Your Care, Your Views - February 2021 - West Hertfordshire ...
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Your Care,
Your Views
February 2021
1
Your Care, Your Views
for illustrative purposes only
Our vision
T he course is set for a
transformational redesign
of health and hospital services
The forthcoming redevelopment of
our sites is the perfect opportunity to
accelerate plans that are rooted in the
Our board will be approving proposals
this summer on which services will be
provided at each site.
in west Hertfordshire. goals we have been delivering against
for some years now: care closer to Your thoughts on our proposals will be
We have plans to provide services where people live, joined up services an integral element of the information
and buildings which are designed to and more emphasis on preventing ill considered as part of that decision-
improve your experience as a patient health. We are also incorporating the making process.
or carer. latest technology and building design
into our thinking. We also want to hear your views on
Our vision is to meet the health needs how we plan to embrace the way that
of all the communities we serve in west The proposals set out in this document technology is changing healthcare and
Hertfordshire. Every proposal you read will breathe new life into our hospitals, how we will use lessons learned from
here is focused on achieving that. giving them all a unique purpose in our the Covid-19 pandemic.
three site network and also within the
This document sets out new models of wider framework of local health and Once you’ve read this document (or the
care; the reasons behind them and the care services. shorter version which is available here,
benefits we think they will bring. We there is a survey which we are asking
also outline how you can give us your Creating a distinct role for each site is you to complete.
views and get involved. at the heart of our plans. All three of
our hospitals are equally important; BUT…before you get started on the
Our proposals for new ways to deliver their strength and success will come questions - PLEASE give our website a
services are being developed alongside from the way they fit together to quick visit as we will continue to update
exciting plans for our three hospitals. provide a comprehensive range of it with additional content during this
We have succeeded in making our case excellent hospital care for people in period of public engagement, such as
for investment to the government and west Hertfordshire. short interviews with key staff and bite-
are thrilled to be placed in the New size presentations on key topics.
Hospital Programme. The ideas we are sharing have
benefitted from extensive input from We are keen to talk (virtually) to
We are applying for funding to transform clinical staff and have been developed community groups across west
the site and buildings at Watford to make practical sense. We will co- Hertfordshire, so please contact us if
General Hospital (with up to 90% new locate services that work well together you would like to hear more about
buildings) and to refurbish our hospitals and minimise duplication across our our proposals.
in Hemel Hempstead and St Albans. sites where possible.
More details on how you can
The intention of this document is to generate discussion and assist in the ongoing get involved and how to get in
development of our proposals, so the information reflects our current thinking and touch are on page 28
may be subject to further change.
2
Your Care, Your Views
Contents
Our sites and services 04
Time for a change 05
Starting with strategy 06
Doing things differently 07
Digital transformation 08
Three’s company 09
A better working life for staff 10
Our clinical brief 11
Services before sites 12
Emergency and specialist care 13
Planned surgery and cancer 14
Planned medical care 15
Harnessing the full power of diagnostics 17
Making our sites right 18
Design principles 25
Travel and access 26
Conclusion 27
How you can get involved 28
Glossary of abbreviations 30
Further reading 31
3
Your Care, Your Views Buckinghamshire
A&E facilities
Bedfordshire No A&E facilities
Herts Valleys Clinical
Commissioning Group area
Luton Mi
Stevenage
Luton & County boundaries
Lister Hospital
Dunstable
University
Hospital
Aylesbury M1
Stoke Mandeville
Hertfordshire
Hospital
Hemel St Albans
Hempstead St Albans
Hemel Hempstead City Hospital
Buckinghamshire Hospital
Watford
A&E facilities Watford General Enfield
M25 Hospital Barnet Chase Farm Hospital
Barnet Hospital
Enfield
No A&E facilities Barnet
Camden
Herts Valleys Clinical
Commissioning Group area Harrow Hampstead
Middlesex Northwick Park Royal Free Hospital
Hospital
County boundaries
Uxbridge Greater
Hillingdon Hospital London
Our Watford General Hospital Hemel Hempstead Hospital
sites and Provides emergency care, inpatient
services, surgery, an acute admissions
unit, women’s and children’s services,
Provides a number of services including
urgent care, endoscopy, diagnostics
and outpatient clinics. Around 20
services
as well as the full range of outpatients rehabilitation beds are provided by
and clinical support services. Central London Community Healthcare
NHS Trust.
This is an outline of St Albans City Hospital
our sites and services West Herts Therapy Unit
Provides planned surgical care,
as they are now. We cancer services and urgent care We also provide outpatient
provide care from services*. A renal unit, managed by
East and North Hertfordshire NHS
physiotherapy at the West Herts Therapy
Unit at Jacketts Field in Abbots Langley.
three hospitals, located Trust and a base for Central London
Community Healthcare NHS Trust,
within around 10 miles are also at this site.
of each other. *Our minor injuries unit is currently closed due to the
Some people in the area covered by
pandemic. A review and public engagement will take Herts Valleys Clinical Commissioning
place in Spring 2021 to finalise the model of urgent care
services to be provided. Group (HVCCG) use services provided
by other hospitals in Hertfordshire,
Bedfordshire, Buckinghamshire and
Greater London.
4
Your Care, Your Views
Time for a change
H ealth services have changed
dramatically over recent years.
