Questions and answers

Below you’ll find some answers to questions that were raised during the public consultation.

Breast surgery

I currently have yearly high-risk breast screening at the Linda McCartney Centre (Royal Liverpool Hospital). Would this stay where it is or move to Broadgreen?

Under the proposals, breast screening and monitoring and management (surveillance) services will not change.


Is this change going to increase waiting times for planned surgery?

No, we anticipate that waiting times will improve.


Can you explain how merging the service will improve the two-week target to be seen, if both the Royal and Aintree are already struggling to achieve this? Will GPs be able to see appointments at both hospitals?

Sharing staff and resources will enable us to become more efficient by enabling a similar rapid access service on both sites, reducing the need to re-attend for additional tests and biopsies.

At present we are on a rapid access system. All referrals are reviewed and prioritised by the breast team.


How will the proposal provide the opportunity to address the shortage in radiologists, if diagnostic facilities are to be maintained at both sites? Will staff be expected to work across both sites?

Ensuring the right staff are in the right clinics will enable us to be more efficient, improve patient experience and mean the pathway or journey a patient goes through to receive care is better overall.

 

During my diagnosis, surgeries and beyond, it was very comforting to see the same team of mammographers and to see the same wonderful and lovely breast surgeon consultant. Can you assure me that this continuity of care will continue?

We know that having a familiar face or a good relationship with the person who is looking after you is important.

Our plan is that patients will continue to receive their care from the same diagnostic and operating team.

 

Will staff be expected to work between sites?

Yes, some staff will, and do now, work across all three sites, however, the majority of staff members are primarily based on one site.

 


General surgery

The ambulance service is already stretched – can it work with the additional pressure of transferring patients in an emergency? What would this mean for patients?

We are working closely with NWAS on plans for transfer between hospitals for those patients who require this, but we aim to minimise the number of transfers by ensuring that as far as possible patients get to the right hospital for their condition in the first place.


What would happen if a patient was admitted to the Royal Liverpool Hospital, then assessed as needing emergency surgery?

If the patient was stable for transfer such patients will be transferred to Aintree University Hospital for emergency surgery. If it was felt that the patient was not stable for transfer, the surgery would be performed at the Royal Liverpool Hospital.


Would this change impact on waiting times for planned surgery?

It is expected that waiting times for cancer surgery will be reduced by the proposed changes. Similarly, it is anticipated that waiting times for non-cancer planned surgery will improve.


How would the emergency department at Aintree cope with the increase in patients?

There will be an increase in the number of patients with surgical conditions brought by ambulance following a 999 call to the A&E at Aintree Hospital.

However, patients referred from their GP will go straight to the surgical assessment unit, not to the A&E. Similar changes in the pathway for medical patients will help to create sufficient capacity for the increase in acute surgical patients.


Will there be enough surgical cover at the Royal Liverpool Hospital?

There will always be four consultant surgeons on duty for the Royal Liverpool Hospital for emergencies, covering upper gastro-intestinal surgery, liver surgery, pancreatic surgery and colorectal surgery.

All of these surgeons are also able to operate on general surgical emergency patients. There will also be a full team of surgical junior doctors.

 


Nephrology

What would happen if a patient arrived/is admitted to Aintree Hospital for another reason and needs specialist renal care?

Would they be transferred to the Royal or treated at Aintree?
How will emergency dialysis provision be maintained at Aintree?
What happens if a patient in Aintree needs expertise in more than one speciality?

If a patient requires specialist renal care, they would be transferred to the Royal Liverpool Hospital.
Aintree University Hospital will have eight dialysis stations that will provide dialysis for inpatients. There will be a physical nephrology presence on the Aintree site Monday to Friday, with access to advice over the weekend.

Patients will be treated at the right place according to their primary need. For example, if a stroke patient will be cared for by the stroke team at Aintree and will have their care provided on the Aintree site. A patient whose primary need is for renal care will be cared for at the Royal Liverpool Hospital.


When a patient at the satellite clinic (especially at Aintree) becomes unwell – where will they be transferred to?

If a patient requires specialist renal care they would be transferred to the Royal Liverpool Hospital.

