Grantham Hospital ‘sits between’ urgent and emergency

Dr Suneil Kapadia
Dr Suneil Kapadia

With the threat of a £350 million healthcare deficit across the county if nothing changes in five years, United Lincolnshire Hospitals NHS Trust’s medical director spoke to the Journal about what this means for Grantham Hospital.

Dr Suneil Kapadia revealed this figure was the latest projection for what the combined deficit of all health and care organisations across Lincolnshire would be in five years if things remain the same.

He therefore stressed the need for the new model being brought in after consultation through the Lincolnshire Health and Care (LHAC).

Set up in 2013, LHAC has seen the trust, Lincolnshire County Council, Lincolnshire’s four health clinical commissioning groups (CCGs), the Lincolnshire Partnership Foundation Trust, Lincolnshire Community Health Services and East Midlands Ambulance Services working together on plans.

Dr Kapadia was questioned on the ongoing concerns regarding what changes would be seen at Grantham’s accident and emergency department as a result.

He said: “I think the first thing to appreciate is what’s coming out about NHS England in Bruce Keogh’s review of emergency services. There’s been some very clear definitions and criteria of what’s expected.”

NHS England’s Medical Director Sir Keogh’s review sets out three levels – urgent care centres, emergency care centres and major, or specialised, emergency care centres.

Dr Kapadia explained: “There are clear sets of minimum criteria that you need to deliver to be called an emergency care centre.

“In relation to Grantham we anticipate that in practice we will see the same kind of patients as is currently the case but it wouldn’t necessarily have the criteria for an emergency centre. At the same time it’s not strictly speaking an urgent care centre – it sort of sits between the two.”

Urgent care centres would provide access to walk-in minor illnesses and injuries. In medical emergencies patients are more likely to be directed to an emergency care centre, while a major emergency care centre would have specialist services including for heart attacks, strokes and major trauma.

Dr Kapadia said: “Grantham will still be expected to see the same things but we’re moving away from the current A&E departments. Whether it meets the criteria for an emergency centre remains to be seen.”

He added: “People get hung up on the terminology of accident and emergency. It’s really can you be seen for your particular problem to the standard expected by the public and by the external regulators.

“The aim is to improve our quality across the county. For some services this might mean you have to travel further to get better quality.”

Asked if difficulties for patients and families to get to treatment further away were being considered, he said: “You have to take into account travel times, you have to take into account the standards that need to be met and can you deliver them, and you have to take into account staffing.”

He said: “When it came to be projected the deficit of the health community across Lincolnshire is in the order of £350 million in five years - that’s if we do nothing. Clearly there’s an incentive to see if we can try to alter things.”

In 2013/14 ULHT treated in the region of 145,000 A&E patients – including around 28,000 at Grantham’s A&E. “We do that through three sites, pay for three lots of overheads, three lots of rotas, and three lots of on-call staff,” he said.

Dr Kapadia spoke to the Journal after a presentation with ULHT deputy chief executive Kevin Turner to South Kesteven District Council members. They are consulting with the various councils and CCGs in the area. “There isn’t a secret group looking to decide what’s going on. We’ve been very open about it. We’re aiming for a sensible conclusion over the summer, with a view to having a range of options to then explore in consultation with the wider community.”

After the presentation, Coun Ray Wootten said: “It sounds to me like Grantham will become an urgent care centre, which is what I was expecting. But I was reassured that Grantham will still have a positive future and role.”

He added: “A question I put to Kevin Turner was on the plans for a day surgery unit which was mentioned several months ago at their AGM, and at the last board meeting received the reply ‘that it would cost £5 million and not affordable’. Bearing in mind the proposal to demolish the old hospital and build the day surgery nearby I was very disappointed to hear this.”

However a ULHT spokesperson said that although altered from the proposal originally put forward, plans for a day surgery still remain. “We are still in the process of working through proposals to expand day case services at Grantham hospital and this is very much work in progress,” they said.

“We remain committed to extending elective and day case services at the site. An initial proposal was not workable so we are continuing to work on plans for this expansion, as is part of normal business process.”