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Why single specialty networked care?

Case study 3: Royal United Hospitals, Bath

The Royal United Hospitals Bath NHS Foundation Trust (RUHB) provides acute treatment and care for 500,000 people in Bath and the surrounding towns and villages of north east Somerset and western Wiltshire.

The RUHB is a major acute-care hospital in the Weston suburb of Bath, about 1.5 miles west of Bath city centre, with 565 beds on a 52-acre site.Wheel chair graphic

In February 2015 the trust acquired the Royal National Hospital for Rheumatic Diseases NHS Foundation Trust (RNHRD) – affectionately known as ‘the ‘Min’. Due to significant, long-standing financial challenges the RNHRD could not continue in its current form but needed to become part of a larger organisation to ensure the continuation and future provision of its high quality services.

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The RUHB undertook to protect and develop the RNHRD brand, which has a national and international reputation for services and research, while also benefiting from the closer integration of services and skill sets from both organisations.
The paediatric chronic fatigue syndrome or myalgic encephalomylopathy (CFS/ME) service is one example.

  • CFS/ME is relatively common in children, affecting at least 1% of teenagers. It is probably the largest cause of long-term absence from school.
  • Despite this, there are very few teams in the UK who specialise in seeing children with CFS/ME and even fewer who are able to see severely affected children at home.

The RNHRD’s paediatric chronic fatigue service is now part of the RUHB’s women and children’s division. A multi-disciplinary team led by Dr Esther Crawley, professor of child health, is supported by doctors, occupational therapists, physiotherapists and clinical psychologists employed by the RUHB.

Key points:

  • Networked clinics were originally set up to improve access to services for disabled children in Wiltshire, Somerset and Gloucestershire.
  • It became clear that locally-delivered therapy was more efficient and effective than all patients having to attend the RNHRD hub.
  • Following demand, another clinic was established in 2011 at Macclesfield, East Cheshire, with a local therapist and paediatric team.
  • The local CCG was supportive.
  • There are internal referrals as well as those coming from across the north west.
  • Local paediatricians have basic training and expertise in children with mild to moderate CFS/ME, but not for more severe housebound patients.
  • They also do not have the capacity, and it is not cost effective, to provide NICE-recommended treatments.

Child with toys

To reduce the need for patients to travel to Bath for assessment, or for a member of the Bath specialist service to travel to Macclesfield to see housebound patients, the RNHRD trained an occupational therapist to provide specialist treatment for paediatric CFS/ME in Macclesfield one day a week. This includes activity management and the assessment and treatment of housebound patients, subject to funding approval.

The service is funded on an individual basis by CCGs.