During 2018 we engaged with our communities on hospital services to start developing options for how services need to change. We undertook a survey and number of public events to explore this.

All of the useful feedback we received has been shared with clinicians and senior leaders to consider these views and experiences when thinking about the options for how we might deliver these services in the future. Any options that suggest significant change to hospital services will go through NHS England assurance processes and public consultation before service changes are made.

This previous engagement has helped us to identify some emerging options which we would now like your views on before they are finalised for the formal public consultation. We would welcome feedback on these and in particular your thoughts on travel and transport and technology to support these possible changes in services.
Please visit our website for more information about these services, explanations of why we need to change and the benefits of these emerging options: https://www.lincolnshire.nhs.uk and get involved in a #HealthyConversation.

We would like your views on all of the questions, but if you don't want to answer some or feel they are not relevant, please just skip them and move onto the next question.

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* 1. Please tell us the first 5 digits of your postcode

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* 2. Are you:

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* 3. If you have used any/all of the 3 main hospitals in Lincolnshire within the last 12 months what was the main way you travelled to each of these hospitals? (one tick per column)

  Lincoln County Hospital Pilgrim Hospital, Boston Grantham Hospital
Own car
Friend / family
Public transport
Taxi
Patient transport (non emergency ambulance)
Emergency (blue light) ambulance
I have never visited this hospital
Other please specify below

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* 4. Over the last 12 months, approximately how often have you visited each of the 3 hospitals? (one tick per column)

  Lincoln County Hospital Pilgrim Hospital, Boston Grantham Hospital
Only once or twice
Less than weekly
Weekly
Less than monthly
Monthly
More than monthly
I have never visited this hospital
We recognise that in an emergency you will go to your nearest, most appropriate hospital. Please consider the following questions for outpatient or planned appointments.

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* 5. Which is the main hospital site you have travelled to? (please tick one box)

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* 6. Why is this the main hospital you travel to?

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* 7. For each hospital please tell us if there is ONE main thing that makes it difficult to access services at each hospital (one tick per column)

  Lincoln County Hospital Pilgrim Hospital, Boston Grantham Hospital
It is too far away from where I live
It is difficult to get to using public transport
There is not enough parking at the hospital
I don't know where it is
Other, please specify
Improvements in information technology is important for all of the service transformation in Lincolnshire for both staff and patients. In a rural county like Lincolnshire, some patients have to travel long distances for appointments -  we need to look at how technology can help, such as self monitoring technology and video/skype consultations so patients do not have to travel unnecessarily.

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* 8. Virtual consultations could be phone or video call with a clinician rather than needing to travel for a face to face appointment.

Please tell us to what extent you would like to be offered a virtual consultation instead of having to travel to an appointment?

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* 9. Please tell us the reasons for your answer

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* 10. Some digital solutions can be used at home to monitor your own health (for example, self monitoring or remote monitoring technology such as blood sugar monitor, blood pressure monitor, activity tracker).

To what extent would you use these if that meant you could avoid an unnecessary appointment or stay in your home for longer rather than having to go into hospital?

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* 11. Please tell us the reasons for your answer

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* 12. If you were offered support and training to use digital technology to what extent would this encourage you to use it?

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* 13. Family members or carers could have access to parts of your medical records with your permission. This would mean that they could check your upcoming appointments, see your prescribed medications or contact a medical provider on your behalf.

Please tell us if you would like to give permission for family members or carers to access your medical records

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* 14. Please tell us the reasons for your answer

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* 15. If you have any concerns about using digital technology such as having video/skype consultations, using self monitoring technology or apps please tell us below                                                                                                      

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* 16. If there is anything that would help you to use these technologies to take advantage of the benefits they bring, please tell us below                                                                                                   

Breast services

Breast services refer to a range of screening, diagnosis and treatment of breast problems, including cancer. These services are currently delivered across Lincoln County, Pilgrim and Grantham hospitals with a small number of patients seen in Louth Hospital. There is also a mobile breast screening mammography service that travels across the county.