Advances in technology, medical
At present, some patients make
multiple journeys to at least one of our
sites for their care. There are areas of
practice and the way we now excellent practice where people make
work with partner organisations just one visit at which they can have
has resulted in much less need, tests and see a clinician for a diagnosis
on the whole, to come to hospital. and then make a plan for further
treatment. We intend to make this
A strong focus on making it possible to ‘one stop’ approach the norm and
get the care you need in other ways, not the exception.
such as at a GP surgery or via ‘virtual
care’ (an online consultation or using We want to create a unique purpose
an app to send us information about for each site. This will support better
your health) means that we must think patient care and a more rewarding
differently about the hospitals of the experience for staff as we will improve
future, their services and buildings. the way that teams function by
bringing specialty services together
If you have been to our hospitals, we and reducing duplication of services
hope you have found our staff to be across our sites.
caring and that your care has been
good. But we know that the state Our architect-led design team is
of our buildings can have a negative working with us to translate our clinical
impact on your experience as well as strategy and clinical brief, together with
creating a poor working environment activity and capacity forecast data and
for our amazing staff. technical health planning guidance,
into detailed designs.
We are pleased to be in line to receive
much-needed funding for our estate. We will put the lessons learnt from the
Our preferred option is for a new Covid-19 pandemic into use, such as a
emergency care building at Watford higher ratio of single occupancy rooms,
General Hospital and redevelopment the ability to easily expand critical care
of our other two sites. and ‘surge’ beds when needed and the
value of moving consultations from in-
More detail on the business person to online platforms.
case process we are following to
secure funding and approvals is Our new and refurbished buildings
on our website. will look and feel very different, with
a much greater emphasis on creating
The redesign of our services healing and pleasant environments and
across our three sites will go hand-in- integrating the latest technology.
hand with plans to redevelop
our estate.
5
Your Care, Your Views
Starting with strategy
O ur proposals reflect our
clinical strategy which, in
turn, draws on our own five year
organisational strategy. We have
also considered ‘Your Care, Your
Future’ (a review of healthcare
in west Herts carried out by NHS
and partner organisations), the
Hertfordshire and West Essex
Integrated Care System’s ‘A
Healthier Future’ strategy and
the NHS Long Term Plan. Links to
these documents are at the end
of this document.
Our clinical strategy (currently in draft)
sets out the core elements of the
transformation we need to achieve
over the next five years to deliver the
commitments in the NHS Long Term
Plan and to ensure that we have made
our clinical services fit for purpose and
ready for the completion of our estate The strategy outlines how our estate such as a diagnostic procedure which
redevelopment. redevelopment plans will take account produces an instant result which can
of past and planned progress in moving then be discussed immediately with a
Our clinical strategy sets out our services off hospital sites and into local clinician) will be introduced across
ambitions for the next five years and settings where it is clinically appropriate an increasing range of services.
describes how we will deliver the best and offers greater convenience.
care for every patient, every day by Our strategy supports a reduction in
working towards these three priorities:- It also sets out the intention to hospital visits: through better use of
use technology, such as online technology, making your hospital visits
1. integrating care with primary (ie consultations, apps which transmit fit the ‘one stop’ model and through
care from your GP) and community health data to our clinical teams and the continued shift of services into
care (health visitors, for example) a new integrated electronic patient the community.
record. We will cater for patients who
2. personalising the care each patient are less confident with, or do not have If your condition means that you need
receives (reflecting patient’s wishes access to, the required technology. an in-person appointment, it will be
and individual health needs) arranged at our site which best meets
Another strategic aim is for us to your clinical need. This may not be
3. providing consistent, best make far better use of everyone’s your nearest hospital.
practice care time (including yours) by organising
ourselves, our services and our facilities Our clinical strategy has a partner
Senior clinicians and other staff from around you - putting our patients at document - the clinical brief - which
across the trust have worked with service the centre. describes how the changes we want to
users and our partner organisations make will be reflected in the detailed
to develop this strategy and agree our ‘One stop’ clinics (where many steps design of our new hospital facilities. You
three clinical priorities. of treatment are covered in one visit, can read more about this on page 11.
6
Your Care, Your Views
Doing things differently
T he promise of investment, the
advances in technology and the
positive changes we have made
• incorporate the latest designs and
best practice for infection control
• achieve teaching trust status in
recognition of our role in educating
future generations of doctors, nurses
recently are an excellent starting • embrace technology to store, and other clinicians
point for considering how your transmit and monitor health data,
hospital services could look in the thereby reducing hospital visits • move to care models that mean around
very near future. 200,000 patients will no longer have to
• use robots and artificial intelligence travel in for an outpatient appointment
Below is a list of wide-ranging (AI) to streamline support services,
improvements. We plan to: such as linen deliveries and admin • extend the service where hospital
processes doctors support GPs with specialist
• develop new models of care for advice (which can avoid the need for
emergency services, endoscopy, • group services and staff together a referral and speed up treatment)
maternity and surgery (and more to enable better clinical outcomes,
in time) team working, training and • remove routine follow-up
absence cover appointments (where clinically
• provide new facilities for cancer appropriate) and give patients the
services • reduce duplication of services choice to request one depending
across sites which can affect on their recovery or if symptoms or
• offer more ‘one stop’ clinics quality and efficiency circumstances change
• provide a vastly increased proportion • upgrade and expand diagnostic • design buildings that promote
of ensuite single rooms facilities at all three of our hospitals health and healing.
7
Your Care, Your Views
Digital transformation
T echnological, scientific and
clinical innovations are moving
forward at a great pace and we
are already seeing the benefit of
adding more digital technology
into the way care is delivered.
Our ‘virtual Covid hospital’ was the
first in the country and, with the help
of an app, around 3,000 Covid-19
patients were cared for in their own
homes. Based on their positive clinical
outcomes and high satisfaction levels,
we have been asked to lead the
regional roll-out of this model.
