Frequently asked questions

We know you'll have lots of questions about NHS Future Fit.  Here is a list of frequently asked questions and their answers. If you have a question that is not covered below, please send it to: This email address is being protected from spambots. You need JavaScript enabled to view it.

 

Topics

1. About NHS Future Fit

2. About the public consultation

3. What happens after the consultation? 

4. The preferred option

5. Reasons for change

6. Urgent care

7. Emergency care

8. Planned care

9. Trauma services

10. Recruiting and retaining staff

11. Travel and transport

12. Community services

13. Affordability and cost

14. Women and children's services

15. Stroke services

16. Feedback from the consultation 

 

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 delivered the consultation?
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 did 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 produced a full consultation document and summary version which explained the changes we are proposing, what these would mean for you and your family and the two options on which we want your views.

What happened during the consultation?
Throughout the 14 week consultation we hosed a series of public exhibition events where people could meet our doctors, nurses and other healthcare staff, ask questions and discuss any concerns. We also came along to groups, meetings and events across the area to give a talk or have a stand. In addition, we  arranged around 50 pop-up roadshows at high footfall locations across Shropshire, Telford & Wrekin and mid Wales.

Why did it take 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.

How confident are the CCGs that they comply with the Gunning Principles, which require that in any consultation the public must 'have enough information to make an intelligent choice and input in the process'?
We organised a series of public exhibition events which were open to everyone to attend. We have, and continue to, work closely with the Consultation Institute who are quality assuring the consultation process. As part of this process, they are offering guidance to make sure we are meeting NHS England’s five tests for reconfiguration and following the Gunning principles. They have provided feedback on all of our consultation documents and our communication and engagement plan in order to make sure local people can receive the information they need to make an informed decision. As part of our commitment to following the Gunning principles, any alternative proposals or suggestions put forward as part of the consultation were, of course, conscientiously taken into account and carefully considered as part of the process.

What did the consultation ask 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 wanted as many people as possible from across Shropshire, Telford & Wrekin and mid Wales to provide their views during the formal public consultation. We worked 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.

Wales have their own finances. Why do they have to be included in the Future Fit plans?
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. 

In the financial year 2017/18, what was the activity and costs associated with the treatment of Welsh patients at SaTH?
The table below shows the number of commissioned activity (activity we get paid for) and the associated payment received for Welsh patients who accessed inpatient and outpatient services at our two hospitals during 2017/8:

  Commissioned activity  Payment received 
 Inpatients  11,442 £16.224m 
 Outpatients 40, 230  £4.698m 

As Host Commissioner, NHS Shropshire Clinical Commissioning Group (CCG) receives an allocation for A&E attendances for people who live in mid Wales and SaTH charges Shropshire CCG for any Welsh A&E attendances. The Local Health Boards in Wales commission secondary care from the CCG and pay for this in line with national tariff. For more information on cross border protocols, see the NHS England Who Pays? Guidance.

If I have given you my views before the 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. Our public consultation aksed 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.

No final decision will be made until we have considered the views of everyone who responds to the consultation.

How much has Future Fit spent on promoting its Facebook page?
As of 29th August, £367.76 had been spent on Facebook promotions. The majority of this spend was website promotion to drive traffic to www.nhsfuturefit.org so that people can find out more about Future Fit and complete our consultation survey.

How effective does the Future Fit programme believe their expenditure has been and does it represent value for money?
Our Facebook promotions are designed to encourage people to visit the Future Fit website. Facebook advertising represents good value for money because it allows us to directly target the area in which we are consulting and is an effective tool to promote awareness of the consultation and to encourage people to visit our website and have their say.

How can the CCGs be confident that the consultation will genuinely reflect public opinion?
We have worked closely with the Consultation Institute (tCI) and consultation specialists Participate Limited to develop our survey. Although not compulsory, our survey does ask people to give the first half of their postcode to enable to us to track the areas where our responses are coming from. It also asks for people to answer a range of questions about themselves to help make sure we are capturing the views of as many different people as possible.

Half way through the consultation, tCI conducted a mid-point review. This looked at how well we have engaged and the responses to the survey to make sure we are gathering feedback from a wide range of people across Shropshire, Telford & Wrekin and mid Wales. This allowed us to make changes to our activity if necessary, to make sure everyone had a chance to be involved before the end of the consultation.

