Under the proposals for Newark, what is the PCT’s reaction to patients having to travel 25 miles or more to their nearest hospital? 

If I call for an ambulance, from Newark now, using 999, what happens?

What happens if the ambulance covering Newark is busy with another patient or taking somebody to another hospital e.g. Sherwood Forest?

What would happen under the new propsals?

Does Newark have an issue with ambulances - are more used here than elsewhere or have we missed targets here previously?

Do we have in Newark the emergency vehicles to cover what would be new needs because of the changes in service, while also dealing with accidents, flooding or fire, not forgetting again the new housing build?

Would it not be possible to accept young children into the A&E unit, thus giving more experience to the staff?

Have full studies taken place into the future needs of A&E over, say, the next 25 years, and not just the present needs in making the idea of any cut in services?

Do we have in Newark the emergency vehicles to cover what would be new needs becuse of the changes in service, while also dealing with accidents, flooding or fire, not forgetting again the new housing build?

It is widely known that if you are booked for a procedure at King's Mill, any blood tests which are required prior to that procedure involve visiting King's Mill to have them done. Why is this so? Will this be addressed in the Newark healthcare review to ensure people are able to get pre-op tests done locally in future?

Is it also possible to ensure that in the future checks are done on the quality and availability of previous tests or scans in advance of appointments, to avoid wasted journeys to King's Mill?

Recently I have been told by two people that they travelled from Newark to King's Mill, only to fail to have procedures done when they got there because previously done tests or scans, required for the procedures, were not satisfactory or available.

How much did it cost to run the (current) A&E department at Newark in the last year?

What will the (estimated) cost be per year for each of the two options for the minor injuries unit plus?

Presuming it is cheaper to close the unit over night, where will the saving be spent if the second option is chosen?

In them, a number of local health professionals involved in the consultation process answer some of the most frequently asked questions about Newark’shealth review. If you want answers to these questions and more, watch the films on this page.

Download a transcript of the film here [Adobe Acrobat PDF - 14.33 KB]

Questions from you - week beginning 23 November.

How many patients on average attend A&E overnight at Newark at the moment?

On average, Newark A&E sees less than one patient an hour overnight, between 10pm and 6am.

Questions from you - week beginning 30 November.

What happens if someone breaks a leg or arm or an elderly person has a fall? Do we now have to be transferred to Kings Mill?

Unless the bone fracture is obviously serious (eg the bone is displaced), you will be treated at Newark Hospital. In fact, 85% of people still will be treated at Newark - this will include all minor injuries, including broken bones. If an elderly person has a fall, it all depends on the nature of their injuries. It is possible that an ambulance may take that person straight to King’s Mill, if there is a head wound or the possibility of something serious (eg a damaged pelvis or internal injuries). This is the right thing to do. If such patients were taken to Newark, they would then have to be transferred to King’s Mill, delaying their treatment. So it is better for them to go straight to where they can get the right care, first time.

What happens if someone goes into possible early stages of Heart attack or stroke? Again do we now have to go to Kings Mill ?

A national review called the NEXT STAGE REVIEW showed that if you were to suffer from a heart attack or stroke, in whatever stages, you need to be taken to very specialist centres. In Nottinghamshire, this probably means Nottingham University Hospitals NHS Trust or Sherwood Forest NHS Foundation Trust. You will receive the best care possible, in the right place, first time and will not have to endure any medical transfers which may lead to more medical problems and prolong your recovery. You will receive your life saving treatment at a specialist centre and then return to Newark hospital to recover. It isn't possible to put such highly specialist centres into hospitals such as Newark. There will be only one or two in each region. Clinicials, doctors and nurses all believe this will save more lifes and lead to quicker recovery.

If you were suffering from a heart attack or stroke now you would still be transferred to a larger acute hospital but under all the new proposals you would go straight to the hospital to get your care and treatment.

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What extra stress will this put on the already very concerned local GP's?

GPs are in full support of the review and the proposed changes. Indeed, they have helped scope the options and there will be additional services put in place as needed - including extra GPs and additional cover outside GPs’ normal working hours.

Why, when Newark is a growth point town with three major transport routes intersecting through it, is it having its frontline services reduced?

