Shropshire health bosses hit back at Future Fit 'risk' claims

They have responded to calls from labour officials to scrap the proposals – stating that people will be condemned to a struggling service if the opportunity is not seized.

Heads of Labour Party branches in Telford, The Wrekin, Ludlow, North Shropshire, Montgomeryshire and Shrewsbury & Atcham united to fight against the planned changes to hospital services in the county.

They wrote an open letter to Dr Simon Freeman, accountable officer at Shropshire Clinical Commissioning Group (CCG), and David Evans, chief officer at Telford & Wrekin CCG, stating that Future Fit was a "short-term cost-cutting exercise" which will reduce key services and make it harder for patients to access care.

Claims were also made that the proposals place both staff and patients at risk.

But in a letter of response, the CCG bosses say there is "absolutely no evidence" of this and argue that outcomes would instead be better for patients.

The letter states that the Future Fit programme has been developed by more than 300 clinicians, endorsed by a range of organisations and assured as fit for consultation by NHS England.

It says: "If the proposals did not provide those better outcomes it would not be supported by clinicians, who in their day to day work know what better could look like.

"As regards the Princess Royal Hospital site in Telford it is true, should the preferred option be selected, that some emergency patients treated formerly at Telford will now be treated at Shrewsbury, but a significant majority of patients under either model will continue to be treated at the site at which they currently attend.

"Obviously if option two is selected then the reverse will be true with some emergency patients having to travel from Shrewsbury to Telford.

"As regards the women and children’s centre at Princess Royal Hospital, the majority of services currently undertaken there will remain there under the preferred option, only consultant-led obstetrics and in-patient paediatrics will be undertaken at the Royal Shrewsbury Hospital site. Obviously if option two is selected then the women and children’s centre at Telford would be unchanged."

Concerns were also raised by Labour officials over the funding arrangements for the scheme, which could cost up to £312 million.

In response, the CCG chiefs said: "Your contention that the capital funding for the scheme will require cuts in services is demonstrably not true.

"The £312m of capital to be provided to the health community will be funded in part by de-duplication of services, the ability to better recruit and retain clinical staff and so reduce significant over reliance on costly interim staffing at our two hospitals.

"The business case available on the Future Fit website clearly demonstrates that the hospital will not require income over existing tariff to fund the development."

Health bosses say the precise funding nature of the £312m will not be finalised until the final business case.

But they say that up to £200m will come from public dividend capital and the remainder will come from the trust’s own capital resources, or land sales, and at least one tranche will come from private finance.

The letter continues: "We have a once in a generation opportunity to transform health care for the people of Shropshire, Telford and Wrekin.

"There is a fantastic prize in the hands of the communities we all want the best for.

"To run it down now and not seize it, will not just be a matter of an opportunity lost, it will be to condemn local people to a struggling service, in decaying buildings making the recruitment and retention of essential staff all the more difficult."

The first two public exhibitions in the 14-week public consultation process took place this week.

The public are being consulted on two options.

The preferred Future Fit option put forward by Shropshire and Telford & Wrekin CCGs sites a single emergency department for the county at Royal Shrewsbury Hospital.

Under that model, Telford's Princess Royal Hospital would take on responsibility for providing planned care.

The second option would be for PRH to house Shropshire's emergency department and for RSH to become the planned care site.

Both hospitals would have an urgent care centre that would be open 24 hours a day, seven days a week.

Consultant-led women and children's services would be on the same site as the emergency department, with a range of women and children's services available on the other site.

The consultation documents and details of upcoming events are available at nhsfuturefit.org

The letter in full:

Dear Sirs & Madam

We write in relation to your letter concerning the proposed Future Fit programme and the current public consultation which commenced on 30 May 2018.

The Future Fit Programme has been developed by over 300 clinicians, endorsed by a wide range of stakeholder organisations through the Future Fit Programme Board, subject to an independent process review by KMPG and endorsed and agreed by the West Midlands Clinical Senate.

It was also agreed unanimously through the two CCG Boards and assured as fit for consultation by NHS England demonstrably offering a sustainable future for health services for Shropshire Telford, Wrekin & Powys providing a long term vision for hospital based services.