The explosion of digital technologies
will significantly increase efficiencies
and improve the experience of our
patients by enabling them to send
important health data from their
own homes. Easy-to-use apps and
equipment, such as oximeters (a small
monitoring device which clips onto the
finger and gives a reading of oxygen
levels in the blood) can help patients provide joined-up care. Digitised and members of the public, sets out
manage their own conditions and keep patient records will also support our plans for the next five years and
their clinical teams updated remotely. online booking and boost the ability beyond, and has five core themes:
of clinicians to ‘see’ patients remotely,
We are implementing an electronic via their computer, phone or other • enable patient participation
patient record which will bring benefits device, reducing the need to travel throughout their health journey
to how we manage your care. Having to our hospitals.
a single digitised record means that • provide a seamless and efficient
clinical staff will have more time for Technological and digital advances work environment for our staff
patient care as less time will be spent are also helping with home-working.
on manual data inputting. There will During the pandemic, clinical staff who • join up healthcare and a shared
also be increased safety and accuracy were shielding were able to continue digital patient record
from using systems that reduce the work, including consultations and
need to manually enter data and flag reviewing diagnostic results – in line • enhance ways to care for
when key data is missing. And there with strict protocols to protect your patients enabled by digital
will no longer be cancellations linked to health information. technology
paper notes not being located.
High performing IT systems will also • better data quality and collection
In terms of our strategic aim to work boost staff satisfaction. to drive improvement.
more closely with our health and social
care partners, the new record can be Our new digital vision and strategy,
shared (with permission) to help us which was created with input from staff
8
Your Care, Your Views
Three’s company
O ur proposals are based on
each of our three hospital sites
having a clear and valuable purpose
surgery and medicine which will
improve the way teams work together. Watford General Hospital
which will be strengthened by the This vision for our sites and services has emergency, specialist
way we organise our clinical teams, resulted in this broad outline for our and complex care
provide our services and invest three hospitals.
in new facilities.
Outpatient physiotherapy is currently
St Albans City Hospital*
Whilst being different from each other, provided at Jacketts Field in Abbots
they will work in harmony and to the Langley. planned surgical care,
same high standards. planned cancer services
More detail on what services will be at and an urgent care service
Our proposals are in line with the which site or sites follows later in this
recommendation in the NHS Long Term document at pages 18, 19 and 20.
Plan that there is a clear separation
between urgent and emergency care *Our minor injuries unit at St Albans Hemel Hempstead Hospital
(unplanned care) and planned care. City Hospital is temporarily closed due urgent and planned medical
to the pandemic. Engagement will take care, long term conditions
And within planned care, there will place later this year about the urgent
also be a greater distinction between care services that will be offered.
9
Your Care, Your Views
A better working life for staff
H aving teams stretched across
services delivered from all three
hospital sites can reduce training
always be called on when colleagues
need urgent advice or a second opinion
in person.
There will also be comfortable and
welcoming areas for our hard-working
staff to rest and recuperate in our new
opportunities for junior staff and and redeveloped buildings.
limit opportunities to consult with Our proposals will allow specialty
colleagues and work effectively staff to work from fewer sites (in most The prospect of new facilities is a
as a team. cases two of the three hospitals) and so significant morale boost for current
build stronger teams with better facilities staff and will also help us recruit
There can also be difficulties providing and a working environment that is successfully in the future.
cover for colleagues and this can lead tailored to their service. This will boost
to cancellations of appointments, or job satisfaction and aid recruitment and
whole clinics. The current configuration retention. It will also reduce cancellations
means that senior clinical staff can’t and increase the presence of senior staff.
10Your Care, Your Views
Our clinical brief
O ur clinical brief, currently in
draft, sets out how and where
we expect to deliver services in
Clinical staff have been closely
involved in its development.
The full version can be found here.
future and provides a blueprint
from which our architect-led design Our guiding principles for the clinical
team will work as they develop model for the redevelopment are
the detailed designs for our new as follows:
hospital facilities.
The wellbeing The future system
of our patients and buildings must
and staff must be flexible to adapt
be protected and to medical advances,
enhanced in service future demand and
redesign 1 6 the changing needs
of patients
Our future way of Guiding Technology
working should further
drive separation principles for and IT must be
of HOT functions 2 our future 5 incorporated into
the design of our
(emergency care) and
COLD functions model of care future models
(planned care)
Services with critical 3 4 Clinical teams should
interdependencies
must be co-located e.g. not be spread too
obstetrician-led births thinly to avoid
and acute paediatrics fragmentation and
sited with critical care and duplication of effort
emergency services
11Your Care, Your Views
Services before sites
T here has been a lot of
discussion in recent years
about our buildings. Now that
to providing them and our patients with
first class facilities. The following information
(on the next four pages) sets
the decision has been made to We are working hard to ensure that out our plans for your care.
retain and develop our three our services will be far better coordinated, Improving your experience
existing hospital sites we hope more logically located and offer improved
and the quality and safety of
that there can be a renewed clinical safety and patient experience.
our services is at the heart of
focus on our services. Please read about the many improvements
we are planning to your care. these proposals.
Our staff are keen to start planning
new ways of delivering care from Our clinicians have been sharing their
modern surroundings with the latest ideas on how hospital services could
technology and we are looking forward work better for you.
12Your Care, Your Views
Emergency and
specialist care
O ur emergency and specialist
care will be delivered from
Watford General Hospital. There is
a strong view from clinicians that
patients requiring 24/7 consultant-
led emergency care should only
be seen at a specialised care site
because this provides the safest
and most effective care, with
access to the full range of specialist
expertise and equipment.
The size and layout of the new ED
(emergency department) will enable
clinicians to have easy oversight of
patients and their health data (using
new technology) so that care can be
effectively tailored to individual need.
