HealthVision SWANSEA

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HealthVision SWANSEA

• Planning for better NHS services across the city
• 18th May 2009

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The way Swansea patients receive healthcare is
changing, with 100millions of pounds earmarked
for upgrading hospital buildings, and delivering
a more integrated and balanced service. Over the
next few years both Morriston and Singleton
hospitals will benefit from investment, as will
our Mental Health Services.
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This isnt a jam tomorrow pledge, because a major
scheme is already underway at Morriston Hospital,
(more later) and we have started improving
facilities for patients at Cefn Coed Hospital.
But theres still a lot of planning ahead. And
as we start to turn our visions into reality, we
are keen to get your ideas and views ... to help
us develop healthcare together.
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HealthVision SWANSEA
... is the umbrella title for wide-ranging
projects to modernise Swanseas health
services. Early on, the plan centred on
developing a single Super Hospital for the city,
either on a new site, or expanding Morriston
Hospital. Singleton would have virtually
closed.
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• But that idea has been now been revised, because
  it would have taken too long (a decade or more)
  for enough funds to proceed.
• And also, the Trust and Swansea University have
  since joined forces, opening the door for
  wonderful, cutting edge research-led care with
  both Morriston, and Singleton, hospitals at the
  very heart of it.

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In fact, we are now a Teaching Trust with an
undergraduate school which will attract the best
staff and create jobs. In recent Government
research assessment exercise, the School of
Medicine received a 5 rating - the highest
possible - which is a fantastic achievement.
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The background and how services may develop
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Balancing health care between our hospitals

• Back in the early 1990s, Swansea had quite
  separate NHS Trusts managing our hospitals, and
  one unfortunate legacy of is a duplication of
  some services on both sites.
• Splitting resources this way isnt very
  efficient, and we think having hospitals which
  complement each other instead, is a much better
  way forward.

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The way ahead?

• Singleton Hospital

• Morriston Hospital

• Planned surgery, diagnostics and rehabilitation
• Strong links with GPs and primary
  (community-based) health care
• SWW Cancer Centre

• Emergency care and surgery
• Tertiary (specialist) and regional treatment
• Childrens wards

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Were at the starting point
One important issue were looking at is how best
to use the resources we have for childrens
health care. Another is how to improve the way
we manage surgery.
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Childrens wards split over two sites
From the days of the old Morriston and Swansea
Trusts, over a decade ago, there are Childrens
Wards in both Morriston and Singleton. This
means specialist childrens staff and equipment,
are split over two sites.
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Are we spreading the service too thinly?

• Being in two hospitals doesnt make it easy for
  childrens staff to work together, and share
  their expertise.
• It also costs more that way, instead of using the
  money to invest in a better service.

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Practical problems

• Weve also got practical problems to work
  through, which are pushing the need for change.
• For several reasons, including European caps on
  the hours staff work, we need fresh ideas about
  the way we deliver services.

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How about a better service on one site?

• Would it better to develop one specialist
  in-patient service for children, on a single
  site?
• Its something were thinking about, but its
  still early days.

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A virtual Childrens Hospital?

• While it couldnt be a Childrens Hospital as
  such, having the in-patient wards in one place
  could support that ethos.
• We could set up dedicated paediatric operating
  theatres, for example, and develop other
  child-friendly facilities.

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Surgery

• We are also thinking of modernising the way we
  manage surgery, to make the most of our hospitals
  

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But patients wont have far to travel

• It could mean that some operations currently
  carried in one hospital now, may transfer to
  another in future but all within a short
  distance.

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Hospitals working together

• Emergency and specialist operations could be
  centred in Morriston
• Singleton could concentrate on Day Surgery, or
  stays of just one or two nights.
• Neath Port Talbot Hospital could also play an
  increasing part, particularly around routine
  surgery.

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Quicker access, fewer delays

• By doing this, we hope to shorten waiting lists
  and avoid last-minute cancelations
• Thats because our services will be better
  managed and more robust.

