Hospital trust chief explains why Ipswich cannot maintain orthopaedic surgery
PUBLISHED: 05:30 22 June 2020 | UPDATED: 06:48 22 June 2020
Controversial plans to move hip and knee surgery out of Ipswich Hospital into a brand new facility in Colchester have divided opinion since being announced.
On the one hand, it promises to significantly reduce waiting times and cancellations which have frustrated patients; offer state-of-the-art facilities and allow more complex surgery to be carried out.
But Suffolk patients will be required to travel down the A12 to Colchester for the surgery procedures resulting in a hospital stay of four or five days, prompting Ipswich MP Tom Hunt, Ipswich Borough Council and nearly two thirds of consultation respondents to voice their objections.
Suffolk local democracy reporter Jason Noble spoke with Nick Hulme, chief executive of the East Suffolk and North Essex NHS Foundation Trust (ESNEFT) which runs the two hospitals and Ed Garratt, chief officer of the Ipswich and East Suffolk clinical commissioning group, to talk through some of the concerns.
These has been a feeling since the consultation started that the orthopaedic surgery move to Colchester is a done deal. Is that the case?
Nick Hulme: Was it a done deal in terms of there only being on option? Yes. There was only one option to put the site at Colchester because that was the only affordable option.
One of the challenges that we have as public servants is to do the best we can with the resource available. The only option is to put the orthopaedic centre at Colchester, and the reason for the consultation was to make sure we understood the views of people so we could address their concerns in the full business case and in the detailed clinical work up, so we can do the best for our patients. There are 800,000 people that we serve, so that is what we have to keep in mind – the majority of people that we serve. So was it a done deal? Yes, there was only one option we were consulting on. Done deal is a very emotive, unnecessarily emotive statement, so we were consulting on one option is what I would say.
So does that mean that any level of response in the consultation, even if it was 99% or 100% of people against it, that it would still be pursued?
NH: We need to understand what people’s concerns were. If there was something that we have missed at the public consultation or the discussions with the public raised an issue that we haven’t considered, and therefore made the options unviable, then that may have been something that we would have had to address. But this was not a democratic vote, this was not a referendum, and even were that to be the case I am sure that we would be most uncomfortable about handing just shy of £45million back to the Treasury and not have that invested in our services for local people.
Ipswich Borough Council said it had put forward a couple of possible locations on the Ipswich Hospital site, but I understand they weren’t deemed viable. What was the reasoning behind that?
NH: Although we have had several offers of alternatives in terms of build, in terms of our site, and I understand that Ipswich Borough Council did spend taxpayers money in order to get a view from external architects, as they didn’t understand the site it would have been difficult to really come up with a very strong alternative.
We have looked at, several times, the two-site option, which of course you lose significant clinical benefit by doing that, and the independent cost assessors have said that it would be north of £70m to do both sites.
We are working with an envelope of just short of £45m, and I don’t think – particularly now – were we to go back to the Department of Health and say we would like to do a two site option and could we have another £35m, given all the other pressures we have got on the estate, I don’t think that would be a viable business case.
Access for patients has been mentioned, largely in relation to waiting times and reduced numbers of cancellations because of emergency appointments. Has access in terms of distance, which is obviously a lot more problematic for people in Suffolk rather than Essex, been taken into consideration with this?
NH: It has been the major issue that has been raised in the consultation. What our patients have been consistent about is they are prepared to pay off a slightly longer travelling time for a guarantee of a couple of things. Firstly a brand new, state of the art facility where they will have their operation, and indeed the almost guarantee of not being cancelled.
To point out, all of the care except the operation will be provided at local hospital, so that if you live in Suffolk and currently have your care at Ipswich Hospital all of that except for probably a maximum of five days stay down at Colchester, would happen locally.
Indeed, just on Friday I got a letter from a patient who was happy for me to share, saying she had been to Ipswich and spoke of the experience of being in such an old and not fit for purpose waiting area. She decided to go a little bit further for her treatment because she wanted that guarantee of her procedure not being cancelled and for a better environment. She went to Southampton for her treatment, because she felt that strongly that she wanted to be treated in a specialist centre.
The plans seem to disproportionately affect Suffolk patients negatively over those in Essex. Can you understand why they feel aggrieved?
NH: I can fully understand if we hadn’t done a good job to explain the advantages of having an elective centre that is protected from emergency patients, and that I understand there may be concerns about travel. The NHS is changing and has been changing for many, many years, and you can’t expect to get all your treatment at your local hospital.
It was proved back in 1994 with the cancer reforms and that has been a monumental success in making sure we have specialist care in specialist centres with much better clinical outcomes and more attractives for both staff and patients.
What I know absolutely is those waiting times that were too long in a pre-Covid world are going to be exceptionally longer in a post-Covid world, which for me identifies even more the importance of shortening waiting times by not cancelling patients because of emergency non-elective work coming through the hospital.
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The hospital is going to look and feel very different for the foreseeable future, possibly for the rest of my career. So therefore being able to treat patients safely and appropriately in protected, elective care spaces is even more important now than it was 13 weeks ago.