Patients who no longer need specialist antenatal, postnatal and outpatient
There will be assessment spaces and care are not well served by remaining care in all three hospitals and planned
diagnostic equipment so that specialist with us. Our partners who commission gynaecology surgery at St Albans.
teams can work in the ED, meaning and provide community-based beds
that care will be provided around have increased the range and type of Expectant mothers and their birth
the patient rather than moving care that patients receive when they are partners will benefit from individual
them because the specialist staff well enough to leave hospital but still rooms that are equipped to support
and equipment are in another part need support in a healthcare setting. them at all stages of their labour.
of the hospital. We will create an Delivery suites, in line with the very
environment that is sensitive to the latest building standards, will provide
needs of patients with mental health Women’s and spacious ensuite facilities.
conditions, frailty, dementia and children’s services
learning difficulties. Among a range of Neonatal facilities will also be in line
inpatient improvements are many more Most women’s and children’s services with the latest standards and will be
single rooms. (inpatient care, neonatal care, more spacious, providing comfortable
maternity), with the exception of some facilities for parents and carers to stay
Having the right staff, services, outpatient, cancer, planned surgery and for long visits, if needed.
equipment and access to diagnostics planned medical care will be in the new
within 24 hours of admission is in building at Watford. And there will be purpose-built
line with the NHS Plan’s ‘same day outpatient facilities for children.
emergency care’ approach. These services will be close to theatres,
assessment facilities, diagnostics and Children who need inpatient care
Another planned improvement is the ED. This will reduce transfer time will be cared for in purpose-designed
a smoother route into the emergency between departments. single rooms with facilities for parents
department for adults and children or carers to stay with them. This will
arriving by ambulance, with adequate The new building will also have enable us to better support and meet
space for handover between space for clinical teams to be based the needs of children of all ages.
clinical teams. together. We will continue to provide
13Your Care, Your Views
Planned surgery
and cancer
O ur approach to planned
surgery is the same as our
approach to planned medical care –
“I see numerous cases of prostate cancer
and it can be a real challenge to reach a
consolidate, not duplicate. We think timely diagnosis because of the way our
that better and safer services as services are set out; scans in one place,
well as increased staff satisfaction outpatient appointment in another,
will come from grouping our a biopsy somewhere else and maybe
surgical staff at St Albans where surgery in yet another location. And in
they will provide planned surgery between these appointments is a mass
and cancer care. Emergency and of booking activity for us and travel
high risk surgery will be provided and anxiety for patients. We’ve put a
at Watford. lot of thought into how this could be
so much better and we can’t wait to see
We plan to expand the volume and our proposals become a reality. With
range of surgery provided at St Albans the right diagnostic equipment and
and so will increase the theatre and clinical teams in place at St Albans we
procedure room capacity, provide can reduce the worry and the wait for
enhanced post-surgical recovery care so many patients.”
and extend the range of diagnostic
facilities. These improvements and Mr Freddie Banks
the concentration of staff will enable Consultant urologist, associate medical
St Albans to develop into a planned director of strategy
surgery and cancer centre with a
stronger consultant surgeon presence.
attend several different hospitals for are a better clinical fit on a cancer site
Paediatric surgery (surgery for children) various stages of their treatment with comprehensive diagnostics and
and higher risk or highly complex because the staff and facilities aren’t cancer care and support services. The
surgery will be provided at Watford, all in the same place. new location will be a much better
where there is access to critical care environment for patients. Its size and
if required. The Watford site will provide The new funding will help us to layout will ensure that the unit can
purpose-built spaces called ‘medirooms’ reorganise our cancer and surgical continue to meet the same high Joint
which will allow patients to have an services so that patients can have Advisory Group (JAG) accreditation
individual room for both pre- and post- many, if not all, of their treatment at standards that are achieved at Watford.
operative care on the day of the same place – and with far fewer
their surgery. delays. Concentrating cancer diagnostic Another huge benefit of consolidating
services at St Albans will also ensure planned surgery and cancer care is that
Some cancer care will be provided that patients have access to appropriate it is protected from the pressures of the
from all three sites but St Albans will be support at the point of diagnosis, both Watford site where peaks in emergency
the main cancer diagnostics, care and from clinical teams and via a cancer activity can mean that planned surgery
support base where patients can access information centre. gets cancelled.
a range of services without needing to
travel to another site. This will help us Emergency endoscopy will continue to In addition, we have run St Albans as
co-ordinate care better and reduce the be provided at Watford. Our endoscopy our Covid-free site where we have been
number of hospital visits for patients facilities at Hemel Hempstead, able to continue some services. The
who have been referred with suspected which are restricted in size and need advantages of separating planned and
cancer. At the moment patients with improvement, will move to St Albans, emergency care have been brought into
suspected prostate cancer need to along with cystoscopy. These services sharp focus in 2020 and 2021.
14Your Care, Your Views
Planned medical care
O ur vision is for Hemel
Hempstead Hospital to be a
centre of excellence for people
Our care will be consultant-led, enriched
by other clinicians with specialist
expertise in medical care and long term
from across west Hertfordshire who conditions. Our patients will be at the
have long term and/or multiple centre of a network of health and social
conditions. Tens of thousands of care professionals who will share the aim
patients every year will benefit of patients remaining as well as possible
from our plans to transform how in their own homes without the need for
this site works. an emergency hospital admission.
Most people’s experience of our There will be a strong ‘multidisciplinary’
hospital care is through planned approach and our digitised patient
appointments. In 2019/20 there were records will aid closer working with other
around 150,000 attendances at our parts of the health service through the
urgent and emergency care services sharing of health data (with permission),
across our three sites compared to including customised electronic health
more than half a million outpatient records for chronically ill patients.
attendances. And around 200,000 of
those were for medical care. Conditions catered for at Hemel
“The treatment of rheumatoid
Hempstead Hospital will include:
arthritis has advanced so much.
