Join The Campaign

Save Our NHS Leicestershire

Leicester General and St Mary’s under threat. Here’s our guide to filling in the consultation questionnaire

By Save Our NHS Leicestershire
November 24, 2020

NHS bosses have been told that, subject to public consultation, they will receive government funding of £450m to implement a controversial reorganisation of hospital services across Leicester, Leicestershire and Rutland. Amongst other things, the plan will lead to the closure of Leicester General as an acute hospital, with the majority of land sold for other purposes, and the closure of St Mary’s Birth Centre.

Formal public consultation began on September 28 and ends on December 21 2020. NHS bosses want you to fill in a ‘consultation questionnaire’ so that you can have your say on the plans, but the document is extremely confusing and contains information that is misleading. That is why Save Our NHS Leicestershire has produced this handy guide to filling in the consultation document. We have reproduced the full text from the consultation document below, highlighting the questions in bold italics and our responses in bold blue.

The link to the online consultation document can be found here: https://nhs.researchfeedback.net/s.asp?k=160035362231 We encourage you to fill it in.


– CONSULTATION DOCUMENT –

Improving acute and maternity hospital services for people

The configuration of the three hospitals in Leicester reflects how they have evolved over time rather than a central plan. Patients who are coming to hospital as outpatients (people attending hospital for treatment without staying overnight) are suffering delays and experiencing last minute cancellations.

Medical and nursing staff are spread too thinly making services operationally unstable and services are being duplicated or triplicated. Patients are inconvenienced at a time when they are feeling most anxious and unwell. We believe our proposals would achieve the best patient outcomes, modernise our facilities and make services more efficient and financially sustainable to meet future need.

Our proposal for acute services

We are proposing moving our acute services on to two of our three hospital sites. We are proposing that acute services are provided at Leicester Royal Infirmary and Glenfield Hospital.

  1. To what extent do you agree or disagree with this proposal where 1 is strongly disagree and 5 is strongly agree?

OUR RESPONSE:

There is insufficient information to respond to this question positively at this time. Therefore it would be reasonable to strongly disagree and express concerns and ask for more information in Question 2.

  1. Please explain why you agree or disagree with this proposal. It would be helpful if you could explain the impact of these proposals on you, your family or any groups and if you, your family or any groups would be disadvantaged and how any concerns could be overcome.

OUR RESPONSE:

This question asks you whether you agree to the closure of the Leicester General Hospital (LGH) as an acute hospital and the removal of its acute hospital services to the other two hospitals. The closure of the LGH would be followed by the sale of most of the land and buildings. However, the proposals include no bed planning after 2024 – that is, they have no plans to increase the number of acute beds after 2024 and yet the population is growing and getting older and we will have a lot of house building in Leicester, Leicestershire and Rutland (LLR).

If the LGH is closed as an acute hospital and the land sold off, where will expansion of our hospital services be in 4 years’ time if more services are required? It is important to understand their expansion plans before we agree to this.

The Pre Consultation Business Case (PCBC) developed by University Hospitals Leicester to show the need for £450m in funding tells us that more patient care will be given in community settings and because of this they will not need so many beds for the size of population. However, they have given us very little information about community services and we cannot tell whether community services will be good enough to plug the gap left by smaller hospital facilities per head of population.

The investment of £450m in our hospital services is to be welcomed. However it has been made clear this is a once in a generation opportunity so it is necessary to ensure that we will have services that will provide for the next generation.

Our proposal for a new treatment centre

We are proposing that outpatient services would move from Leicester Royal Infirmary to a new purpose-built treatment centre at Glenfield Hospital.

  1. To what extent do you agree or disagree with this proposal where 1 is strongly agree and 5 is strongly disagree?

OUR RESPONSE:

It would be reasonable to tick strongly disagree here because of concerns outlined below in response to Q4.

  1. Please explain why you agree or disagree with this proposal. It would be helpful if you could explain the impact of these proposals on you, your family, or any groups and if you, your family or any groups would be disadvantaged and how any concerns could be overcome.

OUR RESPONSE:

Investment in new facilities is very welcome. However, much information is missing such as, how many beds this Treatment Centre will have and whether the wards, single occupancy rooms and other clinical spaces will be big enough to enable the hospital to treat Covid-19 and future pandemic patients safely, alongside non-Covid-19 patients, as these proposals were drawn up before the Covid-19 outbreak. Future pandemics are more likely, not less, and new facilities must provide for this future need.

