Agenda item

Fit for the Future Programme

To receive an update on Fit for the Future Consultation Programme



The committee received an update on the progress of the Fit for the Future (FFTF) Programme, including an overview of issues raised by HOSC at previous meetings and proposals relating to the next stage of implementation of the programme (FFTF Phase 2). 


Fit for the Future (FFTF) is part of the One Gloucestershire ICS vision focussing on the medium and long-term future of specialist hospital services at Cheltenham General Hospital and Gloucestershire Royal Hospital. The aim of the programme is to:


a)    Improve health outcomes for the people of Gloucestershire

b)    Reduce waiting times and ensure fewer cancelled operations

c)    Ensure patients receive the right care at the right time in the right place

d)    Ensure safe staffing levels, including senior doctors available 24/7

e)    Support joint working between services to reduce the number of visits patients make to hospital

f)     Attract and retain the best staff in Gloucestershire.


Following publication of the NHS Long Term Plan in January 2019, HOSC has received more than 10 reports and presentations relevant to the development of specialist hospital services in Gloucestershire: dedicated FFTF agenda Items; and regular updates as part of the NHS Gloucestershire CCG Clinical Chair and Accountable Officer’s Report and the ICS Lead Report.


The report considered at this meeting included an update on the progress to date of implementation of the FFTF proposals approved by the GCCG in March 2021. It was noted that implementation of the proposals would be phased and not fully implemented until 2022/2023.


The committee was informed that the following service changes had been approved by the CCG Governing Body at a meeting on 18 March 2021.


1)    Formalise ‘Pilot’ Configuration for Gastroenterology inpatient services at CGH

2)    Formalise ‘Pilot’ Configuration for Trauma at GRH and Orthopaedics at CGH

3)    Centralise Emergency General Surgery at GRH

4)    An Image Guided Interventional Surgery ‘Hub’ at GRH and ‘Spoke’ at CGH

5)    Centralise Vascular Surgery at GRH

6)    Centralise Acute Medicine (Acute Medical Take) at GRH

7)    Planned General Surgery. (This recommendation relates to further work on defining a new option to deliver: a) Planned High Risk Upper Gastrointestinal (GI) and Lower Gastrointestinal (Colorectal) surgery at Gloucestershire Royal Hospital and b) Planned complex and routine inpatient and day case surgery in both Upper and Lower GI (Colorectal) at Cheltenham General Hospital).


FFTF Pre-Consultation (PCBC) and Decision-Making business cases (DMBC), including the relevant appendices, can be viewed here


The new members of the committee were advised that FFTF proposals had been considered by the former committee on several occasions, culminating in some members raising concerns on issues for which further information had been requested. Notable discussions had taken place at HOSC meetings held in October 2020, January 2021 and March 2021. (A summary of the discussions, including updates on specific issues, can be found at pages 2 to 4 of the report relating to this item).


The purpose of the update at this meeting was to provide the new members of the committee with an overview of the issues raised by the former HOSC prior to the council elections in May 2021. A former member of the committee stressed the importance of not losing track of the issues raised at previous meetings and was reassured by the in-depth detail referred to by the report on how the issues had been addressed and the arrangements for monitoring and reviewing agreed changes going forward.


Chairman of the Committee, Cllr Andrew Gravells, sought reassurances from the local NHS that appropriate action had been taken to address the issues raised at previous meetings and that implementation of the proposals agreed during Phase 1 of the FFTF Programme was being progressed without being impacted on by the concerns of former members. It was confirmed that all issues had been addressed and that the phased implementation of Phase 1 of the FFTF Programme had commenced, without delay.


Forming part of the presentation at this meeting was an introduction to Phase 2 of the FFTF Programme.


Members were informed that the FFTF Programme was currently working with clinical and operational colleagues at GHNHSFT, ICS Clinical Programme Groups and patient groups to identify services where improved patient experience and outcomes could be delivered. Following the standard FFTF programme approach, the proposals would be shared and discussed with HOSC at future meetings.


A list of initial ‘potential’ service changes was presented to the committee. The proposals were presented on the basis that any proposals relating to the future configuration of such services would be subject to continued patient, public, staff, stakeholder and regulator involvement.





1. Frailty/Care of the Elderly (COTE)

It was explained that this proposal aimed to look at the opportunity of developing ‘Frailty Front Door’ services at CGH, (services already in place at GRH). Development of the new service would be in line with the new ICS frailty strategy, aimed at developing additional services at CGH.


2. Spinal, hand, wrists & ankles

Services are currently delivered at GRH. This proposal aims to consider opportunities to move planned services to CGH, in line with the FFTF Strategy. Legacy services to be excluded from the initial pilot, (as formalised in FFTF Phase 1), to split trauma (GRH) and orthopaedic (CGH). Current assessments are being made at GRH, assessing which, if any, of the procedures can be moved to CGH.


3. Medical (Non-interventional) Cardiology

To consider options linked to IGIS centralisation at GRH (FFTF Phase 1).


4. Renal/Haemodialysis

It was explained that the change of provider of renal/haemodialysis services in 2022/23, (when the current contract ends), provided the opportunity to look at the location and potentially decentralise the GRH service in order to improve access for patients. Consideration of the relocation of a second GRH Haemodialysis Unit to be considered, (to improve patient travel access/times). There would be no changes to the Forest of Dean facility.


5. Benign Gynaecology

This proposal to look at the possibility of moving planned care services to CGH in line with the FFTF Strategy. It was explained that the learning from planned General Surgery service changes considered as part of FFTF (Phase 1), had prompted investigations into routine elective gynaecology procedures at CGH, (risk-based).