We think that a centre of excellence approach would work well in Lincolnshire as has already proven so in rural Cornwall – visit our website to see a case study. We think this will help us address the quality of care issues and shortage of specialist staff.  

In practice, this emerging option would mean that all follow-up outpatient appointments and routine breast mammography screening services would continue to be available across the county as they are now. These appointments are where most patients receive their care.  First outpatient appointments and all surgery would be provided at the centre of excellence. This would enable specialist staff to fully cover rotas, see more patients and retain and develop their skills.  Together, this means patients will be seen more quickly and receive a better standard of care. 

Our emerging options indicate that this centre of excellence could be at Lincoln Hospital or Grantham HospitalThe NHS’s current preferred emerging option is Lincoln Hospital for this centre of excellence as it requires the least amount of capital funding.  If located at Grantham, any complex breast surgery would be done at Lincoln.

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* 17. Please tell us if you would have any problems accessing these breast services at Lincoln County Hospital and if you have any suggestions of how we could overcome this

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* 18. Please tell us if you would have any problems accessing these breast services at Grantham Hospital and if you have any suggestions of how we could overcome this

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* 19. Please tell us if you have any other comments or suggestions about our emerging options for breast services

Stroke Services   

Stroke services refer to a range of services for the diagnosis of stroke, acute treatment, rehabilitation and follow-up after discharge from hospital. Currently these services are delivered at Lincoln and Pilgrim Hospitals.  Diagnostic services start in our emergency departments and then patients have treatment on the acute stroke units in these two hospitals.  There is also a stroke rehabilitation service in the community that cares for people after they have been discharged from hospital. 

Our first emerging option, similar to that for breast services, is to take a centre of excellence approach, providing acute stroke care from the Lincoln Hospital site.  This is the NHS’s current preferred emerging option because it will provide the best model to meet national care standards for patients, and to recruit and retain staff.  

The second emerging option is to retain the current service at Lincoln and Pilgrim Hospitals but with an out of hours combined on-call rota being based at Lincoln.  

In both emerging options, our intention would be to enhance rehabilitation in the community across Lincolnshire to reduce the length of stay in hospital from 14 days to 7 days in line with national best practice.

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* 20. Please tell us if you would have any problems accessing these stroke services at Lincoln County Hospital and if you have any suggestions of how we could overcome this

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* 21. Please tell us if you would have any problems accessing these stroke services at Pilgrim Hospital, Boston and if you have any suggestions of how we could overcome this

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* 22. Please tell us if you have any other comments or suggestions about our emerging options for stroke services

Women’s and children’s services

Women's and children's services refer to a wide range of services across acute and community settings including obstetrics (maternity care), neonatal (care of premature or sick babies), paediatric (care of children) and gynaecology (care for women and girls, especially related to the reproductive system). 

Currently all these hospital services are delivered in both Lincoln and Pilgrim Hospitals. We have a neonatology intensive care unit at Lincoln Hospital and a special care baby unit at Pilgrim Hospital. Babies born pre 29-weeks and children under five who require surgery are all treated out of county. Women in Lincolnshire have a choice of giving birth at home or in a consultant-led obstetrics unit at these two hospitals.  Midwife services are available in the community and at home.  

There are two emerging options. 

The first emerging option is to have the following services at the two hospital sites;

At Pilgrim Hospital
  • to continue with a consultant led obstetric service with the addition of a co-located midwife-led unit
  • to continue with a specialist care baby unit caring for babies born from 32 weeks (the interim position is that it currently cares for babies born from 34 weeks. Prior to August 2018 it cared for babies from 30 weeks)
  • to have a short stay paediatric assessment ward for children needing up to 23 hours of care
  • to have low acuity paediatric in-patient beds overnight
  • to have paediatric day case surgery. 
At Lincoln Hospital
  • to continue with a consultant led obstetric service with the addition of a co-located midwife-led unit
  • to have a neonatal unit caring for babies born from 27 weeks
  • to have a short stay paediatric assessment ward
  • to have paediatric in-patient beds
  • to have paediatric day case and planned surgery.   
We would wish to keep the gynaecology services the same as now on both Lincoln and Pilgrim Hospital sites with our clinicians working as one team across these two sites. This is currently the NHS’s preferred emerging option.  

