Agenda item

To consider a presentation in respect of the development of the Same Day Emergency Care Centre at Rotherham Hospital.

 

The Chair welcomed the Managing Director, Bob Kirton and the Chief Operating Officer, Sally Kilgariff, TRFT to the meeting and invited them to introduce the presentation.

 

The Managing Director, TRFT explained that they had recently taken up the role previously occupied by Michael Wright who had regularly attended the Commission’s meetings, having undertaken the same role previously at Barnsley. They were now in their third month of getting to know and understand the Trust and were working closely with partners through the Health and Wellbeing Board, Place Partnership and Rotherham Together Partnership.

 

The Managing Director, TRFT outlined their intention to set out the plans for the Same Day Emergency Care (SDEC) Centre, which was essentially an extension of the Urgent and Emergency Care Centre (UECC) at the hospital.

 

They explained that the UECC was set up in 2017 and had proved very successful. The opportunity was presented to obtain some national funding through NHS England following a rigorous process that concluded in December 2024, which was pursues by the Trust with the support of the Board due to increased attendance at the UECC.

 

The Managing Director, TRFT explained that TRFT felt it was important to engage with the Health Select Commission at an early stage to offer an opportunity to influence the development of the SDEC in a way that reflected the needs of Rotherham people.

 

They described that the SDEC represented a £7 million investment through the national Additional Capacity Targeted Investment Fund (ACTIF), which aimed to increase urgent emergency care capacity and same day emergency care capacity within departments and the associated benefits to patient flow.

 

The Managing Director, TRFT summarised the practical purpose of the SDEC, and explained that when a patient presented at an emergency department, health professionals often knew what the patient needed but struggled to deliver the care required within the available space.  The SDEC provided the additional space needed to deliver care in one location, which reduced the need for costly and time-consuming admission which did not always deliver optimal patient experience.  Ultimately, its purpose was to support Urgent and Emergency Care demand, improve timely access and patient outcomes.

 

The SDEC implementation had also offered the opportunity to unlock additional benefits which addressed issues elsewhere within the Trust such as pre-op assessment, sexual health and the fracture clinic.

 

The Managing Director, TRFT explained that the Trust had had to move at pace to secure the capital, considerations around workforce and clinical models were simultaneous workstreams. They explained that staff engagement was undertaken, patient engagement and public engagement which took place the day prior to the Health Select Commission meeting. They outlined some of the areas of discussion from the public engagement event including accessibility for people with neurodiverse needs and dementia, the toilet facilities and kitchen facilities etc.

 

The Managing Director, TRFT explained that the aim was for the SDEC to open in June 2025, whilst the overall project comprised of a number of phases.  The Chief Operating Officer, TRFT distributed and described a site plan which saw movement of a number of services and clinics to different locations across the hospital site, with the planned moves intended to improve overall patient flow.  The example of the relocated fracture clinic, which delivered co-location with the orthopaedic clinics and wards and provided a dedicated facility across inpatient, elective, non-elective and outpatient areas with dedicated x-ray facilities, was cited. Sexual Health was also cited as an area of growing demand where relocation offered the welcome opportunity for growth and expansion. The final example referred to was the pre-op assessment facility which was relocated adjacent to day surgery, optimising patient flow and the patient pathway.  This was to be augmented by a dedicated drop-off area and reflected a tangible improvement for patients in terms of accessibility.

 

It was acknowledged that some disruption to services was expected whilst services were relocated, with some aspects of care already having moved to temporary location, however efforts were made to minimise the impact of any disruption and the benefits anticipated justified the level of disruption experienced for both staff and patients.

 

The Managing Director, TRFT explained that there was robust governance around the SDEC development, with progress updates reported regularly through the Trust’s internal governance structures. They provided an overview of the proposed layout of the SDEC, linked this to existing capacity pressures experienced within the UECC which were particularly evident at times of volume attendance and explained the positive impact this delivered to patient flow.

 

They emphasised that the Trust was keen to work with the public to refine the remit of the SDEC and maximise its impact.  This involved an element of engagement to ensure patients understood the offer within SDEC and that the UECC wasn’t always the first port of call.