The NHS review is taking Newark’s expected growth into account. There will be many additional services, including more care at home for people with long term conditions, more outpatient clinics in Newark, and more day case surgery. The change in the designation of A&E is driven by changes in clinical standards, which make it clear that Newark Hospital is not equipped to deliver an A&E service. Patients with serious conditions like strokes or heart attacks need to go to specialist centres, with the medical expertise and back-up facilities to deliver the right treatment. Newark Hospital cannot do this. It is important to note, however, that there is NOT a significant reduction in what is being offered at Newark Hospital. 85% of patients will continue to be treated there. It is only the most serious cases that need to go elsewhere. Newark’s population growth will not alter this.

Download a transcript of the film here [Adobe Acrobat PDF - 9.74 KB]

Newark's healthcare review does take the expected growth into account. There will be many additional services, including more care at home for people with long term conditions, more outpatient clinics in Newark, and more day case surgery. It is important to understand what the exact proposals for urgent care are. While the new service would not be called A & E, in effect, it will largely offer the same care as now.

The change in the designation of A&E is driven by changes in clinical standards, which make it clear that Newark Hospital is not equipped to deliver a full A&E service. This is already the case, and protocols have existed for some time so that ambulance crews take people with major trauma, for instance, to a centre that can offer the specialist support services, such as an intensive care unit. Patients with serious conditions like strokes or heart attacks will shortly, when the new models of care are established, need to go to specialist centres, with the medical expertise and back-up facilities to deliver the new treatments. Newark Hospital cannot do this. It is important to note, however, that there is NOT a significant reduction in what is being offered at Newark Hospital. 85% of patients will continue to be treated there. It is only the most serious cases that require specialist intervention that will need to go elsewhere. Newark’s population growth will not alter this.

So rather than being short-sighted, this is a deliberate attempt to ensure that NHS services in Newark meet national standards AND the future needs of local people.  Local doctors agree about this.

Dr Andrew Parkin, a GP at Newark’s Lombard St practice: “Even if there’s a major increase in the population of Newark, there still won’t be sufficient numbers of seriously ill patients going through A&E to maintain the skills of the doctors in post. This review is an attempt to respond to the population increase. At the same time, standards of medical care are rising.”

Doctor Andrew Molyneux, Service Director for Emergency Care and Consultant Physician: “The sickest patients require the highest quality specialist care and facilities. The size of Newark Hospital’s means it would not be possible to develop the required facilities to support a full emergency department. These facilities could not be sustainably developed even with the predicted increase in the population, as the doctors would not see a sufficient number and range of patients to maintain and develop their skills.”

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We need open hours of 24/7 taking on board what I call disgusting out of hours GP service, where they often suggest going to A&E. Could I ask your thoughts on this?

We are proposing that there will be additional and enhanced GP services with out of hours cover. And would like to hear your views on what that service need to do. If patients have specific problems about the current out-of-hours GP service, they can contact NHS Nottinghamshire County on 0800 028 3693. We want local people to help us decide whether it is worth keeping the Newark Hospital unit open overnight, when the number of patients averages less than one per hour.

My own views on the change in services at the A&E are a definite no, but I have poor health although I can go out and see many people worse than me, and I ask what wil happen both to them and their families who will have to travel?

85% of all patients currently treated at Newark hospital will continue to be treated there. The only patients to go elsewhere will be those who need to, because their injury or condition is serious, and they require specialist care at a bigger hospital. This is what the national medical guidelines say should happen. If patients with serious conditions arrive at Newark Hospital, they have to be transferred by ambulance. This delays their treatment, and we want to avoid that. Once patients have received their urgent specialist care, they will return to Newark Hospital as soon as possible, to continue their recovery closer to home.

I am concerned the consultation meetings organised by the Trust are at times that make it awkward for all people to attend due to work commitments. Would it not be possible to arrange some meetings in evenings?

We will be holding three public meetings. These are split across December, January and February. Two will run in the evening and one in the afternoon. Details of these can be found on our website, www.nottspsct.nhs.uk, and in our consultation document. We will also be attending local groups and market stalls to listen to public opinion. In addition, the local MP Patrick Mercer is holding a public meeting about health on the evening of December 10. We will be participating in that. You can also contribute via our website, www.nottspct.nhs.uk/newark, by freepost or by phone.

