University Hospitals of Leicester (UHL) is planning to reorganise acute hospital services in Leicester, Leicestershire and Rutland via a project for which it is seeking capital investment from the department of Health of around £370m. The plans involve consolidating services away from Leicester General onto two sites – the Royal Infirmary and the Glenfield – and include a new maternity hospital at the LRI and a new treatment centre at the Glenfield.
There are a number of public concerns about these plans. This short report provides an overview of some of the most important:
- Virtually no detail about the plans has been put into the public domain and made available for public scrutiny. The recent Better Care Together (BCT) engagement events provided an overview, including artists’ images of the new builds, but not detail. The public are being asked to trust that ‘doctor knows best’.
2. UHL’s new plans do not include an increase in the number of beds, despite ongoing issues with capacity in local hospitals. In response to a question from a member of the public at a BCT engagement event, the UHL spokesman confirmed the reconfigured hospital facilities will have 2,048 beds. In May 2018, UHL had 2,045 beds. Even though current bed numbers are closer to 2,000, this represents no real increase to address (a) the current capacity constraints and (b) future capacity needs arising from an ageing population, a growing population and rising need.
3. Indicators of insufficient capacity in 2018 have been: the cancellation of thousands of operations last winter (according to the UHL spokesman) due to capacity constraints as UHL was unable to deal with both emergency admissions and planned (elective) care at the same time; the high level during last winter and during 2018 of Opel Level 4 alerts (‘black alerts’) which are issued when comprehensive care can no longer be given due to capacity constraints with a risk to patient safety; the decision by the Clinical Commissioning Groups (CCGs) to transfer 4% of UHL’s elective care away from UHL to other providers in this year’s contract so that emergency care can be prioritised within the capacity available. (See BBC on UHL’s high level of Opel Level 4 alerts: https://www.bbc.co.uk/news/uk-england-46361699 )
4. Bed numbers are not the only capacity constraints. Staffing, for instance, especially nurse staffing, has become increasingly problematic as chronic underfunding adds to pressure and undermines quality. However, the staffing situation is more fluid and an expansion in training places and increased pay can help address these problems. By contrast, the number of theatres, recovery areas, intensive care beds and general and acute beds is fixed in the capital plan, hospital services will be fixed in scale with no hope of expansion in the coming years.
5. The local NHS believes an expansion in community services and different pathways of care will offset rising need for hospital care. However, community services are under review and these plans have not yet been written while the previous plans (the Sustainability and Transformation Plan) failed in large part due to optimism bias and a failure to get ‘the sums to add up’.
6. The local NHS has a very poor track record of capacity planning, repeatedly building in excessively optimistic assumptions which were not reflected in reality (e.g. that expanding care in community settings would permit large scale bed closures).
7. Once funding has been agreed for a local hospital plan, it will lock the people of Leicester, Leicestershire and Rutland into an inadequate facility for the next twenty years with no hope of large-scale government funding from future government during this period to address the shortage of hospital services. So it is important to get it right now.
8. UHL hopes their highly detailed pre-consultation business case for reorganising acute services will be considered by the NHS investment committee in December 2018 and hopes the plan will receive surety of funding from the Department of Health and Social Care. However, the details of this plan have been subjected to no close public or political scrutiny and opportunities for meaningful change to plans through formal public consultation are scant.
9. Local MPs, councillors and pubic need to know what the details of the hospital plan are and what the details of the wider NHS plans for Leicester, Leicestershire and Rutland are before UHL seeks approval of the pre-consultation business case.