6. Diabetes and endocrinology

To review service options in line with wider integrated care development in community and primary care services.


It was explained that, distinct from the list of proposals relating to Phase 2 services, detailed work on the implementation plans for Phase 1 proposals had indicated the requirement for the creation of a hub & spoke model for Lung Function and Sleep Services, (to support the Phase 1 implementation plan).


Lung Function and Sleep Services Hub

The Lung Function and Sleep department is a multi-faceted service providing diagnostic and monitoring testing for respiratory diseases; non-invasive and invasive ventilation provision and support; as well as diagnosis and treatment for sleep disordered breathing conditions. In addition to this, the service delivers diagnostic testing and assessment of the digestive tract in the G.I. department.


The Fit for the Future (FFTF) Phase 1 programme proposals included the establishment of a Hub for Image Guided Interventional Surgery (IGIS) at Gloucestershire Royal Hospital. Capital works to establish a IGIS Hub are expected to begin in August 2021, impacting on Lung Function and Sleep Services in November 2021. The relocation of the Lung Function and Sleep Service from its current location would enable the preferred implementation option for the IGIS Hub by allowing for the establishment of an IGIS day-case recovery area.


The proposed solution to manage the move and mitigate any impacts associated with the relocation would be to implement a ‘hub and spoke’ model for Lung Function and Sleep Services. This would mean the Lung Function and Sleep Service would have a main hub, with most activity taking place at CGH.


A smaller ‘spoke’ service at GRH would be responsible for providing support to inpatients in addition to supporting lung cancer outpatients.


Members were referred to the Memorandum of Understanding Pro-forma, (consideration of ‘substantial’ nature of a proposed service variation) at Annex 1 and the following proposal: -


Proposal - Based on the need for the ‘enabling move’ to the wider FFTF programme and the identified benefits for patients of the Lung Function and Sleep Services Hub & Spoke model, the ICS intend to initiate the process for formal service change via a targeted engagement process. Details of plans to progress the proposal will be presented at the next meeting of HOSC. It was noted that this proposal would need to be progressed quickly.


Gill Bridgland, (representing Healthwatch Gloucestershire), enquired if the CCG wished to take up the offer of support from Healthwatch in facilitating the engagement and communications process for the anticipated change of service provider in respect of Renal/Haemodialysis Services at Gloucestershire Royal Hospital. The offer was accepted. It was suggested Becky Parish (GCCG) make contact with Gill Bridgland (Gloucestershire Healthwatch) after the meeting. Action by – Becky Parish (NHS Gloucestershire Clinical Commissioning Group (CCG)


Responding to questions, the following comments were made at the meeting:


1)    Changes to the estate, equipment and staff, (at GRH and CGH), would be made during implementation of Phase 1 of the FFTF Programme;


2)    The timeline for the proposed implementation of Phase 2 of the FFTF Programme had not been agreed at the time of the meeting but would be presented to the committee at the HOSC meeting in October 2021; Action by – NHS GCCG


3)    Responding to questions seeking clarification on the impact of service changes to be implemented as part of Phase 1 of the FFTF Programme, members were advised that short, regular updates would be made at future meetings, including updates on bed capacity; Action by – NHS GCCG


4)    In response to questions on the long term aspiration for the development of a Single Hospital for Gloucestershire, it was agreed that it was important not to lose sight of this as a long-term ambition. It was later suggested that it might be useful to consider asking the NHS Reference Group to look at possible implementation dates for the proposal. (Anticipated dates to be considered by the NHS Reference Group and included in ICS update reports at future meetings). Action by – NHS GCCG


5)    Several members sought reassurances on the arrangements for the proposed separation of emergency and planned surgery. One member noted that, (based on recent surveys), CGH had been identified as the preferred location for the centralising of elective colorectal surgery. The member enquired why it had been proposed to locate high risk upper Gastrointestinal (GI) and lower GI (colorectal) surgery at GRH rather than at CGH, (particularly when planned complex and routine inpatient GI and colorectal surgery was being undertaken at CGH)? In response, it was confirmed that as much planned surgery as possible would be performed at CGH. COVID-19 was the stress test for the success of changes emerging from the FFTF Programme. Robotic equipment purchased for GRH, (similar to that used at CGH), would place Gloucestershire in the favourable position of being able to perform planned surgery at both sites.


6)    It was explained that decisions relating to planned surgery were based on the needs and comfort of the patient and reflected by the confidence in assessing the risks to patients by the surgeons involved. It was agreed patient confidence and comfort should be a priority and suggested that patients, (in general), received a better, overall experience at planned care sites, (with experienced and highly trained surgeons). Protocols were in place to respond to unexpected situations. Members welcomed the reassurances provided at the meeting.


7)    In response to questions on the benefits of producing a ‘Centre of Excellence’ strategy, it was explained that, whilst not specifically driven to strive for Centre of Excellence status in respect of individual services, an overarching ambition of One Gloucestershire ICS was to deliver the best possible services in all areas. Not only did this create the best possible environment for success but also attracted the best possible people to work in Gloucestershire. It was agreed that investment in the improvement and delivery of services and in the purchase of new equipment should be supplemented in the investment of the right people. Members were informed that, currently, Gloucestershire was benefitting from attracting new and experienced people and was in a good position in terms of performance.


The report was noted, (including update on the outcomes of issues raised by the former committee and proposals relating to Phase 2 of the FFTF Programme).

Supporting documents: