The Director of Public Participation, the Operations Manager for Cardiology and Clinical Director for Cardiology for Shropshire, Telford & Wrekin NHS Trust provided members with an overview of the recommended changes to Cardiology Inpatient Services. As an interim measure it was proposed that all Cardiology inpatient services are moved to Princess Royal Hospital (PRH) in order to prevent diagnostic delays and interventional procedures that had been experienced by Royal Shrewsbury Hospital (RSH) patients and strengthen the cardiology workforce. At present there was a Cardiology service at both hospitals for both inpatients and outpatients, however the majority of patients accessed the service through PRH (70%). The proposed changes would only effect inpatient services and would be on a temporary basis.
Members heard that centralising the Cardiology service supported the workforce by mitigating the challenged they had faced in recruiting speciality nurses and consultants. It was also noted that the move resulted in more general medicine beds at RSH during winter pressures. The Operations Manager for Cardiology informed the Committee that although some patients were travelling further they remained at the site they were admitted to rather than having to transfer from RSH to PRH for further treatment, meaning that there length of stay was shortened overall. The Clinical Director for Cardiology advised that due workforce challenges, one-site working had become the norm across NHS England and HTP was still a long way off and changes needed to be implemented now.
The Head of Public Participation outlined what engagement had been undertaken throughout the process with patients, staff, communities and stakeholders. The key themes that had emerged through the engagement had centred on travel concerns and how long the temporary change would be in place for. They acknowledged that the proposal impacted on travel time but had found that the public accepted that was mitigated by the shorter length of stay. The planned changes were to be implemented by winter so sought JHOSC approval before taking the plans to the Trust Board.
During the debate Members raised a number of questions.
What considerations have been made for staff and visitors having to travel further?
Whilst at present neither hospitals were accepting visitors there was a bus service between the two hospitals that could be utilised by both staff and visitors. Members heard that from the engagement undertaken, patients' friends and family were accepting of the further distances due to the shorter stays. Similarly, staff from both RSH and PRH were supportive of the move as they believed it was necessary to provide a better service.
When the move is complete will there be additional cardiac beds available?
There was slightly less beds available overall. However, due to patients' stays being shorter it was predicted that there would still be more than necessary.
Was there direct access from the ambulance straight to the ward when patients arrived at PRH? And was there travel arrangements in place upon discharge?
Whilst direct access wasn’t planned they were developing training in conjunction with Stoke hospital for a chest pain nurse service which greatly supported the A&E consultants when fast tracking urgent cases. The majority of cases were lower risk so would go through the Acute Medical Unit but were picked up by cardiology with 24 hours. The Clinical Director for Cardiology stressed that additional support would be provided to RSH to assure patients were identified quickly.
When patients were discharged arrangements were made with the individual and their carers ensuring they return safely whether through patient transport or relatives. All outpatient follow ups and cardiac rehab continued to take place at both sites.
Is this proposed move being suggested too late?
The modern matron advised members that the service was fragile and that this plan allowed them to make changes before they were forced to.
Members thanked the Director of Public Participation, the Operations Manager for Cardiology and the Clinical Director for Cardiology for their thorough consultation and expressed their support for the proposed changes to Cardiology inpatient services outlined.