 

The Chief Operating Officer, TRFT added that the Trust were working closely with community colleagues and teams, and the ambulance service to ensure appropriate referral pathways existed which aimed to minimise unnecessary attendances.

 

The Chair thanked the officers for the presentation and invited questions and comments.

 

Councillor Bennett Sylvester wanted to understand whether the relocation of the Sexual Health clinic would impact on the Diabetes centre. 

 

It was confirmed that it did not and there would be no change.

 

Councillor Bennett-Sylvester also queried whether the SDEC development was expected to relieve pressure on the Acute Medical Unit (AMU) and Acute Surgical Unit (ASU) which anecdotal evidence reflected did not deliver a positive patient experience and represented a ‘bottleneck’ in terms of patient flow and treatment.

 

The Managing Director, TRFT commented that in many cases, people believed that Accident and Emergency, or UECC in TRFT’s case was the greatest pinch point, but AMU and ASU were also highly pressurised as the reception points for all in-patients.  They described those areas as rewarding but challenging places to work.

 

They added that the principle of the SDEC was that it was for people that didn’t need full admission as an alternative route, and explained that people often thought of physicians working in emergency care as one big team but there was a distinct difference between emergency care physicians and acute care physicians.  In that sense, the SDEC represented a space where those clinicians and physicians could work side by side on agreed pathways and meant that patients could be assessed in that area rather than taken into the AMU.

 

Councillor Clarke commented that a common concern raised through Councillors surgeries was hospital parking.  Increased attendance, and increased patient flow inevitably meant an increased number of vehicles, and as such they queried whether the Trust were investing in the car parking or park and ride schemes.

 

The Managing Director, TRFT acknowledged that hospital parking was challenging in any setting.  The Trust had implemented automatic number plate recognition to parking facilities to simplify the process, and alongside that had increased the number of parking spaces, but accepted that there was more work to do and no easy solutions.  To their knowledge, park and ride facilities had not been considered specifically, but parking more generally was very much on the agenda.

 

Councillor Havard wanted to understand whether the SDEC would make it easier for patients with reoccurring issues to access ongoing treatment rather than having to go through complicated assessment processes each time.  They cited a personal example to illustrate the barriers presented to accessing ongoing care.

 

The Managing Director, TRFT advised that as a general principle, the NHS was good at providing emergency care, but aftercare was the area where it struggled as a service.  The purpose of the SDEC was to offer a clear pathway, predominantly concerned with medical issues such as deep vein thrombosis (DVT) to begin with, extended over time to address precisely those issues; direct access to the service at point of delivery rather than repeated triage and assessment.

 

Councillor Havard queried whether GPs were appraised of hospital care a patient had received so that they were mindful of this in the event that patients needed additional support in the period of time shortly after receiving treatment at hospital.

 

The Managing Director, TRFT confirmed that GPs were always advised of the hospital’s interactions with patients, but acknowledged that through digital communication channels there were sometimes issues.

 

The Assistant Director of Transformation, South Yorkshire ICB added that there was a significant piece of work underway to make information sharing and communication more effective and patient centred. This work recognised differing approaches across different pathways and aimed to deliver a greater degree of consistency.

 

Councillor Thorp commented on the terminology used and the confusion changes to terminology can cause for patients and others accessing services and queried whether there would be sufficient clear signage to provide appropriate directions around the hospital estate.

 

The Managing Director, TRFT expressed the view that consistent messaging was key, but the Trust was working with staff and volunteers to ensure that patients and visitors were supported on site.

 

The Chief Operating Officer, TRFT added that the Trust were also exploring, doing something different with signage and potentially upgrading to digital signage which was easier to update.

 

Councillor Thorp noted the SDEC’s clear intent to deliver improvements in terms of patient flow and outcomes, but queried how TRFT proposed to measure success.