Also, it says in the proposals that, in the future, elective care will carry on because they will not need to use these beds for emergency patients. But it is not clear what will happen to an upsurge in emergency patients if there is another pandemic or even a severe flu season. Elective care is often cancelled because either staff have to be move to care for emergency patients and intensive care beds fill up and so procedures that might require a patient to have an ICU bed are cancelled. It has not been explained how having a new Treatment Centre will get over these problems.

There is not enough information to address these issues.

We need to understand what size the new treatment centre should be and what services should be included. It is important that the size of the treatment centre is appropriate to meet the needs of people and takes into consideration the additional number of services we plan to provide local communities closer to home.

  1. Please tell us your views on this including how we can avoid negative impacts or disadvantages on you, your family or any groups and how we can ensure the new treatment centre is right to meet the needs of people.

OUR RESPONSE:

The Treatment Centre needs to be designed so that it is big enough to handle patients in the event of a pandemic outbreak. Although information on the impact of future hospital building plans is only now developing, early advice suggests it needs to have a high number of single occupancy rooms and to provide clinical spaces which are larger than they currently need to be.

The closure of the General Hospital affects people in East Leicestershire and Rutland in particular as it takes much longer in the traffic to get to the Royal Infirmary or Glenfield Hospitals than to get to the General Hospital.

There is not enough information in the plans to address these issues properly at present.

Our proposal to use new technologies to deliver patient consultations

We believe that new technology would help to provide certain aspects of pre-planned care in a different way. Appointments by telephone or video call could reduce the stress of attending a consultation in person due to – reduced travel, reducing possible spread of infection and supporting people to self-care.

  1. To what extent do you agree or disagree with this proposal where 1 is strongly agree and 5 is strongly disagree?

OUR RESPONSE:

It would be reasonable to tick strongly disagree here because of concerns outlined below in response to Q7.

  1. Please tell us your views on using technology to reduce the need for attending appointments – including how we can avoid negative impacts or disadvantages on you, your family or any groups.

OUR RESPONSE:

This proposal has the potential to be beneficial to some patients some of the time. However, it will not be suitable for all patents all of the time. Some patients will find it difficult to use technology or may have no access to technology – they may be ‘digitally excluded’. This could be a result of age, poverty, disability or some other reason.

We have also not been told exactly how this will work. Will support be available in a private confidential setting to support those who may be either digitally excluded or unhappy at using digital devices shared with other family members? They might want to use more telephone calls and videos than patients feels is suitable. You or members of your family may have your own reasons for feeling concerned about a strong shift to the use of technology instead of in person health care.

There is not enough information in the plans to address these issues properly at present.

Our proposal for Leicester General Hospital

We would like to create the following services at Leicester General Hospital in a GP-led primary care urgent treatment centre:

  • Observation area with beds where patients can be observed when they are not well enough to go home, but don’t meet the criteria to be admitted to hospital.
  • Diagnostic service – this provides appointments for people to have a test or simple procedure
  • Community outpatients service – this is treatment for people with health problems requiring a diagnosis or treatment, but do not require a bed or to be admitted for overnight care
  • Potentially extra primary care capacity – to provide family health care to people living in the east of the city.
  1. To what extent do you agree or disagree with this proposal where 1 is strongly disagree and 5 is strongly agree?

OUR RESPONSE:

There is not enough information to answer this question. What does matter is under each of the services listed below asking how these services are going to be funded.

Please explain why you agree or disagree with this proposal to create these services on the Leicester General Hospital site. It would be helpful if you could explain the impact of these proposals on you, your family or any groups and if you, your family or any groups would be disadvantaged and how any concerns could be overcome.

  1. Primary care urgent treatment centre
  2. Observation area
  3. Diagnostic service
  4. Community outpatients service
  5. Extra GP/primary care capacity

OUR RESPONSE:

This section is headed “our proposal for Leicester General Hospital”. However, to clarify, these are proposals for services at some future point in time on the site of the General Hospital as the Leicester General itself will be closed as an acute hospital

The beginning of this section begins “We would like to create the following services at Leicester General Hospital in a GP-led primary care urgent treatment centre.” Although this gives the impression there will be many new services on the site of the General Hospital, it is important to note that these services (extra GP capacity, observation beds, community outpatients service, diagnostic service and primary care urgent treatment centre) are not included in the £450m scheme’s plans. Instead, they are uncertain possibilities for a future point in time.

