Future Fit debate: Could this model be the answer to A&E question?
It was England’s first purpose-built specialist emergency care hospital when it opened in 2015 – and now calls have been made for the model to be replicated in Shropshire.
Northumbria Specialist Emergency Care Hospital has emergency care consultants on duty at all times and a range of specialists available seven days a week.
It heralded the start of a new era in emergency care across Northumberland and North Tyneside.
But its opening led to the downgrading of A&E units to urgent care centres at Hexham, Wansbeck and North Tyneside hospitals, prompting concerns that seriously ill or injured patients would have to travel further for treatment.
Urgent care covers any healthcare need which needs immediate attention, but is not serious enough to require an A&E visit.
A similar model to the one provided by Northumbria Healthcare NHS Foundation Trust has now been proposed for Shropshire by Councillor Andrew Eade, leader of the Conservative opposition on Telford & Wrekin Council.
He wants a specialist A&E centre to be built between Royal Shrewsbury Hospital and Telford’s Princess Royal Hospital, with the two existing hospitals catering for planned care.
Senior medics say the Northumbria model and the situation in Shropshire are different. They want a single A&E at Royal Shrewsbury Hospital with urgent care centres also at RSH as well as Telford’s Princess Royal Hospital.
The debate around Shropshire’s Future Fit hospitals review is similar to that in Northumbria because a solution was found there.
Councillor Eade has worked closely with NHS officials in the North East and says the option used there should also be considered in Shropshire. He claims it will improve outcomes for patients and the idea should be included as an option in the forthcoming Future Fit consultation.
He claims the current proposals will be a “step backwards” and has even called an emergency meeting of Telford & Wrekin Council to ask for the backing of his fellow councillors.
Councillor Eade visited the specialist centre in Cramlington with Wrekin MP Mark Pritchard, Telford & Wrekin Councillor Nigel Dugmore and David Sandbach, former chief executive of Telford’s Princess Royal Hospital, in November last year.
The Northumbria Specialist Emergency Care Hospital provides emergency care for seriously ill and injured patients from across Northumberland and North Tyneside.
Cases include patients with suspected strokes, severe chest pain, blood loss or those experiencing a sudden shortness of breath.
The specialist centre also has a birthing centre with midwifery and consultant-led care.
Planned surgery
It has en-suite delivery rooms, two birthing pools and en-suite bedrooms where partners are able to stay overnight.
Some planned surgery which is considered to be high-risk is also carried out at the centre and other facilities include individual treatment rooms, a critical care unit, a paediatric unit, operating theatres and beds for emergency admissions across seven speciality wards.
Clinicians also have access to X-ray, MRI, ultrasound and CT scanners, an endoscopy room and cardiac catheter lab.
When it opened, hospital bosses said treating all seriously ill or badly injured patients at Cramlington would save more lives and although emergency patients might have to travel further, this would be counterbalanced by the specialist staff and facilities available for their sole use.
A year on, the trust reported a 14 per cent reduction in emergency admissions to hospital, with almost 7,500 less people being admitted, resulting in a £6 million saving for the local health economy. It noted improvements in clinical outcomes and that Northumbria Healthcare was one of only a handful of trusts nationally to meet the government four-hour A&E waiting target during the whole of 2015/16.
There was, however, an impact on ambulance handover times with around seven per cent of all ambulance arrivals at The Northumbria waiting over 30 minutes to handover patients.
Speaking at the time, then chief-executive of the trust, David Evans, who has since left that post, said: “There is no doubt that our new model of emergency care is already having a very positive impact on patient care, clinical outcomes and experience.
“All early indications and measures show it is delivering exactly what we set out to achieve for emergency patients by centralising our specialist expertise on one site.”
Recommendation
A report, which was drawn up following Councillor Eade and the group’s fact-finding visit to Northumbria Specialist Emergency Care Hospital, has been sent to health bosses in Shropshire.
It made a recommendation that: “The pre consultation business case which was recently submitted to NHS England should be amended to include the provision of a standalone specialist emergency care hospital between Telford and Shrewsbury.