 

The Managing Director, TRFT confirmed that the level of funding secured necessitated comprehensive monitoring and evaluation throughout.  The premise was a different approach to delivering services in the face of increased demand and stagnant budgets, with the expectation that services operated more efficiently and in less overtly pressurised environments. In order to demonstrated that, the Trust were expected to implement checks and balances around take-up and outcomes, patient experience and staff satisfaction.

 

The Chief Operating Officer, TRFT added that the Trust had to be clear when they submitted the funding bid what improvements would be made across a number of metrics, with focus on the 4-hour emergency care standard.  The SDEC bid was based on an out of hours fracture clinic pilot which garnered positive results.  The SDEC bid was modelled on those principles.

 

Councillor Thorp queried the relatively small waiting area detailed on the SDEC plans and that whilst there was a proposed dedicated drop off zone for the pre-op assessment centre relocated to the rear of the hospital estate, no indication was given that the needs of those arriving on public transport had been considered.

 

The Managing Director, TRFT reflected that testing out the proposals and the potential shortcomings was the purpose of the engagement activities that were undertaken, and added that TRFT were working through identified issues and concerns, such as the one highlighted by Councillor Thorp, to develop solutions.

 

The Chief Operating Officer, TRFT expressed the view that Councillor Thorp had raised a valid point which required further exploration.  With respect to the waiting area the Trust had modelled the numbers of patients coming through against waiting times and factored in the expectation that patients would be seen more quickly and would not accumulate in the waiting area. Some patients were expected to stream into existing the existing UECC waiting area or Paediatric waiting area.  The overarching intent was to have different waiting areas for different categories of patients based on evidence that reflected that helped patients understand their place within and reduced friction around differing waiting periods for different types of care or clinicians and physicians.

 

The Managing Director, TRFT noted that it was amazing that the team had worked so quickly to put the bid together, but emphasised that the proposals shared in the agenda pack were the best first attempt and there was the opportunity to be flexible with the space based on feedback received.

 

The Chair queried the reference made to making better use of existing resources.  They wanted to know whether that meant there were no additional staff resources to support the SDEC, and if so whether that would adversely impact other hospital services.

 

The Chief Operating Officer, TRFT explained that all of the services that were being brought together under the SDEC umbrella were functional elsewhere within the hospital and the intention was to create space and capacity through co-location, collaboration and efficient pathways.  Significant investment in staffing within the service areas that comprised the SDEC had already been made, such as the increased UECC workforce in terms of Doctors, Clinical Fellows, Nursing and Reception staff.  Further recruitment was planned as needed.

 

Councillor Yasseen applauded the effort that went into securing the SDEC investment capital.  They commented that it would have been helpful if the information provided in the agenda pack had provided some basic data concerning the drivers for the SDEC development such as the increased levels of attendance at the UECC, perhaps illustrating Rotherham’s comparative position to other Accident and Emergency environments to allow the Commission to consider the impact over time.

 

The Managing Director, TRFT advised that the drivers of emergency care attendance was an extremely complex area, and one which had dominated conversations within and beyond the Trust. Increased attendance was the national trend within Accident and Emergency Departments and Rotherham was no exception to this.  Some drivers were due to epidemiology, population health, co-morbidities and health inequalities, the latter of which were perhaps felt more acutely in Rotherham than in other areas. It was also noted that there was increased incidence of working age patients due to the perception that hospitals were a faster route to accessing care than primary care services.

 

The Chief Operating Officer, TRFT added that the Trust were engaged in collaborative work with Healthwatch Rotherham around understanding attendance behaviours. Growth was seen in both walk-in and ambulance attendance, and it was felt important to understand the finer detail. It was suggested that it may be appropriate to share those findings with the Health Select Commission once that work was complete.

 

Councillor Yasseen echoed Councillor Clarke’s comments relating to parking at the hospital, and added that they didn’t feel that the Trust always understood its role as part of a wider residential community, with a significant proportion of the impact of increased attendance around access and parking being borne by the hospital’s residential neighbours, where permit boundaries were imposed sequentially when parking concerns were displaced from one location to another. They wanted to know how the Trust intended to respond to that element of their community responsibility.

 

The Managing Director, TRFT explained that the Trust understood the concerns around parking and accepted that it was a big issue and one that they were happy to work to resolve.

