NEWS FLASH - In Spring 2007, Vanguard Healthcare were experiencing unprecedented demand for mobile medical facilities from NHS Health Boards in all parts of Scotland. “Our track record north of the Border speaks for itself. We are working flat out to meet demand and there is more on the horizon”, said Business Development Director Ian Monaghan: “We are proud of what we are achieving here in partnership with NHS Scotland and the Scottish Executive”.
In Scotland in 2004, the National Waiting Times Unit agreed local performance improvement targets and plans with individual NHS boards. These set out the progress to be made between 2004 and 2006 towards delivery of the Scottish Executive target that no patient should wait longer than 26 weeks for treatment.
Funding was made available from the National Waiting Times Unit and the Centre for Change and Innovation to drive forward service redesign initiatives that would enable NHS boards to meet their targets.
More recently, the target was reduced to a maximum of 18 weeks waiting time by the end of 2007.
The waiting times challenge has been approached in various ways by Scotland’s NHS boards, mostly by further investing in staff and hospitals but also at times they have found it makes sense to make use of high-tech solutions provided by the independent sector.
The mobile solution offers significant benefits to patients including:
• reducing the stress of long waits for diagnosis and treatment
• no additional travelling - the elderly, in particular, appreciate that they only have to travel to their local hospital where the mobile unit is based
• continuity of care – the hospitals’ own surgeons, anaesthetists and other clinical staff can carry out the procedures, assisted by experienced theatre staff who travel with the unit.
Vanguard Healthcare operates a fleet of 30 high-tech mobile operating theatres, wards and mobile endoscopy units suitable for a wide range of procedures.
By early 2007, Vanguard’s fleet had carried out approximately 65,000 NHS operations across the UK, including ophthalmic, urology, ENT, gynaecology, plastic surgery, general surgery and endoscopy.
Vanguard’s first Scottish commission came in March 2005 when Woodend Hospital, Aberdeen, used a mobile theatre for 150 orthopaedic operations over a six week period. It provided valuable short-term assistance with waiting lists while the hospital’s fourth operating theatre was being completed.
The procedures, undertaken by NHS Grampian consultant orthopaedic surgeons, ranged from minor operations requiring local anaesthetics to arthroscopies and total hip and knee replacements. Vanguard provided four fully qualified ODPs (Operating Department Personnel) to support NHS Grampian’s medical team.
Day case ‘visiting hospital’
NHS Grampian went on to commission the first ‘visiting hospital’ in Scotland, sited at Aberdeen Royal Infirmary for four weeks in January and February 2006. Comprising a mobile operating theatre with an associated ward, the £1m visiting hospital enabled more than 200 day case operations to be performed, including cataracts, hernia, varicose veins, endoscopy, vasectomy and cystoscopy.
The operations were performed by NHS Grampian surgeons while Vanguard supplied the anaesthetics, recovery and scrub support staff. NHS Grampian’s own nurses staffed the eight-bay ward area.
Day cases and extended hours
Moray Council and NHS Grampian are working closely together to promote better health and social care in the community. Focusing closely on the needs of their patients, they brought in a mobile theatre which would be available for minor operations during evenings and weekends, not just normal weekday times.
The unit was located at Dr Gray’s Hospital, Elgin, for nine weeks from October 2006 and procedures were undertaken by NHS surgeons, supported by Vanguard ODP staff. Surgery undertaken in the unit included varicose veins, hernias, gall bladders and tooth extractions. The unit also provided capacity for a number of patients from Aberdeen, including several whose hip operations were brought forward as a result.
Up to 100 patients needing minor operations, such as tonsillectomies, were treated in a fully equipped Vanguard mobile operating theatre at St John’s Hospital, Livingston, in August 2005.
Pre-operational assessments were carried out in the hospital by NHS Lothian staff, while the operations themselves were handled by a highly trained Vanguard team. Among those to benefit were people awaiting surgery at both St John’s and the Western General Hospital.
