What now for Shropshire's hospitals as CQC takes urgent action?
After enforcement action is taken against the NHS trust running Shropshire’s two main hospitals, our reporter Mark Andrews looks at what could come next.
If the week started badly for Simon Wright, chief executive of Shrewsbury and Telford hospitals, it scarcely ended any better.
Beginning the week with the hospital trust facing fresh criticism about the number of deaths at its maternity unit, and ending with the hospital regulator, The Care Quality Commission (CQC), taking ‘urgent enforcement action’, Mr Wright could be forgiven for wondering what will come next for his beleaguered trust.
If that were not enough, the furore has broken out in the middle of a public consultation on the controversial Future Fit shake-up of hospital services in the county. And then there is the matter of whether one of the county’s A & E units at Royal Shrewsbury Hospital or Princess Royal Hospital Telford, could be forced to close at night due to staff shortages.
The first decision for Mr Wright, and his colleagues at Shrewsbury & Telford Hospital NHS Trust (SaTH), will be whether or not to appeal against the CQC decision.
The regulator has put conditions on the trust in how it handles patients with sepsis and other deteriorating conditions, and environmental safety in Telford’s A & E. It gives the CQC the power to either suspend the hospital trust or to impose restrictions on it.
But the reality is that even if such an appeal were successful, it would only have, at best, a marginal impact on the more substantive issue of restoring confidence in the county’s hospitals.
'Animals and cattle'
The CQC action came after claims the hospitals’ own staff told inspectors that patients were being treated like ‘animals and cattle’ in ‘unsafe, demeaning, undignified, and disgusting’ conditions.
The trust has also faced criticism over the use of ‘boarding’, leaving patients in temporary beds that are not on wards.
Supporters of the Future Fit programme, which proposes replacing the separate emergency units at Telford and Shrewsbury with a single, new, state-of-the-art A & E, will probably argue that the CQC action underlines what they have been saying for many years: that the trust is being held back by cramped, outdated facilities, and staff shortages caused by the fact that the trust is struggling to recruit staff.
They will argue that creating a large, modern A & E on a single site serving the whole county will not only make for better conditions and greater efficiency, it will also make it easier to recruit the doctors they need to provide a satisfactory service.
They also argue that rejecting the Future Fit plans will mean the loss of a £312 million investment in the county’s hospitals.
'Future Fit is a cuts project'
Such arguments will cut little ice with campaigners such as Gill George, of Shropshire Telford & Wrekin Defend Our NHS, who fiercely opposes any plans to close one of the county’s A&E units.
“The solution to unsafe services cannot be to close them down, leaving patients without care,” she says.
“Future Fit will turn the existing crisis into a catastrophe. It will reduce the bed base by 110 beds and will slash the number of nurses by an estimated 330 posts. Future Fit is a cuts project.”
Even among Future Fit’s supporters, there are arguments about where the new emergency department should be based. The reality is that there is no easy answer to the conundrum, and any decision is going to spark a backlash from someone.
Financial pressure
One thing that both sides will probably agree on, though, is that Shropshire’s major hospitals are facing acute financial pressures, not helped by the county’s ageing population and rural, sparsely populated character.
The trust has been operating at an annual deficit of £20 million, so it is inevitable that cuts will have to be made somewhere.
Of course Future Fit is only part of the picture, and many of the problems – such as the alleged failures in the maternity services – go back as far as the 1990s. Only this week, it was revealed that law firm Lanyon Bowdler was investigating seven more cases relating to deaths and injuries to mothers and babies under the care of the trust’s maternity units.
Shropshire’s hospital crisis has been decades in the making, and will probably take many years to put right.
But equally, hospital trusts in other areas must look at the problems the county is facing and wonder whether, in years to come, they could face similar difficulties as their pressures increase.
Mr Wright says he has action plans in place. But he will surely be in little doubt about the size of the task he faces in rebuilding the public’s trust in the county’s hospitals.
And people will no doubt be watching very closely how it copes if we suffer another cold winter.