Can you tell me how questionnaires will be assessed and what will you do if people disagree with both options?

Our Future Fit consultation asked for your views on the impact that either option will have on you and your family. Please remember that this is not a vote as it is all about hearing what patients and the public think about the proposals.

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 consultation document lists several areas where work will need to be completed after the consultation before a decision can be reached. But it doesn’t state which aspects of the current models are subject to alteration through the consultation process. Is the consultation only about the location of the ED and DTC? What other elements of the common model may be changed through the consultation? Are only mitigations acceptable or material changes to the proposals themselves?

As part of our commitment to following the Gunning principles, any alternative proposals or suggestions regarding the proposed model of hospital care would, of course, be conscientiously taken into account and carefully considered as part of the process.

Has Future Fit used Government guidance on rural proofing its policies? If yes, why is there no reference to rural proofing in the consultation documents?
Rural proofing is practical guidance from the Department for Environment, Food and Rural Affairs (Defra) for policy makers and analysts in government to assess and take into account the effects of policies on rural areas. It is not guidance that we would use for an NHS public consultation. 

However, we are aware of the rural nature of our county and that this has an impact on some communities accessing hospital services. We have included rurality as one of four additional areas to focus our engagement on in addition to the nine protected characteristics that are in the Equality Act 2010. The issue of rurality is therefore being covered as part of our equalities and inclusion activity and our work with seldom-heard groups.

What happens after the consultation?  

What happens now that the consultation has finished?
All feedback from the public consultation was collated and analysed by an independent company, consultation specialists, Participate Limited.
 
How will the findings from the consultation be presented?
The Future Fit Findings Report was produced by Participate, in which all comments received were coded by themes. This report will be considered by Shropshire and Telford & Wrekin CCGs as part of their decision-making process.

As data controllers, the Accountable Officers of Shropshire and Telford CCGs, also received the full survey responses, formal letters from key stakeholders and detailed submissions from members of the public.
 
Will Participate pass any comments that might be relevant directly to the CCGs or will they filter them out?
All comments from the surveys, letters and other correspondence is passed to the CCG Accountable Officers with no information filtered out.

When will the consultation findings be made public?
The Consultation Findings report, was published in November 2018.

What work has to be completed before a decision is made?
The views and suggestions of everyone who has responded to the 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 until this work has been completed and considered. They include:

• more work to model the care we will need to deliver in the community
• 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

What if the majority of people who responded to the consultation have chosen one option? Will you go with that option?
The consultation is not a vote, it’s about listening to the views of what people think about our proposals and the impact that either option will have on them and their family. All views will be taken into consideration as part of the decision-making process. They will also help inform what plans the CCGs put in place to help lessen any negative impact that the chosen option may have on our communities.
 
What are you doing to ensure that you consider responses to the public consultation?
The decision-making process has being designed to make sure that we conscientiously consider all responses to the public consultation. This will include a series of meetings over a number of weeks where key stakeholders will be invited to discuss, reflect and fully consider the key themes, detailed responses and any counter proposals. This will include meetings with the Shropshire and Telford CCG boards and the Future Fit Programme Board, the Joint Health, Overview and Scrutiny Committee (HOSC), Powys Teaching Health Board and Powys Community Health Council.

Who will make the final decision and when will this be?
The boards of the two CCGs and the Future Fit Programme Board will consider all of the evidence. A Joint Committee of Shropshire and Telford & Wrekin CCGs will then be convened in early 2019 to make the final decision. This will be a meeting held in public which will be live streamed on the internet.

How long will it take before the changes happen?
It will take about five years before all changes are fully implemented. There will be lots of opportunities for patients, families and the public to get involved over the coming years.

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.

If Option 2 is cheaper in the short term, why Option 1 cheaper in the long term?

Our Report on the Appraisal of Options  describes in more detail the financial appraisal. It sets out the 30-year and 60-year calculations, both of which ranked Option B (Option 2 in the consultation document) first by a margin of 0.8% on financial grounds. Once viewed from the perspective of whole life costs (as required by guidance), however, these differences become minimal. For example, although Option B has a capital requirement of £250m and Option C1 of £312m, the final difference in terms of equivalent annual cost is just £2.7m (0.8%).

Through the economic analysis, the appraisal sets out the two calculations we used to bring together the non-financial and financial evaluations. The overall conclusion is that Option C1 (Option 1 in the consultation document) provides the best value for money in the long term whether that be over 30 or 60 years.

