Hospitals Transformation Programme (HTP) Visual Impairment Focus Group – 16^th May 2024.

This document is a guide to what was discussed in the presentation.  As there are no slides this will outline the points to be addressed.  A recording was made by Sight Loss Shropshire and is available upon request.

1) Introduction – who is on the call: name and job title.

It’s important to remember that we are one hospital delivering services on two sites (and others eg community hospitals, Hollinswood House etc).  There was a public consultation in 2018 around the way we should provide clinical services in the future based on best practice in the NHS.  This described the clinical model, and this has been agreed and we will discuss this and where we are in the process with you today.

The changes were proposed due to a number of problems we were facing with the way services were delivered.  Without going through this in great detail as it has been covered many times these included:

• Duplicated services being inefficiently provided in aging buildings.
• Services being located on the wrong site for patients who presented at one hospital (eg surgery/women’s services).
• Poor connections between our services and the wider health and social care system.

What is our vision through the HTP:

• HTP will enable us to improve the quality of services we provide, in a modern hospital environment.
• We are working with partners across health and social care to transform our hospital services and deliver better healthcare services in the community, such as improved access to GP services.
• Our wider plans involve all our health and social care partners working together, using our resources in the best way for our communities and meeting the needs of our population, now and in the future.

Benefits for our patients and staff:

• Faster access to the right care and clinicians.
• Buildings that support modern healthcare practices.
• Shorter waiting times for planned surgery.
• Faster ambulance handover times.
• An improved work environment for our colleagues.
• Shorter hospital stays for our patients.
• Continuous investment into both our hospital sites.

Questions from participants about this section.

We will now go on to talk about what services will be on each site and Dr Ed Rysdale Consultant in Emergency Medicine and Clinical Lead for HTP will speak with you about this.

2) The Clinical Model

1. a) Both Sites will provide:

• 24-hour urgent care.
• Outpatient adult and children.
• Diagnostics including endoscopy.
• Midwife led maternity unit.
• Frail and elderly care.
• Day case anti-cancer immunotherapy services – currently this service is only provided at the Royal Shrewsbury Hospital.

1. b) Royal Hospital will become the site specialising in planned care:

• Vibrant planned care site providing planned inpatient surgery with medical and surgical inpatients on a planned pathway of care.
• 24/7 urgent treatment service which would enable c.65% of patients who would have attended the traditional accident and emergency department to still be seen at PRH.
• Day case surgery centre and a dedicated procedure suite for local anaesthetics.
• Enhanced rehab facilities and new therapy led wards.
• Respiratory diagnostic and treatment centre.
• Cancer treatment day unit.

Princess Royal Hospital dedicated planned care hub – £24 million Planned Care Hub at PRH will be able to deliver 3,500 more operations per year.

1. c) Royal Shrewsbury Hospital will become the site specialising in emergency care:

• Emergency Department and Urgent Treatment Centre.
• Critical Care Unit.
• Consultant-led Maternity Care.
• Children’s Inpatient Services.
• Emergency and Trauma Surgery with complex, planned and children’s surgery.
• Emergency Medicine, including Cardiology, Stroke, Respiratory and Acute Medicine.
• Consultant Neonatal services.
• Head and Neck inpatient services.
• Radiotherapy and inpatient and day cancer care treatment – which is in addition to the extra service we will now provide at Telford.

 Questions from participants about this section.

Gareth Banks – principal Architect for HTP will talk about the new build at Shrewsbury Hospital.

 3) Interaction of new build with the existing hospital site.

The location of the new building is very well connected and integrated into the site, utilising and strengthening much of the existing site infrastructure.

The original hospital, inevitably, was organised around the Emergency department and the new building is located to take advantage of those connections.

Try to imagine a letter “Y” with the left hand (western) “branch” elongated. The top part of the branch is where the ED department is now and will be extended from. The rest of the “Y” is the new building, occupying the grassed area between the outpatients and car park.

In this way we are retaining and expanding the Emergency department ensures that the most critical linkages (to imaging and Theatres) is retained. The creation of a dedicated Acute Medicine (Assessment & short Stay Wards) adjacent to the Emergency Department and Emergency Care facilities, centred around a new entrance to the hospital, places the key critical functions of the hospital in the optimum place for time sensitive clinical care and provides a clear entrance and orientation point for effective Hospital wayfinding.

4) The new building.

The key components of the accommodation are arranged over four floors in response to the capacity of each floor and the critical adjacencies and patient traffic and privacy.

1. a) Level 1 (Ground floor).

The Ground floor places the emergency department to the north of the entrance (directly adjacent to the imaging and theatres) taking advantage of the recently refurbished elements of the emergency department and expanding and remodelling the rest of the existing accommodation to provide safe and effective clinical accommodation to match the expected increase in emergency activity.

To the south of the new entrance is placed the Acute Medical department which works in tandem with the adjacent emergency department. The Acute Medicine department features an assessment area (closest to the emergency department) and short stay bed accommodation in the finger block to the east.

1. b) Level 2 (1^st floor).

The first floor accommodates the birthing suite which is linked to the southern entrance and main entrance via the central core and is directly adjacent to the Neonatal department which also has its own reception.

The final element of this floor is the gynaecology department, which afford discreet access and egress, for Early Pregnancy Assessment Service (EPAS) and Gynaecology Assessment & Treatment Unit (GATU).

1. c) Level 3 (second floor).