The Pre-Consultation Business Case makes a clear distinction between services it plans to retain at the General Hospital on the one hand and “the potential development of other services at LGH which could include” other services – which are the services they list here. These services are not acute hospital services and will not be funded through the £450m given by government; they are not planned for 2024 as the other proposals are. It is not clear how these services would be funded or whether they will ever exist. Moreover, local NHS leaders have said this consultation is about acute hospital and maternity services and not about community services and primary care.

Is the purpose of including this question to create the mistaken impression there will be more services at the General than there will be in reality?

Our proposal for a new standalone maternity unit

We are proposing to relocate the standalone maternity unit at St Mary’s in Melton Mowbray. We want to trial a new standalone midwifery unit at Leicester General Hospital. This would be midwife-led and would not have access to specialist obstetric (childbirth) doctors onsite. For this standalone unit to be viable it must have a minimum of 500 births each year. During the trial period we would assess the unit’s viability according to the number of births and by understanding the experiences of expectant mothers. After the trial period if it is not viable the unit would close. This would mean all maternity services would be located at Leicester Royal Infirmary.

  1. To what extent do you agree or disagree with this proposal where 1 is strongly agree and 5 is strongly disagree?

OUR RESPONSE:

It would be reasonable to answer this by ticking disagree or strongly disagree in Q14 and then to register concerns (outlined below) under Q15.

  1. Please explain why you agree or disagree with this proposal. It would be helpful if you could explain the impact of these proposals on you, your family or any groups and if you, your family or any groups would be disadvantaged and how any concerns could be overcome.

OUR RESPONSE:

NHS leaders are proposing to close St Mary’s in Melton Mowbray despite the fact it is a highly regarded unit. Research shows that free-standing midwife led units have very good outcomes for low risk mothers and their babies. They are also more cost effective than obstetric units (which are doctor led) and the midwife led units which are next to obstetric units such as those currently at the General and the Royal Infirmary. Moreover, the highly valued inpatient postnatal care at St Mary’s, which has been singled out for praise by the Care Quality Commission, would also be lost

However, the Pre-Consultation Business case states that the trial of the standalone midwifery unit on the site of the General Hospital will be for only one year. It will be very difficult to get 500 births in that unit in a 12 month period if the trial is for only a year as after a few months, women may not want to choose the unit for the birth as there is a good probability it will not exist when the time comes for them to have their babies.

Therefore a trial of 12 months may well fail and everyone will have to go to the Royal Infirmary to have their babies (apart from the very small proportion who give birth at home), reducing choice to a minimum. Moreover, there is no intention of including inpatient postnatal beds in this proposed trial.

It is important that the mothers of Leicester, Leicestershire and Rutland have the option of a free-standing midwife led unit, an option which is now at risk. The Trust should ensure that the Birth Centre at St Mary’s is championed. At present the Trust says they mothers are informed about the option of having their babies at St Mary’s but many mothers say they are not informed about this possibility.

If in addition to keeping St Mary’s, he Trust chooses to trial a midwife led unit at the General Hospital, if it is to have any chance of working, the trial must be for a longer period of at least 3 years. Even if it met its target of 500 births it is not certain how a standalone unit would be funded as this does not appear to e covered in the £450m.

Our proposal for two new haemodialysis treatment units

In addition to the current units based in Loughborough and Hamilton, we are proposing providing two new haemodialysis treatment units. Haemodialysis is the treatment that performs the job of kidneys when they stop working properly. We are proposing that one is in a unit at Glenfield Hospital and the second is in a new unit to the south of Leicester.

  1. To what extent do you agree or disagree with this proposal where 1 is strongly agree and 5 is strongly disagree?

OUR RESPONSE:

Further information is required to ensure that patients from East Leicestershire and Rutland are not being disadvantaged.

  1. Please explain why you agree or disagree with the proposal for one unit to be at Glenfield hospital. It would be helpful if you could explain the impact of these proposals on you, your family or any groups and if you, your family or any groups would be disadvantaged and how any concerns could be overcome.

OUR RESPONSE:

Further information is required to ensure that patients from East Leicestershire and Rutland are not being disadvantaged.

  1. Please explain why you agree or disagree with the proposal for one unit to be in the south of Leicester City. It would be helpful if you could explain the impact of these proposals on you, your family or any groups and if you, your family or any groups would be disadvantaged and how any concerns could be overcome.