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.

Why are there two options and no others?

In September 2016, an Options Appraisal workshop took place which invited representatives from over 50 organisations from across Shropshire, Telford & Wrekin and mid Wales to form a panel. This included health organisations, patient representatives and Shropshire and Telford & Wrekin Councils.

The panel’s criteria were accessibility, quality, workforce and deliverability. Panel members were asked to decide on the relative importance of each of the criteria and give them a weighting out of 100. Option C1 (now known as Option 1) and Option B (now known as Option 2) received the highest scores on all four criteria. Similarly, in the financial appraisal, which looked at capital costs, these two options were the most preferable.

In August 2017, the Joint Committee of the two clinical commissioning groups approved the preferred option for the Royal Shrewsbury Hospital to become the Emergency Care site and the Princess Royal Hospital to become the Planned Care site.

Surely with a growing population in Telford, there has to be an A&E there?
Our proposed model of hospital care takes into account the expected changes in our population over the coming years and how the best care can be provided for everyone.

Having the Emergency Care site at Shrewsbury would mean fewer people would have to travel further for emergency care. More people would be disadvantaged under Option 2 (if the Emergency Care site was based at Telford) as they would have to travel further to access emergency services. This includes communities across Oswestry, South Shropshire and mid Wales.

We also have an older population, especially in Shropshire and mid Wales. The majority of our older population live in Shropshire and mid Wales and these numbers are growing at a faster rate than across Telford & Wrekin. Population projections estimate that by 2036, people aged 70 and over will account for 25% of the population of Shropshire and 29% in mid Wales, compared to 18% in Telford & Wrekin. This has been another factor in deciding our preferred option of having the Emergency Care site at Shrewsbury.

Over half a million people across Shropshire, Telford & Wrekin and mid Wales use our two hospitals. This covers a very large geographical area of approximately 2,500 square miles. Shropshire, Telford & Wrekin and mid Wales are three very different areas with different populations and therefore different health needs. There is also huge variation in where our communities live, ranging from areas of densely populated housing to sparsely populated rural villages.

If emergency care is moved to Royal Shrewsbury Hospital, this is a much older building that Princess Royal Hospital. Surely Princess Royal Hospital has more ground to build on?
Both our existing hospital sites were built many years ago. Although we have invested in some new buildings in recent years, we now have many outdated areas that have become more difficult and more costly to look after. They do not provide the modern environment for delivering high quality services that our patients rightly expect and need. We know that building standards have now greatly improved and new hospitals are built to higher specifications that are based around the needs of the patient.

Our proposed model of hospital care would allow us to improve our existing buildings and create some new buildings. Facilities would be designed to meet the needs of our patients, their families and staff. Having the Emergency Care site at the Royal Shrewsbury Hospital would mean that it can continue to be a Trauma Unit, 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 and it offers the best value for money over the long term.

Will Option 2 allow the NHS to invest in a second state-of-the-art cancer centre?
Whatever the outcome of the consultation, adult cancer day services would remain at the Royal Shrewsbury Hospital. Outside of this consultation, The Shrewsbury and Telford Hospital NHS Trust is exploring opportunities around how some adult cancer day services could be provided at the Princess Royal Hospital.

The two tables on page 111 of the PCBC are only compatible if the ‘Clinical trolley and recliner chairs’ in table 20a have been included in the ‘General and Acute’ line items in table 20b. How are they distributed between the different line items?
This is correct. The 991 figure shown in table 20a is broken out in a different way in table 20b and the 49 clinical trolley and recliner chairs will form part of the medical beds number of 354. The occupancy improvement number of 91 beds is the additional beds that would be provided in the Trust to give us a lower occupancy rate and therefore improved flow. This improved occupancy will be seen in the adult medical bed base and therefore an increase in the number of beds provided when compared to now. These two tables are based on different year activity. Table 20a is based on 2015/16 activity data and table 20b is based on 2016/17 activity data. We will continue to review our activity as we progress to ensure that the size of the hospital is appropriate to care for patients of the future. This includes growth and new ways of working.

Table 20b shows a planned reduction of 41 medical beds. Tweets from a Twitter chat on the NHS Future Fit Twitter account said ‘there will be 50 more inpatient beds for medicine. That’s it’. If that is correct, it implies 91 more medical beds than shown in the table. Please explain?
The additional benefit that the tweets refer to is the increase that will be delivered from improving our occupancy level, as referred to in the above answer.

