Wednesday, 25 April 2018

Proof that new Townlands is good for us

THE New QEII Hospital in Welwyn Garden City opened fully to patients on June 15 last year.

THE New QEII Hospital in Welwyn Garden City opened fully to patients on June 15 last year.

The £30million hospital replaces an old and somewhat dilapidated building that is now closed to the public and its land is being used for housing and a care home.

The hospital has 443 rooms and no beds. The intermediary care beds are located in care homes across the area with an excellent level of medical treatment linked to the hospital.

I went to this hospital because it seemed to have so many comparisons with what is being proposed for Townlands in Henley.

I wanted to follow up on concerns expressed by constituents in Henley and see for myself where and how it was already working. What I found was a thriving hospital with a fully developed ambulatory care service.



The main hospital with full accident and emergency is located some 14 miles away at Stevenage.

I spoke to patients about their experience of the hospital. Take Dave, for example. He could not speak highly enough of the treatment he had received. He called in every day for treatment and then got on with his life at home.

This was revolutionary — doctors had confirmed that otherwise he would have required a debilitating 56 days of medication while staying in hospital.

Dave’s experience of hospital stays had shown up the disadvantages of them. He pointed out that people were so much more likely to improve and feel better if they could stay at home. He was clearly a great enthusiast.

I was shown round the hospital by Rachel Quinn, an acute medicine consultant, Dagmar Loue, the senior nurse from the ambulatory care unit, and Jacquie Bunce, the lead person from the clinical commissioning group responsible for seeing the development of the new hospital through from the inception of the idea to completion last year.

The main difference between Townlands and the way the QEII was approached comes down to time, not substance.

The QEII project was much bigger, involving a change from a traditional- style district hospital to this new-style provision and had taken more than seven years to come together. During this time there was considerable opportunity for the project to mature and for the commissioning group to take people with them.

These people included the local Conservative MP Grant Shapps, who had reservations about the change and also campaigned for the retention of an accident and emergency department at the hospital instead of moving it to the acute care hospital in Stevenage.

The unit was replaced at the QEII by an urgent care centre, essentially a minor injuries and minor illnesses unit run by GPs.

What the extra time had provided was the opportunity to communicate the benefits of the proposed new system widely and to allay any fears that people had over the change.

I asked about where the impetus for the change had come from. The benefits of an ambulatory care model had come from clinicians — two of whom were showing me round.

They pointed to the wealth of evidence from the Royal College of Physicians to support the model and how this had become best practice. What they had been trying to achieve with the reorganisation of medical facilities at Hertfordshire hospitals was to ensure that there was the best use of resources within the county for the benefit of patients — the right care in the right place.

This was clinically driven, not policy driven by the Government, just as at Townlands.

As my recent question to health ministers in the House of Commons showed, the policy element of this was about ensuring greater choice, particularly in end-of-life care so that people are able to be cared for in the place they choose and which is appropriate to their needs.

Most people wanted to be cared for at home. The decision to locate specialist services in strategic locations around the county was down to local clinical decision-making.

The QEII provides an interesting range of services. There are two GPs working there, particularly to deal with the out-of-hours service they provide. They are also able to deal with antenatal, anti-coagulation, hearing, imaging and X-ray and radiology, endoscopy, breasts and fractures.

There is place to drop people off outside and plenty of parking.

On the day that I visited, the hospital was heaving with people wanting to access these services.

However, it was the ambulatory care model which I had come to see and to better understand how it works as part of the overall package of healthcare.

Ambulatory care is where some conditions may be treated without the need for an overnight stay in hospital. As in Dave’s case, the service had taken away the need for an intermediary care bed for his treatment.

The advantages of this are clear. It allows patients to get on with their lives and to improve their recovery in a way which hospitalization cannot.

From what I could see and from the conversations I had, the system was working well and to the obvious delight of patients.

Of course, there is still a need for some intermediary care beds to be provided and the Hertfordshire system acknowledges this through the provision of such beds in care homes with strong medical care provided through the hospital.

In Hertfordshire there has already been a close integration of social care with the NHS which has made this easier. But to focus too much on this misses the point that ambulatory care is in the best interests of the specific patients using its services and of the patient population as a whole.

It also showed that it is not just Henley that is experiencing this change in the provision of medical services but that it is widespread and driven by clinical experience.

Visiting the hospital was a useful exercise for me and helped allay some of the concerns constituents had raised.

What it showed was how a system that included a strong local hospital without beds in the hospital itself had become the mainstay of non-GP medical facilities in the area.

The use of beds in care homes to provide the clinical beds to treat people with intermediary needs was crucial and was based on clinical evidence. Commissioning beds across the area also allows for greater opportunity for everyone to be nearer their home, which makes things easier for relatives.

A similar exercise had been conducted to the one at Henley to ascertain the number of beds required and the numbers were  comparable.

We must not forget that Townlands has up to 14 beds associated with it — some permanent beds and others on demand beds.

It is a great shame that we have not had the chance for a broader and longer discussion on this and that the withdrawal of Sue Ryder from the Townlands scheme helped force the new model forward.

In any visit, you are in the hands of those conducting the tour but my guides answered all my questions and provided the reassurance I requested.

Although it is not possible to answer all questions from a visit like this, I was pleased that I took the initiative to go see for myself what is happening in a nearby county.

I will leave the last word to Dave. He praised the staff at the hospital, pointing out that without good staff nothing would get done.

He said that his whole experience of the hospital had been so good that if we needed his help in telling the people of Henley just how much patients like him get out of the new system he would be very happy to come and talk to us. You can’t do better than that.



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