The second floor accommodates the maternity inpatient accommodation in the eastern wing and the children’s centre to the south and west.

The children’s centre is divided into three key components.

• The Children’s assessment unit which is located to the north closest to the dedicated patient lifts adjacent to the emergency department.
• The Daycase unit, which is also located to the north, allowing convenient access to the main theatres.
• The children’s inpatient accommodation, which provides access to an enclosed external terrace.

This arrangement allows a single main reception, accessed from the central core, and facilitates good clinical zoning to keep day patients separate from inpatients.

The maternity inpatient accommodation is accessed from the central core allowing quick and efficient transport from the birthing suite below.

 d) Level 4 (third floor).

The final floor houses the Critical Care unit ((which is divided into two 12 bed wards and one 8 bed ward) and the oncology and haematology ward (to take advantage of the high proportion of single bedded accommodation).

This is the smallest inhabited floor plate and uses this to its advantage to create patient terraces to aid clinical treatment and recovery.

Questions from participants about this section.

5) Ed Rysdale on Latest Developments.

1. a) Where are we in the process?

• Working with lead clinicians to help design our clinical services.
• Our plans have been reviewed by leading independent experts who believe our plans are the best way forward.
• Planning permission has been granted and we have begun enabling works at RSH.
• We are working on our Full Business Case, which is the last stage of government approval.
• The Independent Reconfiguration Panel have looked at the clinical model twice – once in 2019 and gain this year and have concluded this offers the best model for all the communities we serve. This Panel is made up of clinicians and Royal College experts in the specialties involved.
• We will continue to talk to and engage with our communities across Shropshire, Telford and Wrekin, and mid-Wales.

1. b) Copthorne construction works – beginning at the end of May.

• These works are the first phase of the larger road realignment and widening works.
• There will be no change to patient activity.
• The road leading to Copthorne house, the building that includes the Eye Clinic, will be realigned at the end of May, it will be moved to the left as you approach the building. The existing drop-off area outside Copthorne will be replaced by an adjacent temporary drop off area that is on the same side of the side road but closer to the main road. This would be accessed in the same way as it is now.
• We will be notifying patients via the SaTH website – https://www.sath.nhs.uk/patients-visitors/getting-to-us/royal-shrewsbury-hospital/, or via a mailing list that can be joined by emailing construction@cascadecommunications.co.uk.

1. c) Travel and Transport.

• We held two travel and transport focus groups for the public to give feedback and listen to concerns. This feedback is now being worked through to inform our wider Estates Travel and Transport plans.
• Ongoing work to improve car parking for everyone:
  • We know how challenging the car parking situation can be and we are committed to improving this at all our sites.
  • We continue to prioritise our car parking for patients and visitors.
  • Staff are being encouraged to use the free Park and Ride available for colleagues working at RSH and PRH.
  • We are working to maximise the existing space, in particular at our hospitals, to create additional car parking.

 Ask participants if they have any questions about this section.

We will now go on to talk about the work we are doing with local communities – Julia Clarke Director of Public Participation.

 6) Working with our communities.

We hold regular focus groups for the public which you can attend in person at RSH or join via MS Teams.  There are two main quarterly focus groups – Medicine, Emergency Care, Surgery, Anaesthetics, Cancer (MEC&SAC) and Women’s and Children’s.  These are delivered by MS Teams and the HTP team speak to a presentation.  We have deliberately not used a presentation today so we have to think more about what we are describing.  We would be happy to set up further meetings like this if the normal quarterly meetings wouldn’t be suitable.  We have also held one-off focus groups on specific topics such as Learning Disabilities and Autism, Mental Health, and Dementia which feed into the quarterly focus groups.

These focus groups have helped us develop our plans around the new building at RSH.  Ideas which we have incorporated include:

• A redesign of the new front entrance to provide two entrances, one for the main hospital entrance, one for the Emergency Department.
• We will have a second bereavement suite within the Women and Children’s facilities.
• Plans are being developed for ‘calm spaces’ which will provide quieter areas for visitors with neurodiverse needs.
• Incorporating a sensory room for children to support those with learning disabilities or autism.
• Providing sensory maps on each floor which help identify quieter areas for visitors with neurodiverse needs.
• Ongoing work to develop clear wayfinding and signage around the new facilities, which will include focus groups at the appropriate time.

Our next focus groups are on:

• Medicine, Emergency Care, Surgery, Anaesthetics, and Cancer (MEC&SAC) – Thursday 11 July, 10:00-12:00, online over MS Teams.
• Women and Children’s (W&C) – Friday 12 July, 10:30-12:30, online over MS Teams.

General Engagement sessions.

• Casual ‘drop-in’ sessions are being arranged throughout our catchment, with senior members of the HTP team present to discuss the project, as well as information that can be taken away.
  • These will be taking place throughout the next few years; the next planned sessions are:
    • Wellington Market, Telford, Thursday 23^rd May, 10:00-14:00.
    • Mayfair Community Centre, Church Stretton, Wednesday 13^th June, 10:00-13:00.
  • About Health are online meetings, one hour in length, that are held from 18:30-19:30 on MS Teams; sessions covering HTP are held quarterly.
    • Next scheduled event is Tuesday 30^th

Now that we have covered the main elements of the programme, we want to hear from you.  What challenges do you face when attending the hospital?

Is there anything we could do in terms of the design of the building which would make it easier for you to access our services?