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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.) 1 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 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: 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: 2 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. 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. 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. 3 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 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. 4 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: 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. 5 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. 6 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. 7 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: 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. 8 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. 9 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: 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 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: 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. 10 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: 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. 11 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: 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 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 In an emergency, you would initially be seen in your local A&E department or by your local out of hours service 12 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. More keyhole surgery for County Durham patients Specialist surgeons using the latest techniques to treat cancers of the pelvis Specialist prostate cancer clinics at all hospitals The latest laser technology for treating kidney stones Specialist urologists cover for emergencies 24 hours a day. 13 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 52 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 14