A Vanguard mobile surgical unit returned to St John’s Hospital in November 2005 for a four week period to assist with approximately 80 ENT operations and maxillo-facial work. On this occasion, NHS Lothian’s own surgeons carried out the procedures, supported by staff, including theatre staff, provided by Vanguard.
In a UK first, NHS Lothian hired a mobile endoscopy unit for six weeks from January 2006. Caring for up to 20 patients a day, it cut waiting times for approximately 600 patients who were seen by one of NHS Lothian’s own consultants. Other members of the clinical team, such as ODPs, were provided by Vanguard. Once again, the unit was based at St John’s Hospital, Livingston.
More than 140 patients at Raigmore Hospital, Inverness, benefited from a Vanguard state-of-the-art theatre over a three week period in March 2006.
Situated adjoining the hospital’s day case unit, it provided the additional capacity to enable NHS Highland general surgeons to address waiting times for hernias, varicose veins and vasectomies.
Following their experience in 2005 when Tayside patients were offered the chance to be treated at a private hospital in Glasgow, NHS Tayside opted to bring additional treatment capacity closer to home in 2006. Patients had been reluctant to travel to Glasgow because of the effect on relatives visiting from a distance.
Thus, in June 2006, a Vanguard mobile operating theatre was sited at Ninewells Hospital, Dundee, to create additional capacity for orthopaedic patients. During a ten week stay, the unit shortened the wait for more than 200 patients. Supported by Vanguard nursing staff, Ninewells surgeons performed the operations which included hip and knee replacements. A number of spare slots in theatre time were allocated to general surgery, ENT and plastic surgery.
THE THINGS THEY SAID
NHS Grampian Medical Director, Dr Roelf Dijkhuizen, said: “Feedback from our surgeons and nurses has been very positive, both in terms of the facilities and the service provided by Vanguard staff. Patient care in the mobile unit does not differ from that undertaken in our existing theatres. The modular unit is attached directly to the hospital, enabling pre and post operative care in the orthopaedic wards as normal. Comments from patients have also been positive.”
Orthopaedic patient Netta Forrest, 62, from Shetland, underwent a knee operation in the mobile theatre at Woodend Hospital. She said: "My consultant told me about the theatre the night before my operation and I thought it would be quite small. But it turned out to be three big rooms. I had no worries about having my operation in it and it had all the latest equipment. Everyone was very nice and I had no problems at all."
Lead System Manager at Dr Grays, Issie Graham, said: “We feel it has been very successful...we’ve been very happy to provide day, evening and weekend slots to fit around personal commitments.”
Jackie Sansbury, NHS Lothian Director of Strategic Planning, said: “We are constantly looking for ways to make services swifter. This innovative approach means up to 100 patients in need of straightforward surgery will be treated more quickly. The mobile unit delivers additional resources locally and means we can focus on the needs of one group of patients without affecting services for others.”
Brian Cavanagh, NHS Lothian Chairman, said: “The state-of-the-art endoscopy facility demonstrates our commitment to driving down waiting times. It will provide extra facilities and specialist staff to allow patients’ clinical investigations to be carried out more quickly.”
NHS Tayside Clinical Director of Orthopaedics, Ben Clift, said: “Patients should notice no difference at all. The mobile theatre is just a small part of the patient journey.”
NHS Tayside Clinical Group Director for Orthopaedics, Hazel Carroll, said: “Several options had been considered for increasing the volume of patients being treated...bringing in the mobile unit satisfied patients’ desire to be treated close to home and would help achieve the waiting times targets.”
In February 2006, Scottish Health Minister Andy Kerr welcomed the significant progress made by NHS Scotland to reduce waiting times; applauded the dedication and hard work of all NHS staff who have helped meet the targets; acknowledged the contribution made by the Scottish Executive through additional investment in the NHS; noted that partnerships with the independent healthcare sector have also contributed to the capacity available to treat NHS patients and supported the continuing work by the NHS to modernise and redesign services to further improve access to and accelerate diagnosis and treatment.
Brian Cavanagh, NHS Lothian Chairman, said: “NHS Lothian has proved that it makes sense to target our resources exactly where they are needed and use the private sector when it is appropriate.”