Wirral Hospital has 11 Clinical Directorates, 3 Operational Directorates and a number of corporate functions ensuring between them that the Trust provides the best services for its patients, visitors and staff. A diagram of the Directorate structure can be seen below and a brief description of the services that each Directorate provides and the role it plays within the Trust follows. Each Directorate has a Director and a Directorate Manager responsible for the running and oversight of the Directorate. The names and contact details of each Directorate Manager can be seen in the contact information section in Part 3.

Clinical Services

ACCIDENT & EMERGENCY
The Accident & Emergency Department at Arrowe Park was opened in 1982 and is the only A & E department on Wirral, providing full 24 hour facilities for the care of the acutely ill and injured. The department underwent major refurbishment in 2002 and now provides a wide variety of high quality emergency treatment services including; resuscitation area, dedicated majors and minors areas, a trolley bay, decontamination suite and a short stay observation ward. The department also arranges outpatient appointments for patients seen in A & E, at the Review Clinic and Fracture Clinic. The Resuscitation Area is equipped for the reception and treatment of seriously ill or injured patients and has its own quiet room for distressed relatives. The Majors Area has 9 majors cubicles providing facilities for the treatment of patients coming in with major injury or illness and has direct links with the Mersey Regional Ambulance Service, whilst the Minors Area receives and treats patients with minor injuries and has a suture room and plaster room. The trolley bay provides 11 cubicles for patients and has a relatives waiting area and the short stay ward has 10 beds which are used for the monitoring and observation of patients who are unlikely to require a hospital stay of 24 hours or more. The department has a large, well-equipped and secure waiting area providing a comfortable location for patients or family to wait and there is also a police presence on Friday and Saturday nights. The department is participating in the Emergency Services Collaborative (ESC), which is national programme designed to assist A & E departments in meeting the targets laid out by the NHS Plan and to generally improve the patient experience.

GENERAL MEDICINE
The General Medicine Directorate is a large Directorate made up of a number of specialised services. These are Cardiology, Diabetes and Endocrinology, Respiratory, Gastroenterology, Palliative Care, Genito-urinary Medicine, Renal, Haematology and the Medical Assessment Unit. The Directorate has a wide variety of clinical and non-clinical staff as well as four Advanced Nurse Practitioners, whose role exists to assist Medical staff in the management of patients' care.

The Cardiology department has inpatient facilities and a 9 bedded cardiac care unit, which cares for patients who have suffered heart attacks. The Cardiovascular department offers a comprehensive outpatient service offering a range of clinics and investigation. The Diabetes and Endocrinology service cares for patients with diabetes related problems and offers inpatient facilities and outpatient clinics. The Respiratory service cares for patients with all types of respiratory illness and provides inpatient and outpatient facilities for patients. The Gastroenterology service treats patients with gastrointestinal problems. It offers an inpatient and outpatient service and is supported by the Endoscopy unit. The Palliative Care team provides specialist care across the Trust and aims to promote the best possible quality of life for patients with advanced progressive disease. The department of Genito Urinary Medicine runs an open access clinic for patients to attend for treatment and diagnosis of sexually transmitted diseases, HIV and AIDS and aims to provide a totally confidential service for its patients. The Renal unit cares for inpatients and outpatients with acute and chronic renal conditions. The Haematology unit cares for the needs of patients with haematological disorders and provide inpatient and outpatient facilities. The Medical Assessment Unit is the initial treatment and assessment area for the management of emergency medical admissions.

GENERAL SURGERY & UROLOGY
The Directorate has surgical wards and departments at both Arrowe Park and Clatterbridge hospitals. Both sites have busy outpatient departments. The Arrowe Park site also deals with acute admissions and major elective surgical cases. There are 10 consultant surgeons, 4 consultant urologists, and 1 associate specialist, each having a special interest and expertise in a certain surgical field including colorectal, vascular, upper gastro-intestinal and breast surgery.

At Arrowe Park Hospital there are three surgical wards and one urology ward. Ward 15 also incorporates a 13-bedded GP Admissions Unit. At Clatterbridge Hospital, ward M2 is an elective surgical ward. Surgical services are also provided by the Leverhulme Day Case Unit, and the Directorate has responsibility for the elective theatre suite, and surgical services are supported by the Pre-operative Assessment Unit.