The opportunity to invest in the Hemel general medicine, older peoples’
Many patients live with it
Hempstead site, the increase in the services, cardiology, dermatology,
now without being in great
70+ population and a new approach diabetes and endocrinology, neurology,
pain or needing surgery. But
(nationally and internationally) to neurophysiology, rheumatology,
these patients – and thousands
planned medical care present the respiratory and respiratory physiology,
of others with long term
perfect backdrop for the changes we stroke, audiology, medical oncology,
conditions – still need expert
wish to make. children’s services and some
care to keep well and have a
maternity services.
good quality of life. In creating
We plan to bring clinicians from
a base for planned medical
different medical specialties together Our changing models of care mean
care at Hemel Hempstead
and provide new diagnostic facilities that we are not planning to provide
Hospital, our patients can
and the latest technology so that ward-based inpatient care on the Hemel
see a range of clinicians all
we can give first class care to a Hempstead Hospital site. The main
under one roof. Great hospital
large and growing group of provider of adult community health
care doesn’t just happen on
patients. This approach will improve services in west Hertfordshire (Central
emergency sites or on busy
teamworking and efficiency as London Community Healthcare NHS
wards – it can be in a calm
well as provide easy access to an Trust) will be developing and engaging
environment where everything
experienced physician when a on how it plans to support people
the patient needs has been
review or second opinion is required. following a hospital stay over the
thought through and is close
coming year.
at hand.”
Our proposals include work to make
the hospital a pleasant and healing Patients will be more involved in their Dr Sundeept Bhalara
environment, for it to be easy to find care and encouraged to manage their Consultant rheumatologist
your way around and for the services conditions where possible, by using and clinical director for
to be co-ordinated so that we can offer technology to monitor their health and specialties medicine
a ‘one stop’ approach to cover several update their clinical teams. Patients
steps on their treatment in a single visit. will also have a greater say in follow up
15Your Care, Your Views
appointments as we move towards a More joined up working between GPs
model of our patients (or their carer) and hospital doctors is another way of
requesting follow-up appointments
depending on how they are recovering
making sure that patients have the care
they need without having to make a
Better care
or if symptoms or circumstances
change. This will replace routine follow-
hospital visit. Our ‘advice and guidance’
system means that GPs can quickly get
through
ups (where clinically appropriate) and is
already working well for our patients in
information from specialists to help
them look after their patients without
partnership
some specialty areas. the need for an outpatient referral.
Direct routes are now in place for a Complications of diabetes can
Our proposals also take into account large number of conditions. lead to a range of problems
the continued success in moving including – at the most
services away from hospital settings And as covered already, digital extreme – foot amputation.
and into the community (GP surgeries, technology is taking care directly
shopping centres or other premises). into patients’ homes, proving that We lead the service in
To date, these include diabetes, you don’t need to come to hospital partnership with Herts
musculoskeletal (MSK) services, eye to get hospital care. Community NHS Trust and
care (ophthalmology), nutrition and Herts Partnership NHS
dietetics, ultrasound, ear, nose and Foundation Trust.
throat (ENT) services and more.
A range of health
professionals to help patients
maintain the best foot
health possible by increasing
the education and support
available to them and ensuring
early treatment in the right
place at the right time.
Our joint diabetic foot service
has helped achieve:-
• a reduction of unplanned
hospital admissions for
diabetic foot problems (as
the main diagnosis) by 70%
from 98 patients in 2016/17
to 29 patients in 2018/19
• a cut by more than half of
the number of total bed
We have partnered with Community Health Eyecare Ltd (CHEC) days (in hospital) for this
since January 2019 to manage follow-up activity before final patient group from 1,313
discharge back to the patient’s own GP or onward referral to bed days in 2016/17 to 571
secondary care where necessary. bed days in 2018/19
Working with CHEC (which is a consultant-led service) has • savings in 2018/19 of
improved access to diagnostics and treatment, providing a £200,000 across the health
‘one-stop’ service where possible. economy
Nearly 5,000 virtual reviews were undertaken by CHEC between • seven day service provision
April - August 2019, resulting in 1,850 patients being transferred
to the community service. This created hospital capacity for either
925 new patients or 1,850 follow ups (or a combination of the
two), leading to a two week drop in waiting times.
16Your Care, Your Views
Harnessing the full
power of diagnostics
D iagnostics is front and centre
to delivering quality patient
care because it determines the next
will provide extensive support to all
patients, especially cancer patients and
underlines our clinical strategy to have
be updating and expanding the
diagnostic services to best provide
rapid and accurate diagnoses for our
steps of treatment and can provide St Albans as our main planned surgery most unwell patients.
answers and clarity when patients and cancer site.
have been experiencing symptoms. Hemel Hempstead will be our planned
We are also planning to improve medical centre, with a diagnostic
We’re excited that there will be diagnostic resources on the other strategy to support that function
significant enhancements on all two sites and have started work on including plain film x-rays, MRI, CT,
three sites. a detailed diagnostics and imaging ultrasound and DEXA scanning (bone
strategy, drawing on recommendations density test).
We are aiming to create a new rapid from the national diagnostics strategy.
diagnostics centre at St Albans, offering This will confirm future requirements in
MRI, CT and other diagnostics including more detail.
endoscopy and nuclear medicine
(a medical imaging and treatment In the case of Watford, which will
specialty using a gamma camera). This be our emergency care site, we will
17Your Care, Your Views
Making our
sites right
W e felt it was important to
tell the story of our services
before concentrating on our sites.