“We believe this is the right thing to do because members of the public deserve to see an alternative option to the one currently under consideration.”
NHS England is yet to give the go-ahead for a public consultation to begin in the Future Fit process. Shropshire and Telford & Wrekin clinical commissioning groups have said they are still prepared to consider new ideas and suggestions during the consultation process.
Earlier this month, health chiefs said it would take up to four weeks for a public consultation to begin once given the green light.
Top medics reject hospital proposal
Despite the clamour from some quarters for Shropshire to follow the Northumbria model, two of the county’s senior health service figures have rejected the idea.
Dr Julian Povey, chair of Shropshire Clinical Commissioning Group, and Mark Cheetham, care group medical director at Shrewsbury and Telford Hospital NHS Trust, have both said that a plan for a new hospital would not work.
Writing on Twitter Mr Cheetham argued that the plan would not deal with staffing issues currently faced by hospitals in the county.
He said: “Building another site won’t help the workforce shortage or deal with backlog maintenance.”Dr Povey said that the plan had been looked at before Future Fit made its recommendations and that the emergency centre (EC) idea was abandoned because it was a more expensive option. He said: “A greenfield EC and obs was considered early on and discounted, was a more expensive option.”
Dr Povey said that the emphasis should be on consulting on the two options put forward by the Future Fit board. He said: “The Future Fit process has arrived with a preferred option, we plan to consult on two options. .Future Fit needs to be in a position to get to consultation as soon as possible after NHS England give the go-ahead.”
Mr Cheetham added: “We really don’t need to revisit old discarded options again.”
‘Open your eyes to 21st century solution’
It is time to broaden our horizons on the Future Fit debate, says Councillor Andrew Eade, Leader of the Tory group on Telford & Wrekin Council
Shropshire needs a 21st Century solution to our hospital service which has at its heart clinical quality and fair access to the very best technology, first class facilities and enthusiastic well motivated clinical staff.
That is why I joined MP Mark Pritchard, Councillor Nigel Dugmore, and the former chief executive of Princess Royal Hospital David Sandbach in a visit to see for ourselves the new arrangements in Northumbria built to meet almost identical demands that we face in Shropshire and Powys.
The Northumbria Specialist Emergency Care Hospital opened during June 2015 and was described by Sir Bruce Keogh, NHS England Director of Medicine, as “a vision of the future”. From what we witnessed, he was absolutely right.
The emergency hospital serves a population of around 500,000 people across a geographical area larger than Shropshire and Powys and contains 220 beds, all but four of which are in private en-suite rooms.
Included in this provision are 18 intensive therapy beds and 34 Consultant led maternity beds. The hospital cost £100 million to build and replaced A&E departments at three other general hospitals which now provide urgent care centres, planned surgery, and specialist services
The trust runs community hospitals, home nursing services, and also employ most of the social workers who once worked for the local council.
Effectively the emergency care hospital is a cog in a very “well oiled” integrated machine working for the public in Northumbria. Average time spent as an in-patient in Emergency Care is only 32 hours compared to the 72 hours on offer in Shropshire’s Future Fit proposals.
A specialist emergency care hospital built between Shrewsbury and Telford would see both the Princess Royal and Royal Shrewsbury Hospitals retained for planned surgery, specialist clinics, and intensive rehabilitation services.
Urgent care and walk in cases would be dealt with at urgent care centres in Shrewsbury and Telford.
Another essential part is the retention of community hospitals in the county which are needed for rehabilitation close to where patients live.
What we are proposing is a modern, cost effective, and cutting edge solution which has provided some of the best health outcomes in the country despite have longer ambulance journey times.
The challenge for Future Fit now is to not only deliver on their promise to consider alternative suggestions during the consultation process, but to actually include the Northumbria model as a formal part of the consultation.
The challenge for Telford & Wrekin Council is to play a more constructive and cooperative role in shaping the county’s future health provision and help ensure that our community have a full range of future health care options to consider during the coming consultation.
