Anger as Shropshire A&E decision is put back

Bosses of Future Fit, the team behind the reconfiguration of health services in the county, were expected to announce their preferred site for Shropshire's new single emergency unit today ahead of public consultation.

But the decision has been put back, possibly until next summer — and now health chiefs say none of the options on the table tackle the growing £23 million deficit of Shrewsbury & Telford Hospitals NHS Trust.

The Programme Board of NHS Future Fit today committed that the programme will continue as it offers the best solution to challenges facing the local NHS.

They have however agreed to defer a decision on naming a preferred option for transforming NHS services for patients in Telford, Shropshire and Mid Wales.

The deferral will allow more detailed work to be carried out into financial and staffing challenges.

David Evans and Brigid Stacey, senior responsible officers for Telford and Wrekin and Shropshire Clinical Commissioning Groups said: "Representatives from across the area have decided there is no preferred option and there will be no consultation this year.

"The NHS Future Fit Programme to-date has involved an immense amount of hard work and told us clearly why services need to change and why 'no change' is not an option.

"It has engaged clinicians and the public in outlining a compelling clinical model for the future, including for our patients in Mid Wales. This includes a network of urgent care centres supported by a single emergency centre.

"We have engaged patients and communities so we can better understand their needs, hopes and concerns."

Work will be carried out developing Outline Business Cases based on both Princess Royal Hospital and Royal Shrewsbury Hospital as the single Emergency Centre.

David and Brigid said: "We still have an opportunity to create something that will deliver for several decades to come. We plan to be able to say something further within the next month."

What have we heard?

Hospital Clinicians are telling us that we're not moving quickly enough to address the critical workforce challenges facing their services and patients.

Community clinicians and GPs are telling us that we're not being ambitious enough in designing a new and fully integrated system that supports the growing number of us living with long term conditions.

Patients and communities are telling us that we need to do more to work with them to define a compelling vision of what health care services will look like in future in each of our localities.

While patients and clinical safety come first we do also have to acknowledge financial realities. The financial climate for the NHS has changed dramatically in the last year. The money we receive enables us to invest in the future health of our communities. We must live within our means and not bankrupt future generations. Current options help but there are wider financial issues in the local NHS that also need to be tackled. We can't identify a preferred option to discuss with the public until these wider issues are addressed.

NHS Future Fit has done very valuable work

It has told us clearly why services need to change – not least the immense fragility of key hospital services on which we all rely ... emergency care, acute medicine, critical care to name but a few. This means that "no change" is not a realistic option.

It has engaged clinicians in outlining a compelling clinical model for the future of health care delivery in Shropshire and Telford & Wrekin, including for our patients in mid Wales. This includes a network of urgent care centres supported by a single Emergency Centre.

It has engaged patients and communities so we can better understand their needs and hopes and concerns.

It has set out what we expect the future to look like in terms of the number of operations, appointments, procedures and how we can provide more care closer to home.

What do we need to do now?

We are asking SATH and hospital clinicians to work with patients and wider stakeholders to develop solutions to the immediate challenges their services face. This includes immediate business continuity as well as developing Outline Business Cases based on both Princess Royal Hospital and Royal Shrewsbury Hospital as the single Emergency Centre. These should be developed by next summer for public consultation in 2016.

As local commissioners, we will work with service providers to look again at a whole system plan that best meets the needs of our communities within the financial framework in which we all have to operate.

Before the end of October the Programme's Core Group will set out, at a high level, how this work will be undertaken and the timescales for it. We expect to share more detail later this month.

Options include siting A&E just at the Royal Shrewsbury Hospital or just at Telford's Princess Royal Hospital, or on a new build site somewhere between the two.

Bosses of Future Fit initially wanted a preferred option before the General Election in May.

But it was put back – and health chiefs said it was looking like "late summer or early autumn" before the preferred site was announced.

However, at a private meeting today, news was announced that none of the options was preferred and the team would go back to the drawing board.

The future of the county's women and children's unit, which only opened at the Princess Royal a year ago, remains unclear.

This afternoon Telford MP Lucy Allan said she was "amazed" at the delay on the hospitals decision.

"The Future Fit programme was set up in 2013. It is concerning that a final decision still cannot be reached," she said.

"The financial situation that both NHS Trusts are facing will not improve by postponing the decision further.

"We have always been told that keeping the current system of A&E on two sites is 'unsustainable' and is causing real financial strain.

"This lack of decision creates uncertainty and anxiety for local people around the provision of A&E services in the county.

"I'm amazed to hear that the Future Fit team will be going back to the drawing board after so much time and money has been spent on this programme.

"I have offered my support to the Clinical Commissioning Group to assist in any way possible."

This evening Telford & Wrekin Council said it found the delay "unbelievable".

A council statement said: "The financial delay that has put the Future Fit programme on hold raises very significant and further doubts over the whole process and how it can review hospital services in Telford and Wrekin and Shropshire.

"The Future Fit programme says it cannot progress any hospital reconfiguration option for consultation until this more effectively tackles Shrewsbury and Telford NHS Trust's deficit, due to reach almost £23 million next year.

"The council says it is unbelievable that a process can spend two years developing options that fail to address such a fundamental and obvious issue.

"Councillors say that the public will also find it 'madness' that the Future Fit programme can even consider recommending moving the successful £28 million Women and Children's Centre, just one year after it opened, from the Princess Royal Hospital to the Royal Shrewsbury Hospital. In the climate of austerity and huge cuts to other parts of the public sector, this is even harder to understand.

"Despite the financial delay, Future Fit appears to still recommend a model that would also move A&E services from the PRH to RSH.

"The council's political group leaders warn this 'direction of travel' for Future Fit signals the greatest threat yet to the PRH.

"The council also questions the basis on which much of the evaluation of the two hospital sites has been completed and whether this has been skewed against Telford by the weighting given to patients from Wales, who should come under the Welsh NHS, not part of the English NHS's Future Fit review.

"Councillors say that the PRH provides the most cost effective and viable site for any reconfiguration of services. Indeed the Future Fit programme's own reports showed this earlier this year.

"The review's recommendations, now on hold to allow a solution that addresses SaTH deficit to be found, also ignore many key facts about Telford and Wrekin.

"The borough, which also provides acute health services for large parts of eastern Shropshire, is growing fast and is already the area's main population centre. It has very clear and incontestable health needs – in Telford and Wrekin these are worse than other parts of the region and significantly worse than the national average on many health indicators.

"The council is urging people to join its A&E4PRH campaign via www.telford.gov.uk/aande4prh and sign the public petition already started to protect the PRH."

Deputy council leader and chair of health and well-being Richard Overton said: "I am sure the public will be flabbergasted that the NHS has taken almost two years and spent so much money to arrive at a blindingly obvious conclusion.

"Any proposed solution has to address SaTH's deficit. Those that are on the table just make a small dent, cause huge upheaval and in eyes of those at the top in the NHS are simply non-starters.

"How we ever got to this position begs the question – is Future Fit fit for purpose? Common sense says not.

"Despite what we think are some very questionable decision-making processes, the Future Fit juggernaut continues rolling and if unchecked, the PRH's future, as an acute hospital, will be as a downgraded hospital stripped of its A&E.

"We will be keeping a very close and vigilant eye on developments and urge people to join our A&E4PRH campaign."