LABORATORY MEDICINE
There are five main Departments within the Laboratory Medicine Directorate which are Clinical Chemistry, Haematology, Histopathology/Cytology, Medical Microbiology / Infection control and Phlebotomy. Clinical Chemistry deals with very specialised sample testing and also performs the routine basic tests required. Haematology provides four types of service, a Blood Bank, Coagulation, Haematinics & Flow Cytometry and Routine Haematology. The Histopathology/Cytology section processes histology and cytology cases and carries out all immunology screening for the Trust. Medical Microbiology offers a comprehensive service for the diagnosis and management of infections in Wirral and gives access to consultative and principal diagnostic services. The Phlebotomy Department obtains blood samples from patients for analysis by the hospital laboratories and provides services to all wards and outpatient clinics within the Trust as well as to the Clatterbridge Centre of Oncology.

The Directorate also provides a Mortuary service at Arrowe Park and Clatterbridge for both Wirral Hospital and the Clatterbridge Centre for Oncology.

The laboratories are located on two sites, Arrowe Park Hospital and Clatterbridge Hospital and provide a 24hr service throughout the year.

MEDICINE FOR THE ELDERLY & REHABILITATION
The Directorate of Medicine for the Elderly and Rehabilitation provides acute care and rehabilitation services for patients over the age of 74 and manages specialised rehabilitation units for patients of all ages.

The Directorate provides six acute wards at Arrowe Park Hospital for inpatients over the age of 74 and provides 4 rehabilitation wards at Clatterbridge Hospital and 2 rehabilitation wards at Victoria Central Hospital. The Directorate operates outpatient clinics for elderly patients at Arrowe Park, Clatterbridge, Victoria Central and St Catherine's Hospitals along with Day Hospital facilities at Victoria Central Hospital. There are specialist rehabilitation services within the Directorate. These include the Stroke Rehabilitation Unit, Wirral Neuro Rehabilitation Unit and Wirral Limb Centre all based at Clatterbridge Hospital and these are designed to give long term care to patients with specific rehabilitation needs. There is also a Dermatology Department providing inpatient facilities, minor operating facilities and outpatient services at Clatterbridge, Arrowe Park and Victoria Central Hospitals.

The Occupational Therapy Service is managed within the Directorate and provides acute, rehabilitation and outreach services across the Trust to General Medicine, Surgery, Musculoskeletal, Childrens, Womens, DME and Accident and Emergency Directorates. The Disability Advisory Service is also managed by the Directorate of Medicine for the Elderly and Rehabilitation and provides support to patients and staff across the Trust. The service aims to ensure compliance with the Disability Discrimination Act to ensure equal access to services and facilities.

MUSCULOSKELETAL SERVICES
The Musculoskeletal Directorate comprises orthopaedic, rheumatology, physiotherapy, appliance and back pain services. The directorate is also responsible for medical photography services.

The Orthopaedics department is made up of 11 consultant orthopaedic surgeons and one staff grade. Each of the consultants has a particular sub-speciality interest, including areas such as foot and ankle, hand and upper limb and knees. There are three orthopaedic wards on the Arrowe Park site, which deal with trauma admissions and major elective surgical cases. Ward 27 specialises in rheumatology and also includes a rehabilitation unit. At Clatterbridge, services are provided by an elective orthopaedic ward and the Leverhulme Day Case Unit. Orthopaedic outpatient clinics are held at both Arrowe Park and Clatterbridge, and a surgical appliance department is situated on both sites. The Rheumatology service has 2 consultant rheumatologists, with outpatient clinics running at Arrowe Park, Clatterbridge and Victoria Central hospitals. There are physiotherapists working in all the wards of Arrowe Park, Clatterbridge and Victoria Central Hospitals, plus outpatient services at Arrowe Park and Clatterbridge Hospitals. A domiciliary service is provided for the South Wirral area, and children's services are available in special schools, mainstream schools and the Child Development Centre at Clatterbridge Hospital.

RADIOLOGY
The Radiology Directorate aims to provide a comprehensive range of quality imaging services to all clinical departments and to meet the needs of outpatients referred by GP's. The Radiology services are provided in X-ray departments based on each of the four hospital sites. General radiography and general ultrasound referrals take place on all these sites and the department also provides a number of specialist services.

The Trust operates a CT department, Bone Densitometry, and Cardiac Catheterisation services and has its own MRI Scanner, which are all located on the Arrowe Park site. The Radiology Directorate also provides a Breast Screening Service at the Breast Care Centre at Elm House, Clatterbridge Hospital that allows fast access to specialised treatment as required.

SPECIAL SURGERY
The Special Surgery Directorate is made up of four specialities: Ear Nose and Throat (ENT), Ophthalmology, Oral and Facial Surgery (OMFS) and Orthodontics which aim to provide high quality care for patients with a variety of special surgery requirements.