I can see the clinical improvement you claim will occur from the concentration of true emergency services at either Telford or Shrewsbuy.  My concern is that Future Fit, without a realistic plan to fund the growing need for health services and after care, will simply place a band aid over the gaping wound which lies between the present plans for funding (including the announced budget increases over the next few years) and the expectations of excellent clinical service from all elements of the NHS in the post-Future Fit period.
Our proposed model of hospital care takes into account the expected changes in our population over the coming years and how the best care can be provided for everyone. The proposed transformation would allow us to improve our existing buildings and create some new buildings. Facilities would be designed to meet the needs of our patients, their families and staff. Having the Emergency Care site at the Royal Shrewsbury Hospital would mean that it can continue to be a Trauma Unit, fewer people would have to travel further for emergency care, and it better meets the future needs of our older population, especially in Shropshire and mid Wales and it offers the best value for money over the long term.

The consultation document uses Northumbria as an example of a high quality healthcare system.  But the proposition that Future Fit should adopt a similar model was dismissed by the Rider Hunt report presented at your board meeting of the 24 July 2018. I gather the key reasons for dismissing the Northumbrian model have been comprehensively addressed by an expert witness. Will Future Fit now revisit this, seemingly better, option?
We want to transform the way we deliver emergency services and we believe that having a dedicated emergency care hospital similar to Northumbria is the solution. But, there are key differences in the services that our hospitals provide and those which Northumbria provides to their population. If we adopted a clinical model exactly the same as in Northumbria then it would mean some services would have to be delivered outside of the county. The services that our hospitals provide which Northumbria doesn’t include urology, nephrology (the diagnosis and treatment of kidney diseases), oncology and haematology and 24 hours a day, seven days a week urgent care centres.

Adopting the Northumbria model would also have a huge impact on our workforce. We are already struggling to provide staff to cover two hospitals so it would be even more difficult to staff three sites. In addition, we would not bemaking the best use of our resources with staff having to work across three sites and duplication of clinical and non-clinical services.

We have also looked at adopting the Northumbria model and keeping all the hospital services that we currently provide in Shropshire. This is estimated to cost around £400-500m and that’s before we include infrastructure costs (such as roads) and the cost of the land. This is much higher than the £312 million we have been allocated from the Department of Health and Social Care. The Shrewsbury and Telford Hospital NHS Trust recently commissioned a report to provide a more detailed comparison of hospital services in Northumbria with our proposed model of hospital care. You can read this at https://bit.ly/2vMKzSp 

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

You can read more about the reasons we need to change our hospital services on page 10 of the main consultation document and page 6 of the summary consultation document.

Why can't we stay as we are?

The main reason we need to change our hospital services is to make sure our hospitals provide high quality, safe services for all patients for the long term. We want to make sure that, wherever possible, patients are seen by the right person at the right time in the right place. At the moment, we know that this is not always happening.

All our hospital staff work extremely hard to deliver the very best service to our patients across Shropshire, Telford & Wrekin and mid Wales. However, it is becoming more difficult to make sure that we have enough doctors, nurses and other healthcare staff to provide a 24-hours a day, seven days a week service at both our hospitals. We have also had to recruit temporary staff that are not as familiar with our hospitals and have therefore needed additional support.

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.

Urgent Care

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.

Who decides what an urgent care case is and what's emergency care?
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.

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.

Where would you go if you had an epileptic fit?
This would be dependent on the patients’ medical history, severity of the seizure and presentation to the department. If an ambulance is in attendance, the paramedics would begin treatment and assess where the most appropriate treatment could be provided. If a patient presents at the Urgent Care Centre on the Planned Care Site, they will be assessed by the team. If, on assessment, they determine that the Emergency Department was required, they would arrange an emergency ambulance to transfer the patient safely for ongoing treatment. Otherwise, they would be treated at the Urgent Care Centre.

Given the difficulties experienced in the local recruitment of doctors and nurses to work in urgent/emergency care, how do the CCGs anticipate that SaTH will fill posts in the Urgent Care Centre? 

SaTH has an extensive five-year workforce plan that is well underway which incorporates clinical posts that will support the urgent care centres at both hospitals.