OUR RESPONSE:

Further information is required to ensure that patients from East Leicestershire and Rutland are not being disadvantaged.

  1. Please tell us where in the south of Leicester you think that the new unit should be?

OUR RESPONSE:

Further information is required to ensure that patients from East Leicestershire and Rutland are not being disadvantaged.

Our proposal for hydrotherapy pools

There is currently one hydrotherapy pool at Leicester General Hospital. We are proposing using hydrotherapy pools already located in community settings so we can provide care closer to home. This would improve access to hydrotherapy pools for our population.

  1. To what extent do you agree or disagree with this proposal where 1 is strongly agree and 5 is strongly disagree?

OUR RESPONSE:

It would be reasonable to disagree or strongly disagree with this proposal and put concerns in answer to Q21

  1. Please explain why you agree or disagree with this proposal. It would be helpful if you could explain the impact of these proposals on you, your family or any groups and if you, your family or any groups would be disadvantaged and how any concerns could be overcome.

OUR RESPONSE:

There is a strong logic in increasing the number of pools available but is it as easy as that? It is not a case of saying ‘there is a pool – jump in’. Many of these pools are in school settings. Would the staff have the right experience to deal with what could be complex and frequently changing medical issues and indeed dealing with adults?

As for pools in private medical facilities and those in sporting settings, the commissioning of them by the NHS would be a complex affair. Consider some risk assessment issues. For instance, hospital patients can be in the hydrotherapy pool the morning after an operation. Hip and knee replacement patients may have daily hydrotherapy as part of mobilisation. Small things such as checking the integrity of the dressing becomes hugely important. More complex issues are bacteriological water testing, maintenance of temperature at 34C for hydro (not required for sport or leisure and very high cost), hoist access and experienced people to operate.

Is this proposal likely to reduce access to high quality safe hydrotherapy facilities? Will access be delayed?

Improving acute and maternity hospital services for people

We believe that the facilities we provide for expectant mothers require modernising to provide a better experience, to meet the increase in demand and offer patient choice whilst meeting statutory standards. At present, maternity services are spread across units at Leicester Royal Infirmary and Leicester General Hospital and it is challenging to maintain adequate staffing over the two sites.

We also recognise that many women may prefer to choose to have their baby in a community-based standalone midwifery birth centre, but believe it should be accessible for more women across Leicester, Leicestershire and Rutland. The standalone birthing unit at St Mary’s in Melton Mowbray is currently under-used with births decreasing every year since 2012-13, with only 141 births in 2018-19. To make the centre viable it would need 500 births per year. The centre is also not accessible for the majority of women who live in Leicester, Leicestershire and Rutland.

We believe our proposals would increase choice by providing expectant mothers with an option of a home birth, a birth in obstetrics and neonatal services in a new maternity hospital, a birth at a midwifery birth centre at Leicester Royal Infirmary and Leicester General Hospital.

Our proposal for a new maternity hospital

We propose building a new maternity hospital on the Leicester Royal Infirmary site. This would include a midwifery-led birth centre provided alongside the obstetric unit. This would mean that existing maternity services (services provided in pregnancy, childbirth and post-pregnancy) and neonatal services would move from Leicester General Hospital to Leicester Royal Infirmary.

  1. To what extent do you agree or disagree with this proposal where 1 is strongly agree and 5 is strongly disagree?

OUR RESPONSE:

It would be reasonable to Strongly Disagree in Q22 and give your reasons under Question 23 below.

  1. Please explain why you agree or disagree with this proposal. It would be helpful if you could explain the impact of these proposals on you, your family or any groups and if you, your family or any groups would be disadvantaged and how any concerns could be overcome.

OUR RESPONSE:

This proposal reduces choice for expectant mothers. Setting aside home birth which the vast majority of expectant mothers do not consider a realistic option, at present women have the option of two obstetric units (at the Royal Infirmary and the General), two alongside midwife led units (at the Royal Infirmary and the General), and a free-standing birth centre at St Mary’s in Melton Mowbray. Putting all maternity care onto the site of the Royal Infirmary reduces choice dramatically for expectant mothers.

