11. Shropshire, Telford & Wrekin
What concerns have been raised about your STP?
Health planners are trying to reduce NHS deficits and think about ways to re-organise care. However getting the large deficit under control could prevent facilities being developed that can cope with the health and care social needs of local people.
The closure of A&E services at either Royal Shrewsbury Hospital or Princess Royal Hospital in Telford; the preferred option would mean all emergency and critical care services transferred from Princess Royal Hospital in Telford to the Royal Shrewsbury Hospital.
A review of community services could lead to closures of minor injury units and a reduction in community beds.
The walk-in health service at Telford's Princess Royal Hospital will close late 2017.
What are the proposed aims of the STP?
- Reduction of the predicted 2021 deficit of £131.4 million.
- The development of coordinated and integrated care across the NHS, Social Care and the Voluntary Sector.
- Development of a sustainable workforce.
- To develop a transformed system of care that is high quality, financially sustainable, efficient and delivers on national standards all the time.
- Encouragement of self-care.
- Overall the thrust of the STP is to reduce the use of the acute sector by shifting care out into the community.
Like other areas the STP aims to transfer services out of hospital and into the community. The concern is that cuts in hospital care will be made, helping to achieve savings, but without proper investment in community health services.
Both Shropshire Council and Telford & Wrekin Council have refused to endorse the STP, saying that it is insufficiently developed. The councils consider the STP to contain too much emphasis on the future of Shropshire’s hospitals and not enough on how GP services will be sustained during a tight financial period. The councils say they have a lack of confidence in the financial projections and the rationale for future cost reductions, arguing that significantly more resources should be put into prevention and reconfiguring community and primary care services.
The development of integrated community hubs to shift 27,000 hospital appointments out to the community.
Changes to carry out 35,000 outpatient appointments a year via video link.
According to the STP the closure of the A&E at one of the two current hospitals will save an estimated £22 million a year. However, the re-configuration will cost £300 million to complete and the plan did not identify where the new single unit should be based.
The most controversial detail in the STP is the re-configuration of A&E services.
Shropshire's Future Fit program, which was set up in 2014 to look at reconfiguration of hospital services in Shropshire, continued its work as part of the STP. In December 2016, the FutureFit board presented its recommendations to members of two CCGs representing Shropshire and Telford & Wrekin.
The Future Fit review recommended that the best of four options would be to have one A&E serving Shropshire and Mid Wales at Royal Shrewsbury Hospital (RSH). The Princess Royal Hospital’s Women and Children’s unit would also be moved to RSH. However, the CCG panel rejected the recommendations.
All six panel members from Shropshire CCG voted for taking the plans to public consultation – but the six members representing Telford & Wrekin CCG voted against.
In August 2017, the two CCGs said they intended to proceed to the public consultation stage.
The whole process will now go to an independent review before any progress can be made, although Telford & Wrekin Council has pledged legal action if necessary to block changes.
The preferred option for the re-configuration of services is as follows:
Princess Royal Hospital will provide: 24/7 urgent care; most day case surgery; planned orthopaedic surgery; outpatient services; diagnostics; and a midwifery led unit
Royal Shrewsbury Hospital will provide: emergency and critical care; 24/7 urgent care; complex surgery; outpatient and diagnostic services; and a women and children’s centre.
In 2017, a review of community care began under the STP with Shropshire CCG’s public engagement period on community hospital cuts ending on 10 November 2017. The review includes the county’s four minor injury units (MIUs) in Oswestry, Bridgnorth, Ludlow and Whitchurch, and community beds.
A new Save Ludlow Hospital “coalition” has been formed, bringing together Ludlow Hospital League of Friends, Shropshire Defend Our NHS, councillors and residents to make the case for saving services at the hospital.