'We’re at crisis point' - Letter sent to Health Secretary Jeremy Hunt after vote of no-confidence in hospital trust management

Telford & Wrekin Councillors agreed at a full council meeting they had no confidence in senior management at the Shrewsbury and Telford Hospitals NHS Trust over its proposals that could see the A&E depart ment at the Princess Royal Hospital close overnight due to staff shortages.

Following the vote at a meeting last week, members have now written to the chairman of the trust to advise him of the vote.

The letter to Peter Latchford has been signed by council leader Councillor Shaun Davies, deputy leader Councillor Richard Overton, Liberal Democrat and Independent group leader Councillor Bill Tomlinson and group deputy Councillor Peter Scott.

The letter says: “Councillors received the trust’s position statement and debated the motion in full which was then carried.

“We hope the trust understand the strength of feeling held by councillors on this incredibly important issue for our residents.”

A further letter has also been sent to Jeremy Hunt, secretary of state for Health, calling for him to step in.

Signed by Councillor Davies, deputy leader Councillor Richard Overton and Councillor Arnold England, cabinet member for communities, health and well-being, it informs Mr Hunt of the motion that council passed last Thursday and asks him to immediately intervene as it claims that local health services are now as “crisis point.”

At the meeting, members were told by the trust that A&E services are perilously close to “tipping point” and that it would be “failing in its duties” if it did not plan for potential closure of the Princess Royal Hospital’s emergency department at night as staffing levels continue to be stretched.

He said that Sath has five consultants, and four locum temporary specialists to cover the A&E departments at both the Royal Shrewsbury Hospital and the Princess Royal Hospital. They should have 20.

The closure could start from September, should staffing levels get worse. The trust has previously claimed that closing the A&E overnight at the Royal Shrewsbury Hospital would not be an option because of its role as a trauma centre and moving emergency surgery to Telford would take more than a year.

Health bosses say the plans are needed because without intervention the ‘tipping point’ on consultant cover will be reached before the Future Fit plans for a single unit is opened.

They say the plans will not influence the Future Fit process, which is looking at the reorganisation of hospital services and has proposed downgrading the emergency unit at the Princess Royal Hospital.

Letter: ‘No confidence in trust’

Here is the full letter:

Dear Secretary of State,

We write further to our letter of the 31st March 31 concerning the fragility of the A&E departments at both the Royal Shrewsbury Hospital and the Princess Royal Hospital and also the Shrewsbury & Telford Hospital Trust’s (SaTH) position that it needs to undertake contingency planning to suspend full A&E services overnight at the Princess Royal Hospital Telford.

At full council, on the 20th July 20, the following motion was debated and was fully supported by all political groups on the council:

“This council notes with grave concern that SaTH are considering the overnight closure of the PRH 24/7 Accident and Emergency Service potentially from September 2017. We feel that this is yet again another attack on vital services provided at the PRH and appears inconsistent with previously made clinical arguments, including the location of the Women & Children’s Centre on the same site as the 24/7 A&E Unit.

“As a result of this new development and previous attempts to move crucial services away from PRH, this council no longer has confidence in SaTH’s management board to deliver safe and sustainable health services. This council further calls for health provision to be configured in such a way at the Princess Royal Hospital as to attract the required number and quality of consultants to facilitate the delivery of a safe and sustainable service.

“As our local health services have now reached a crisis point, this council calls upon the Secretary of State for Health to immediately intervene in this increasingly worrying situation.”

We have written to you on numerous occasions in the past, often in a joint letter with the leader of Shropshire Council, asking for you to intervene and ensure sufficient clinical resourcing of the accident & emergency departments at both hospitals until the long-running matter of the long-term future of this and other hospital services in Shropshire is settled in a legal, fair and transparent manner.

We heard from the trust at full council about the fragility of the A&E services and given the current use of locums and their short notice period – the ‘tipping point’ the trust describe could be reached with very little notice.

We are increasingly worried about the continuing ‘disarray’ in Shropshire’s local NHS and which you referred to as ‘local incompetence’ when we met with you in January. There are many services, not just A&E, that are looking fragile where there has been last-minute service changes and service closures due to staff shortages.

These include opthalmology, neurology, dermatology, spinal services and in their midwifery-led units. The hospital clearly has major issues recruiting and retaining staff in a number of service areas. Residents are confidentially describing to me more and more their concerns about our hospitals.

The council has no confidence in the management of the trust and we urge you once again to step in to ensure the proper management of these hospitals for the sake of the clinical teams who work so hard for our communities.

We are also copying in the Care Quality Commission because of our concerns about SaTH and the concerns that residents are sharing with us.

Yours sincerely,

Councillor Shaun Davies, Leader of the Council

Councillor Richard Overton, Deputy Leader and Cabinet Member for Housing & Enforcement

Councillor Arnold England, Cabinet Member for Communities, Health & Wellbeing

Trust ‘tough decisions’ on hospitals

The trust behind Shropshire's two acute hospitals has previously said that it has "tough decisions" to make on how to provide the safest services for patients at A&E.

In a letter sent to Telford & Wrekin Council following its proposal of vote of no-confidence, Neil Nisbet, deputy chief executive of the trust said the overnight closure of the A&E was a last resort.

But it said it needed to put together a plan, because of staffing problems, that would ensure patients are kept safe at all times.

He said: "As a trust board, we are absolutely committed to maintaining services at PRH, as well as RSH. But to do this we do have to have difficult discussions or make tough decisions to ensure all our patients are safe at all times.

"The potential overnight closure of A&E at PRH – and I must stress that it is just a potential overnight closure - is one such topic. No decisions have been made and we are doing all we can to avoid having to close A&E at PRH at night.

"We must have business continuity plans in place for our A&Es – like other services – to ensure we have a plan in place so we can still run them safely should we reach a tipping point, such as consultants or locums leaving as our staffing levels are currently stretched.

He said: "Shrewsbury is a designated trauma unit so the A&E there must stay open 24/7 – which is why our business continuity plan suggests closing A&E overnight at PRH.

"We currently don't always have on-call consultant cover, nor cover at weekends, at PRH A&E, senior cover is provided by associate specialists with consultant support by telephone from RSH as the trauma unit. This is clearly not satisfactory.

"More work needs to be done on NHS Future Fit but we need to have a short term plan in place now, in case our staffing situation worsens.

"We would be failing in our duties if we didn't have business continuity plans in place. This is exactly the procedure we followed when we had a similar problem with our stroke services which resulted in services being based at one of our sites, Princess Royal, so they could be provided safely to the whole community."

On Tuesday, his sentiments were echoed by chief executive Simon Wright who said services are at "tipping point" and warned staffing levels were a "major concern" and impacting on patient safety."