Travelling to the Royal Infirmary involves longer journeys for expectant mothers who live in east Leicestershire and Rutland and the proposed closure of St Mary’s in Melton Mowbray means there will be no maternity unit closer to them. The Royal Infirmary is in a very traffic congested part of the city centre. By putting all births into one building, are UHL creating a risk? Where will mothers in labour go if for some reason, the new building cannot be used or can be only partially used (eg as a result of infection outbreak or fire)? If about 900 babies are being born every month in Leicester, how can other hospitals eg Nottingham and Coventry cope with so many extra babies being born in their units?

The proposals include a possible trial of a midwife led unit on the site of the Leicester General but there is no guarantee the trial will take place and there is no guarantee that the trial will succeed. This means around 10,000 mothers every year who want to give birth in Leicester, Leicestershire and Rutland will have no choice but to go to the Royal Infirmary.

There is not enough information to address this issue properly at present.

Our proposal on breast feeding services

We are proposing enhancing breastfeeding services for mothers by providing post-natal breastfeeding drop-in sessions alongside peer support.

  1. Please explain why you agree or disagree with this proposal. It would be helpful if you could explain the impact of these proposals on you, your family or any groups and if you, your family or any groups would be disadvantaged and how any concerns could be overcome.

OUR RESPONSE:

It is difficult to see why anyone would object to enhancing breastfeeding services but the question does draw our attention to the fact that the very highly regarded breast feeding services and postnatal care currently provided at St Mary’s in Melton Mowbray at St Mary’s would be lost. The question does not state what the quality and nature of these breastfeeding services will be and we don’t know whether they will be as good as the breastfeeding services at St Mary’s. Mother have reported being advised to read leaflets or watch online videos when community based postnatal care is not available.

There is insufficient information to address these issues adequately.

Our proposal for a newly established children’s hospital

We believe that the facilities we provide for children and their families require modernising to provide better and more appropriate experience. Leicester has the biggest children’s hospital in the East Midlands, though it is hard to see as services are dotted around the site.

Our proposal for a new children’s hospital

We propose to refurbish the Kensington building at Leicester Royal Infirmary to create a new children’s hospital including a consolidated children’s intensive care unit, co-located with maternity services.

  1. To what extent do you agree or disagree with this proposal where 1 is strongly agree and 5 is strongly disagree?

OUR RESPONSE:

To Strongly Agree would be an appropriate response.

  1. Please explain why you agree or disagree with this proposal. It would be helpful if you could explain the impact of these proposals on you, your family or any groups and if you, your family or any groups would be disadvantaged and how any concerns could be overcome.

Access and transport

  1. Do you have any concerns about being able to travel to or access any services and what would need to happen to make this less of a concern?’

OUR RESPONSE:

For around 30% of people, the closure of the Leicester General Hospital means that patients will have to travel further for their hospital care. It is essential that community based facilities are improved and expanded for everyone as the two remaining hospitals will not be as big as they would have been if they had continued providing care as now. It is even more important for people living far away from Leicester’s city centre that their community services, including community hospitals, be expanded and improved as travel for hospital care will take longer.

However, the NHS announced its plans to close (ie close down beds) two community hospitals (Feilding Palmer in Lutterworth and Rutland Memorial in Oakham) back in 2016 and they have never withdrawn this threat. Although residents in the east of Leicestershire and Rutland are the most affected by the closure of St Mary’s Birth Centre and the General Hospital (which is one the east side of the city), this threat to the future of their community hospital remains. Thus, not just one hospital but three hospitals in Leicester Leicestershire and Rutland currently face the threat of closure.

There is not enough information to address these issues.

It would be appropriate to discuss not only how the changes will affect your access but also your concerns for other patients living in Leicester, Leicestershire and Rutland.

  1. If you have any other specific comments about the proposals for acute and maternity services, or there are any alternative proposals that you think we should consider, please use this space to tell us what they are.

OUR RESPONSE:

It is concerning that a formal public consultation has been called during a pandemic when it is impossible for people to meet in person to discuss the proposals or to attend real public meetings and drop-in sessions. This forces everyone to engage and respond digitally but thousands of people are excluded from this either because they do not have online access or because they are not confident about using it. The online meetings run by the NHS are a poor substitute for real meetings. Moreover, thousands of people appear not to have received the glossy brochure promised to all resident of Leicester, Leicestershire and Rutland. The consultation should not have been held now, during a pandemic, and if it is found in the future to have failed to meet the lawful requirements of a formal public consultation, it will represent an enormous waste of public money.