Acute services review recommends closer working between hospitals to improve services

20 June 2017

Clinicians in Devon today announced the results of a review into how some hospital services could be provided more effectively in future.

Local doctors, nurses and consultants have been reviewing a range of services in hospitals in Exeter, Plymouth, Torquay and Barnstaple since late 2016.

The review was undertaken because doctors said key acute hospital services were likely to become unsustainable in future due to difficulty recruiting key clinical staff, large increases in demand for services – and difficulty meeting national service standards.

Services such as stroke, maternity, paediatrics and neonatal care and urgent and emergency care were included in the first stage of the review. Other services will be reviewed in a later second stage.

Hundreds of clinicians, nurses, managers and patient representatives contributed to the review through workshops, events and feedback. 

Announcing the results of the first stage, clinicians said that all four acute hospitals in Devon, would continue with A&E, emergency stroke services and maternity services. This would be acknowledged by stronger collaboration between clinical teams and new networking and workforce solutions.

Other key recommendations include:

  • 24/7 urgent and emergency care services (including A&E) should continue to operate at our four main acute hospitals – the Royal Devon and Exeter Hospital, North Devon District Hospital, Derriford Hospital and Torbay Hospital.
  • We will continue to provide first-line emergency response for people experiencing symptoms of a stroke at all four hospitals. This will include rapid stroke assessment, diagnostics and thrombolysis. These services will be supported by ‘Acute Stroke Units’ (ASUs) at all four sites, and will ensure rapid intervention and aftercare for those with a stroke.
  • We will work towards clinical best practice to improve outcomes for stroke patients by developing two specialist ‘Hyperacute Stroke Units’ (HASUs) in Exeter and Plymouth where patients will receive 3 or more days of intensive treatment for their stroke immediately following emergency treatment, following which they will return home or to their local ASU.
  • Retaining consultant-led maternity services at all four main hospital sites is proposed. These specialist units have access to 24/7 clinical care and the specialist services to provide more intensive care when that is needed.
  • Delivering choice for home or midwifery-led births will continue to be provided in line with the national strategy ‘Better Births’. Therefore, clinicians have recommended that we adopt the strong evidence base for midwifery-led units co-located with consultant-led units. 
  • Maternity, neonatal and paediatric inpatient services will be retained at all four main hospital sites

Dr Phil Hughes, who led the review and is a medical director and consultant radiologist at Derriford Hospital in Plymouth, said:

“The recommendations will see us bringing services closer together – networking our clinical teams, sharing recruitment and developing new workforce solutions. 

“For example, we may have specialists who are based in one particular hospital who could support other sites and enhance services – giving a Devon-wide focus.

“Emergency stroke care, A&E and maternity services will continue to be provided at all four acute hospitals in Exeter, Barnstaple, Plymouth and Torquay. 

“These recommendations will not only save lives, but will also improve the quality of life after an emergency, such as a stroke, for many people too.  This is great news for patients and the local NHS in Devon.”

The clinical recommendations are the first stage in the review. As part of the second stage, the recommendations will be tested in more detail to ensure they can be delivered with safe, cost-effective and reliable staffing solutions for the future.

Only once this assurance work is complete, can the recommendations be finalised. This is an important step, as the recommendations do not, at this time, immediately solve all the problems that drove the need to review these services.

Should the final proposals be likely to result in significant change to local services, the public will be fully consulted in line with the NHS’ statutory requirements. A full timetable would also be developed and published.

Dr Phil Hughes explained that that the review had encouraged clinicians to view services across Devon as a whole.

“We needed to think more collectively and consider how we share the treasured clinical expertise we hold within Devon, working in partnership to ensure that health and social care are working closer together than ever before.

 “The NHS is still facing an unprecedented challenge and the recommendations do not, at this stage, solve all of the problems we face.

“For maternity services, national best practice shows us that more women could be giving birth at home so we will continue to explore this in the next phase of this work.

“Over the coming months we’ll be talking to local communities about any specific proposals but for now we are publishing the results of the clinical review so that the public can be assured that this represents the clinical view of how acute services should be secured in Devon.”

A full briefing and a report of public involvement into this review is available on the Devon STP website here.

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