Your contention that the capital funding for the scheme will require cuts in services is demonstrably not true.

The £312m of capital to be provided to the health community will be funded in part by de-duplication of services, the ability to better recruit and retain clinical staff and so reduce significant over reliance on costly interim staffing at our two hospitals.

The business case available on the Future Fit website clearly demonstrates that the hospital will not require income over existing tariff to fund the development.

What is more, both options provide for better outcomes for both planned and emergency care over the current configuration of services. Put simply the plan, and this is true for both options being consulted on, provides for a future that is BETTER for patients, BETTER for outcomes, provides BETTER facilities for staff to work and BETTER facilities for patients to be treated in.

If the proposals did not provide those better outcomes it would not be supported by clinicians, who in their day to day work know what better could look like.

As regards the Princess Royal Hospital site in Telford it is true, should the preferred option be selected, that some emergency patients treated formerly at Telford will now be treated at Shrewsbury, but a significant majority of patients under either model will continue to be treated at the site at which they currently attend.

Obviously if option 2 is selected then the reverse will be true with some emergency patients having to travel from Shrewsbury to Telford.

As regards the Women & Children’s centre at Princess Royal Hospital, the majority of services currently undertaken there will remain there under the preferred option, only consultant-led obstetrics and in-patient paediatrics will be undertaken at the Royal Shrewsbury Hospital site.

Obviously if option 2 is selected then the Women & Children’s centre at Telford would be unchanged.

The rural maternity units are not part of this consultation, but any recommendation to amend the maternity delivery model will be subject to public consultation in due course.

This is not expected to commence prior to the closure of the Future Fit consultation on 5 September.

You say that you are ‘open to any set of proposals which will improve the level and quality of care for our patients and communities’.

The Future Fit programme evidentially provides just that.

If you believe otherwise then this should form part of a formal consultation response.

There is absolutely no evidence that these procedures place either patients, or staff, at risk and we are concerned that this may be communicated to the public without any clinical or other evidence to support that statement.

As regards capital funding and viability we would comment as follows.

The pre-consultation Business Case was subject to rigorous assurance through NHS England as to affordability.

This is important as CCGs cannot legally consult on options, or service changes, that are not demonstrably affordable.

As with any major capital scheme, the precise funding nature of the £312m will not be finalised until the Final Business Case.

What we are aware of at this time is that up to £200m will come from Public Dividend Capital, the remainder will come from the Trust’s own capital resources, or land sales, and at least one tranche will come from private finance.

Such mixed capital funding solutions are stated NHS and Department of Health policy.

Lastly we have developed these plans over a number of years precisely as the current state of play of split services across the Princess Royal Hospital and the Royal Shrewsbury Hospital site are neither financially, or clinically sustainable.

Put simply we cannot afford them within allocations, and we cannot staff them.

That is why the Future Fit plan provides for a strategic plan that is funded to meet the needs of all the communities of Shropshire, Telford & Wrekin and mid-Wales for now and the future.

We appreciate how much you care for and support the NHS. Its continued existence depends on the backing of people who are passionate about its future.

This is never more so than in the year in which it celebrates its 70th birthday.

Please, though, acknowledge that the NHS clinicians, health experts, managers and staff that have worked so hard on these models for change, care just as passionately as you do.

We do not embark on this difficult case for change because it is easy - it is not - we do so because it is essential.

We have a once in a generation opportunity to transform health care for the people of Shropshire, Telford and Wrekin.

There is a fantastic prize in the hands of the communities we all want the best for.

To run it down now and not seize it, will not just be a matter of an opportunity lost, it will be to condemn local people to a struggling service, in decaying buildings making the recruitment and retention of essential staff all the more difficult.

Objecting to the Future Fit programme thinking something better will turn up is to live more in hope than the reality of what we have before us.

We ask you to re-consider your opposition for the sake of everyone in our county and beyond.

Kind regards.

Yours sincerely

Dr Simon Freeman, Accountable Officer, Shropshire CCG

David Evans, Chief Officer, Telford and Wrekin CCG