Doctor shares his opinion on how Hemel Hempstead Hospital can operate with no inpatient beds

Plans to transform hospital sites in west Hertfordshire include no inpatient beds at Hemel Hempstead Hospital.

Instead, West Hertfordshire Hospital NHS Trust intends to expand the range and volume of planned medical procedures at the hospital to create a multi-specialty site that will seek to provide care on a ‘one stop’ model as far as possible.

In the trust's redevelopment proposals, Hemel Hempstead Hospital will be the site for patients receiving planned medical care and those with long-term conditions.

Because of this, it is not expected that patients seen at this site would need to stay in hospital after their appointment - and so there are no plans to provide inpatient beds at this site.

But some people have questioned the Trust's plans and asked how can you have a hospital with beds.

The Gazette spoke with Dr Thomas Galliford, deputy Chief Medical Officer specialises in endocrinology, who shared his thoughts on the plans and why he believes a hospital with no beds has many advantages.

Dr Tom said: "I believe these plans are really good, and I can say that the clinicians that have been involved in it all think the same.

"I'm aware of how passionate Dacorum residents are and how they feel about what has happened to the hospital over time even though there are valid clinical reasons why we don’t provide emergency care at Hemel.

"We believe that trying to keep people out of acute hospitals is a good thing, most people who have a chronic condition, they just live with it, and are often not ill, they just have a condition.

"When they come to the site, which in my opinion is still a hospital, they get all the care they need, they don't go from pillar to post.

"We call that integrated care, or planned care and that is what the Hemel site is envisaged as being.

"If you look at people with chronic conditions or planned care, it's a lot of the medical specialties like frailty/elderly care, diabetes, rheumatology, cardiology and medical outpatients come into this area too.

"The idea is that they come and it's a bit more of a one stop shop.

"At the moment people get to sent to Watford for this, St Albans for something else, but this new way is that you come, you see your doctor or specialist nurse, and while you're there you have all the diagnostic things that you need - by that I mean blood tests, x-rays or scans - and you have it a one stop shop.

"Ideally, for some people that's all the contact they need with West Herts.

"It is good for patients, and it is about making quick, medical decisions and it means we can start treatment earlier.

"Having it all as one service, that is what we hope to move towards and there are lots of advantages for that for the patients.

"The clinicians are getting involved with this because we see the advantages of this and we see the advantages of being away from a busy, acute hospital.

"Any acute hospital always fill their beds and then they end up moving to other areas of the hospital. Having it away from the acute site has an enormous amount of benefits because it protects that care for that patient group.

"It's in Dacorum, so it will be good for people in Dacorum, but there will also be people from St Albans and Watford coming for planned care as well. It's good news that you have got co-localisation of all these specialities.

"It is a really attractive model and I think that if we are honest we have seen it work elsewhere.

"Health care is moving towards having planned care sites, having acute sites where really sick people need to be in a hospital, and then people having planned care at another site and then a surgical site, which for our trust would be St Albans.

"It makes sense for our population, it makes sense for the patients, it makes sense for the doctors and the clinical teams.

Dr Galliford spoke about how the pandemic has changed the way things were traditionally managed in hospitals, and the move towards virtual appointments, if it is right for the patients.

He said: "During the pandemic we were able to protect sites, and still run clinics at St Albans and Hemel, when we couldn't run anything at Watford, because it was a hot site.

"It was useful having different areas to work in and if we can make those areas better, and model them on what we think is progress and better. This model is admission prevention, keeping people out of hospital, but if you need to be in a hospital bed, then you will be.

"We will do all we can at the Hemel site, but if they need to be admitted then they go to an acute site. That is similar to what happens at the moment."

Dr Galliford believes that moving away from the traditional idea of a hospital has its advantages, and says Hemel Hempstead Hospital just won’t have beds for out patient care.

He said: "It will all be on your doorstep, you have all of the planned care.

"If you have the services that can get this person better at the Hemel site, then you don't need to go to Watford.

"It's about working together, it's still doing everything we are doing at the moment, but just better.

"It is about efficiency, get it all done in one go, see the doctor, get the scan, get the answer and that's it done. That is what we are moving towards, we are doing a bit of it at the moment, but not enough, this is a great opportunity.

"In my opinion, it is still a hospital, there are still doctors, nurses and health care professionals, health care assistants, dieticians, specialist physiologists, radiographers, all those people. There will be all the diagnostic tests, we just don't have hospital beds.

"We think this is a really positive step, and we think it will improve care. We need to develop our pathways, and the sites.

"There is a choice for patients, there are new ways of working, there is a virtual way, but it has got to be right for that patient. It is about patient choice, do they want to see someone face to face, or virtually.

"Most people do attend hospital as an outpatient, most of our activity in the hospital doesn't actually need beds, most of it is prevention or treatment.

"We need to make improvements for patients, and I think that this is an opportunity to do that right."