 


Urology

Would patients who arrive at Aintree A&E with a urological emergency be transferred to the Royal or treated at Aintree?

Currently there are an average of three patients per 24 hours who are admitted under urology at Aintree Hospital as an emergency.

With ambulance and GP referral diversion to the new Royal, we believe the number of walk-in A&E patients who need admitting under urology will drop to about one per 24 hours. These patients will need to be transferred to the new Royal. Some emergency patients with urological problems are seen, investigated, treated and sent home by the A&E teams with urological advice, or with some outpatient urological follow up. This will continue at the Aintree site. Protocols have been developed to ensure the safe care of patients with urological problems who walk in to Aintree A&E

 

Will there be enough bed capacity at the Royal Liverpool Hospital for the amount of urology operations that would take place there? Will this have an impact on waiting times?

The number of overnight urology beds in Liverpool is not reducing. By co-locating in-patient emergency and elective care in one place, this will streamline care, reducing length-of-stay and improving the access of urology patients to sub-specialty care. This will reduce waiting times and care quality and equity of access to care across the city.

 

Is there going to be any emergency urology cover at Aintree?

Urology emergency cover will be based at the new Royal Liverpool hospital, where the vast number of urology patients will be. They will also provide hub and spoke emergency cover to other hospital sites at LUHFT, including Aintree and Broadgreen hospitals, coming to those sites as needed. There will also be urologists present on the Aintree site every day doing outpatient work or day case surgery, and some will be timetabled to deal with urological queries in inpatients on the Aintree site.

 

What happens to the specialist centre at Broadgreen?

The urology outpatient centre at Broadgreen will transfer to the Royal Liverpool Hospital. The specialist staff who are currently based at Broadgreen will also then be able to use their skills to help the care of urology inpatients.

 

How have you involved people living with neurological conditions? How will the proposed changes link to these community services so people get the care in the community when they come out?

Historically, much of the Urological input into patients with neurological problems has been via the North West Regional Spinal Injuries Unit at Southport Hospital, which also has links with a neuro-urologist based at Whiston Hospital. Under 5% of Urological patients have a neuro-urological diagnosis.

There is a consultant urological surgeon with a functional and reconstructive subspecialist interest currently based at Aintree hospital, whose clinics would continue if the change went ahead. The urodynamics service for Liverpool University Hospital would be based at the Aintree site. Botox injections for patients with MS (multiple sclerosis) would continue to take place at Aintree, as this is done in a daycase setting.

Outpatient Urology continence nurse specialist activity would continue on the Aintree site, and may be strengthened. Where patients with MS need inpatient care for treating urinary tract infections, this is more commonly under the care of physicians and this will continue. Urologists will be present on the Aintree site most/all days to provide any urology specialist advice needed.

Many patients from north Liverpool are already treated at the Royal Liverpool Hospital and discharge liaison with community service is already well established.

The proposed changes aim to provide a better service for patients, in part, by using resources better and it is anticipated that this will improve access and reduce waiting times and inequity across the city, ultimately providing a better urology service for patients with neurological problems.

 


Vascular surgery

If it’s a serious, time-sensitive emergency (e.g. ruptured AAA – abdominal aortic aneurysm) and the patient is closer to the Royal, could it be life threatening to take them to Aintree?

No, the evidence suggests transferring a patient to the vascular centre of excellence produces a better outcome for the patient.


Will staff move with the service, or are we loosing expertise in exchange for generalist roles?

We are actively working with staff to retain the specialist skills and expertise. There may be a requirement for additional nurses, and we have plans for their necessary training and education.


How will patients who attend Royal A&E with a vascular issue get to Aintree?

We have been working with North West Ambulance Service (NWAS) throughout so that safe transfers will be possible by ambulance.


The new Royal has a specialist vascular theatre – why have we spent money on this theatre and equipment to move the speciality over to Aintree?

The hybrid theatre was a necessity in 2016 to ensure vascular services continued at the Royal Liverpool University Hospital. We will have two hybrid theatres in the new unit (at Aintree) from April 2023, this will improve our endovascular service capacity.

 

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