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Singleton Hospital
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Ambulatory Care Services
One idea we are are keen on is introducing an
Ambulatory Care Service at Singleton Hospital.
Working in partnership with Swansea University
and GPs, we believe we can develop a service
which will be a first in Wales.
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Patients should be able to get better diagnostic
services, like access to new hot clinics within
days of seeing their GP. But its still early
days, and exactly what the Ambulatory Care
Service could offer, is still being thought
through.
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Singleton could also have the major role in
future for elective (planned) care, and helping
people get back on their feet. Sometimes
emergency patients need the beds booked for
elective patients, and those operations are then
delayed. Evidence shows that keeping elective
and emergency treatment apart - on different
sites - can help avoid this. Singleton is an
ideal centre to focus on elective treatment.
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We also believe its good practice to have most
of our rehabilitation services in one place, like
Singleton Hospital, because patients will get a
better service, and it uses staff skills and
resources to the full.
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Childrens out-patients

• And while childrens in-patient wards might be in
  Morriston, we could have out-patient clinics in
  Singleton.
• There is also an opportunity to develop a
  Childrens Centre there for youngsters with
  disabilities.
• Maternity and neonatal care could also remain at
  Singleton.

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Morriston Hospital
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Morriston Hospital
Morriston Hospital is already home to excellent
specialist services like cardiac burns and
plastic surgery, and renal services. It has one
of the busiest AE Departments in Wales.
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We want to build on this, with Morristons role
centring on treating patients with an unexpected
serious illness or injury, who need emergency
care, along with those who need specialist care.
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Neath port talbot hospital
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Neath Port Talbot Hospital

• Were also looking at the additional role Neath
  Port Talbot Hospital might play, as its so close
  to Swansea, easy to get to, and has excellent
  transport links.

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Swansea doctors already there

• Swansea-based surgeons have for some time been
  operating and holding clinics at Neath Port
  Talbot Hospital.
• It makes sense to see if Neath Port Talbot one
  of the most modern and well-equipped hospitals in
  Wales could play an increasing role,
  particularly around routine, planned surgery.

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This is the general direction of travel we think
our hospitals should be going. But there is still
much debate engagement with patients, staff and
the public and detailed planning and design
ahead.
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Better buildings
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While theres much discussion ahead before any
firm plans can be made, you may recall we
mentioned that major building work has started at
Morriston. This doesnt mean were jumping the
gun. In fact, were just getting prepared for the
future. Anyone whos been to Morriston Hospital
knows that access isnt great and parking can be
a real nightmare.
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The City and County of Swansea granted planning
permission in December to improve access to the
hospital and around the site. We are also
providing better car parks, including a multi
storey. This is the start of a huge overhaul for
Morriston Hospital, which, with continued Welsh
Assembly Government support, will see very old
parts of the hospital (dating back to the 1940s)
demolished, and brand new buildings in their
place.
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This is an artists impression of the new car
parks for Morriston Hospital.
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Work is already well underway
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Over the coming months we will unveil further
plans for the redevelopment of Morriston
Hospital. It will have a brand-new
out-patients department and a greatly enhanced
main entrance with a selection of shops and other
patient, staff and visitor-friendly facilities.
We also want to develop a range of modern
accommodation for essential behind-the-scenes
hospital services like Medical Records.
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You may wonder just where we could build on
Morristons site, because it already seems pretty
cramped. Actually, because Morriston Hospital
is built on a slope, we can build up to three
storeys, rather than out, and still keep the new
roof at the same level as the main hospital, so
it wont be an eyesore. The new multi-storey
will also take advantage of the hill, and be
stepped into the slope.
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The benefit of this natural land slope was not
recognised when the hospital was first built,
which is why older parts of the hospital have
sloping corridors like this one, and you have to
walk down a hill to access the out-patient
department. By building up, we wont need to
shoehorn new buildings into the existing site.
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Mental health
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Mental Health
As well as our two acute hospitals, we are also
improving our Mental Health Services. We are
favouring a twin-tracked approach, investing in
buildings, but also in improving our community
services.
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Mental Health care has changed a lot over the
years, and Cefn Coed Hospital is one of the last
remaining examples of a large Victorian-style
in-patient mental health hospital. One of the
issues we are looking at is how best to provide
in-patient care in future, and whether the aging
Cefn Coed remains the best building, or if a new
build is needed. In the meantime, we are
planning to build in the grounds of Cefn Coed to
replace some parts of the hospital and other
Mental Health accommodation which is no longer
suitable.
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These include a new step-down unit for patients
who are almost ready to live back in the
community, but need support to re-build their
daily living skills confidence. We also want to
build new accommodation in the grounds for
patients with dementia.
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Old, dormitory-style wards will go
This is a ward at Garngoch Hospital, which offers
little privacy for dementia patients, who live
there for months or even years.
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• Instead of these wards, we are planning a looped,
  purpose-built unit, designed to improve the
  quality of life for older Mental Health patients.

