About NHS Future Fit
What is Future Fit?
The NHS Future Fit Programme was the name given to the project to review the future of health services in the county and the hospital services provided at the Royal Shrewsbury Hospital, Shrewsbury and the Princess Royal Hospital, Telford. The four year project has been led by NHS Shropshire Clinical Commissioning Group (CCG) and NHS Telford & Wrekin Clinical Commissioning Group (CCG) – the organisations that are responsible for buying and making decisions about healthcare services in Shropshire and Telford & Wrekin on your behalf.
How is the Programme governed?
Future Fit has a Programme Board whose role is to agree, lead and coordinate the Future Fit Programme. 17 partner organisations are part of this board which includes five sponsor member organisations (Shropshire CCG, T&WCCG, Powys Teaching Health Board, The Shrewsbury and Telford Hospital NHS Trust and Shropshire Community Health NHS Trust). The remaining stakeholder organisations are Shropshire and Telford & Wrekin Councils, Powys Teaching Health Board, West Midlands Ambulance Service and Welsh Ambulance Service, and patient representatives
Who is delivering the consultation?
There is a small team who have a specific role to deliver the NHS Future Fit consultation process on behalf of Shropshire and Telford & Wrekin CCGs. They are part of the Sustainability and Transformation Partnership (STP) team and work from offices based at Telford & Wrekin CCG in Telford and Shropshire CCG in Shrewsbury.
About the public consultation
What is a public consultation and why do we need one here?
Commissioners are required by law to involve the public when considering making significant changes to the provision of NHS healthcare. This is done through a formal public consultation process. We are proposing to make changes to the hospital services provided at the Royal Shrewsbury Hospital and the Princess Royal Hospital in Telford so it is important that we seek the views of people across Shropshire, Telford & Wrekin and mid Wales. Any alternative proposals or suggestions put forward as part of the consultation would, of course, be conscientiously taken into account and carefully considered as part of the process.
How can I find out more about the Future Fit consultation?
We have produced a full consultation document and summary version which explain the changes we are proposing, what these would mean for you and your family and the two options on which we want your views. We want to gather people’s views and will do this with our online survey and hard copy surveys. You can also share your thoughts with us by letter or email.
What will happen during the consultation?
Why has it taken so long to get to consultation?
We started talking about Future Fit in 2013 and we know that local people are frustrated about how long it has taken to reach this point. Over the last four years, we have listened to and involved thousands of local people, including NHS staff, patients and community groups. There have been some very difficult decisions to make and we take these very seriously.
We have taken into account the views of people and organisations across a very large geographical area in England and Wales and that takes time. It also takes time to consider and develop new clinical models and collect all the data and evidence needed to make decisions. It also takes time to bring people together to analyse the evidence and the data. In addition, we have and continue to follow a robust NHS England assurance process, which involves a large number of meetings and assurance panels both locally, regionally and nationally. We have to follow these processes to ensure we conduct a safe and thorough public consultation. We have also had to ensure that the funding is in place to take our proposals forward before starting the consultation process. We can only consult on options that are affordable and able to be delivered. The funding has now been confirmed.
Who has been involved in the Future Fit process so far?
We have involved patient representatives, voluntary and community sector organisations, Shropshire and Telford & Wrekin Healthwatch organisations and Powys Community Health Council in forming and developing our proposals and plans. This is in addition to the extensive work we have carried out with local GPs and clinical staff working in the community and hospitals in Shrewsbury and Telford to ensure the model of care we will adopt meets the needs of local people, both now and in the future. We have engaged and involved NHS England, the Joint Health Overview and Scrutiny Committee of the two councils in Shropshire, Telford and Wrekin, MPs, councillors and partner organisations.
What hospital services are included in the consultation?
This public consultation is about the hospital services delivered at the Royal Shrewsbury Hospital and the Princess Royal Hospital.
This consultation does not ask you about community hospitals, community midwife-led units or community services. It also does not ask your views on the location of adult cancer day services, which are currently provided at the Royal Shrewsbury Hospital and would stay here whatever the outcome of this consultation. We are looking at how we best deliver all health services and much work is being done to look at these as part of a programme of work known as the Sustainability and Transformation Partnership (STP). In the future, we may need to ask for your views on any proposed changes to these services.
What are you asking my views on?
We are proposing to make changes to the hospital services provided at the Royal Shrewsbury Hospital and the Princess Royal Hospital, Telford, so that one hospital provides emergency care services and the other hospital provides planned care services. Both hospitals would have an Urgent Care Centre that is open 24 hours a day, seven days a week as well as Outpatient Services and diagnostics (x-rays, blood tests)
We are asking for your views on two options:
- Option 1: The Royal Shrewsbury Hospital becomes the Emergency Care site and the Princess Royal Hospital becomes the Planned Care site.
- Option 2: The Princess Royal Hospital becomes the Emergency Care site and the Royal Shrewsbury Hospital becomes the Planned Care site.
Option 1 is the CCGs’ preferred option. You can read more about the reasons for this on page 24 of our public consultation document.
Why do we have to include the views of people in Wales?