• an urgent treatment centre
• larger emergency department
with assessment areas
Your nearest hospital might not always
be the best site for your needs but it • acute inpatient admissions
will be the best site it can be in terms
of the quality of the care it offers • high risk surgery
and the logical way the services are
grouped together. • critical care “It’s been a really tough last
twelve months. We’ve been
A summary of what our sites will • a fracture clinic next to the pushed to the limits and so
offer is set out below and tables emergency department have our buildings! Covid-19
showing in more detail where services has taught us a lot about
have moved from and to follows later. • complex diagnostics managing during a pandemic
and there are definitely lessons
• women’s and children’s services for the future about being able
(obstetric and midwifery-led births, to rapidly expand our critical
To be provided at the Watford neonatal care, children’s inpatient care beds and the importance
General Hospital site ... care and surgery, and emergency of having a Covid-free site.
and specialist gynaecology) Like many staff, I can’t wait to
• a well-designed and technology- have new and better facilities
enabled building for your healthcare • wide range of outpatient and clinical and that’s why I’m so pleased
services support services that the trust has chosen an
option that means we can make
• extended and improved emergency • new specialist services (such as a start soon. It’s going to be
and specialist care services inpatient neurology, inpatient such a morale boost to see a
chemotherapy and some additional new building rising out of the
cardiology) so that local people will ground.”
We understand that news of no longer need to travel outside of
construction at Watford might west Hertfordshire for care Vicky Houghton
make you worry about disruption Intensive care matron and chair
but please bear in mind that we • new multi-storey car park of the staff joint consultative
are not rebuilding on the same committee
footprint as our current buildings. • reworked access routes and drop
The construction is taking place off points
on land next to the current
buildings. Also, in line with the • a vastly improved working • ability to accommodate services
other frontrunners in the New environment for staff from Mount Vernon Cancer Centre
Hospital Programme, we will
be using ‘modern methods of • a lower impact on the environment • landscaped green spaces, coffee
construction’ which means that from using greener ways to power, shops, restaurants and leisure
many components of our new heat and light our new building and facilities.
building will be made off-site. through using materials with a lower
This reduces the amount of on-site carbon emission count
building work.
18Your Care, Your Views
St Albans City Hospital will… • become the location for a new • benefit from enhanced technology
endoscopy unit to support cancer
• have a new and unique purpose as care and other specialties • provide improved facilities for breast
the site for specialist planned surgical care services
care and cancer services for people in • offer gastroenterology and associated
west Hertfordshire hepatology services • provide spaces for multidisciplinary
meetings so that staff from different
• broaden its range and volume of • provide urgent care services specialties can work together for the
surgery (including surgery that was (a review will take place in Spring benefit of our patients
previously provided at Watford) 2021 to establish the exact type
and level of services) • offer refurbished recovery areas
• provide better and faster diagnosis following surgery
following a significant upgrade to its • be the location for an increasing
MRI and CT provision number of ‘one stop’ clinics • provide wheelchair access for
audiology (not previously available
• offer nuclear medicine (a medical • offer cancer-related support services at this site)
imaging and treatment specialty and an information centre
using a gamma camera) – moved • remain as our ‘clean’ hospital; ie a
to this site as it sits better with • undergo a complete replacement of site we can protect from infectious
cancer care theatre and procedure room facilities disease outbreaks and where we
can continue to provide services
• offer pre and post-surgery whilst our main site provides care
appointments to patients with infections, such as
Covid-19.
19Your Care, Your Views
Hemel Hempstead Hospital will… • provide better and faster diagnosis, • provide a calm and supportive
with MRI, CT and DEXA scanners environment where services are
• have a new and unique purpose logically grouped together and
as the site for specialist planned • be the location for an increasing where there is an ethos of keeping
medical care site for people in number of ‘one stop’ clinics people as well as possible in their
west Hertfordshire own homes.
• offer health and wellbeing support
• provide urgent care services for a wide range of long term With around 30% of the population
conditions having a long term condition, our
• broaden its range and volume of care changes at Hemel Hempstead have
for people with long term conditions • provide spaces for multidisciplinary the potential to bring huge benefits
meetings so that staff from different to tens of thousands of people in
• become our site for specialist medical specialties can work west Hertfordshire.
diabetes and rheumatology together for the benefit of our
patients Our proposals will see a number of
• benefit from enhanced technology new ‘hubs’ at this site – the tables on
• offer refurbished outpatient facilities the following pages show how many
• expand outpatient services for services will now have their centres of
paediatrics, respiratory, cardiology • become a model for how planned expertise at Hemel Hempstead Hospital.
and dermatology care can be delivered from a
multi-specialty site, embracing
the latest best practice
20Your Care, Your Views
The following tables outline our proposed changes to outpatient services:
where services are located now, and from where they will be provided in the future.
Medicine and long term conditions
Hospitals
Outpatient services: WGH HHH SACH
now
cardiology proposed
appointment changes =
now
dermatology proposed
appointment changes =
now
diabetes and endocrinology proposed
appointment changes
now
gastroenterology and hepatology proposed
appointment changes =
now
general medicine proposed
appointment changes = = =
now
haematology proposed
appointment changes = = =
now
medical oncology proposed
appointment changes = = =
now
neurology proposed
appointment changes =
now
neurophysiology proposed
appointment changes = = =
now
older peoples’ services proposed
appointment changes =
now
rheumatology proposed
appointment changes
now
respiratory and respiratory physiology proposed
appointment changes =
now
stroke proposed
appointment changes = = =
now
TIA (transient ischaemic attack
proposed
- or ‘mini stroke’)
appointment changes = = =
This information
Service provided Hub Service not provided = No change increase in service Reduction in service may be subject
to change.
