Out-patients: Health chiefs want to redesign the out-patient department clinics to make better use of resources at each of the five west Wiltshire hospitals.

Specialist clinics could be designated in each hospital, or GP practice sites, with the aim of improving patient care and cutting waiting times.

The proposal comes after the review highlighted inefficiencies in the 'out-dated' departments with limited space, equipment shortages and a lack of skilled staff crippling the service.

An out-patient department manager may be appointed to work with GPs, hospital staff and the RUH to improve the overall appointments system.

In-patients

THE WEST Wiltshire Primary Care Trust's review flagged up national problems of bed blocking and a lack of specialist in-patient services in west Wiltshire hospitals.

To combat the problems, trust members put forward a proposal to view the five hospitals as 'a single resource.'

This means specialist services could be based at each site, but all of the sites are open to west Wiltshire patients regardless of in which town they live.

Dedicated beds for patient rehabilitation, acute medical care and intermediate and long-term care are planned.

This will help healthcare providers cope with the majority of elderly patients admitted to community hospitals.

The stroke unit already based at Westbury is a prime example of how the trust sees in-patient services developing.

Elderly mental health

THE NUMBER of elderly patients suffering from dementia, delirium and depression is on the increase.

Health chiefs recognise that clear guidelines for the provision of specialist mental health services in hospitals have to be developed.

One suggestion is to staff new community hospital in-patient wards for elderly people with registered mental nurses in addition to registered general nurses, ensuring a better standard of overall care.

The Older Adult Service which cares for people over 65 with severe and long-lasting mental illnesses is currently provided by the Avon and Wiltshire Partnership Trust.

Day hospitals, liaison nurses and a relief care sitting service already exist.

But staff at community hospitals said specialist beds staffed by trained professionals should be provided for patients suffering from mental health problems.

Trust members propose to link further with Avon and Wiltshire Partnership Trust, voluntary and private sectors and carers to gauge the service's long-term future.

Intermediate care

COMMUNITY support teams, day hospitals and residential rehabilitation beds were all assessed in the strategic review.

The aim is to ensure as many patients as possible are cared for at home or at nearby facilities.

One proposal is to appoint an intermediate care co-ordinator to create one community support team for west Wiltshire. Linked with social services' home care service, the plan is to provide round-the-clock care.

A suggestion to increase the use of day hospitals could see dedicated days for sufferers of Parkinson's Disease, Alzheimer's or asthma. Increased opening hours will mean more patients being treated closer to home.

Therapy services

A LACK of trained physiotherapists and occupational therapists has sparked a revamp of how therapy services are provided.

Coupled with a dramatic 37 per cent increase in referrals, the therapy service has reached breaking point.

Changes proposed include the development of a general occupational therapy service to provide immediate rehabilitation and treatment.

Staff will be given the opportunity to experience work placements in local services, such as falls groups, for those patients who have suffered falls, and community support teams, to improve skill levels.

This could assist in reducing the staffing crisis.

Better use of physiotherapist assistants is also an option being considered.

Children's services

AN ESTIMATED 27,500 children live in west Wiltshire.

To improve healthcare services for children, health chiefs propose to strengthen the links between midwifery, health visitors, school nurses, child mental health officials and secondary care sources, such as Great Ormond Street Hospital.

Health officials and school nurses will be handed increased responsibilities under the sweeping changes, especially in the areas of nutrition, sexual health and accidental injury.

Trust members want to continue working with the RUH in Bath to assess the changing management of childhood illnesses, including the impact that early discharge of patients has on primary care and therapy services.

A nurse and health visitor triage system is outlined to deal with children suffering from acute chronic conditions.

Day/minor surgery

A DESPERATE need for sweeping changes to the day-surgery network has prompted a series of proposals.

Shorter waiting times and a drastic reduction of last-minute cancellations are two areas being targeted by officials.

Day surgeries are available at Westbury Community Hospital and at a Melksham GP surgery but plans are for more surgeries and hospitals to carry out minor operations and other secondary medical procedures including ophthalmology and orthopaedics.

GP out-of-hours service

CARE of patients outside GP surgery hours operates through various methods including practice rotas and GP co-operatives. Members of the trust have praised the system's efficiency but plan to create a more fully integrated model.

Developing an electronic patient health records system and improving the range of diagnostic services to support the GP out-of-hours service, such as ultrasound and x-ray machines, are two suggestions in the pipeline.

Minor injury units

TWO night-time casualty units look doomed under the latest proposals.

Melksham and Warminster units have already shut temporarily at night because of staff shortages.

A lack of patients visiting the out-of-hours units and a duplication of services are two other problems prompting the controversial move.

Trust members looked at every option, from closing all of the casualty units to keeping the service in its present state.

A 24-hour shared care service with GPs and nurses working together is the preferred model.

The Melksham, Trowbridge, Warminster and Westbury sites will continue to provide in-hour services but only one hospital will provide an out-of-hours facility. This is likely to be Trowbridge.

Human resources

AT THE root of countless problems is a lack of qualified staff.

Problems in recruiting and retaining staff have led to many services being adversely affected.

Officials want to improve morale and change the roles of all employees including GP specialists and nurse practitioners.

The aim is to make posts more appealing and offer opportunities to rotate departments between west Wiltshire community hospitals and the RUH in Bath.