CCGs have a legal responsibility to involve and consult with all patients who use their hospital services. Our two hospitals serve a population of over half a million people which includes around 70,000 people who live in mid Wales. We therefore want as many people as possible from across Shropshire, Telford & Wrekin and mid Wales to provide their views during the formal public consultation. We are working closely with Powys Teaching Health Board, Powys Community Health Council, Powys County Council and Powys Association of Voluntary Organisations (PAVO) to help reach out to people across mid Wales.
If I have given you my views before the 14 week formal consultation started, will these be taken into account when decisions are made after the consultation or do I need to complete the consultation survey?
Since the Call to Action in 2013, local people and organisations have been sharing their views with us. Comments received during this pre-consultation engagement period were taken into account in developing the consultation options. We are now conducting a formal 14-week public consultation and are asking people to formally respond during this time for the views of people across Shropshire, Telford & Wrekin and mid Wales on two options to be taken into account.
What will happen after the consultation finishes?
No final decision will be made until we have completed the formal public consultation. At the end of the consultation, all feedback will be collated and analysed by an independent company. They will then produce a report which will be considered by Shropshire and Telford & Wrekin CCGs as part of their decision-making process. It will be considered alongside other pieces of work that are underway. These include travel and transport considerations including ambulance travel times.
The views and suggestions of everyone who responds to this consultation are an important part of how we will make a decision. However, we also have to complete a number of pieces of work before any final decisions are made. These have been requested by the West Midlands Clinical Senate, NHS England and members of the CCG Governing Bodies. No decision can be made after the end of the formal public consultation until this work has been completed and considered. They include:
- more work to model the care we will need to deliver in the community
- ensure that the CCGs are confident that options are affordable
- looking at what we might need to do to lessen the impact for women and children and older people, their families and carers, particularly around travel
- understanding how the Urgent Care Centre at the Planned Care site will be staffed by skilled professionals to deliver the high level of care required for children
- understanding the effect of the proposed changes on the demand for both emergency and non-emergency ambulance and patient transport services
- ensuring we are considering new ways of working in the future including new staff roles
You can read about the work we are doing on page 9 of our public consultation document.
Who will make the final decision?
The boards of the two CCGs will consider all of the evidence. A Joint Committee of Shropshire and Telford & Wrekin CCGs will be convened to make the final decision.
How long will it take before the changes happen?
It will take about five years before any changes are fully implemented. There will be lots of opportunities for patients, families and the public to get involved over the coming years.
Having your say
How can I have my say?
The easiest way to have your say is to fill out our online survey. Before you fill out the survey, please take time to read our consultation document, which explains the reasons why we need to change our hospitals, details our proposed model of hospital services and the two options we are asking for your views on. There is also a summary version of the consultation document. We will also be distributing these documents to public places across Shropshire, Telford & Wrekin and mid Wales. You can also find out more by attending one of our events or attending a meeting. You can also provide us with your views by letter and email and by attending one of our events.
What events will be held during the consultation?
We are holding a series of drop-in public exhibition events throughout the consultation which will offer people an opportunity to find out more about the proposed changes, meet our doctors, nurses and other healthcare staff and ask questions. There will be five ‘stalls’ at our events which will focus around emergency care, planned care, urgent care, women and children’s services and outpatient services and tests. Healthwatch or Powys CHC will also have a stall at each event. The consultation documents and survey will be available at all events and a box will be provided for you to post your completed survey.
The events will take place 3.30-7.30pm in Shrewsbury, Telford, Wellington, Oswestry, Market Drayton, Newtown, Ludlow and Bridgnorth. The events are open to everyone - there is no need to book your place - just turn up.
In addition, we will be holding pop-up events at public places across Shropshire, Telford & Wrekin and mid Wales, for example, shopping centres, town centres and supermarkets.
Why are you holding events in Wales?
Our two hospitals cover a very large geographical area, from Oswestry and Market Drayton in the north to Cleobury Mortimer and Clun in the south; Welshpool and Llanidloes in the west and Bridgnorth and Newport in the east. As a county that borders Wales, many of the patients that come to the hospitals are from Wales, so we are making every effort to ensure that everyone affected by these proposed changes has an opportunity to give us their views.
What events are you holding in Wales?
We will be holding a public exhibition event in Newtown. In addition, there will pop-up events in community spaces and we will be attending existing meetings to provide regular updates.
The preferred option
You are going out to consultation with a preferred option. Haven’t you already made a decision about what you will do?
No decision will be made until we have heard the views of our communities across Shropshire, Telford & Wrekin and mid Wales.
Choosing a preferred option has been a very difficult decision which was reached following lots of discussion and careful consideration of the results of the financial and non-financial analysis, along with the findings of several independent reports. In August 2017, the Joint Committee of the two CCGs voted unanimously to proceed to consultation with a preferred option of the Emergency Care site to be based at Shrewsbury and the Planned Care site to be at Telford.
Why did you choose Option 1 as the preferred option – for the Royal Shrewsbury Hospital to be the Emergency Care site and the Princess Royal Hospital to be the Planned Care site?