The ENT department provides outpatient treatment in Clinic 2 at Arrowe Park Hospital and inpatient care on Ward 10 for patients following surgery. The ENT department is supported by Audiology in the provision of clinical cover and assessments for all outpatients and inpatients. The Ophthalmology department has its own outpatient department and a 7-bedded ward for patients following surgery in the dedicated Eye Theatre. Oral and Maxillofacial Surgery (OMFS) and Orthodontics share a department based in Clinic 10 at Arrowe Park Hospital. The department provides care for outpatients and also has inpatient beds available on Ward 10 for any patients who require admission. This department also provides facilities for community dentists to provide services on the Arrowe Park site.

THEATRES AND ANAESTHETICS
The Directorate is made up of six distinct services, Operating Theatres, Critical Care, Acute Pain, Chronic Pain, Adult Day Ward and Sterile Services. The Directorate is responsible for 14 operating theatres at Arrowe Park Hospital, which provide theatre sessions for all elective and emergency day and inpatient surgery for the whole range of the Trust's clinical specialities. The Directorate also provides staffing cover for the 5 operating theatres at Clatterbridge, which are managed by the General Surgery Directorate.

Critical Care is made up of 2 wards, the Intensive Care Unit and the High Dependency Unit both designed to provide care for very poorly patients. The Directorate offers an Acute and Chronic pain relief service to assist patients who have post operative pain relief needs and also patients who require pain relief on a long-term basis. The Adult Day Ward is managed by the Directorate and provides a service for patients having day surgery, including its own pre-operative assessment area. The Directorate also provides vital sterile services to support the work of the theatre staff and clinicians. The Hospital Sterile Services Unit (HSSU) and Theatre Sterile Services Unit (TSSU), work to ensure that all trays and instrumentation used in theatre and in other clinical areas of the hospital are decontaminated and sterilised. The Central Sterile Supply Department (CSSD) prepare green linen packs for use on the wards and in theatre.

WIRRAL SERVICES FOR CHILD HEALTH
Wirral Services for Child Health (WISCH) provides acute secondary health care services for babies, children and adolescents up to their 16th birthday. Arrowe Park Hospital has two specialist children's wards for those children who require admission for inpatient care and the Children's Day Ward allows for the treatment of children who are having day surgery. The Trust also has a Hospital at Home nursing team, who provide nursing care for children in their own homes, to allow for early discharge from Hospital.

There is a dedicated Children's Outpatients Department at Arrowe Park hospital, which is located separately from adult outpatient facilities and provides general paediatric clinics as well as specialist children's clinics with visiting consultants from Royal Liverpool Alder Hey Children's Hospital. The Child Development Centre at Clatterbridge Hospital is a centre of excellence for the assessment, diagnosis and treatment of children with chronic and continuing health needs and acts as a base for the wider Paediatric healthcare team required to deliver comprehensive care, including the team of School Nurses.

WOMENS SERVICES
The Women's Services Directorate is based in the Duchess of Westminster Wing at Arrowe Park Hospital and provides gynaecology, obstetric and neonatal care services. The Directorate also has a Practice Development and Research Unit. The gynaecology service has two wards providing treatment for patients having planned surgery, day case patients and oncology patients. The Directorate also has an emergency admissions area, early pregnancy unit and pregnancy-counselling clinic, Pre-operative assessment and ultrasound clinics are also provided. Specialist gynaecology clinics and routine gynaecology outpatient clinics are held within the unit.

The obstetric service is made up of two wards, one to provide high dependency care (antenatal, caesarean sections and operative delivery) and the other to provide low dependency care (normal deliveries). There is also a Delivery Suite with 10 rooms. The service operates using 17 teams of midwives that cover the Wirral. Each team is GP attached and provides complete maternity care. The Trust has a neonatal service, made up of a Neonatal ward with 4 intensive care, 6 high dependency and 14 special care cots for premature or ill babies.

Non-Clinical Services

FACILITIES MANAGEMENT
The Facilities Directorate provides vital support services to all other Directorates, clinical and non-clinical in the Trust, to ensure that the patient experience is of the high quality it should be. The Directorate encompasses the following departments:

• Core Cleaning service - based in Hotel Services
• Catering service
• Transport service
• Portering service
• Supplies section
• Works department
• Estates section
• Switchboard and Reception service
• Accommodation programme
• Linen Distribution

PHARMACY
The Pharmacy Department is a forward looking department where routine activities such as medication supply are largely automated leaving staff to concentrate on assessing and meeting the medication needs of patients. In the Audit Commission's report, "A Spoonful of Sugar", Wirral Hospital Pharmacy was identified as a 'best practice site'. The department is based across two sites, Arrowe Park and Clatterbridge Hospitals and provides pharmaceutical services to three NHS Trusts.