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A view of the planned courtyard

• Purpose built, safe, with en-suite, single rooms,
  and enclosed courtyard gardens

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Garngoch Hospital

• While inpatient beds are planned to move to the
  new Cefn Coed unit, Garngoch will have an
  increased role to play in community care for
  dementia patients, and continued partnership with
  the Alzheimers Society.

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More details in the summer

• More details are expected to emerge over the next
  few months
• But plans are unfolding which could develop
  Garngoch as a flagship centre.

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Bricks and mortar, important though they are, are
just a part of improving Mental Health
Services. Mental illnesses are very common, but
the vast majority of these patients, need care
and support at home, not as an in-patient in a
hospital. We are looking at ways to improve the
community support we provide, so patients can
stay in their own homes, with their family and
loved ones around them, as they recover.
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Minor injury unit
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Singleton Minor Injury Unit
One of the reasons were here today, is to talk
about developments at Singleton Hospitals Minor
Injury Unit. (MIU) It isnt, strictly speaking,
part of HealthVision Swansea at all, but changes
to the way it has been run will actually help to
support the Ambulatory Care Services we mentioned
earlier.
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Since the start of January, GPs now man the MIU,
supported by a specialist emergency care nurse.
The change was driven by the urgent need to find
a safe and reliable alternative to the old
system, which was badly affected by staff
shortages, and was often being forced to shut at
little or no notice.
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Swanseas GP Out of
Hours Service is already based at Singleton, so
it made sense to have GPs man the MIU as well.
Patients have seen very little change when they
use the new-look MIU other than it is always
open! A small number may need to go to Morriston
for tests or more specialised treatment, but the
majority are unaffected. We are asking patients
to ring 08458 501 362 first between 10pm and 8am
to help doctors manage their workload and shorten
patient waiting times. But no-one is turned away
if they havent phoned first.
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So far the changes have been working well.
Monitoring will continue in the months ahead, so
we can resolve any problems quickly. Working
closely with GPs like this is really helping to
lay a strong foundation for our vision of
improving NHS care at all levels in Swansea.
Its cutting through artificial NHS boundaries
and putting the focus on the patient, instead of
the system.
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This is a very positive beginning as we move
forward to develop plans like the Ambulatory Care
Centre at Singleton Hospital. One of its key
aims will be to provide seamless, easy-to-access
patient care, with hospital and primary care
staff working in partnership, just like we are
beginning to now.
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Tell us what you think
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We hope this presentation has given you a brief
overview of some of the ideas we have and the
overall direction were taking to improve NHS
care in Swansea. As plans develop, well do all
we can to publicise them - ahead of any formal
consultation process to encourage further
suggestions and viewpoints.
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Were more than happy to answer any questions you
may have now, and welcome your views and
comments. As well as the Question and Answer
sessions which will follow, feedback forms are
also available if anything occurs to you later
just send them on to us and well get back to you
as soon as we can. Thanks for listening.