There are four main reasons why we chose Option 1 as the preferred option.
• Having the Emergency Care site at the Royal Shrewsbury Hospital would mean that it can continue to be a Trauma Unit
• Having the Emergency Care site at Shrewsbury would mean fewer people would have to travel further for emergency care
• It better meets the future needs of our older population, especially in Shropshire and mid Wales
• It offers the best value for money over the long term
You can read more about how we reached this decision on page 24 of the main consultation document.
Isn’t Option 2 the cheaper option?
As part of the decision-making process, a financial appraisal was carried out on the two options. Although Option 1 (the preferred option) has a projected capital cost of £312 million compared to £250 million for Option 2, in the overall economic analysis of the options, which combines the results of the financial and non-financial appraisal, it is estimated that Option 1 would offer the best value for money over the long term. You can read more about how we reached our preferred option on page 24 of the main consultation document.
How did you decide on the preferred option?
Choosing a preferred option was reached following lots of discussion and careful consideration of the results of the financial and non-financial analysis, along with the findings of several independent reports. This includes the two Integrated Impact Assessments (IIAs) which assess the potential impact and equality effects of the changes we are proposing. You can read these in the Documents section of the website.
In July 2017, the Future Fit Programme Board confirmed that Option 1 was its preferred option. In August 2017, this was then agreed unanimously by the Joint Committee of Shropshire and Telford & Wrekin.
Why aren’t you consulting with no change as an option?
Doing nothing was one of the options that were considered as part of a robust and thorough appraisal process which involved representatives from over 50 organisations from across Shropshire, Telford & Wrekin and mid Wales. Based on their feedback, the Future Fit Programme Board decided that doing nothing could not be an option. This was because it was considered neither safe nor sustainable to continue as we are now. You can read more about the reasons why we need to change our hospital services in our public consultation documents.
Reasons for change
Why do you want to change hospital services?
We need to make changes to the hospital services at the Princess Royal Hospital in Telford and the Royal Shrewsbury Hospital so that we can make sure we can provide high quality, safe services for all patients for the long term.
Having a separate Emergency Care site and Planned Care site with a 24-hour urgent care centre at both hospitals would help to make sure that:
• Patients receive the very best care in the right place at the right time
• Patients’ operations are highly unlikely to be cancelled due to an emergency admission
• Waiting times are reduced for our patients across both hospitals
• We can provide much improved facilities for our patients and staff
• We attract the very best doctors to work at our hospitals
• We can be more efficient with our resources
• We can plan ahead for expected changes in our population, with more people living longer and with long-term conditions
• We can help reduce the time people spend in hospital
• We can continue to have two vibrant hospitals in our county
Why can’t you just ask the Government for more money to stay as we are?
Money on its own will not address the problems we are facing. This is not just about money. Staying as we are is not an option. We have to change the way we deliver the services at our two hospitals to make sure we provide high quality, safe services for all patients for the long term.
Across the UK, there is a severe shortage of healthcare staff. When we look at certain services, such as A&E, the situation is even worse. Having two hospitals so close together offering the majority of the same services on both sites means that some of our consultants are providing support ‘out of hours’ far more frequently than their colleagues in other hospitals. This makes our hospitals a less desirable place to work and therefore difficult to recruit new staff. It is also difficult to keep our staff as some leave to take up jobs at other hospitals where they can enjoy a better balance between their work and their personal lives.
In addition to this, the needs of people and their expectations have also changed. Evidence and guidance tells us that we need to deliver as much of the care people need at home or as close to home as possible. When people come to hospital, we need to have all the relevant specialists in the same place so we can see, assess and treat them as safely and quickly as possible, and where appropriate help them to get home without delay.
You can read more about the reasons we need to change in the consultation document.
Why can't you just ask the Government for more money so that we can keep our two A&Es?
The main reason we need to change our hospital services is to make sure high quality, safe services are provided for all patients for the long term. Patients need to be seen by the right person at the right time in the right place and at the moment we know that this is not always happening. At the moment, lots of patients attending our A&Es do not need specialist emergency care, they need urgent care. Urgent care would continue to be provided at both hospital sites.
Like many other hospitals, we face enormous challenges around recruiting and keeping staff, particularly within our Accident and Emergency (A&E) departments and critical care services. The Royal College Guidance states we need 20 consultant doctors to run our two A&E departments, 24-hours a day, seven days a week. Currently we only have five permanently employed consultants in post. We have had to rely on a high number of temporary consultants which is expensive and they need additional resource to support them to carry out their duties. Over the years a huge amount of work has taken place to recruit new consultants, however, we did not successfully recruit a consultant for over five years. We believe that, by having a separate Planned Care site and Emergency Care site, we would be able to recruit more doctors and nurses to work at both our hospitals in the future.
In addition, the existing model of A&Es is becoming outdated. At our two A&Es, we are treating patients with minor injuries, for example a sprained ankle, alongside those with a life-threatening illness, such as a stroke. By creating a separate Emergency Care site with a dedicated Emergency Department and a 24-hour Urgent Care Centre at both hospital sites, patients would be safely and quickly seen in the right place by the right doctors, nurses and other healthcare professionals.
