Frequently asked questions

//Frequently asked questions
Frequently asked questions 2018-03-22T09:19:53+00:00

Who is responsible for decision-making in the STP?

Answer from Dr Anita Donley OBE, independent chair of Mid and South Essex STP

The Mid and South Essex Sustainability and Transformation Partnership (STP) includes five clinical commissioning groups (CCGs), three local authorities, three hospital trusts, three community and mental health service providers, one ambulance service and other national and local partners. The full list is in our consultation document on page 8.

Each organisation is a statutory, legally accountable organisation in its own right:

  • Decisions about the arrangement and level of services, planning and funding services are made by the CCGs and local authorities.
  • Decisions about running and staffing services are made by provider organisations, such as NHS Trusts and GP practices.

The STP brings all of these decision-makers together to develop and agree system-wide improvement and transformation, with an STP programme board to coordinate the work. The STP is not a statutory decision-making body, but a vehicle for partnership across the health and care system.

The STP plan was published in October 2016 and is available on our website click here to view

Within the STP, the five CCGs have formed a joint committee with legally delegated powers to make planning and financial decisions on behalf of the five CCGs. The three hospital trusts have formed a joint working board to lead and manage hospital reconfiguration and service redesign.

When the CCG Joint Committee voted to approve proposals for consultation, why did three of the CCG clinical chairs abstain?

Answer from Dr José Garcia Lobera, GP Chair of Southend CCG and member of the CCG Joint Committee. Dr Garcia was one of the clinicians who abstained.

The GP Chairs are in complete agreement that the proposed hospital changes should be published for consultation. Our hospital services do need modernisation and we support the five principles upon which these proposals are based. Backed by national and international clinical evidence, the proposals represent clinical best practice and take into account the particular needs of our area.

We look forward to hearing the views of staff and local people before considering our commissioning decisions in 2018. Clearly, we want a meaningful consultation that will inform plans and ensure the best possible services in the future for mid and south Essex.

The reason for abstaining was to highlight our view that the mid and south Essex health and care system needs further investment in primary and social care. As partners in the Mid and South Essex STP, we will continue to discuss how best to secure this.

How have clinicians been involved in developing the proposals for consultation?

Answer from Dr Celia Skinner, chief medical officer for the three hospital trusts;

The proposed changes in hospital services were developed by clinicians over 18 months and with input from local people and organisations. Relevant clinical experts in each area of hospital care led the development of specific proposals; and some 70 leading doctors and nurses were involved in reviewing and narrowing down the options for clinical services across the three main hospitals.

As part of the development process, there were four clinical reviews by the independent East of England Clinical Senate and an options appraisal involving a panel of clinical experts from outside our area, which has provided substantial clinical assurance. There is still further work to do both during the consultation and in future implementation to ensure complete clinical assurance. Our clinicians will work together to ensure patient safety and to test and review plans at every stage before moving on to the next.

Is the STP trying to play down the number of people affected?

Answer from Dr Ronan Fenton, medical director for the STP “In hospital” programme and medical director for Essex and Herts Air Ambulance

It is fair and factual to say that the number of people affected is relatively small compared with the number of people treated every day in our hospitals. The estimate of 15 people per day transferred to another hospital from their local A&E is around 5% of the number of people currently admitted to hospital from A&E and 1-2% of the current daily attendances in A&E. The estimate of 14 people per day travelling to a planned operation is around 3-4% of the total number of people who visit hospital for a planned operation

Having said that, we would in no way wish to underestimate the potential impact on those patients who may be affected by service change. While the aim is to improve clinical care and achieve the best possible outcomes for those patients, we know there are also potential disadvantages for some people in having to travel further than their local hospital and we are keen to invest in new transport arrangements, for example, to help mitigate some of these issues.

Would more people transfer from Southend than Basildon and Chelmsford?

Answer from Dr Donald McGeachy, medical director for STP joint commissioning

Under the specific proposals in this consultation, it is possible that the number of people likely to transfer from one hospital to another is greater from Southend compared with Basildon and Chelmsford; however, this is not the whole picture.

The proposals for service change in this consultation are in general concerned with services that may be needed, possibly once or twice in a lifetime and only for a very short period of around three to four days. It is already the case that many cancer patients travel between hospitals under current arrangements. For example, for radiotherapy from Monday to Friday, around 50 patients per day already travel to Southend Hospital from mid and south west Essex.

One of the aims of our consultation is to listen to local views on the balance between arranging specialist services so that we secure the best possible care for patients in the future, and the challenge for some families of having to travel further for this care and how we may be able to help with this.

We have already listened and modified significantly our proposals before the start of consultation, so that we could reduce the number of potential emergency transfers. We will continue to listen to your views and take these into consideration alongside the clinical evidence and other factors that are important to improving our health and care system for the next decade.

With regard to the number of patients affected per day (in emergency and planned care), why are figures in the consultation document slightly different from figures in the pre-consultation business case?

