• East of England’s largest provider to make emergency departments “referral only” for walk-ins
  • Chief says proposals involve “expanding further” on national plans for better streaming and service colocation
  • Trust also faces pressure from home secretary over clinical reorganisation

Walk-in patients will be unable to access emergency care at a major hospital trust without a referral from a colocated urgent treatment centre, its chief executive has told HSJ.

The plans put forward by East Suffolk and North Essex Foundation Trust, which runs Ipswich and Colchester hospitals, are part of a major reorganisation backed by £35m of capital funding. It proposes to cut emergency department activity by 50 per cent as a result of the changes.

Nick Hulme

Nick Hulme is chief executive of East Suffolk and North Essex Foundation Trust

Chief executive Nick Hulme said: “Instead of [walk-in patients arriving at the] ED… patients will arrive in the urgent care centre and only be referred into ED [if necessary].”

Colocating the UTCs and emergency departments and redesigning pathways to stream patients more rapidly to specialties is in line with national policy set out in the NHS long-term plan and common across the service. But the trust’s plans, which will see a completely new UTC built at Colchester hospital, represent the ambitious end of the scale.

Mr Hulme added: “A lot of [hospitals have developed] models [which stream patients to] medical assessment units, emergency assessment units [and] GPs [etc]… What we are doing is expanding that further, with good triage through an urgent treatment centre, ED becoming referral only at the back of that.

“We can probably reduce pure ED activity down to about 50 per cent, if not lower, by taking minor injuries and illnesses to a UTC run by ourselves and the local GP confederation.

“We will be quite cautious to start with. But if every patient went direct to speciality… then pure ED activity would be about 25 per cent of what it is [so we think getting to 50 per cent is achievable].”

The trust formed after the merger of Ipswich and Colchester hospitals in July 2018 and is now the largest acute provider by volume in the East of England. It had 201,747 emergency attendances in 2018-19.

It was in the upper quartile against the four-hour target in the first quarter of 2019-20 for both its overall and type one performance, scoring 90.7 per cent and 87.9 per cent respectively against the 95 per cent target. But Mr Hulme said demand was rising sharply and a shortage of emergency consultants also made the move “pragmatic”.

The home secretary makes her case

The trust has also set out controversial plans to build a new £30m orthopaedic centre at one of the sites. The move has led to local MPs, including home secretary Priti Patel, lobbying on behalf of their local hospitals.

Ms Patel made the case for the new unit at Colchester hospital, which sits in her Witham constituency.

She said: “I am supporting calls for [the trust] to select Colchester Hospital as the preferred site for this new centre and I have raised this directly with [Mr Hulme].

“If the new orthopaedic centre was based in Ipswich, my constituents would have to travel more than 20 miles to attend an appointment, which would be difficult for a number of patients, especially those who have limited access to appropriate transport services.”

Ipswich’s Labour MP Sandy Martin has also been in contact with Mr Hulme.

Mr Hulme said no decisions would be made until after a formal consultation later in the year. The centre would not be opened for around another four years.

Roughly 750 patients a year would be affected, although the chief executive stressed patients would return to their local hospital for outpatient and follow-up appointments and they would only need to go to the specialist centre of major procedures.

He added: “Making this a political issue is not terribly helpful, but of course we understand why that would be the case.”