Why can’t we have one hospital in the middle?
Due to the large geography of the area our hospitals serve, it would not be possible to have one hospital in the middle that offered all services for all patients across Shropshire, Telford & Wrekin and mid Wales. We would still have to provide some services locally. As part of our robust appraisal process, we carefully considered four options which would involve building a third hospital site which had an emergency department.
A full cost analysis was carried out and as a result of this, it was decided that all four options would be unaffordable. In addition, the Trust is finding it increasingly difficult to staff just two hospitals so it would not be feasible to staff a third hospital. Having listened to the views of our communities, keeping two vibrant hospitals in Shrewsbury and Telford was one of the key messages that came through. Our doctors and nurses believe that our proposed model of transforming our existing hospital sites into Emergency Care and Planned Care sites is the best solution for all our communities.
What is an Urgent Care Centre?
An urgent care centre provides care and treatment for illnesses and injuries that are not life or limb-threatening but require urgent attention. Examples of this include a suspected broken arm, minor burn or scald, or a cut that needs stitches.
Under either option, both hospitals would have a 24-hour 7 days a week Urgent Care Centre which would be staffed by highly skilled senior health professionals who are specifically trained to deliver urgent care for adults and children.
How will I know whether to go to my local urgent care centre or to the Emergency Department?
The Emergency Department would be based at the Emergency Care site and provide care for patients in a life or limb-threatening situation. The Urgent Care Centres at both hospital sites is for illnesses and injuries that are not life or limb-threatening but require urgent attention.
We understand that it is sometimes difficult to know how serious your condition is. If you call an ambulance then the paramedics would assess you and decide on the most appropriate place for your care. This may be the Emergency Department or your nearest Urgent Care Centre. In some cases (as is the case now), you would be taken out of county to a Trauma Centre at Stoke or Birmingham.
If you walk in to an Urgent Care Centre and have a condition that requires emergency care, or in the unlikely event that you became critically unwell in an urgent care centre, then you would be assessed and cared for by skilled clinical staff. If needed, you would be safely transferred to the Emergency Department, or out of the county to a Trauma Centre, as now.
At the Emergency Care site, there will be one entrance for both the Emergency Department and the Urgent Care Centre. On arrival, you would be quickly assessed and doctors and nurses would decide on the best place for your care.
It says in the consultation document that under our proposal, almost 80% (8 out of 10 people) would continue to go the same hospital as they do now for emergency and urgent care. How is this worked out?
These numbers are based on the fact that around half of the people who currently attend our A&Es go to the Princess Royal Hospital and the other half go to the Royal Shrewsbury Hospital.
We know that around 6 out of every 10 people who currently attend our A&Es do not actually need emergency care. They need urgent care. In the future, these people would be treated at one of our 24-hour urgent care centres at either the Princess Royal Hospital or the Royal Shrewsbury Hospital. In other words, they would be going to the same hospital as they do now for their urgent care.
Around 4 out of 10 people who attend our A&Es do need emergency care as they have a life or limb-threatening illness or injury. In the future, all of these people would need to be seen at our new Emergency Care site. For around half of these people (that’s 2 in 10 people) they would go to the same hospital for emergency care as they do now. This means that the other half (2 in 10 people) may have to travel further than they do now for emergency care.
How long will I have to wait to be seen in the urgent care centre?
In our new model of care, we are aiming for all patients to be seen, treated and discharged as efficiently as possible and within the national standard of four hours.
Who will run the urgent care centres?
The centres will be run by the Shrewsbury and Telford Hospital and staffed by highly skilled senior health professionals who are specifically trained to deliver urgent care for adults and children.
What will happen if I arrive at an Urgent Care Centre and I need emergency care?
If a seriously ill patient arrived at an Urgent Care Centre or in the unlikely event that a patient became critically unwell in the centre, they would be assessed and cared for by skilled clinical staff. If needed, then they would be and safely transferred to the Emergency Department at the Emergency Care site or out of the county to a Trauma Centre, as they are now.
What are the benefits of having a dedicated Emergency Care site?
There are lots of benefits to separating out planned care and emergency care and having a single dedicated Emergency Department on an Emergency Care site. It would mean that:
- Patients are seen quicker by a variety of specialist doctors and nurses 24-hours a day, seven days a week who are all located on one site
- Patients are less likely to have their operation cancelled due to a bed not being available due to an emergency admission
- More patients would be able to be quickly assessed, observed, treated and discharged the same day, avoiding the need to stay in hospital overnight
How would I be treated in an emergency?
Our proposed changes to the way we deliver emergency care would mean that, in a life or limb-threatening emergency, patients from across Shropshire, Telford & Wrekin and mid Wales would be treated in a single, dedicated, purpose-built Emergency Department. Here, you would receive 24-hours-a-day, seven-days-a-week care from specialist emergency doctors and nurses. This would improve the recovery of our patients and lead to faster diagnosis, earlier treatment and improved clinical outcomes.