21Your Care, Your Views
Surgical, anaesthetics and cancer services
Hospitals
Outpatient service WGH HHH SACH
now
audiology proposed
appointment changes = = =
now
breast proposed
appointment changes = = =
now
clinical oncology proposed
appointment changes = = =
now
ENT (ear, nose and throat) proposed
appointment changes =
pre-covid
now
fracture clinic
proposed
appointment changes =
now
general, colorectal
proposed
and vascular surgery
appointment changes =
now
ophthalmology
proposed
and orthoptics
appointment changes = = =
now
oral surgery and dental proposed
appointment changes = = =
pre-Covid
orthopaedics and now
spinal surgery proposed
appointment changes (from pre-Covid)
now
pain management proposed
appointment changes = = =
now
upper gastrointestinal
proposed
surgery
appointment changes = =
now
urology proposed
appointment changes =
This information
Service provided Hub Service not provided = No change increase in service Reduction in service may be subject
to change.
22Your Care, Your Views
Women’s and children’s services
Hospitals
Outpatient service
WGH HHH SACH
now
children’s services proposed
appointment changes = = =
now
gynaecology proposed
appointment changes =
now
gynaecology oncology proposed
appointment changes = = =
now
obstetrics and maternity proposed
appointment changes = = =
This information
Service provided Hub Service not provided = No change increase in service Reduction in service may be subject
to change.Your Care, Your Views
Diagnostic scans
Hospitals
Outpatient service
WGH HHH SACH
now
plain film Xray proposed
changes = = =
New in
now 2021
MRI proposed
changes = =
now
cardiac MRI proposed
changes = = =
New in
now 2020
CT proposed
changes = =
now
nuclear medicine proposed upgrade
changes
now
DEXA proposed
changes =
now
ultrasound (obstetrics) proposed
changes = = =
now
ultrasound (non-obstetrics) proposed
changes = = =
now
endoscopy and cystoscopy proposed
changes =
now
fluoroscopy proposed
changes = =
now
mammography proposed
changes = = =
This information
Service provided Hub Service not provided = No change increase in service Reduction in service may be subject
to change.
Please note, you’ll find a description of each of the above
diagnostic tools in the glossary at the end of this document.
24Your Care, Your Views
Design W e have developed a set of • flexible, cost-effective design
detailed design principles
for the redevelopment and • services designed around patients
improvement of our three hospitals
principles with input from members of our
stakeholder reference group and
the public.
• facilities for patients, visitors
and staff that promote healing
and wellbeing
These tried, tested and trusted • flexibility to grow
principles will help us set the
foundation for safe and cost-effective • multi-purpose, adaptable
quality healthcare. They are explained in approach to design to make full
full in our clinical brief document and and efficient use of space
summarised below:
• maximising clinical space
and creating bespoke
administrative space
25Your Care, Your Views
Travel and access
W e know that access and travel
are commonly cited concerns
associated with health and hospital
care in west Hertfordshire. As well
as reducing the need for people
to visit our hospital sites through
adopting new models of care, we
will also continue to work with
partners to find ways to make it
easier to get to our hospitals and
address the issues with car parking
on all three sites.
We are committed to engaging with
local people around the impact of our
service provision upon local access and
travel, and there will be many ongoing
opportunities to get involved and have
your say. We will be setting up a travel
and access reference group, and we
welcome applications from members of
the public. Details of how to apply can
be found on our website.
We understand that our plans may
mean that some people will need to
travel further than they do now for
some services, but many will have
shorter journeys and certainly there will
be fewer journeys overall.
We expect that this reduction in
journeys will have a positive impact on
the wider environmental situation. So,
while some people will find some of
our proposed changes inconvenient,
overall there will be considerable
benefits of the new service model for
local people.
continue to be the case. Depending We will conduct an indicative travel
In addition we know that some patients on where you live, you’ll have other impact analysis for several of our key
do not always choose the hospital options regarding where you choose areas. The outcome of this analysis
nearest to where they live, and this to access planned care, such will be available for the trust board to
is for a range of reasons including as outpatient care and surgical consider alongside the engagement
personal choice and convenience, for treatments, for example Luton & feedback.
example opting to attend a hospital Dunstable, Stoke Mandeville, Barnet
near to where you work. This will and other London providers.
26Your Care, Your Views
Conclusion
W e hope you are as excited
about our plans as we are!
our goal of transformational redesign
of our services and our hospital
facilities together. We have a once in
We have listened to feedback from staff a generation opportunity to make
and patients about the future shape of a positive and lasting impact on the
our services and have given our ideas a healthcare services we provide and we
great deal of thought, using the latest intend to grab it with both hands!
information about new models of care
as well national policy and clinical best We believe that the results will be three
practice guidance. fantastic hospitals, all with a unique
and different purpose but all geared
And now, with the promise of towards our vision: the very best care
significant investment, we can achieve for every patient, every day.
27Your Care, Your Views
How you can
get involved
W e want to enable feedback
from our staff, patients,
carers, stakeholders and other Take part in our phase one survey
members of our local community We would like as many local people as possible to give us their
to be considered as part of our views by completing our online survey. This survey asks for your
decision-making. We are therefore views on our draft clinical strategy, draft clinical brief, and our
planning a two phase engagement proposed three site model.
programme. The first phase will run
until 24 March 2021. Please read this briefing document before completing the survey.
We will review and analyse feedback at Closing date for the survey is midnight on Wednesday 24 March 2021.
the end of each phase of engagement
to ensure that any conflicting In addition to completing the online survey, there are several other ways you
suggestions can be considered can get involved and share your views with us.
together. We have arranged for the
feedback from this first phase of
engagement to be independently
analysed to help us consider the Attend online meetings and events
feedback as we develop more specific
plans. We will share the independent We will be running an extensive community engagement programme,
analysis, our response and updated hoping to talk with and hear from a wide range of people including
proposals through a second phase patients, carers, community and voluntary groups, in dialogue with healthcare
of engagement in mid-May. This will organisations, professional partners, and our managers and staff.. There will be
enable us to test our proposals in more opportunities to learn about the many aspects of our redevelopment programme
detail and get further feedback from including costings, design and planning.
our community and stakeholders.
