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Seizing the future

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How could this affect you?

Everyone has different experiences of receiving care and treatment in hospital. These experiences will differ depending on your condition and the type of service you need.

The proposed changes would affect different people in different ways. The stories on this page aim to show ‘pathways’ of care as they exist now and the improvement in care that would result from the implementation of the proposals, across a wide range of services.

Click on a link below to read a story that interests you:

Jack and Eileen’s story – emergency care

Jack, from Shildon, is driving to work in Stanhope when his car veers off the road hitting a pedestrian, Eileen, who lives in Wolsingham. Eileen sustains multiple injuries, including a fractured pelvis and abdominal injuries.

Jack suffers from cuts and bruises and a suspected broken arm.

Scenario 1 – what happens now Scenario 2 – what may happen in the future

Jack is taken to the Accident and Emergency (A&E) department at Bishop Auckland where he is treated and can then go home. He is given an appointment for follow up at the fracture clinic the next day.

Eileen is given treatment, which includes painkillers, oxygen and fluids, by the attending ambulance crew at the scene and during her transportation to Darlington Memorial. She is investigated and given further treatment in the A&E before having abdominal surgery and being transferred to the intensive care unit and then a few days later to the surgical ward.

During the early stages of her admission to hospital, she receives care and attention from a large number of specialist staff, including the trauma team in the A&E, an orthopaedic surgeon, a general surgeon, the team in intensive care and physiotherapists.

After five weeks, she is discharged home.

Jack would be taken to the urgent care centre at Bishop Auckland where the treatment he receives would be the same as that provided now, but led by a trained nurse practitioner instead of a doctor.

Most of Eileen’s care, would be exactly the same as that provided now.

Under Option B, however, once medically stable Eileen would be transferred to the rehabilitation centre of excellence at Bishop Auckland. This is nearer to her home, but more importantly allows her to make an earlier, quicker and more successful recovery

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Albert’s story – elective day case surgery

Albert from Chester-le-Street has had trouble with a hernia in his right groin for several years. It is beginning to cause him problems while gardening so he sees his GP who refers him a surgeon.

Scenario 1 – what happens now Scenario 2 – what may happen in the future

The surgeon sees him in the outpatient department at Chester-le-Street Community Hospital. His surgeon recommends an operation to repair the hernia.

He has his surgery in the daycase centre at University Hospital at Durham.

He makes a good recovery and has his follow up clinic appointment at Chester-le-Street.

When Albert sees his surgeon and the surgery is recommended, he is offered the choice of having his surgery at either Shotley Bridge Community Hospital or at Bishop Auckland in the day surgery centre.

As Albert’s daughter lives in the Bishop Auckland area, he chooses to have his surgery at Bishop Auckland.

His follow up clinic appointment still takes place in Chester-le-Street.

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Jenny’s story – she needs to travel for specialised care

Jenny, who lives in Bishop Auckland, has been feeling generally unwell for two days and suddenly, experiences pain in her left arm. Worried that she might be having a heart attack, she phones 999.

Scenario 1 – what happens now Scenario 2 – what may happen in the future

On arrival, the ambulance paramedics carry out an on the spot heart tracing test. A ‘blue light’ ambulance takes her to James Cook University Hospital in Middlesbrough where she undergoes a procedure to unblock one of the blood vessels in her heart.

This procedure is only performed in a small number of specialised cardiac centres in the North East. The procedure is particularly beneficial because it relieves the symptoms the patient is experiencing such as chest pain, and helps prevent further heart attacks.

Jenny’s care would be unchanged.

As medicine advances, the need for this kind of specialised treatment will become more common – it is one of the many reasons why having teams of specialist doctors, nurses and other staff together in one site, in teams large enough to provide 24 hour cover, is in the best interests of patients.

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Sarah’s story – medical assessment clinic

Sarah is a 26 year old student with asthma who lives in Bishop Auckland. She sees a respiratory specialist as an outpatient twice a year.

She takes a number of treatments for her asthma including three different types of inhaler. Her asthma has worsened over the last week and she has been to her GP twice.

Scenario 1 – what happens now Scenario 2 – what may happen in the future

Sarah’s GP refers her for immediate admission to the medical wards at Bishop Auckland.