As happens now with our existing A&E departments, in an emergency situation, you would either arrive by ambulance or be brought to the Emergency Department at the Emergency Care site. As soon as you arrive, you would be assessed by the emergency clinical team who would decide on the best place for your care:
- If doctors decide that you do not need emergency care then you would be directed to the 24-hour Urgent Care Centre which would be based alongside the Emergency Department
- If needed, you would receive emergency care and treatment in the Emergency Department without delay.
- As is the case now, if you suffer a major trauma, you may be brought to the Emergency Department to receive immediate lifesaving treatment before being transferred to a Trauma Centre.
If I have to have an emergency operation, would I be able to stay at the Emergency Care site for my recovery if this was nearer to my home?
Following your emergency care, our aim would be to get you back home as soon as possible. However, depending on your condition, the doctors and nurses looking after you may decide that you need ongoing hospital care. Where this ongoing care takes place will depend on your condition and the care services you need. For many patients, this will mean they are transferred to the Planned Care site.
Where would I go if I need to have a planned operation?
Most patients now have their planned surgery as a day case and most day case surgery will take place on the Planned Care site. However, if you are classed as high risk, or in the case of a child, surgery would take place at the Emergency Care site.
Where would I go if I have an existing health condition and need to have a planned operation?
This will depend on the clinical assessment by the doctor who is carrying out your operation. Depending on your needs and the risk assessment, you may still have your operation on the planned care site. If your doctor feels that you may need the support of the critical care team, for example, if you’re having a complex planned operation, then your operation would take place at the Emergency Care site.
If the Planned Care site is at Telford, would I have to stay there after my operation, even if I live in mid Wales?
Most patients now have their planned surgery as a day case and most day case surgery will take place on the Planned Care site. This would mean that you should be able to go home afterwards. If you are having your operation as an inpatient then you will have to remain at the Planned Care site until you are well enough to go home.
I’ve heard one of the reasons that the Royal Shrewsbury Hospital is the preferred option for the Emergency Care site is because it’s a Trauma Unit. What is a Trauma Unit and why is it at Shrewsbury not Telford?
The role of a Trauma Unit in each region is to accept and manage, at any time, arrival of patients from the following two groups:
- Those considered to have injuries not requiring expertise of a Major Trauma Centre
- Those critically injured for whom direct transfer to a Major Trauma Centre could adversely affect outcome (with subsequent plans to transfer)
Following assessment, if a patient no longer requires management by the Trauma Team, they will then come under the care of the appropriate clinical speciality.
A Trauma Unit could be the primary receiver of seriously injured patients and are responsible (for up to 2 days when patients should refer on to a Major Trauma Centre) for resuscitating and caring for patients who require optimisation as they were too unstable and unable to cope with a 45 minute transfer to a Major Trauma Centre.
A Trauma Unit may receive local trauma patients with less serious injuries which will include simple fractures of one limb, lacerations and minor head injuries. In addition, Trauma Units need to have the expertise to recognise patients who are beyond their capacity to treat and to be able to transfer them rapidly to a Major Trauma Centre.
It is correct that one of the reasons why the CCGs have chosen the Royal Shrewsbury Hospital to be the Emergency Care site is so that it can continue to be a Trauma Unit. If a patient suffers a major trauma, for example a serious head injury, severe wound or multiple fractures, they may be taken to a Trauma Unit to be treated, or, in the most severe cases, stabilised and then transferred to Major Trauma Centre.
The North West Midlands and North Wales Trauma Network coordinates trauma care services across our region and it is their view that a Trauma Unit should be at the Royal Shrewsbury Hospital. This is because of its location and access for patients in the west of the region, mainly residents of mid Wales. They have advised that, if the Trauma Unit was at Telford, there would be an increased risk for the group of patients from Powys as their transfer times to a Trauma Unit would be significantly increased. However, if Telford was chosen as the Emergency Care site, it could apply to become a Trauma Unit. It would have to meet a number of quality standards and requirements in order to do that.
Recruiting and retaining staff
Why is it so difficult to recruit and retain staff?
Across the country, there is a national shortage of nurses and doctors, especially within paediatrics, psychiatry, neurology, obstetrics and gynaecology and emergency department specialties.
Whilst some specialities are predicted to have adequate national training numbers coming through over the next five years (obstetrics and gynaecology, for example) to meet anticipated staffing needs, it still does not guarantee recruitment to Shropshire at all, or in a timely manner; nor is it reflected in all specialties.
Locally we have additional problems by having nearly all the same services at both hospitals. This means that we need to have staff to cover both sites 24/7, seven days a week. This means that staff on a rota are working many more unsociable hours (on call rota) than their colleagues in other hospitals. This causes a lack of balance between work and home life. Other hospitals are therefore more attractive to work at, so we struggle to recruit and keep staff. In addition, potential staff are concerned the lack of certainty about the future of the hospitals. Until we complete a consultation, consider the feedback and make a decision, we cannot reassure many potential recruits.
How hard are you trying to recruit and what are you doing?
