Agenda item

General Surgery Services - Case for Change and Emerging Option (Healthy Conversation 2019)

(To receive a report from the Lincolnshire Sustainability and Transformation Partnership, which provides the Committee with an update on the national and local context regarding the vision and strategy for delivering an effective and accessible general surgery service for patients in Lincolnshire.  Senior representatives from the Lincolnshire Sustainability and Transformation Partnership will be in attendance for this item)


Consideration was given by the Committee to a report from the Lincolnshire Sustainability and Transformation Partnership, which explained the national and local context regarding the vision and strategy to deliver an effective and accessible general surgery service for the patients of Lincolnshire.


The Chairman welcomed to the Committee Dr Neill Hepburn, Medical Director, United Lincolnshire Hospitals NHS Trust and Catherine O'Dwyer, Consultant Anaesthetist and Clinical Director for Surgery, United Lincolnshire Hospitals NHS Trust.


The report presented provided the Committee with background information relating to the clinical speciality for general surgery and what conditions/treatments that encompassed.


It was highlighted that for general surgery the main concern had been the impact of workforce challenges, which had limited the ability to provide adequate cover across the County; it was felt that ULHT was operationally unsustainable in its current form; and as a result a review of healthcare provision was required.


Details of the elective admissions, non-elective admissions and day cases for the hospital sites were shown on page 80 of the report.  It was highlighted that performance against the 18 week Referral to Treatment (RTT) standard for all providers across the region for the month of June 2019 had shown that performance for general surgery was only being achieved by three private providers.  This information was presented in a chart on page 81 of the report.  Page 82 of the report detailed by provider the median waiting times for patients to access the general surgery outpatient clinics as at June 2019.


The Committee were also provided with details of Incidence and Prevalence of Bowel Cancer, this information was contained on pages 83 to 84 of the report.  It was noted that ULHT currently provided general surgery theatre lists on three sites Lincoln County, Boston Pilgrim and Grantham and District (Non-elective surgical provision being much smaller at Grantham than at Lincoln or Boston).  It was noted further that outpatient appointments were offered at the three main sites plus peripheral sites.


It was highlighted that there was a strong case for changing the way in which general surgery services were delivered in Lincolnshire, as 15% of elective and day case surgical procedure were cancelled per annum due to bed pressures brought about by medical emergencies each year and the 18 week RTT and national cancer standards were not being met.  It was also reported that the service had made a £15.67m loss in 2017/18.  It was reported further that the reasons for the loss also covered the losses made for trauma and orthopaedics. The reasons for the loss being as a result of the high level of cancelled elective procedures.


It was highlighted further that there would need to be financial investment at the Grantham Hospital site as the emerging option had indicated that five theatres would be required; and Grantham currently only had four theatres.


The Committee was advised that there had not been any Healthy Conversation 2019 feedback relating to general surgery.


During discussion, the Committee raised the following comments:-


·         Performance information relating to cancer standards; and how ULHT compared with other Trusts.  The Committee was advised that a more detailed breakdown of information could be provided for the Committee;

·         Cancellation Rates – The Committee was advised that once the preferred option was rolled out; cancellation rates would be expected to reduce;

·         Day Surgery Unit – The Committee was advised that day surgery was being looked at and that Grantham Hospital would be considered for day surgery cases; as it was the ambition to increase the number of day care surgery facilities;

·         The Committee was advised that it was hoped to get new surgical facilities for Grantham Hospital, as the report indicated a fifth theatre to increase activity;

·         How much of a factor were delayed discharges in the current cancellation rate of 15%.  Confirmation was given that rate of delayed discharges was low; and

·         How winter resilience effect planned operations in January and February.  The Committee was advised that the new model worked well, as the elective centre was not impacted by large numbers of acute admissions.  It was noted that operations at acute sites might be affected.




That the Chairman be authorised to provide feedback on behalf of the Committee as part of the Healthy Conversation 2019 engagement exercise on the emerging option for general surgery.

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