The STP contains plans to

• Reduce the predicted 2021 deficit of £131.4 million.
• To develop of coordinated and integrated care across the NHS, Social Care and the Voluntary Sector.
• To develop 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.

In early 2018, CCGs in this STP were in the process of developing a large public consultation on the Future Fit plans for A&E and hospital services. The Future Fit programme began in 2014, before the STP was developed, but its work has been incorporated into the STP.

Public consultation plans were voted against regarding the brief for Royal Shrewsbury Hospital (RSH), instead will undergo an independent review (see further details below).

A public consultation on maternity services in the STP area is planned for 2018.

The most controversial detail in the STP is the re-configuration of A&E services. 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 walk-in health service at Telford's Princess Royal Hospital will close late 2017.

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.

The development of community hubs to shift 27,000 hospital appointments out to the community. Changes to carry out 35,000 outpatient appointments a year via a video link.

A further review of  community services could lead to closures of minor injury units and a reduction in community beds. Further changes to orthopaedic services, including the possibility of reducing the number of sites these services are delivered at - currently three separate hospital sites are used.

A review has taken of maternity services and in December 2017 proposals were put forward for the future of the services. Under the plans, women would have the option of giving birth at a midwife-led maternity unit in Shrewsbury, Princess Royal Hospital in Telford or at home. Births would no longer take place at the rural maternity units, in Oswestry, Bridgnorth or Ludlow, although a number of maternity hubs may be created to support women before and after birth.

These proposals will be put forward for public consultation in 2018.

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.

The STP envisages a move to Neighbourhood Care Teams, which would be the first port of call for people with diabetes and other long-term conditions and people who have recently been discharged from hospital. This would involve GPs, social care, community nurses, therapists and mental health workers increasingly working together at a local level.

The STP includes plans to acute the workforce in acute care, but it states it needs to expand the community nurse workforce by 144 to meet the needs of the population.