Since July 2015, the Trust has been running a recruitment campaign to attract new staff to Shropshire. Shropshire, Telford & Wrekin and mid Wales are attractive places to live and anecdotally, we have a number of people we know would like to work for us, but they are unwilling to leave their current jobs while the future of the two hospitals is undecided and the rotas mean that they would probably have a worse balance between work and life.
Have you had any success in recruitment?
Yes we have in some areas but in our key emergency services we are still unable to recruit doctors (for example in A&E and Acute Medicine). We are also struggling to recruit nurses to work in our A&Es.
The Royal College of Emergency Medicine (RCEM) considers the proper staffing of the Emergency Department as the single most important factor in providing a high quality, timely and clinically effective service to patients.
There are 5 full time substantive Consultants in post, covering both sites. The Royal College of Emergency Medicine (RCEM) recommends that all A&E departments should have an establishment of at least 10 Emergency Medicine Consultants to provide up to 16 hours a day of consultant cover. There are 4 Locum Consultants in post following a decision by the Board in December 2016 to over-recruit Locum Doctors to provide additional resilience to the On Call rota as there had been no applicants for the substantive posts.
Due to the challenges of the current workforce configuration across two sites the On Call rota is particularly demanding for our substantive workforce some of whom will consistently provide cover twice a week.
If you have had success in recruiting, why do we still need to change?
Despite these successes, the scale of the staffing problem locally is still enormous. Changes also need to be made for other reasons, such as quality concerns which were raised by the Care Quality Commission in their 2017 report:
- Changing healthcare needs of the population now and into the future
- Quality standards that are required and that individuals and organisations aspire to deliver
- A need for improved productivity and a reduction in inefficiencies (in line with the Carter Review 2016 and the Trust’s work with the Virginia Mason Institute)
- On-going developments in medicine and technology
- Workforce changes in terms of skills, availability and training
- Poor quality existing facilities and level of backlog maintenance.
What about keeping and developing existing staff?
Whilst we quite rightly are concentrating on recruitment, we also work hard to keep our existing staff through development, engagement and culture change initiatives. As the proposals for Shropshire, Telford & Wrekin and mid Wales become reality, staff will be supported to develop and adapt to any required new ways of working.
Travel and transport
What if I don't have any transport and I can't get from Telford to Shrewsbury for my care or vice versa?
As now, if you are unable to get to or from one of our hospitals, there are a number of options available and these will continue in the future.
If your reason for going to hospital is not an emergency, you'll normally be expected to make your own way there. Wherever possible, patients are advised to make their own arrangements with a relative or friend, or to use public transport.
If there is difficulty in meeting the cost of transport to and from hospital, you may be able to claim a refund of the cost of travelling under the ‘Healthcare Travel Costs Scheme’ (HTCS). This is part of the NHS Low Income Scheme and was set up to provide financial assistance to those patients who do not have a medical need for ambulance transport, but who require assistance with their travel costs to attend NHS appointments. For more information please visit https://www.nhs.uk/nhsengland/healthcosts/pages/travelcosts.aspx or ask your GP or the healthcare professional who referred you to hospital.
Alternatively, some people are eligible for non-emergency patient transport services. These services provide free transport to and from hospital for:
• people whose condition means they need additional medical support during their journey
• people who find it difficult to walk
• parents or guardians of children who are being transported
To find out if you are eligible for patient transport services and how to access it, you will need to speak to your GP or the healthcare professional who referred you to hospital.
We do understand that travel and transport are important considerations for people and that any change to our hospital services would have an impact on travel for some of our patients, visitors and staff.
Travel and transport has been a key factor in developing our proposed model of hospital care and deciding our preferred option. We have undertaken a Travel Impact Analysis to understand the impact any changes to our hospital services would have on patients across Shropshire, Telford & Wrekin and mid Wales. You can read this in our Integrated Impact Assessment.
Whatever the outcome of this consultation, the majority of patients would continue to go to the same hospital as they do now. However it will mean that some people will have to travel shorter distances and some will have to travel further for their care.
What are you planning to do to help people to travel for treatment or to visit relatives at each of the hospitals?
We have a number of ideas that we are looking at, but we want to hear people’s views during consultation. We will then consider these suggestions and see whether we can work with partners or make some changes to how we organise appointments to make it easier for people. You can read more about this in the consultation document.
Won’t the ambulance services struggle if we only have one Emergency Care site?
Both the West Midlands Ambulance Service and the Welsh Ambulance Service currently transport patients across Shropshire and mid Wales. Paramedics assess patients and decide on the best place for them to go to receive the care and treatment they need. For example, many patients from Powys, Oswestry and surrounding areas are taken to the Princess Royal Hospital to the stroke unit or Wrexham Maelor Hospital and some patients from Telford area are taken to the Royal Shrewsbury Hospital trauma unit. Equally, it a patient suffers a major trauma, they may be taken out of county to the Royal Stoke Hospital or University Hospitals Birmingham.
We have been and continue to work closely with both Welsh and West Midlands Ambulance services on the processes and pathways for the future and both ambulance services are supportive of the need to change and our proposed model of care.
Will the ambulance services take people to the Planned Care site?