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Download a transcript of the film here [Adobe Acrobat PDF - 11.72 KB]

What happens if someone breaks a leg or arm or an elderly person has a fall ?? Do we now have to be transferred to Kings Mill?

Unless the bone fracture is obviously serious (eg the bone is displaced), you will be treated at Newark Hospital. In fact, 85% of people still will be treated at Newark - this will include all minor injuries, including broken bones. If an elderly person has a fall, it all depends on the nature of their injuries. It is possible that an ambulance may take that person straight to King’s Mill, if there is a head wound or the possibility of something serious (eg a damaged pelvis or internal injuries). This is the right thing to do. If such patients were taken to Newark, they would then have to be transferred to King’s Mill, delaying their treatment. So it is better for them to go straight to where they can get the right care, first time.

What happens if someone goes into possible early stages of Heart attack or stroke?? Again do we now have to go to Kings Mill?

'Right place, first time' and national research mean that people suffering from heart, stroke and major trauma need to go to specialist units. It may be King's Mill, it may be NUH - but EMAS will have clear protocols. The issue is that patients get the specialist and life saving treatment they need and then are returned to hospitals closer to home to recover. It is scienticially and clinicially proven this saves more lives. People will be brought back to Newark Hospital to recover, once their urgent treatment has been given and they are well enough.

What extra stress will this put on the already very concerned local GP's?

GPs are in full support of the review and the proposed changes. Indeed, they have helped scope the options and there will be additional services put in place as needed - including extra GPs and additional cover outside GPs’ normal working hours.

Why, when Newark is a growth point town with three major transport routes intersecting through it, is it having its frontline services reduced?

The NHS review is taking Newark’s expected growth into account. There will be many additional services, including more care at home for people with long term conditions, more outpatient clinics in Newark, and more day case surgery.

The change in the designation of A&E is driven by changes in clinical standards, which make it clear that Newark Hospital is not equipped to deliver an A&E service. Patients with serious conditions like strokes or heart attacks need to go to specialist centres, with the medical expertise and back-up facilities to deliver the right treatment. Newark Hospital cannot do this. It is important to note, however, that there is NOT a significant reduction in what is being offered at Newark Hospital. 85% of patients will continue to be treated there. It is only the most serious cases that need to go elsewhere. Newark’s population growth will not alter this.

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How much money is spent on health care for a citizen of Mansfield compared to one in Newark?

On average, expenditure per head figures of £1,632 for High Point (Mansfield & Ashfield) and £1,459 for Newark & Sherwood. This spend is consistent with the fair share funding methodology which shows that High Point have a higher need for healthcare services due to social deprivation factors.

How long before an accident occurs on Boundary Road due to the horrendous carparking situation?

Transport issues will be addressed as part of the consultation. Ultimately, street car parking and traffic issues are the responsibility of the local authorities. We are working closely with the Councils to ensure that provision is put in place.

Will the people of Newark now face an ardous thirty minute journey of extra pain and risk to life if these proposals are allowed to go through? How may people have died on route to KMH, QMC and Lincoln Hsopitals because of lack of Heart attack care at Newark?

Doctor Andrew Molyneux, Service Director for Emergency Care and Consultant Physician, said: "All doctors are in agreement that if a patient suffers a heart attack  there is now a better treatment called primary angioplasty. This requires the patient to be in a specialist centre, with state-of-the-art equipment, facilities and with doctors who have unique skills. This saves more lifes and  improves the patient's quality of life"

In essence we are seeing a systematic neglect of the people of Newark by the Nottingham Health trusts, we in Newark are the second class citizens of Nottinghamshire?

Matt Youdale, Director of Communications and Engagement, said: "The opposite is just the case. This is about ensuring that Newark’s NHS is even better than it is now. So this is a positive thing for the people of Newark. People need to understand and believe that the review will possibly save more lives because it will ensure patients are taken to the 'right place, first time'. Newark is the lead for projects, such as this review, which will be happening right across Nottinghamshire to ensure that patients are getting the best possible care and treatment." 

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What effect would higher numbers of patients have, on already congested, Accident and Emergency Departments at Nottingham QMC and Kings Mill Hospitals?

