Right care, Right place, Right time - saving lives
How will I access specialist services?
Under the Healthier Together hospital plans to drive up quality and safety, ‘shared single services’ will be formed – networks of linked hospitals working in partnership. This means care will be provided by a team of medical staff who will work together across a number of hospitals within the shared single service.
Every hospital already specialises in providing certain types of care, for example some specialise in stroke care, others in cancer care. Similarly, one of the hospitals within each of the single services will specialise in emergency general surgery (surgery on the abdomen and bowel) for patients with life threatening conditions. All hospitals will improve to ensure they meet the quality and safety standards, will keep their existing specialisms and continue to provide care to their local populations as they do now.
These specialist services exist to ensure that when a patient needs a specific procedure, a highly experienced team is available at the right place and right time. Working in this way ensures that doctors working within these teams are performing the same procedures day in, day out, building up excellent levels of expertise in treating these complex conditions. There is evidence that consolidating services onto fewer hospital sites in this way has already saved lives and improved patient care and we want to do more of this. Already in Greater Manchester, major trauma and stroke services have been changed to work in this way and we have used learning from the changes to these services to design the ‘single service model’ for changes to emergency medicine and specialist abdominal surgery.
This new way of working is entirely consistent with NHS England’s vision set out in the NHS Five Year Forward View, to develop networks of linked hospitals to ensure patients with the most serious needs get to specialist emergency centres, and consistently receive the highest standard of care.
How will I know which hospital to go to?
In an emergency, you don’t need to worry about which hospital is right for you. Ambulance staff and your hospital care team will decide the best place for you to go, to make sure you and your family get the right care, in the right place, at the right time.
Via ambulance: Currently in Greater Manchester some hospital emergency services are already delivered in only a few hospital sites – for example major trauma (if you have a car crash or bang your head). If you have a trauma incident now and you call an ambulance, the paramedics will use a tool called Pathfinder to help them assess which hospital you need to go to for the specialist treatment you need. The same Pathfinder tool will be used in future for paramedics to assess which hospital you need to go to for specialist A&E or General Surgery care if you are very seriously ill. The paramedics will therefore take you to the right hospital for your care.
Via A&E: If you do not go to hospital by ambulance, the doctors in A&E will assess you and if they decide that you need to go a specialist hospital for your treatment, they will arrange for you to be taken directly to the appropriate hospital. In some cases, patients are too ill to be moved between hospitals. For these patients the appropriate doctor will be called to the hospital to treat the patient. This happens now and there are agreed protocols to follow at each hospital to make sure that the right doctor can attend quickly.
Does this mean I will have to travel further?
The numbers of patients who need this type of specialist treatment are very small. Under the proposals some of these patients may need to travel to a hospital that is not their local hospital to access the very best standards of care. It is vitally important to make sure that all residents can access these specialist services in a reasonable amount of time.
The following targets that have been set to ensure that patients, their friends and family can access specialist services.
- All locations in Greater Manchester can access specialist services by ambulance / car within 45 minutes
- All locations in Greater Manchester can access specialist services by public transport within 75 minutes (1 hour and 15 minutes)
This analysis was done in two ways:
- How many of the population can access services within the standards described above?
- How much longer might people have to travel to access Specialist services under each option?
Detail about how this analysis was completed is given below.
1. How many of the population can access services within the standards described above?
This was analysed using data provided by Transport for Greater Manchester. This data shows the time and distance between each location in Greater Manchester with each hospital in Greater Manchester for both car and public transport journeys. The car journey times are generated using a system called Saturn – a computer model of the road network. The information in this model has been calibrated with over 1 million actual journeys. The public transport journey times are generated from timetables and walking times between legs of a journey.
The current journey times from each location in Greater Manchester to the closest hospital were identified. The percentage of locations able to access the local hospital within 45 minutes by ambulance / car and 75 minutes by public transport was assessed - this is the current compliance with the transport targets. All locations can currently access the closest hospital within 45 minutes by ambulance / car. Not all locations can reach their local hospital within 75 minutes now.
Under each option the journey time from each location in Greater Manchester to the nearest specialist hospital by both car and public transport was analysed. Note in a small number of locations, this could be outside of Greater Manchester. The percentage of locations able to access the local hospital within 45 minutes by ambulance / car and 75 minutes by public transport under each option was assessed. All locations can still access the nearest specialist site within 45 minutes by ambulance / car under every option. For some options, fewer locations are able to access specialist services within 75 minutes by public transport.
Healthier Together has worked closely with the North West Ambulance Service (NWAS). Senior doctors and paramedics from NWAS have been involved in designing the model of care. The Ambulance Service have played a vital role in developing the model as they will help in directing patients to the most appropriate site to get the care they need. To do this, NWAS will use their Pathfinder tool, which allows qualified ambulance clinicians to determine the most appropriate place for patients to receive their treatment based on their presenting symptoms. This model is already used in Greater Manchester for Stroke and Trauma care. Healthier Together clinicians have worked with NWAS to develop a new Pathfinder tool to direct patients to the right site for emergency medicine and general surgery and will audit this to ensure safety and accuracy before any changes are made.
2. How much longer might people have to travel to access Specialist services under each option?
Data on the patients who attended hospitals in Greater Manchester in 2012 / 2013 was analysed and those patients who needed specialist treatment identified. The hospital that these patients would need to travel to receive their specialist care under each option was identified. Any additional journey time that it would take to reach this hospital compared to the hospital they attended in 2012/2013 was identified. The total additional minutes that would need to be travelled under each option was added up.
Want to be kept up to date on what happens next?
Sign up for our mailing list and we'll send you regular updates of changes to the NHS in Greater Manchester.