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Gloucestershire CCG response

See below for the response from Deborah Lee, Chief Executive of Gloucestershire Hospitals NHS Foundation Trust, following my letter querying reports of further downgrades to Cheltenham General Hospital.


Dear Max,

Thank you for your letter dated 27th September in which you raise four questions which I have aimed to respond to below.

I have also responded to your more general reference to the term ‘downgrading’ when describing previous and proposed changes to the configuration of clinical services at Cheltenham General Hospital.

In order to enable us continue to deliver safe care, with increasingly better outcomes and experience for our patients and their families, Gloucestershire Hospitals NHS Foundation Trust (GHFT) has successfully centralised a number of services at the two acute hospital sites within the county; either Cheltenham General Hospital (CGH) or Gloucestershire Royal Hospital (GRH). All of these changes were in response to the evidence that patients would be better served by bringing together scare skills, expertise and resources. Recent examples include:

  • Centralised at CGH: vascular surgery, urology, ophthalmology, orthopaedics
  • Centralised at GRH: obstetrics, acute paediatrics & neonatology, ear nose & throat, trauma

Over the same period, for the same quality and safety reasons, some specialties have been centralised at regional centres e.g. Major Trauma Centre at North Bristol NHS Foundation Trust again reflecting the overwhelming evidence that more specialist care benefits from the centralisation of resources.

Our aim has always been, and remains, to ensure a vibrant future for both our hospitals whilst recognising that, increasingly, service standards, evidence and consequently models of care are evolving nationally and we want to ensure that care in Gloucestershire remains at the forefront of emerging best practice. Work with our health and social care partners, as part of the One Place Programme, is supporting this aim as a means of also responding to the increasing challenges facing health and social care set out in One Gloucestershire’s Sustainability and Transformation Plan (STP).

Responding to the four issues you raise

1. £20 billion NHS funding announcement and link to maintaining services at CGH

We welcome the NHS funding announcement made by the Prime Minister in June 2018 as part of the NHS70 celebrations and look forward to receiving the detail on how additional £20.5 billion, (which we understand will be phased in before 2023/24) will be passed down to hospitals and other health care organisations. Elements of this funding are already benefiting our Trust through the recent three year NHS pay award, which sees some of our lowest paid staff receive the most significant increases; additional capital investment in the upgrading of the Cheltenham and Gloucestershire Royal A&E departments, funding for IM&T developments and just this week additional capital for another linear accelerator at Cheltenham General. I do not recognise your comment about the continuing move of services away from CGH; just three weeks ago we secured the support of the HCOSC to pilot the centralisation of gastroenterology at the Cheltenham site and last winter brought elective orthopaedics to the Cheltenham site.

You asked me to confirm that the General Surgery proposals are not a stepping stone towards further changes to CGH A&E department. There is consensus among our clinical team that emergency General Surgery should be centralised at GRH and the proposal is supported by the South West Clinical Senate and nationally by the Getting It Right First Time (GIRFT) programme. CGH A&E and Minor Injury and Illness Unit (MIIU) can continue to provide urgent and emergency care services to the population of Cheltenham with Emergency General Surgery centralised at GRH. The clinical case defines a range of patient benefits that will be achieved through centralisation, similar to those we have delivered through the pilot reconfiguration of Trauma and Orthopaedics.

However, as you are hopefully aware, through the One Place Programme, Gloucestershire Integrated Care System (ICS) is currently reviewing the future model of care for urgent and emergency care across our county which will consider the future nature of all such services in the county and how we can best ensure that recent national guidance on these services is met in Gloucestershire. Any changes proposed will be taken through the HCOSC and subject to public engagement and formal consultation, which will be led by the ICS.

2. Link between £39.5M capital award and service reconfiguration

The planned level of capital investment on both the Gloucestershire Royal Hospital (GRH) and Cheltenham General Hospital (CGH) site is a prerequisite for delivering sustainable high quality hospital services for people in Gloucestershire. The capital investment case is not dependent on consultation; the proposed scheme is necessary to address shortcomings in the current estate and secure the operational efficiencies required irrespective of the outcome of any future service configuration. The building design will take account of both current and likely future need so that no options for the future are rule in (or out) as a result of the capital scheme.

3. Link between service centralisation and clinical vacancies.

Without doubt, one of the biggest challenges facing the NHS is ensuring the availability of staff with the requisite skills and experience and providing a working environment which ensures those staff commit to a future in the NHS and benefit from the training and development that comes with tenure. We are fortunate in Gloucestershire in the very high calibre staff of staff we attract but we too are affected by many of the national staff shortages in key areas such as emergency medicine, diagnostics, care of the elderly and vacancies across a wide range of medical training posts. Sadly, workforce gaps throughout the NHS continue to rise. With respect to Gloucestershire’s figures, I will need to provide these to you next week when my Director of People returns and can validate the monthly figures.

Whilst workforce challenges often form part of a clinical case, they are rarely the sole driver though the supply of a suitably trained and resilient workforce is inextricably linked to our ability to deliver safe services and excellent outcomes. I can assure you that, contrary to some views, none of our service changes (past or proposed) have been done for the convenience of staff. To gain support, a service centralisation case needs to demonstrate how it will address workforce challenges alongside how it will improve (or prevent the deterioration of) patient safety, outcomes and experience.

4. Were details of service changes discussed with Jeremy Hunt in November 2017?

Recognising it is not typical to share the content of private conversations, in the spirit of demonstrating our commitment to openness, I am happy to respond.

The Secretary Of State for Health visited the Trust as part of his national programme of visits highlighting the importance he placed on patient safety, during his tenure. Aside from the formal aspects of his visit, which included a presentation to more than 50 Trust staff on his vision to make the NHS the safest healthcare system in the world, informal discussions took place covering a wide range of topics. However, as proposals for service change had yet to be developed, these were not discussed.

In conclusion, my commitment remains ensuring that the residents of Gloucestershire can receive the very best care, with outcomes and experience comparable to the best in England and that our hospitals are increasingly seen as a place the very best staff want to work. I remain committed to local access, where it can be delivered without compromise to the goals above.

Finally, thank you for confirming that you and your colleagues are keen to continue an active role in discussions around the future of Cheltenham General. I hope this offer extends to discussions on the future model of health and social care provision across Gloucestershire. In moving to an Integrated Care System (ICS) it will be important we describe any future changes to either acute site in the wider context of how services will be delivered by all health and social care providers. The ICS is a huge opportunity to reduce the reliance of local people on hospital based care, which will benefit all, in my view.

Kind regards


Deborah Lee

Chief Executive

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