Around 25,000 people a year attend Newark A&E. Between 10pm and 7am, the department sees less than one patient an hour. These numbers are tiny in comparison with other A&E departments - for example, King’s Mill sees 100,000 patients a year. So we are not talking big numbers in hospital terms. Under the proposals at least 85% of all patients will continue to be treated in Newark. The remaining 15% of people (ie fewer than 4,000 a year) will be those already directly transferred to other acute units because of the seriousness of their condition, and hence covered under the existing figures. The amount of patients from Newark to other regional hospitals - which would also potentially include Lincoln - would therefore be minimal and we have worked with the various different organisations to ensure this is accounted for. For example - 3,750 people spread across three hospitals is around three per day! This will have no impact.

For information, currently, 70 patients are transferred to Kings Mill every month, this equals 900 transfers a year. Under the proposals, these patients will go to the right place, first time and these transfers will stop.

Under the proposals for Newark, what is the PCT’s reaction to patients having to travel 25 miles or more to their nearest hospital?

These changes are about saving saves and improving recovery. That has to come first, and doctors agree. We need to comply with national clinical guidelines. People need to be taken to the right place, first time. 85% of patients will still be treated at Newark hospital. The remaining number of patients - 15% - who require highly specialist treatment and care will go to where they need the specialist care. Newark can't provide the care needed for this minority of patients with major illnesses or injury. Even with the growth in the population there will still not be enough patients to justify a new A&E under the new national guidance

999 callers who ask for the ambulance service are transferred to the East Midlands Ambulance Service (EMAS) control room in Nottingham. A call taker asks a series of questions about the patient’s condition and the call is then catergorised as follows:

Category A - Serious, immediately life-threatening
The target is that an emergency response (either a solo responder or conventional ambulance) should be made within 8 minutes in 75% of cases.  Where a fully equipped ambulance is needed, the vehicle should arrive within 19 minutes of the request in 95% of cases.
Category B - Serious, not immediately life-threatening
The target is that an emergency response should be made within 19 minutes in 95% of cases
Category C - Not serious, not life threatening
A response should be made within four hours. Most Category C calls are dealt with over the telephone by a nurse in EMAS’ Control room
Urgent cases
Note: all targets are measured across the whole area served by EMAS and over a full year.

EMAS vehicles and crews are not ‘ring-fenced’ to serve a specific area exclusively.  If all vehicles serving Newark are engaged, EMAS Control will mobilize a vehicle from another area to provide cover until such time as the normal vehicle becomes available again (and vice versa).  EMAS also positions vehicles in the locations where activity is likely to be highest – a system called ‘dynamic stand-by’. This ensures that available vehicles are in the best place when they are called upon to respond to a 999 call.

The way EMAS provides cover and responds to calls will not change.  Under the first two options, EMAS will carry out 900 fewer transfers from Newark hospital to other specialised hospitals and this will reduce demand.  However, this is unlikely to free up enough resources to provide the level of cover needed in Newark and allow EMAS to achieve its performance targets. NHS Nottinghamshire County is working in partnership with EMAS to identify what additional resources may be needed under all the new proposals.

Does Newark have an issue with ambulances - are more used here than elsewhere or have we missed targets here previously?

EMAS monitors demand and resource levels regularly and will continue to work with NHS Nottinghamshire County and other commissioners to ensure performance targets are achieved across the area served over a full year.

Do we have in Newark the emergency vehicles to cover what would be new needs because of the changes in service, while also dealing with accidents, flooding or fire, not forgetting again the new housing build?

NHS Nottinghamshire County have discussed the proposed changes with EMAS managers so they can assess the impact of the options under consideration.  The outcomes of this process will form part of the overall review of services.  The fact that EMAS operates on a regional basis means that additional resources can be drafted into an area should there be an unexpected peak in demand or a serious incident requiring extra support on a short, medium or long term basis.

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Would it not be possible to accept young children into the A&E unit, thus giving more experience to the staff?

Young children do need specialist care and specially skilled doctors.  In order to give doctors and clinicians the right mix of skills, they need to treat and care for many different patients with varying illnesses and injury. This is recognised by national bodies and doctors themselves, and is especially true of A&E units. Children will be accepted into Newark hospital for minor injuries under both the proposed options but as is currently the case, if the issue is a serious one they will be taken to the “right place first time” - dependent on their illness or injury.