If paramedics decide that a patient can be treated in one of the two Urgent Care Centres, they will take them directly to the nearest Urgent Care Centre which may be the Urgent Care Centre at the Planned Care site. If paramedics decide that they need emergency care then they would be taken directly to the Emergency Care site.
If more care is to be provided in the community so I don't need to go to hospital, what will that be and how will I access it? I can never get a same day appointment with my own GP practice now.
Our vision puts the needs of patients at the centre of our neighbourhood model. This will operate in a more efficient, focused manner, steering away from bed based services to a more community centered style of care.
The proposed model of care aims to provide and design services that work more effectively around the patient. This involves integrated health and social care community services that provide alternatives to hospital care for mild, moderate and severe long term conditions, with rapid access to urgent and crisis care. It will also aim to ensure as much as is clinically safe and efficient to do so, that patients receive the right care in the right place and do not have to travel to a hospital for treatment unnecessarily.
The Sustainability and Transformation Partnership (STP) for Shropshire and Telford & Wrekin has a range of coordinated activities that focus on looking at ways we can develop neighbourhood care services, where patients are seen and treated in their local community by a co-ordinated team of medical, nursing, therapy, mental health and learning disabilities teams. They are also looking at how we can reduce the number of times patients need to come to hospital and when people need hospital care, how we can more rapidly assess, treat and discharge those who are well enough back to home or into community care.
Our neighbourhood care model will remove existing barriers and bring together all the services that patients may need. These include:
- primary care (such as your GP practice)
- community care
- mental health services
- learning disabilities services
- local authority services such as the Housing Association
- voluntary sector such as Help the Aged and the
- independent care sector such as Nursing Homes
- social care
This approach will ensure the public receive the right care in the right place and maximise the efficiency and effectiveness of local services.
As we continue to work to develop healthcare services, we will continue to review the services we currently provide. Where we believe that a change in the way we deliver services may lead to better, higher quality care for patients and therefore significant change may be identified as an option then we will follow due process. This may require further public consultations in the future as with any other significant changes to your services.
Affordability and cost
Why are you spending £312m of public money to change our hospitals?
In order to secure the future of our two hospitals, we need make changes and this costs money. The hospitals were built many years ago and are no longer organised in the right way for the number of patients the hospitals treat. Having explored a number of options, we feel that investing this money into our hospitals is the best way to secure the future of our two hospitals in the future.
How are you going to pay for it?
In order to change our hospitals, a number of goods and services need to be paid for. This includes professional services which we don’t have routinely within the NHS, such as architects, engineers and construction teams. We will also need to be able to purchase equipment and temporary facilities whilst building work takes place.
We need to gain approval from HM Treasury (the Government's economic and finance ministry) for the total cost associated with these changes.
The Shrewsbury and Telford Hospital NHS Trust understands that some of this funding will be from capital funding known as Public Dividend Capital (PDC). However, there is a potential shortage of capital through this route and, as such, the Trust would need to explore additional funding.
The discussions for funding are well underway and involve both NHS England (the organisation that leads the NHS in England) and NHS Improvement (the organisation that supports NHS Trusts to be financially sustainable) and HM Treasury.
Women and children’s services
What is a consultant-led maternity unit?
This is where there are both doctors (obstetricians) and midwives available to support women and their babies. Obstetricians are doctors who specialise in pregnancies and births where there are complications. Obstetric units offer epidural pain relief, and have an operating theatre nearby in case a baby needs to be delivered by caesarean section. They also have special care baby units.
The consultant-led unit is currently based at the Women and Children’s Centre at the Princess Royal Hospital. All births classed as high-risk, for example, multiple births, caesarean sections or women with complex health needs, give birth at the consultant-led maternity unit. However, expectant mothers can choose to have their baby at the consultant-led unit.
What is a midwife-led unit and what services are offered there?
If you are having a low-risk pregnancy, then you can choose to give birth at a midwife-led unit. These are run by highly skilled midwives who provide care for women before, during and after the birth of their baby.
If you are having your baby in a midwife-led unit and the labour doesn’t progress as it should or if you or your baby needs extra support, you would be transferred to the women and children’s consultant unit. This would mean that a doctor and medical equipment would be on hand if needed.
What types of births happen in midwife-led units or at home?
Women with no ongoing health problems who have been assessed as low risk can choose to give birth at a midwife-led unit or plan a homebirth.
You decided in 2012 to build the women and children’s centre at Telford at cost of £28 million. You said it was the right place for it. Why is Shrewsbury now the best place for it less than 5 years later?
The changes to women and children’s services in 2014 were needed because the previous accommodation that housed these services had become unfit for purpose.
Sustaining inpatient paediatric services on two sites, providing senior paediatric input and maintaining accreditation for doctors in training was a risk. The challenge of maintaining smaller inpatient paediatric units within 30 minutes of each other is well documented by the Royal College of Paediatrics and Child Health (RCPCH) who recommended the consolidation of services into larger single site centres.