With the Covid-19 situation, is this the right time for pursuing these changes?
Ed Garratt: Prior to Covid one in three [orthopaedic] surgeries were being cancelled, which was a terrible patient experience, and is not good enough for our communities. If we don’t have protected capacity we can’t improve that, especially now with Covid. We need protected capacity otherwise we can’t support our community properly, and waiting times will continue to rise.
So I think the case for this was compelling prior to Covid, and I think that it is even more so given the challenges we have got in the next few years, because we are going to be working with Covid for some time.
In the rationale for not having Ipswich, a reason we heard is there is not the space on the site to do that. But then plans for a women’s centre were unveiled. Was that one that had always been earmarked even before this consultation had started, and that is why there is not that space in Ipswich?
NH: There is a difference between £44m and £70m, quite a big difference between those two numbers. What we are talking about is an affordable space option. There isn’t an affordable space option on the Ipswich site, which is why we have been very clear that the estate strategy going forward was a long term five year strategy, to which we have no financial commitment. But you would expect us as public sector leaders to be thinking about a long term strategic option. The issue wasn’t about space, it was about affordable space – that is the key difference.
The reputation of orthopaedic surgery in Ipswich is seen as very high quality, possibly higher quality than it is at Colchester currently. This is another question mark as to why Ipswich is losing that site when it is doing good work to move to one elsewhere that isn’t performing as well. What would be your response?
NH: It’s not the building that produces good outcomes, and in fact the letter that I had from the member of the public on Friday was very clear that she was moving her care because of the shoddy building. It is not the building in the same way that if we moved Ipswich Town to play at the Emirates, they would not be a Premiership side, and if we moved Arsenal to play at Portman Road, they wouldn’t be in the first or second division. It’s about the team, and we are keeping those that want to stay, some may decide that they don’t want to work on a two site option and they may choose to leave, but it is the team that deliver the care.
The surgeon is only part of that team, it is the anaesthetists, it is the ODAs, the nursing staff, it’s the nursing staff on the ward, in theatres, and those staff will stay the same if they choose to stay. The idea we get good outcomes in Ipswich because we are working out of 1970s theatres and wards, is a very strange concept to me. I have never understood the three consultants out of 27 who have an issue with this, claiming that for whatever reason the outcomes are going to be worse because we have moved the site where the care is delivered.
We know more work is being done on transport solutions. Is there a reason why more of that wasn’t done beforehand so that people could have had that information when responding to the consultation? Particularly when travel came up as such a big issue in the consultation?
NH: I am a steward of taxpayers money and I wouldn’t spend taxpayers money on an option that hadn’t yet been approved by the CCG, by the region, by the NHS nationally, by the clinical senate, by the joint health scrutiny committee, so to spend a lot of hard earned taxpayers money on an option that might not see fruition [was not acceptable]. If we get the final decision on 14 July from the CCGs, we will then, as we have committed to from the outset, spend time in investing in working with independent advisors and ourselves in travel options for those patients.
It was mentioned in the health scrutiny committee that having that support network of people being able to visit is quite an important part of their recovery process. We have been hearing from some people saying their friend or loved ones wouldn’t come and visit them if they were being treated in Colchester. Is this being considered?
NH: It is, of course it is. People will be likely to be in hospital for less than four days for these procedures, and we have learnt over the last 13 weeks how important visitors are to patients, and we have been able to open that up to visitors in a controlled and safe way to patients at Ipswich and Colchester hospitals. We do recognise how important that is. It is one of the many considerations that we will be looking at as we develop the finer points of the plan over the foreseeable future, if it is approved.
The CCG boards make the final decision next month. Given there were some comments made by Ed Garratt in the health scrutiny committee about how this is a positive and actually investing into the system and not taking things out, does that indicate that this decision been predetermined?
EG: It is a live debate, so there will be a decision made by the two boards – one for Ipswich and East Suffolk CCG and one for the North East Essex CCG on 14 July, no decision made before then. But to put this into context we have been working on this for some time and both CCGs supported the pre-consultation business case, and we wouldn’t have moved ahead if there wasn’t support for us to consult the public. So no decision has been made, but to date the CCGs have been supportive of the direction.
Any final thoughts?
NH: This isn’t just a decision made by this organisation without any reference to anyone else. We have had several levels of scrutiny from external and independent bodies, so we have been liaising with the head of orthopaedic elective work, this has been to the independent clinical senate, where we got a lot of support. This has been to the NHS regional office which has held us to account. We obviously have been to the CCG.
We are not in a position of being able to just make a decision and act upon it, and we have taken very careful consideration of the feedback we have had from our staff, and much more importantly from our patients. Although there are three consultants that don’t want it to happen, that is three out of 27 orthopaedic consultants, out of 10,000 staff, out of 800,000 people we serve. In the consultation itself 400 people were unhappy, that is out of 800,000 people. It is hardly statistically significant. It is important, of course it is important to listen to people’s concerns, but you couldn’t argue that it was in anyway statistically significant.
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