Have full studies taken place into the future needs of A&E over, say, the next 25 years, and not just the present needs in making the idea of any cut in services?

Yes, we have studied research papers, looked at best practice and used computer modelling to predict what healthcare needs will be, and how best to meet them. This isn't about cutting services - far from it. indeed, the proposals include many additions to services (such as more community care, more GPs, more day case surgery and outpatient clinics). This provision will be fit for purpose for the next 25 years. It will be ready to meet demand if the population doubles. But that growth still would not see enough patients going into the hospital to warrant a full A&E, as designated under new national guidelines.

Do we have in Newark the emergency vehicles to cover what would be new needs becuse of the changes in service, while also dealing with accidents, flooding or fire, not forgetting again the new housing build?

NHS Nottinghamshire County have discussed the proposed changes with East Midlands Ambulance Service so they can assess the impact of the options under consideration. The outcomes of this process will form part of the overall review of services. The fact that EMAS operates on a regional basis means that additional resources can be drafted into an area should there be an unexpected peak in demand or a serious incident requiring extra support on a short, medium or long term basis.

It is widely known that if you are booked for a procedure at King's Mill, any blood tests which are required prior to that procedure involve visiting King's Mill to have them done. Why is this so? Will this be addressed in the Newark healthcare review to ensure people are able to get pre-op tests done locally in future? 

Patients identified suitable for surgery at King’s Mill Hospital can and do have blood tests at Newark Hospital.

However, some patients may need a pre-operative assessment prior to their surgery date which would be undertaken at King’s Mill Hospital. Such an assessment may include a blood test.
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Is it also possible to ensure that in the future checks are done on the quality and availability of previous tests or scans in advance of appointments, to avoid wasted journeys to King's Mill?

The follow up appointment date is attached to the request for tests and whenever possible the test is completed prior to the appointment date. Outpatient staff are responsible for ensuring results are available prior to the patients appointment.

However, there are circumstances when the out patients appointment is required before the tests can be completed. The Trust is working on a system to reduce the time this occurs.

Recently I have been told by two people that they travelled from Newark to King's Mill, only to fail to have procedures done when they got there because previously done tests or scans, required for the procedures, were not satisfactory or available.

The Trust is unable to comment on any individual cases; however procedures are in place to ensure all relevant scans and test results are satisfactory and available however, we recognise on occasion results have not been available at clinic appointments and that this situation is unsatisfactory.

Currently there is an outpatient review project underway to ensure these procedures meet the required standard.

We would welcome feedback if a patient has any comments about the service they have received by Sherwood Forest Hospitals NHS  FT. They can contact the Patient Advice Liaisons Services (PALs) on 01623 672222.

How much did it cost to run the (current) A&E department at Newark in the last year?

For 2008/09 £2.2 million is the projected cost to NHS Nottinghamshire County as the commissioner of the service.

What will the (estimated) cost be per year for each of the two options for the minor injuries unit plus?

The cost will be of a similar level but services in the community could be enhanced if the resource is not being used to keep the MIU open 24 hours.

Presuming it is cheaper to close the unit over night, where will the saving be spent if the second option is chosen?See above point 2.

One the question about which Trust is responsible for organising taxis to take patients and their families to hospital appointments/visiting and also pay the taxi fares?

Chris Kenny, Director of Public Health for NHS Nottinghamshire County, said: "Unfortunately, the NHS has a limited resource and the pot of money we do have needs to be spent on ensuring the best quality services for patients, focusing on medical need.

"It is not possible to pay the taxis or transport of all patients and their families to hospital appointments and visiting but there are circumstances which mean that transport is available to those who are most in need e.g. x, y and z. This is done through Patient Transport Services and is handled within the acute hospital Trust's such as King's Mill Hospital or Queen's Medical Centre. We also have services for visitors to use such as the Medilink at Nottingham University Hospitals NHS Trust and the volunteer drivers scheme at Sherwood Forest Hospitals.

"We understand that this is a concern as some patients needing the more specialist care e.g. stroke patients will be treated at the larger hospitals. The Healthcare Review will actually see more patients lifes being saved this way and once the acute or specialist phase of care or treatment is completed, patients would return closer to home, such as Newark hospital."

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