 
The second emerging option is to have consultant obstetric, neonatal and paediatric services at Lincoln Hospital and a midwife-led unit and short stay paediatric assessment ward at Pilgrim Hospital. Both hospitals will have midwifery-led units.

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* 23. Please tell us if you would have any problems accessing  Lincoln County Hospital for consultant led services or both consultant led and maternity services and if you have any suggestions of how we could overcome this

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* 24. Please tell us if you would have any problems accessing  Pilgrim Hospital, Boston for maternity led services or both consultant led and maternity services and if you have any suggestions of how we could overcome this

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* 25. Please tell us if you have any other comments or suggestions about our emerging options for women's and children's services

Medical services at Grantham Hospital
 
The medical services at Grantham Hospital support urgent and acute patients in the A&E Department, on the in-patient wards and in the out-patients department.  There is currently a range of medical conditions which Grantham Hospital does not provide services for, meaning that the most acutely ill patients with life threatening illness and injuries go to a more specialist site, first time to receive treatment.  Specialist doctors from Lincoln Hospital also remotely support Grantham Hospital staff and patients (using online technology) when required.   

There are two emerging options. 

The first emerging option is to maintain inpatient medical services at Grantham Hospital and adopt a new model whereby they are joined up with local primary and community services and managed as part of the local enhanced neighbourhood team.  This new model would be led by Community Health Services (not ULHT) with hospital doctors and the hospital services being part of an integrated service with GP services, community health and other local services. This is the NHS’s preferred emerging option.  

The second emerging option is to have no medical inpatient services at Grantham Hospital. Diagnostics and outpatients would continue.

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* 26. Please tell us if you would have any problems accessing acute medical beds at Grantham Hospital and if you have any suggestions of how we could overcome this

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* 27. Please tell us if you have any other comments or suggestions about our emerging options for acute medical beds at Grantham Hospital

Trauma and Orthopaedics

These services diagnose and treat a wide range of conditions of the musculoskeletal system. This includes bones and joints and their associated structures that enable movement - ligaments, tendons, muscles and nerves.  Currently, both urgent and planned care is delivered in Lincoln, Pilgrim and Grantham Hospitals, with additional activity in our local community hospitals.  These services are out-patients, minor procedures and operations. 

National clinical best practice evidence is that separating urgent work from planned work prevents operations being cancelled. Planned care sites have better outcomes for patients, lower rates of readmission, reduced lengths of stay and reduced risk of infections and injuries. 

We have been testing this way of working since August 2018 at Grantham Hospital and this pilot is due to conclude in April 2019.  This pilot has virtually eliminated cancelled operations.  The evaluation will help decide whether the best practice model of care works in Lincolnshire, including the extent to which non-complex trauma could continue at the Grantham Hospital site.  Outpatient services will remain at all sites.

Our emerging option is to make Grantham Hospital a ‘centre of excellence’ for planned and day case orthopaedic surgery.

Lincoln and Pilgrim Hospitals would provide some day case surgery and planned care for those patients with complex needs. Outpatient services would remain at Lincoln, Pilgrim and Grantham Hospital as now.

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* 28. Please tell us if you would have any problems accessing trauma and orthopaedic services at Grantham Hospital and if you have any suggestions of how we could overcome this

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* 29. Please tell us if you have any other comments or suggestions about our emerging option for trauma and orthopaedic services at Grantham Hospital

General Surgery
 
These services focus mainly on the abdominal organs; stomach, gall bladder, small bowel, colon, rectum and anus. Benign skin conditions and hernias are also included within general surgery.  This surgery is currently carried out at Lincoln, Pilgrim and Grantham Hospitals, with more complex cases seen at Lincoln and Pilgrim Hospitals only.