Pharmacists are routinely involved in prescribing decisions and technicians have important roles in managing medicines at ward level. Most pharmacy services are linked to consultant teams and attendance at ward rounds is normal practice. Patients are seen as soon as possible on admission by a member of the pharmacy staff who is responsible for taking a drug history and who may be responsible for generating the admission prescription. In addition, pharmacists are often responsible for writing discharge prescriptions. The electronic patient record gives pharmacists access to relevant clinical information from the dispensary during clinical checking of prescriptions and accuracy checking of dispensed medicines by accredited technicians is normal practice. Other specialist services offered include Medicines Information and an Aseptic Unit (licensed by the Medicines Control Agency). Assistant technical officers play an important role in stock control of medicines throughout the hospital.

The formulary and procurement operations are based at Clatterbridge Hospital. The Wirral Prescribers' Guide (current edition) (£) aims to provide rational advice to help selection of the most appropriate drug. It also encourages safe, effective and economic prescribing of medication. Copies may be obtained from the Formulary Pharmacist*.

OPERATIONAL MANAGEMENT
The Director of Operations* has responsibility for this diverse operational directorate which has a variety of departments, both clinical and non-clinical within the Trust. The Directorate encompasses the following departments / services:

• Outpatients Department/ Discharge Lounge
• Medical Records
• Human Resources - including Training & Development
• Risk Manager - Risk Management department and Complaints
• Occupational Health
• Park Suite - Private Inpatient Ward
• Commodity Advisor
• CPR/Control & Restraint
• Clinical Facilitators
• Tissue Viability/ Equipment Loan
• General Office
• Volunteer Organiser
• Cash Office
• Patient Advice & Liaison Service
• Chaplains
• Social Services Administration
• Flexi-Bank
• Bed Management - Bed Bureau, Clinical Co-ordinators and Discharge Co-ordinator

MEDICAL DIRECTOR'S DEPARTMENT
The Medical Director's Department incorporates a number of functions related to clinical care within the Trust, including Clinical Effectiveness, through the Clinical Practice Research Unit (CPRU), Medical Workforce Development, Caldicott (patient confidentiality), Clinical Information (including data quality), and Clinical Risk Management.

The Clinical Practice Research Unit based at Arrowe Park Hospital supports Directorates' research and audit projects and the development of care pathways, through Directorate Clinical Governance Co-ordinators. The Unit co-ordinates the Trust's Clinical Governance Work Programme that addresses areas where systems and processes can be improved. The Unit also uses clinical data to measure the Trusts performance against national standards for the purpose of improving services.

SERVICE DEVELOPMENT
Service Development is one of the corporate functions of the Trust. The directorate is focused on ensuring that the local and national priorities set by the Department of Health are met and also monitors the progress made by the Trust in line with the NHS Plan. The Directorate oversees the delivery of the Modernisation agenda, to ensure that the service patients receive is of a high standard and that targets are being achieved. The Modernisation Team encompasses the Booked Admissions Programme Team and the National Service Framework & Cancer Co-ordinator. The Directorate also works so that developments in service at Wirral Hospital can interface with those of the entire Wirral Health economy.

WIRRAL HEALTH INFORMATICS SERVICE (WHIS)
Information Management within the Trust is dealt with by Wirral Health Informatics Service (WHIS). WHIS is a shared service for the Wirral NHS Community with responsibility for Information Management and comprises the Information and I.T. staff of the various NHS organisations in Wirral, including Wirral Hospital Trust, Cheshire & Wirral Partnership Trust, Clatterbridge Centre for Oncology, Bebington & West Wirral PCT and Birkenhead & Wallasey PCT. WHIS works to create a seamless IT service for the health economy as a whole and is divided into five divisions, Information Management, Computer Applications, Computer Networks, Intranet and Internet Sites and Business and Projects.

The Lead for Information Management within Wirral Hospital (NHS) Trust is the Director of Clinical Information* and the two Directors based within WHIS, the Director of WHIS* and the Technical Director of WHIS* are responsible for overseeing the service. The Trust has an Account Manager and Head of Application, Project & Training division* who is responsible for the running of the WHIS department.

One of the many responsibilities of the department is the production of statistics related to inpatient and outpatient waiting times within the Trust. The information is compiled and sent to NHS UK who publicise the information on their website. To view the waiting times for Wirral Hospital (NHS) Trust you can visit the NHS UK website at www.nhs.uk or contact the Information Services Manager*.