Following a public consultation, it was decided that the Telford was the right place for the new building. If, following this consultation, the decision is made to base the Emergency Care site at Shrewsbury; then the acute, inpatient element of women and children’s services would need to be based on the Emergency Care site. Clinical adjacencies are essential for patients to access safe and high quality care and critical when considering the co-location of services such as Women and Children’s and the Emergency Department. The firm view of the Trust’s clinicians is that Women and Children’s and Emergency services need to be on the same site.
The Women and Children’s Centre has accommodation for parents, if you move it where will we be able to stay?
If women and children’s inpatient services moved to Shrewsbury there would be the same standard and type of on-site accommodation available for families.
Would I still be able to go to Telford if women and children’s services move to Shrewsbury?
If Shrewsbury became the Emergency Care site (Option 1) then women and children’s consultant-led services would move to Shrewsbury. This includes consultant led births, children’s inpatient services and children’s cancer and haematology. However, many women and children’s services would still be available at Telford. This includes adult, children’s and neonatal outpatient appointments, midwife-led unit, Antenatal Day Assessment Unit, gynaecology outpatient appointments, maternity outpatients and scanning and tests.
Most women and children would still receive care and treatment in the same place as they do now. The following women and children’s services would be available at both sites:
- Midwife-led unit, including low-risk births and postnatal care
- Maternity outpatients, including antenatal appointments and scanning
- Gynaecology outpatient appointments
- Early Pregnancy Assessment Service (EPAS)
- Antenatal Day Assessment
- Children’s outpatient appointments
- Neonatal outpatient appointments
What are you going to do with the building if women and children’s services inpatient services move to Shrewsbury?
The building will not be wasted and the plan is that it will be used for the women and children’s services that will remain at Telford along with other essential planned care services.
What will happen to children’s cancer and haematology services?
This service will be based at the Emergency Care site alongside children’s inpatients, surgery and assessment services.
If I have my baby at the consultant-led women and children’s unit at the Emergency Care site and I live closer to the Planned Care site, will I be transferred closer to home if I need ongoing hospital care?
If it is clinically safe for you and your baby to transfer to the midwife-led unit at the Planned Care site and there is a bed available, then yes, you will be able to transfer.
Why do women and children’s inpatient services have to stay with emergency services?
The West Midlands Clinical Senate (expert clinical leaders who provide independent advice and guidance to CCGs) recommended that emergency care and women and children’s inpatient services should be located on one site. This is so that emergency doctors, nurses and other healthcare staff are on hand if needed. Under Option 1, this would mean that women and children’s inpatient services moves from Telford to Shrewsbury.
What changes would there be for women and children’s services?
Whatever the outcome of this consultation, most women and children would still receive care and treatment in the same place as they do now. The following women and children’s services would be available at both sites:
- Midwife-led unit, including low-risk births and postnatal care
- Maternity outpatients, including antenatal appointments and scanning
- Gynaecology outpatient appointments
- Early Pregnancy Assessment Service (EPAS)
- Antenatal Day Assessment
- Children’s outpatient appointments
- Neonatal outpatient appointments
All women and children’s consultant-led inpatient services would take place at the Emergency Care site. This includes:
Consultant-led maternity and neonatal services: Inpatient facilities would be provided for pregnant women who need consultant-led care. This includes antenatal and postnatal wards, delivery suites and a neonatal intensive care unit
Children’s inpatient services: Children’s inpatient services (if a child has to stay in hospital overnight) would take place here. The children’s ward cares for children with serious illness and complex problems who need care from specialist doctors and nurses. This includes children’s surgery and children’s cancer and haematology services
Why might stroke services move following this consultation?
Prior to summer 2013, stroke services were provided at both hospitals. In response to staffing challenges during summer 2013, The Shrewsbury and Telford Hospital NHS Trust acted promptly, with the support of the CCGs, to secure safe, dignified stroke services for our patients and communities. This involved bringing together hyper-acute and acute stroke services to create one stroke service at Telford. Telford was chosen as it offered the best facilities and staffing model at that time. In early 2014, the Trust board and the CCGs approved the continuation of the single-site stroke service at Telford until the longer term plans were agreed through the Future Fit programme.
Research shows that patients are more likely to have a better outcome if they receive care and treatment in a dedicated stroke unit. If following a consultation it was decided to base the Emergency Care site at Shrewsbury then the stroke unit would need to move to Shrewsbury to be alongside all critical care.
You moved stroke services to Telford in 2013. Why are you now considering moving it again?
We had to consolidate stroke services onto one site in 2013 due to staffing challenges and at the time, Telford was chosen as the best location as it offered the best facilities and staffing model.
Stroke is a life-threatening emergency so it is vital that our stroke unit is based alongside the Emergency Department. It therefore has to be on the Emergency Care site. Following this consultation, if option 1 is approved, this would mean that the stroke unit moves to Shrewsbury.
If I had a stroke, would I be able to have my rehabilitation at my nearest hospital?
Whatever the outcome of this consultation, stroke rehabilitation services would continue to be provided at both hospitals and at home, wherever possible. For those patients whose rehabilitation needs to be at hospital, we would aim for this to take place at the hospital nearest to where they live.