Liverpool Women’s Hospital working with the large Acute Hospital trust

This is the fourth of a series of blog posts intended to share the current issues facing Liverpool Women’s Hospital.The posts are based on a report to the Board meeting held in public on 7th November 2019. The earlier posts are about Maternity, Gynaecological Oncology, and the age profile of the medical staff at LWH. This post is about LWH working in partnership with the large acute hospital, Liverpool University Hospitals NHS Foundation Trust, which includes the Royal, Broadgreen and Aintree. The proposals are for ways LWH can work with the Liverpool University Hospitals NHS Foundation Trust

As with the earlier posts, the purpose of publicising these papers is to make these important discussions accessible to the concerned lay woman and to medical, midwifery and nursing staff who do not have easy access to the main papers, which can be found here. Publishing them does not imply support, nor is this a critique. Such a critique will follow when our supporters have had the opportunity to discuss the options. We are all too aware that the NHS is monstrously underfunded and overworked and that policy changes since 2010 have done great harm.We are aware that life expectancy for women in poor areas is slipping and that many people have died from the impact of Austerity. Our campaign to Save liverpool Wiomen’s hospital goes on. Our petition is here.

Partnership Board

Following discussions between the respective CEOs of LWH and LUH, an MoU (Memorandum of Understanding) has been created for the formation of a Partnership Board between the two trusts. This group will be accountable to the respective Boards of Directors via the executive bodies and will have operational, medical and nursing/midwifery representation. It will further develop and formalise the ‘virtual bridge’ linking the two organisations with respect to the provision of clinical care.

In addition to details given above around the provision of gynaecological oncology, the Partnership Board will examine the following:

 · Partnership working for HDU provision at LWH which may include joint nursing and anaesthetic appointments, rotation across sites and support at LWH from LUH intensivists

· Consideration of the pattern of critical care outreach services that could feasibly be provided on the LWH site

 · Formalisation of the working arrangements that allow for the provision of urgently needed specialist care from non-women’s specialists on the LWH site · Formalisation of the working arrangements that allow for the provision of urgently needed care from women’s specialists on the LUH sites

 · Review of the present pattern of delivery of maternal medicine services in the light of national drivers for change

· Establishment of a gynaecological nursing and midwifery presence on the LUH sites

· Formalisation of pathways for access to imaging and diagnostics on a seven day basis, with consideration of providing CT and extending other imaging facilities at the LWH site; including image generation and timely reporting

 · Partnership working to provide staffing for a proposed new blood bank and extended lab facilities at LWH with 24/7 delivery of urgent services

 · Formalisation of pathways surrounding access to seven day service requirements with respect to therapies, dietetics, pain management and tissue viability services

Consideration of the potential for the use of the LWH site for LUH clinical activity where clinically appropriate, if this is needed to enable gynaecological activity on the LWH to be moved onto LUH sites

· Exploration of the use of digital technologies for the sharing of clinical information across sites to advance patient safety

· Formalisation of the process of safe repatriation of patients from LUH to LWH sites, taking into account the available services and facilities available at the LWH site

· Provision of oversight wrt (with regard to) the transfer of sick patients from LWH to LUH, reducing delayed transfer and minimising the risks associated with the transfer itself.

 LWH has also suggested that NHSE/I and Liverpool CCG join that Partnership Board, which would then also report into (a) the One Liverpool place based care leadership group and (2) the Acute Sustainability Board for C&M. This would provide all parts of the system with continued sight until such time as the trust’s clinical problems have been fully resolved.

 Recruitment and Retention The Trust is finding it difficult to recruit and retain consultants with the skills to maintain and develop its adult services. The problem has been highlighted above with respect to gynaecological oncologists but there have also been difficulties recruiting consultant anaesthetists and consultant gynaecologists with advanced skills in complex benign laparoscopic surgery.

 In future, obstetricians trained in maternal medicine may also prefer to work elsewhere as LWH is unable to meet the essential MMC criteria. This will have a negative impact upon the trust’s prestige.

 In principle, there are two ways in which the trust can maximise its potential for recruitment and retention and these are now being considered as a separate workstream by the Director of Workforce and Communication’s team:

 Optimise the professional offer

 · Increased access to facilities off site (eg) multidisciplinary teams, robotic surgery

· Improved facilities on-site (eg) imaging, blood bank, digital

· Bespoke job plans to prioritise each consultant’s professional preferences

· Attractive terms for study leave

 · Overseas recruitment

· Promote the LWH brand.

Optimise the personal offer

· Part time working and job shares

· Annualised working hours

 · Off site delivery of non clinical duties

· Leeway in holiday provision

· Attractive remuneration with respect to recruitment

 · Attractive remuneration with respect to retention.

The establishment of a Partnership Board with LUH and the forging of closer working relationships may help with some of the ‘professional offer’ issues as it will provide LWH clinicians with access to a greater range of facilities and multidisciplinary expertise. Similarly, an expansion has been seen in the number of joint consultant anaesthetist posts with LUH and this is likely to continue but the services provided by LWH are otherwise highly specialised and the same opportunity is unlikely to be found in the trust’s other clinical services.

 Without relocation, the recruitment and retention of consultants is likely to be problematic for the foreseeable future

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