Urology Services in the Black Country

Demand for healthcare is at an all-time high, with an estimated 7.5 million people waiting for elective care treatment across the NHS in England. Locally, within the Black Country, demand is growing by approximately 4% on average per year.

We know that waiting for treatment is a concern for local people and local health leaders alike and we have to find new ways of working to improve access and quality without increasing the costs.

Background

The Black Country NHS Joint Forward Plan sets out an ambitious programme of improving healthcare and building on the provision of existing high-quality care, through improved health outcomes and patient experience.

All NHS providers and local clinical leaders have been working together to map out areas to make the best use of the resources we have to give local people better, faster, safer care.

The Black Country Provider Collaborative (BCPC) is the partnership between providers of acute, hospital services including Sandwell and West Birmingham NHS Trust, The Dudley Group NHS Foundation Trust, The Royal Wolverhampton NHS Trust, Walsall Healthcare NHS Trust.

The Black Country Provider Collaborative has a vision for, ‘one healthcare system, across multiple sites, working in partnership to provide better, faster and safer care to the population of the Black Country and beyond.’

The BCPC has identified urology services as one area where we might make changes to ensure we are providing a more efficient and resilient service for local people.

Urology is a surgical specialty caring for various ailments affecting kidneys, ureter, bladder, prostate and male reproductive organs.

What the offer looks like today

Our highly skilled staff are spread thinly across the Black Country, and it remains difficult to recruit. Evidence from other regions has shown that it would be better to organise service delivery differently for these urological cancers (especially over a smaller geography like the Black Country) to better utilise the available workforce within the Black Country, which will result in better health outcomes for patients.

Currently, renal surgery and PCNL surgery takes place at Russell’s Hall Hospital, New Cross Hospital and Sandwell Hospital which means there are inefficiencies and competition in retaining our skilled workforce across the Trusts.

Proposed changes and their benefits

We know that waiting for treatment is a concern for local people and we have to find new ways of working to improve access and quality without increasing the costs.

The current wait time for renal cancer (also referred to as kidney cancer) services means that only 26.8% of patients achieve the 62 days wait national target and the demand on urology services will remain high in the coming years. We need to ensure we can address this quickly and consistently across the Black Country.

The initial focus is on improving some of our urological cancer provision, through the following key proposals:

  1. Development of a centralised Renal Surgical Centre (Nephrectomies and Partial Nephrectomies – surgery to remove all or part of a kidney)
  2. Expansion of the existing Pelvic Surgery Centre (Cystectomies and Prostatectomies – surgery to remove the bladder and prostate)
  3. Development of a centralised service for Percutaneous Nephrolithotomy or PCNL (the removal of kidney stones when they can’t be passed on their own)

Overall, we want to ensure that patients and the public are able to receive high quality care within the Black Country, with many positive benefits expected such as:

  • Improved outcomes for patients e.g. post cancer surgery patient survival rates
  • Improved quality of life through faster access to surgery e.g. meeting national targets
  • Improved satisfaction with level of care and the positive patient experience received
  • Reduction in patient waiting times e.g. meeting 31-day, and 62-day national cancer targets
  • Better use of theatre capacity across all four provider Trusts including use of robotics e.g. improved theatre productivity
  • Create more opportunities for Black County patients to access care from Black County Providers (rather than needing to travel to other areas) – care closer to home.
  • Support elective recovery post COVID pandemic and support the reduction in Cancer 62- day backlog
  • Development of an expert workforce e.g. better skilled workforce, with greater retention of the Black Country professional and easier recruitment for difficult to fill roles.
  1. Proposal for a Renal Surgical Centre
    With demand on renal services already exceeding capacity and the continued growth of the waiting list, we are proposing to centralise robotic renal surgery at Russel Hall Hospital in Dudley, for both renal cancer and benign renal conditions.

    This would allow for a standardisation of practice across the Black Country, moving from open or laparoscopic surgery (an operation performed in the abdomen or pelvis using small incisions with the aid of a camera) to robotic as a default, unless deemed inappropriate (which is rare).

    This would result in a reduction in waiting times, improvement in health outcomes and experience for patients undergoing surgery, and build the workforce through extending the development of the renal team.By organising and establishing a Renal Surgical Centre at Dudley, we will create the capacity to undertake up to 300 surgical procedures (e.g. nephrectomies and partial nephrectomies) per year, an extra 170 procedures than current capacity can accommodate.

  2. Expansion of the existing Pelvic Surgery Centre (Bladders and Prostatectomies)
    The proposed renal surgical centre at Russell’s Hall Hospital in Dudley would create some extra capacity at New Cross Hospital in Wolverhampton, which can be used for Prostate Cancer and Bladder Cancer Surgery (Prostatectomies and Cystectomies).

