The NHS in Gloucestershire has confirmed temporary service changes designed to test out the potential benefits of organising some services differently to improve patient care, experience and outcomes and increase efficiency. The changes relate to community theatres and community beds and will be monitored closely throughout.
The service changes, including changes to individual healthcare facilities, are temporary in nature and the impact on patient care and learning will form part of the evaluation. Evaluation criteria will be agreed with partners before the temporary service changes are put in place.
Chief Medical Officer at NHS Gloucestershire, Dr Ananthakrishnan Raghuram (Raghu) MBE said: “It is important to stress that no plans have been made, or decisions made, about individual services, facilities or sites over the long term. This is about testing out new service models and ways of working. We look forward to reviewing the evaluation reports, including the views and experiences of patients.The reports will be shared publicly at the end of the trial periods. We will continue to work closely with the county’s Health Overview and Scrutiny Committee.”
Further information on the specific tests of change can be found below.
Community Theatres
The new way of running community theatre services will affect Cirencester, Stroud and Tewkesbury community hospitals.
For six months, the NHS will trial the idea of ‘Centres of Excellence’ – bringing together specialist teams, equipment and best practice in a more focused way to explore whether this approach could improve care.
- Tewkesbury will continue to undertake Ophthalmology, ENT and Orthopaedic day cases
- Stroud will continue to undertake Breast surgery with plans to explore Urology surgery during the test period
- Other specialties which are currently performed at the three community theatre sites will be centralised during the test period at Gloucestershire Royal or Cheltenham General.
To make this possible, theatre activity in Cirencester will pause for six months during the test.
By concentrating services in fewer locations, the test of change aims to make more effective use of specialist staff and equipment, while reducing delays, including last-minute cancellations and inefficiencies caused by resources being spread across multiple sites.
This change could also help staff to access more training and development opportunities, becoming more highly skilled in their specialty, which could lead to better care and outcomes for patients.
During this test, patients may need to travel to a different hospital for their treatment, but we will work to minimise disruption and ensure appointments continue as smoothly as possible, and people will still have some choice about where to go for treatment.
After the six-month trial, we will review how well the changes have worked. This will include looking at patient outcomes, staff feedback and how efficiently services have run.
We will present the evaluation findings, including patient and public feedback, once the trial has been completed.
The start date for the temporary change will be confirmed soon.
Community hospital beds, including a specialised complex care unit at Cirencester Hospital
The NHS in Gloucestershire is also developing plans to undertake tests of change relating to community hospital beds with the aim of providing the very best care to local patients.
The NHS is testing these temporary changes in response to the significant healthcare challenges associated with a growing and ageing population and increasing numbers of people living with multiple-long term health conditions.
In Gloucestershire, the number of people and the length of time they stay in community hospital beds is higher than the national average. On average, people stay in a community hospital for general rehabilitation care for approximately 33 days in Gloucestershire.
This gives us the opportunity to think differently about how our community hospital services could be used more efficiently to meet the needs of the local population. We want to ensure that people experience the most appropriate and high-quality care to meet their needs, alongside the best possible chance of returning home more quickly.
We are therefore implementing two temporary tests of change, adopting an approach that will enable us to try out and evaluate new ways of working for a defined period.
The first temporary test of change is to services provided at Cirencester Hospital providing care to patients with more complex needs.
Currently, the two intermediate care wards at Cirencester Hospital have 49 beds. These beds are used to provide care to people who need rehabilitation support, often following a stay at Cheltenham General or Gloucestershire Royal Hospitals, before they can go home. The wards consist of several bays and a few single rooms.
The temporary test of change will reorganise the ward space to retain one intermediate care ward of 28 beds, but then create a specialised 15-bed complex care unit to provide rehabilitative care to patients with a higher complexity of physical and mental health needs. To achieve this one of the existing wards in Cirencester will be temporarily closed and the staff team relocated to a unit on the same site.
Staff will have the specialist skills and expertise required to provide higher levels of care to meet the needs of the patients.
We also hope that providing care that more specifically meets the needs of patients will help to reduce the length of time they need to stay in hospital.
It is hoped that an overall reduction in lengths of stays would offset the minor reduction in the number of beds (reduced by six), meaning that the number of patients receiving community hospital care would not change.
The second change relates to using ten existing community hospital beds to provide a short stay in a community hospital for people who have deteriorated at home and need a longer assessment and review by a multi-disciplinary team.
There will be one or two of these ‘step-up’ beds in each of the county’s community hospitals and they will provide a more complex level of care, enabling patients to stay closer to their home.
These beds will complement the existing ten Community Assessment Treatment Unit beds at Tewkesbury Hospital which are used for acutely unwell adults experiencing an exacerbation in a long-term health condition such as heart failure.
This temporary test of change will not reduce the number of community hospital beds across the county; it will just change the way in which ten of these beds are used.
Both of these tests of change are proposed to start at the end of 2025 for a nine-month period, with the first part of the evaluation due to take place at the end May 2026.