Answer from Dr Celia Skinner, chief medical officer for the three hospital trusts;

On page 15 of the consultation document, there is a table showing estimates of the potential number of people per day who could be affected by the proposed changes in hospital services. Alongside the table, we explain that these figures are based on estimates and averages. Actual figures would vary daily depending on each person’s individual needs.

The consultation document gives our best indication by showing an estimated range of daily transfers, rather than a single average. While this is a different way of presenting the figures from the estimates in the pre-consultation business case, and could lead to a different total figure if taken literally, we felt that this was the clearest way to highlight the potential impact for local people.

Will all three A&Es still take “blue light” ambulances?

Answer from Dr Celia Skinner, chief medical officer for the three hospital trusts;


Under the proposed hospital service changes, the majority of ambulances, including “blue light” ambulances would continue to be received at all three A&Es. We say “majority” because there are already some ambulances which currently take patients direct to a specialist service, such as the Essex Cardiothoracic Centre in Basildon and the major trauma centres in London and elsewhere. These existing arrangements would continue unchanged.

What is the definition of an “emergency hub”?

Answer from Dr Celia Skinner, chief medical officer for the three hospital trusts;

We have coined the phrase “emergency hub” as a way of describing a proposed wider range of urgent care services to improve the flow of patients through A&E at all three main hospitals in Southend, Chelmsford and Basildon.

There are two main ways in which we propose to increase the range of services available. One is to include primary, community and social care professionals within the available services at the A&E “front door”. This is not yet defined in detail and we are keen to hear views on this from local people, but for example, there are potential benefits in developing GP services, pharmacy, mental health professionals and social care working closely with the A&E team. For those who would benefit from these services, this would help people get faster access to the care and support they need, and avoid having to be admitted to hospital.

At the same time, those patients with more serious clinical needs would be seen by the A&E team itself, ensuring faster access to senior doctors and nurses than is sometimes the case currently.

The second main increase in the range of services within the “emergency hub” is the development of four types of assessment centres at all three hospitals, as described briefly in the consultation document on page 30. This will build on and improve our existing assessment centres to provide consistent best practice in assessment, diagnosis, treatment and care planning; and a safe and speedy return home with the right support.

We are listening to views on how the emergency hub could work for patients through discussions in focus groups at each of the open discussion events during the consultation period. The dates of these events are listed in the Events section of this website and on page 54 of the consultation document.

How many children seen in A&E and how many admitted?

Answer from Dr Celia Skinner, Chief Medical Officer for the three hospital trusts;

Currently, over 84,000 children and young people under the age of 19 are seen in A&E over a year across the three hospitals; and around 10.5% (or around 8,860 a year) of these children and young people are admitted.

In the future, we would expect these numbers to reduce as more care is provided for children at home and in health centres in the community.

How many older people that have suffered a fall go to A&E?

Answer from Dr Celia Skinner, chief medical officer for the three hospital trusts;

Currently, we estimate that around 13,500 people over the age of 65 attend A&E as a result of an injury due to a fall. The majority of these people would continue to be treated at their local hospital in the proposed assessment centre for older people.

In the assessment centres, specialist teams would be able to act quickly, including being able to make decisions that involve services in the community as well as within the hospital, to get people home  quickly and safely with the right support.

CCGs, working with their GP practices, are actively developing better care for people who are frail or have long term conditions. This work includes identifying people who may be at risk and acting quickly to help people stay independent, manage any health conditions and hopefully prevent falls and ill health.

How many strokes per day?

Answer from Dr Paul Guyler, stroke consultant at Southend Hospital

Currently, each hospital sees between 450 and 700 strokes a year.  The total number of emergency spells in 2016/17 across all three hospitals was 1,820. The number of people admitted across all three hospitals for stroke roughly equates to five people per day.

Why do we need to improve our stroke services?

We measure outcomes from stroke care, including the number of people who survive and how well they recover. We also review levels of care in terms of the number and types of specialist doctors, nurses, therapists and technicians that are available 24 hours a day for each patient.

This information is gathered nationally and published by the Sentinel Stroke National Audit Programme (SSNAP), which you will find at . This website publishes a clinical audit every four months which looks at recovery, rehabilitation and outcomes at the point of the patient’s 6 month assessment.

We already have excellent stroke services in our three hospitals through the hard work of dedicated staff, which can be seen in the SSNAP audit. This is very good compared with many other hospitals, including some of the larger London hyperacute stroke units. However, there are areas where we can further improve stroke care with better staffing levels for all patients if we all work together.

We can improve patient care and chances of recovery by having a specialist stroke unit in one hospital to lead a network of stroke care across all three hospitals and in our local communities. Stroke specialists at all three hospitals have proposed improvements in diagnosis, immediate assessment and treatment at each local hospital, and improvements in patient care with regard to staffing levels and rapid investigations in a specialist stroke unit. We will also develop a specialist stroke endovascular service, which is a relatively new type of treatment where a clot is physically removed from a blood vessel. This type of treatment is not currently available to all patients in Essex.