Among the planned events, we will hold dedicated events for specific service areas:
We will address feedback from the
• diagnostics (endoscopy, DEXA bone scanning and nuclear medicine)
formal engagement through a response
document and during any follow-up • medicine
engagement activities, rather than • surgery
responding to individual responses Everyone is welcome! Please also visit our website as we will continue to update it
while the formal engagement is taking with additional content, such as interviews with key staff and bitesize presentations
place. We will, however, monitor on key topics.
feedback as it comes in and will clarify
any frequently asked questions or
common misunderstandings on our
dedicated website pages. Join our stakeholder reference group
We’ve already set up a stakeholder reference group (SRG) involving
patients, carers, community and voluntary groups in thinking about
our emerging ideas. We will continue to keep the SRG informed and involved as we
move through the statutory process of business cases and approvals.
New members are always welcome. If you would like to join this group, please visit
our website.
28Your Care, Your Views
Join our travel and access group
We are setting up a travel and access reference group to make sure
that transport and other access issues are fully considered as we look at various
options and develop our plans. We very much want patients, carers and community
groups to be represented on this group, working alongside transport planners from
local councils, public transport providers and East of England Ambulance Service.
You can sign up to join the travel and access reference group by completing the form
on our website here.
Get involved in the design and planning process
There will also be opportunities for community engagement as part
of the design and planning process. Running in parallel with the
engagement work outlined in this document, our architects BDP will be inviting
members of the local community to have their say on the design and access
proposals which are being created as part of the planning application process.
The next steps
Thank you for reading this and thank you again if you have
completed the survey!
We are grateful to all those people who have taken part in our
various engagement activities over the past five years.
We look forward to hearing more from those we have already
engaged with and we also hope to reach new audiences who
haven’t yet had their say on the future of health services in west
Hertfordshire.
The next milestone is to review the shortlisted options in more depth
to identify the final preferred option (the one that provides the best
overall balance of benefits and costs) which we will take forward to
the next stage – full business case. We expect to make this decision
this summer and then submit our proposal for approval from NHS
England, the Department of Health and Social Care (DHSC) and by
Her Majesty’s Treasury.
We expect to hear if all the funding we have applied for has been
approved by the end of 2021 or early 2022. It is possible that the
impact of the current pandemic may lead to movement in some of
these timescales.
29Your Care, Your Views
Glossary of abbreviations
A&E Community
Accident & services Diagnostic techniques MRI
Emergency Healthcare that Magnetic Resonance Imaging - uses
usually takes place Cardiac MRI strong magnetic fields and radio
Acute services in people’s homes. Magnetic Resonance Imaging - waves to generate images of organs
Treatment for a Teams of nurses and uses strong magnetic fields and in the body, used primarily in soft
severe injury, period therapists coordinate radio waves to generate detailed tissue, to look at joints, the brain and
of illness, urgent care, working images of the heart the spine
medical condition, with professionals
or to recover from including GPs, health CT Nuclear medicine
surgery, including visitors and social Computerised Tomography - uses (Gamma camera) A diagnostic
emergency care. computers and rotating X ray medical imaging and treatment
departments, machines to create cross sectional specialty involving the application
inpatient and ED images of the body, more detailed of traceable substances in the
outpatient medicine Emergency than normal X ray images, used diagnosis and treatment of disease,
and surgery department in trauma, looking at the brain, looks at the function of organs such
chest and abdomen in more as the kidneys and is used in cancer
Clinical brief ENT detail diagnosis
Our document which Ear, nose and throat
describes how the DEXA Plain film X Ray
changes we see as HHH A high-precision type of X ray Uses X rays to produce an image of
important can be Hemel Hempstead that measures bone density and the inside of the body, especially
delivered Hospital bone loss, used to monitor bone bones, to aid diagnosis; also used
health and conditions such as frequently on the chest to identify
Clinical strategy HVCCG osteoporosis infections
Sets out the Herts Valleys Clinical
transformation we Commissioning Group Endoscopy & Cystoscopy SPECT CT
need to achieve Involves the insertion of a long, Single Photon Emission Computed
over the next five Primary care thin tube directly into the body, Tomography CT – a combination of
years to deliver the Care provided usually via the mouth or anus, a gamma camera (SPECT) with a CT
commitments of the from your GP and to observe an internal organ image to provide a more detailed
NHS Long Term Plan community services or tissue in detail, used in the diagnostic, used for infection
monitoring of bowel conditions, diagnosis and orthopaedics
Clinical SACH or the bladder
transformation St Albans City Ultrasound (obstetrics)
Assessing and Hospital Fluoroscopy Sometimes called a sonogram, this
continually improving A type of medical imaging in scan uses high-frequency sound
the way patient Secondary care which an X-ray beam is passed waves to create an image of part of
care is delivered Care provided through the body, and shows a the inside of the body, in this case a
at all levels in an by hospitals and continuous moving X-ray image woman’s reproductive organs
organisation specialists on a monitor, used for barium
studies and urological procedures Ultrasound (non-obstetrics)
WGH Sometimes called a sonogram, this
Watford General Mammography scan uses high-frequency sound
Hospital The process of using low-energy waves to create an image of part
X-rays to examine the breast for of the inside of the body, used
diagnosis and screening, primarily to monitor abdominal and pelvic
to allow early detection of organs, soft tissue, joints and joint
breast cancer injections
30You can also read
