer centre that are
best suited to provide that healthcare.
It’s important to appreciate that many service guidance recommendations require
large-scale changes in the way that a section of the NHS works.
Urological cancer
Urological cancer is a general name for a group of cancers. These are:
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bladder cancer
prostate cancer
kidney cancer
testicular cancer (cancer affecting the testicle, sometimes also called the
testis)
cancer of the penis (also known as penile cancer).
Men and women of all ages can be affected by a urological cancer.
Key recommendations
People should be treated by a “multidisciplinary” team
A multidisciplinary team is one that includes professionals with different skills. This is
because the diagnosis, treatment and care of a person with a urological cancer can
be very complex and is best provided by bringing together people with all the
necessary skills, knowledge and experience.
Teams that deal with the more common forms of urological cancer and treatments
are based in the cancer units at local general hospitals.
Local teams diagnose most urological cancers, provide treatment for some types of
cancer, and refer people on to the specialist urological cancer teams if necessary.
Specialist teams are based at specialist cancer centres. These are usually at major
hospitals, which might be some distance from the patient’s home and local
hospital.
Team members should have appropriate clinical skils
NICE recommends that members of urological cancer teams have the specialist skills
needed for the type of patients that they will see. For example, only urologists who
are experienced in performing some of the more specialised operations should carry
out those operations – these urologists will work as part of the specialist cancer
teams.
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Radical surgery for prostate and bladder cancer should be carried
out by specialist teams
‘Radical’ means removing all or most of the organ affected by the cancer (bladder or
prostate) and sometimes some of the surrounding structures.
NICE has recommended that these operations are only carried out by a specialist
team that does at least 50 of either or both procedures each year.
Information and support should be improved
The NICE guidance recommends that people with a urological cancer should be
provided with good-quality information on all aspects of their condition, the tests that
might be offered, and the treatment options.
More research is needed on treatment
NICE has therefore recommended that doctors and other healthcare professionals
working in this area support research projects into treatments for urological cancer
and discuss taking part in research studies with their patients.
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5.
Reviewing urology services
Since 1994, there have been a number of reviews which have attempted to address
the pressures for change outlined in section 3.
In 2002, Primary Care Trusts and Hospital Trusts serving North Durham, South
Tyneside and Sunderland asked the British Association of Urological Surgeons
(BAUS) to carry out a review.
All of these organisations agreed to accept BAUS’s recommendations as the basis
for discussion about the future of the service.
BAUS concluded that:
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The current situation of three separate urology services was
unsustainable in terms of:
 Results for patients
 Ability to recruit and retain staff
 Patient waiting times
 The range of services for patients
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Centralising inpatients at one hospital, with all other services provided
at all other hospitals would provide “ an exciting opportunity to deliver a
superb urological inpatient service and the highest quality satellite
services … available in each local community”.
In their option appraisal BAUS said the best two options for the future were:
1. An inpatient unit at University Hospital of North Durham with all other services
also being offered at South Tyneside, Bishop Auckland and Sunderland
(BAUS preferred option)
2. An inpatient unit at Sunderland Royal Hospital with all other services also
being offered at University Hospital of North Durham, Bishop Auckland and
South Tyneside,
BAUS stated that there was little to choose between these options in terms of
outcomes for patients and waiting times.
Following the completion of the BAUS review, NHS organisations and their clinical
teams formed a steering group to carry out further discussions locally on how these
recommendations. They agreed that the single hub model is the way forward.
However:
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University Hospital of North Durham will not have the necessary
facilities and capacity available within the timescale needed for these
changes, as this will require a new building.
City Hospitals Sunderland Trust will have the necessary capacity
available at the Sunderland Royal Hospital site from April 2005.
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On this basis local NHS organisations agree that an inpatient unit at Sunderland with
all other services also being offered at University Hospital of North Durham, Bishop
Auckland and South Tyneside General Hospital would be the most viable way
forward.
Patient and public involvement
Patients and members of the public met with clinicians and managers to discuss the
future of urology services at an event on 25 May 2004.
Most patients would still be seen at their local hospitals. The meeting also spent time
discussing the key issues for patients who would need to go to Sunderland for
inpatient surgery.
