There are already some very good health services serving patients Shropshire, Telford and Wrekin and mid Wales. They have developed over many years to try to best meet the needs and expectations of the population served.
In spite of this the changing needs of the population now and in the future, coupled with the quality standards that we should aspire to for our population, within the challenging economic environment - it becomes clear that the time has come to look again at how we design services so we can meet the needs of our population and provide excellent healthcare services for the next 20 years.
Staff work hard to provide good care, local people are relatively healthy and local organisations have a track record of working together. However we have been delivering services in the same way for many years. We are aware that even more this approach does not meet local people’s needs. We need to be smarter and use our resources better so we can keep our services going into the future.
We celebrate the fact that many people are living longer and we also understand that most people want to be treated and cared for in their own homes. As medicine and technology advances, the way hospital services are provided is evolving.
The challenges set out below are what need to be addressed - they are largely outside our control and we have to adapt our services to meet them:
- Changes in our population profile - The remarkable and welcome improvement in the life expectancy of older people that has been experienced across the UK in recent years is particularly pronounced in Shropshire where the population over 65 has increased by 25% in just 10 years. This growth is forecast to continue over the next decade and more. As a result the pattern of demand for services has shifted with greater need for the type of services that can support frailer people, often with multiple long-term conditions, to continue to live with dignity and independence at home and in the community.
- Impact on accessing services for populations living in two urban centres and much more sparsely populated rural communities - In Shropshire, Telford and Wrekin there are distinctive populations. Particular factors include our responsibility for meeting the health needs of sparsely populated rural areas in the county, and that services provided in our geography can also be essential to people in parts of Wales. Improved and timely access to services is a very real issue and one which the public sees as a high priority. We have a network of provision across Community Hospitals that can be part of the redesign of services to increase local care.
- Changing patterns of illness - Long-term conditions are on the rise as well due to changing lifestyles. The means we need to move the emphasis away from services that support short-term, episodic illness and infections towards services that support earlier interventions to improve health and deliver sustained continuing support, again in the community.
- Higher expectations - Quite rightly, the population demands the highest quality of care and also a greater convenience of care, designed around the realities of their daily lives. For both reasons, there is a push towards 7-day provision or extended hours of some services and both of these require a redesign of how we work given the inevitability of resource constraints.
- Clinical standards and developments in medical technology - Specialisation in medical and other clinical training has brought with it significant advances as medical technology and capability have increased over the years. But it also brings challenges. It is no longer acceptable nor possible to staff services with generalists or juniors and the evidence shows, that for particularly serious conditions, to do so risks poorer outcomes. Staff are, of course, aware of this. If they are working in services that, for whatever reason, cannot meet accepted professional standards, morale falls and staff may seek to move somewhere that can offer these standards. It is also far more difficult to attract new staff to work in such a service. Clinicians are a scarce and valuable resource. We must seek to deploy them to greatest effect.
- Economic challenges - The NHS budget has grown year on year for the first 60 years of its life, in one decade across the turn of the 21st century its budget doubled in real terms. But now the world economy and the UK economy is in a different place. The NHS will at best have a static budget going forward and yet the changing patterns of population and resultant need, the increasing costs of ever improving medical technology, the difficulties in simply driving constant productivity improvements in a service that is 75% staff costs and that works to deliver care to people through people, mean that without changing the basic pattern of services then costs will rapidly outstrip available resources and services will face the chaos that always arises from deficit crises.
- In Shropshire and Telford and Wrekin the inherited pattern of services, especially hospital services, across multiple sites means that services are incurring additional costs of duplication and additional pressures in funding. The clinical and financial sustainability of acute hospital services has been a concern for more than a decade. Shropshire has a large enough population to support a full range of acute general hospital services, but splitting these services over two sites is increasingly difficult to maintain without compromising the quality and safety of the service. Most pressingly, the Acute Trust currently runs two full A&E departments and does not have a consultant delivered service 16 hours/day 7 days a week. Even without achieving Royal College standards the Trust currently has particular medical workforce recruitment issues around A&E services, stroke, critical care and anaesthetic cover. All of these services are currently delivered on two sites though stroke services have recently been brought together on an interim basis. This latter move has delivered measurable improvements in clinical outcomes.
In 2014 the case for change was developed, you can read more about this in the case for pdf change summary document (168 KB) . This is a pdf clinical design summary (199 KB) which describes in more detail why we need to change and the solutions that are explored.