 

Councillor Bennett-Sylvester commented that, relevant to discussions around car parking, having attended the Badsley Moore Lane site recently, they were aware of a number of vacant or disused units and queried whether the possibility of relocating certain services there to alleviate pressures on the main hospital site had been considered.

 

The Managing Director, TRFT confirmed that this was discussed and outlined a Barnsley project that had successfully relocated a community diagnostics centre which reduced visits to the main hospital site by approximately 60,000 annually. They agreed that there was scope to consider alternate solutions to service accessibility and conversations were being taken forward regarding the overall estates strategy, particularly with respect to community delivery.

 

The Chief Operating Officer, TRFT added that the Trust had already moved quite a few services into the breathing space facility and accepted the benefits around parking and accessibility. The Trust were considering further services that could be offered from that site, mainly diagnostic services, and were considering further funding bids to extend services at that location.

 

The Chair wanted to understand how the SDEC development aligned with the findings and recommendations in the Darzi report and whether investment in hospital-based delivery of NHS serviced best served the needs of Rotherham residents in the long term. 

 

The Managing Director, TRFT confirmed that Same Day Emergency Care featured as an example within the Darzi report and in terms of improved outcomes, responsiveness to the population need, improved productivity and improved accessibility, the proposed SDEC was a great fit but acknowledged the targeted shift for the NHS as a whole from hospital into community services.  They reflected that the response from the Commission in relation to the SDEC in terms of both the support and challenge was helpful, and clarified the emphasis the Trust had placed on accessibility and which had justified its location at the hospital in Rotherham’s case due to service interdependencies and targeted pathways.  The intention was that SDEC would augment facilities like the transfer of care hub, which was a multi-team co-ordination centre for Rotherham, comprised of social care, community care, primary care, and the ambulance service, enabling them to direct patients straight into SDEC pathways, avoiding the UECC.

 

They also explained that alongside the SDEC development, work was underway on a community services review in conjunction with partners which considered primary care, social care, mental health and voluntary sector service modelling and configuration, which they felt reflected that work in progress was not solely hospital centric.

 

The Assistant Director of Transformation, South Yorkshire ICB added that, linked to Councillor Bennett-Sylvester’s previous question, considerations around what services should rather than could be delivered in what setting were important and necessitated a strategic approach which included all place partners.  They acknowledged that whilst there was an opportunistic element to the SDEC funding bid, there was real commitment to that collaborative strategic direction setting to best serve Rotherham people.

 

The Chair queried how public engagement event which took place on 26 March 2025 was publicised, whether it was well attended and whether there were any clear emerging themes from feedback received.

 

The Chief Operating Officer, TRFT advised that early feedback was positive and provided opportunities to take further discussions forward.  The Trust’s Patient Engagement Team were involved in promoting the event, but more specific details were not known.

 

The Chair asked whether any other engagement activities were undertaken or planned with stakeholders.

 

The Chief Operating Officer, TRFT confirmed that the Trust had engaged with all staff groups involved in the SDEC development and involved them in developing the plans and defining service requirements. Staff and Patient governors were consulted as were unions.

 

The Chair thanked officers for their responses to comments and questions.

 

Resolved:-

 

That the Health Select Commission:

 

1.    Noted that the investment secured by TRFT to address patient flow and capacity challenges through the development of the SDEC (Same Day Emergency Care) and the UECC (Urgent and Emergency Care Centre) expansion at Rotherham Hospital was welcomed.

 

2.    Requested that members be provided with an overview of feedback received via the public event that took place on 26th March 2025, and any other consultation activities undertaken relating to the SDEC development/UECC expansion.

 

3.    Requested a further update be provided regarding the SDEC development/UECC expansion at an appropriate stage during the next municipal year, to give members the opportunity to consider its impact for Rotherham residents post implementation. The appropriate update method would be confirmed at a later stage.

 

4.    Requested that TRFT provide an update regarding the collaborative work with Healthwatch Rotherham regarding attendance behaviours. The appropriate update method would be confirmed at a later stage.