    This means that Prostate Cancer and Bladder cancer surgery would make the best use of the robotic technology that is already available at the hospital and increase the number (range between 280 – 421) of prostatectomies and cystectomies performed each year. This would reduce waiting times, improve health outcomes and experience for patients whilst better supporting surgical teams with retaining clinical staff.

    Given that The Royal Wolverhampton NHS Trust is the only centre in the Black Country that currently performs these surgical interventions, there is no further impact on patients receiving this care.

  3. Proposal for the centralisation of Percutaneous Nephrolithotomy (PCNL)
    PCNL is the standard of care for kidney stones measuring 2 cm or more, and for smaller stones in the lower pole with difficult access.

    Currently, this service is offered in a variety of ways at The Royal Wolverhampton NHS Trust, Dudley Group NHS FT, and Sandwell & West Birmingham NHS Trust. A rigorous review has been carried out and has identified Sandwell & West Birmingham NHS Trust as the recommend choice to be the centralised hospital for this procedure.

    It is anticipated that based on available capacity of the proposed hospital, that this will impact in the range of 85 to 132 patients annually.

This table shows the current locations of provision:

Surgery Type DGFT RWT SWBT WHT
Renal Cancer Surgery Yes Yes Yes No
Bladder Cancer Surgery No Yes No No
PCNL Yes Yes Yes No

This table shows the proposed locations of provision:

Surgery Type DGFT RWT SWBT WHT
Renal Cancer Surgery Yes No No No
Bladder Cancer Surgery No Yes No No
PCNL No No Yes No
What this will mean for patients

I am a renal cancer patient:
Your surgery would take place at Russell’s Hall Hospital in Dudley at a specialised renal surgical centre. These procedures would no longer be carried out at New Cross Hospital or Sandwell Hospital. Your pre and post operative care appointments would still take place at your local hospital.

I am a prostate or bladder cancer patient:
Your surgery will continue to be at New Cross Hospital in Wolverhampton where it has always been planned, but we would have additional capacity to carry out between 280 – 421 procedures per year, as our renal cancer surgeries will take place at Russell’s Hall. Your pre and post operative care appointments would still take place at your local hospital.

I am a kidney stones patient:
Your surgery would take place at Sandwell Hospital. These procedures would no longer be carried out at New Cross Hospital or Russell’s Hall hospital. Your pre and post operative care appointments would still take place at your local hospital.

What have local people and patients already told us?

In 2023, more than 1,000 people who live and work in the Black Country completed a survey, the insight from which was used to inform the priorities and delivery plans in the Black Country NHS Joint Forward Plan. Feedback from contributors told us that:

  • 81.49% of those who completed the survey said they were willing to travel outside of the place they live to receive treatment from a team that specialises in that type of surgery.
  • 72.32% of those who completed the survey said they would be willing to travel outside the place they live to receive care more quickly.
  • For care after surgery, the majority of people who completed the survey wanted to receive aftercare in the community (79.71%) or at their local hospital (68.76%) and 60% were willing to return to the health and care setting where they had the surgery.

We also know from a recent listening exercise, conducted to help understand residents’ experiences, attitudes, and views regarding urgent, emergency and elective care services that whilst location and accessibility of planned care and treatment facilities played a key role for some, this was not the case for all, with some willing to travel further afield to access best quality care or for a quicker appointment.

Local insight has also flagged concerns for patients who are unable to drive and have no family to rely on, those with long term conditions, the elderly, those with children/large families, those living in rural areas, those who are unfamiliar to the area (e.g. people who are new to the country) as well as those with multiple health conditions who may need to travel to different hospitals for their care.

We’ve also heard that waiting lengthy periods of time for planned care appointments was noted to cause anxiety and, in some cases, detriment to a patient’s quality of life. Cancellations were additionally noted to be traumatic for patients, especially when patients have to prepare in advance for these.

What is it we need your views on?

Before any decisions are made, we want to understand how these proposed changes might impact upon current patients, as well as people who might rely on these services in the future.

We are particularly keen to understand how the proposed changes will impact upon travel arrangements for patients and their family members, friends and/or carers as well as what support could be offered to make getting to and from planned surgical appointments easier.

How to have your say

You can have your say on the proposed changes and what they will mean for you up until 17th May 2024. You can have your say by completing this short online survey.

From the 8th April, we will be sending letters to patients currently on the waiting list for any of these procedures to let them know about the proposed changes and how they can get involved.

We will also be sharing information on social media and on our website and with wider stakeholders.

What to expect at the end of the public conversation period?

This is an opportunity for you to consider our proposals for the future of urology services have your say on it.

Your views and the findings from this exercise will be used to decide on next steps around developing a case for change and if service change is needed.