Our emerging option is to consolidate most elective care and make Grantham Hospital a ‘centre of excellence’ for elective short stay and day case General Surgery. Lincoln and Pilgrim Hospitals will provide some day case/elective care for patients needing complex surgery, those with complex needs. Outpatients will remain at all three hospitals.

 

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* 30. Please tell us if you would have any problems accessing general surgery services at Grantham Hospital and if you have any suggestions of how we could overcome this

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* 31. Please tell us if you have any other comments or suggestions about our emerging option for general surgery services at Grantham Hospital

Urgent and Emergency Care Services

Emergency care is when you have a serious or life threatening accident or illness and you would usually have to be treated in a major hospital.  Urgent care relates to less serious health problems requiring attention which can be treated by services such as NHS111, pharmacies, GP practices, GP Extended Access Hubs, and Urgent Treatment Centres. The vast majority of urgent care needs are met by our GPs and community health services.  

Emergency care is provided in A&E departments and we currently have three A&E departments at Lincoln, Pilgrim and Grantham Hospitals.  For the last five years, Grantham’s A&E has had restrictions upon the conditions that can be treated at this site, for example, the ambulance service does not take patients with suspected stroke or certain types of heart attacks to Grantham.  Since August 2016, Grantham’s A&E has had restricted opening hours.

Our emerging option is to maintain A&E services at both Lincoln and Pilgrim Hospitals and to add an Urgent Treatment Centre at both sites. We would introduce a new Urgent Treatment Centre at Grantham Hospital to provide 24 hour, 7 day a week access to urgent care services locally.  This means that the vast majority of local patients who need care quickly will be supported in Grantham as they are now.  To ensure the local population receive the right urgent and emergency care, overnight, access to this Urgent Treatment Centre will be supported by NHS111, to ensure patients are sent to the right place, first time. NHS111 will serve as the entry point to the Urgent Treatment Centre during the overnight period.

Grantham’s UTC would still be able to receive patients by ambulance. Refinements to the current access criteria will ensure that critically injured and ill patients will be cared for at their nearest A&E; treated safely and quickly by staff who have the right training and experience to give the best outcome.

This emerging option would also see the 24/7 Grantham Hospital Urgent Treatment Centre provided by Community Health Services rather than ULHT, with hospital clinicians providing specialist advice where this is required for patients.

We would also like to develop Urgent Treatment Centre services at Louth, Skegness and Stamford Hospitals and explore options for Spalding and Gainsborough.

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* 32. Please tell us if you would have any problems accessing urgent and emergency care services at Grantham Hospital and if you have any suggestions of how we could overcome this

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* 33. Please tell us if you have any other comments or suggestions about our emerging option for urgent and emergency care services at Grantham Hospital

Haematology and Oncology Services

Haematology services diagnose and treat blood disorders for conditions such as haemophilia and leukaemia and provide treatments including blood transfusion services. Oncology deals with the treatment of cancer.  These services are delivered in out-patient clinics and in-patient beds.  We currently provide these services across Lincoln, Pilgrim and Grantham Hospitals (haematology out-patients only at Grantham), with the majority of care delivered at Lincoln Hospital.

Our emerging option is to have all haematology and oncology inpatient services at Lincoln Hospital.  
All other services stay the same.  This means that haematology and oncology outpatients and day cases will continue to be provided from all three hospital sites, creating no additional travel for these most frequent appointments.  Chemotherapy and radiotherapy will be provided at Lincoln Hospital as now.  Chemotherapy day cases will continue to be provided locally at Pilgrim and Grantham Hospitals.

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* 34. Please tell us if you would have any problems accessing inpatient haematology and oncology services at Lincoln Hospital and if you have any suggestions of how we could overcome this

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* 35. Please tell us if you have any other comments or suggestions about our emerging option for haematology and oncology services at Lincoln Hospital

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