Key issues which arose were:
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Transport and accessibility/car parking
Continuity of care issues between local hospital and inpatient unit
Quality of patient experience
Further work with patients is taking place including a survey of patients attending
urology outpatient clinics and a survey of people from County Durham who have
been inpatients in Sunderland for other specialties in order to learn from their
experiences.
The proposed future service has been designed to keep all outpatients and day
cases at local hospitals with consultants travelling between hospitals in order to keep
patient travel to a minimum.
Discussions are taking place with the local authority, passenger transport executives,
private transport providers and the North East Ambulance Service to identify options
for patients and visitors travelling to Sunderland.
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4.
Proposal for consultation
We need to make sure that the NHS is providing the best quality care to patients.
That means offering a service which is sustainable and which offers patients a
successful outcome to their treatment.
Following review work carried out, and discussions with representatives of patients in
May, NHS organisations decided in September to consult on the following proposal:
In the future there should be one urology service covering County Durham
(except Darlington) South Tyneside and Wearside.
All inpatient elective (planned) and emergency work should take place at
Sunderland Royal Hospital, in order to meet Cancer Improving Outcomes
Guidance.
All other services should continue to be provided at Sunderland Royal
Hospital, University Hospital of North Durham, Bishop Auckland General
Hospital, South Tyneside Hospital:
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Outpatients
Investigations
Day cases (including some overnight stays)
Pre assessment and follow up appointments.
How patients would be affected
From December 2005, patients will have a choice about where they go for treatment
for any health problem – including urology.
The proposed new service has been designed with this in mind. With the consultant
travelling to the patient, a wide range of service would be available at each hospital.
Even when inpatient surgery is needed, a patient’s outpatient appointment, tests, and
follow up would still take place at their local hospital.
Case study 1 – If you are referred by your GP for treatment
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Outpatient appointment would be offered at your local hospital.
While attending the outpatient clinic tests would be carried out.
If you need an operation, you would be booked into your local hospital for a day
case procedure, or, if the surgery is more complex, you would be booked for an
operation at Sunderland Royal Hospital.
Follow up would be carried out at your local hospital.
If necessary, following inpatient surgery, your ongoing care would be transferred
to the local hospital to prevent you or your family travelling unnecessarily.
Case study 2 – If you need care urgently
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In an emergency, you would initially be seen in your local A&E department or by
your local out of hours service
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If you have a minor problem, the on call urologist would be asked for advice, and
you may be asked to attend a follow up urology outpatient appointment.
For more serious problems, following discussion with the on call urologist, you
would be transferred to Sunderland for admission.
In exceptional circumstances, if you were too ill to be transferred the on call
urologist would come to see you in your local A&E department.
Follow up would be carried out at your local hospital.
Most patients will be treated at their local hospital. Patients will only travel to
Sunderland for surgery requiring an inpatient stay.
More services for patients
A range of new services would be developed for all patients as a result of this
proposal.
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More keyhole surgery for County Durham patients
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Specialist surgeons using the latest techniques to treat cancers of the pelvis
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Specialist prostate cancer clinics at all hospitals
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The latest laser technology for treating kidney stones
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Specialist urologists cover for emergencies 24 hours a day.
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7.
Your views
On behalf of local NHS organisations, Durham and Chester-le-Street Primary Care
Trust is co-ordinating public consultation on this proposal.
The consultation period lasts for three months, from xx October 2004 until xx January
2005.
Members of the public can comment on these proposals at public meetings listed
below or in writing.
Please send your written views to arrive by no later than xx January 2005.
By post to:
Andrew Young
FREEPOST
Chief Executive
Durham and Chester-le-Street Primary Care Trust
John Snow House
xxx
By fax on: 0191 xxxx
By email on: xxxxx
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Public meetings
Members of the public have the opportunity to find out more about these proposals –
and comment on them - at a series of public meetings. These will be held in the
following locations on the following dates:
Durham and Chester-le-Street Primary
Care Trust
Durham Dales Primary Care Trust
Derwentside Primary Care Trust
Easington Primary Care Trust
Sedgefield Primary Care Trust
South Tyneside Primary Care Trust
Sunderland Teaching Primary Care Trust
November 2004
November 2004
November 2004
November 2004
November 2004
November 2004
November 2004
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