She is assessed by the medical team and a range of investigations is carried out over the next two days.

Her medications are reviewed and changes are made. She is discharged home after two days.

The changes in Option B include establishing a medical assessment clinic.

Sarah’s GP contacts the medical rapid assessment clinic at Bishop Auckland and arranges for her to see a consultant in a clinic slot available later that afternoon.

Sarah sees the consultant who arranges some immediate investigations and, after reviewing the results, advises changes to her medication. Sarah returns home, her admission to hospital avoided.

In this example, rapid review and treatment have prevented Sarah’s admission to hospital.

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Helen’s story – care after a stroke

Bob, who lives in Durham with his wife Helen, is sitting watching television one evening.

Helen is walking back from the kitchen with two cups of tea. She suddenly becomes unsteady and collapses to the floor. Bob rushes to help her and notices her speech is slurred and her arm is weak. He suspects a stroke and calls 999.

Scenario 1 – what happens now Scenario 2 – what may happen in the future

Helen is taken by ambulance to University Hospital and is admitted directly to the stroke unit.

Although it is still the middle of the night, Helen needs an immediate CT scan to find out if she is suitable for treatment using clot busting drugs.

She has her scan, receives the clot busting drugs, and within three days is fit for transfer to an elderly care ward in the hospital where she receives some rehabilitation.

Within three months she is able to return home and with extra support, including outpatient treatment, she continues to recover.

The acute phase of Helen’s care is the same as that which happens now.

If the proposed changes described in Option B are implemented, Helen spends three days in the stroke unit and is then transferred to the Trust’s intensive rehabilitation centre in Bishop Auckland. There she has the support of a team of therapists and nurses who are focused on rehabilitation with the result that her movement, co-ordination and speech function improve rapidly.

Helen is able to return home after seven weeks with only minimal community support. The intensive rehabilitation she received has allowed her to recover more quickly.

The changes that are proposed as part of the Seizing the Future review focus on the entire patient journey, not just the care patients receive in the acute phase of their illness.

For patients like Helen, the care that is delivered at the end of their journey, in the rehabilitation phase, is just as important as the care that is delivered in the first few hours.

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Suraya's story – paediatric care

Ali and Sangeetha, who live in Spennymoor, are concerned because their child has some difficulty in breathing.

Scenario 1 – what happens now Scenario 2 – what may happen in the future

At 3am they take Suraya, aged eight, to Bishop Auckland A&E department where they are seen quickly. The decision is made that she should be seen by a paediatrician.

Because the hospital does not have a full 24 hour paediatric department, Suraya needs to be transferred to University Hospital and this is arranged. She is admitted to the paediatric ward where she is seen promptly by an experienced paediatrician, a range of tests is immediately performed and she is started on treatment.

Fortunately, Suraya improves steadily and is discharged home after two nights on the paediatric ward. She needs a check on her progress a couple of days later and this is arranged at the outpatient department at Bishop Auckland.

Ali and Sangeetha take Suraya directly to the A&E department at University Hospital where her care is managed as before.

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Paul's story – being seen quickly by a paediatrician

Paul is eight months old. His parents Darren and Lisa are concerned because he has had a poor appetite for several weeks and looks thin. They arrange to see their GP at her practice in Bishop Auckland.

The GP assesses Paul and feels that while his condition is of concern and needs attention, it is not an emergency situation. She would like Paul to be seen as soon as possible by a paediatrician.

Scenario 1 – what happens now Scenario 2 – what may happen in the future

Paul's GP telephones the paediatric department at the hospital and is informed that the earliest slot for an outpatient appointment is four weeks.

However, the consultant makes special arrangements to see Paul because the GP is very concerned.

Paul is seen later the following week. He has a number of tests, his parents are given advice on nutrition and arrangements are seen to review him every fortnight.

After four months he is on target to achieve his goal weight within six weeks.

Paul's GP telephones the paediatric department and books an appointment in the paediatric rapid access clinic at Bishop Auckland for the following day. (A service proposed in Option B).

Paul is seen by a paediatric consultant and the same treatment plan is arranged as described in the column to the left.

In many specialties, a lot of care can be managed on an outpatient basis and this is particularly the case with paediatrics – no child likes to be in hospital.

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