Who will staff the Urgent Care Centres and what qualifications and experience will they have?
The Urgent Care Centres will be staffed by highly skilled senior health professionals who are specifically trained to deliver urgent care for adults and children. This will include Advanced Practitioners, GPs and nurses.

The CCGs claim that up to 60% of urgent/emergency cases can be treated at Urgent Care Centres. How is this possible?
Detailed discussions have taken place with doctors, nurses and therapists who work at our hospitals, together primary and community care staff, to look at the numbers of people who currently attend our A&Es and the type of conditions that they have. This has helped to develop the urgent care model and determine which patients in the future could be treated in an urgent centre and which would need to be treated in an Emergency Department. 

Based on SaTH’s data of A&E attendances, we believe that, in the future, around 60-65% of patients who currently attend our A&Es would be able to be treated at one of our 24-hour urgent care centres. This includes patients who have a minor cut, sporting injury or chest infection. The new centres would offer more services than our existing centres, including a greater range of diagnostics and mental health assessment rooms.

What is the CCGs' contingency plan and its cost should the Urgent Care Centres fail to meet their 60% target?
Although we believe that 60% of patients who currently attend our A&E departments would be able to be treated at one of our new urgent care centres, our clinical model will be designed to be flexible if this number decreases or increases.

Is it the case that the proposed Urgent Care Centres will be run by a private company?
There has been no decision which organisation will run the Urgent Care Centre. This will be agreed following the outcome of the consultation. 

Emergency Care

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.

Where would I go if I was having a suspected heart attack?
If you are ahving a suspected ehart attack and call an ambulance, the paramedics would quickly diagnose your condition and, if necessary, initiate emergency treatment. They would then decide on the best place for you to receive further care or treatment. Currently, that would be the nearest A&E department or, in more severe cases, a specialist cardiac centre, for example in Stoke or New Cross. Under our proposals, in the future you would either be taken to the Emergency Department or, as now, a specialist cardiac centre like Stoke or New Cross.

What would happen if I had a cardiac arrest?
If you have a cardiac arrest (i.e. your heart stops), paramedics would initiate emergency resuscitation. They would then decide on the best place for you to receive further care and treatment. Currently, that would be the nearest A&E department. Under our proposals, in the future you would be taken to the Emergency Department where you would be treated by specialist emergency doctors.

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.

Will both hospitals have pathology labs and MRI/CT scanners or in urgent cases will patients and samples have to be transferred between hospitals? 
Both hospitals will have diagnostics (including MRI/CT scanners) and pathology to support the need for urgent tests to be carried out. 

Under the Option 1 proposal are you saying that one hospital is being changed to a regional “trauma centre” and the other will still be a normal A&E?
Having the Emergency Care site at the Royal Shrewsbury Hospital would mean it can continue to be a Trauma Unit and Princess Royal Hospital at Telford would be a planned care centre. As CCGs, it is our responsibility to commission (buy) the appropriate emergency and Trauma Unit services for our patients. It is the responsibility of NHS England to commission the services delivered at Major Trauma Centres.

When deciding on our preferred option, we had to consider what this would mean to patients who suffer a major trauma and need life-saving emergency care. A major trauma is defined as serious injuries that are life-changing and could result in death or severe disability. At the moment, if a patient suffers a major trauma in Shropshire, Telford & Wrekin or mid Wales, the most severely injured patients are taken straight to a Major Trauma Centre out of county, such as the University Hospitals of North Midlands in Stoke-on-Trent, Birmingham Children’s Hospital or the Queen Elizabeth Hospital in Birmingham.

A small number of patients are taken to a Trauma Unit to be stabilised before being transferred to a Major Trauma Centre. The Royal Shrewsbury Hospital is a Trauma Unit. Other nearby Trauma Units are based at Wolverhampton, Wrexham, Worcester and Hereford. After assessment, some trauma patients do not require a transfer to a Major Trauma Centre and can safely receive ongoing treatment in a Trauma Unit.

How would the one hospital that has the emergency care centre cope with all the demand?
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.

Shropshire, Telford & Wrekin and mid Wales is an area larger than Greater London and yet just one A&E is now being proposed. How can this be justified?
Our proposal for one emergency care site would improve the recovery of our patients and lead to faster diagnosis, earlier treatment and improved clinical outcomes. 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.

How can a single A&E meet the four hour target when two units fail to meet it on a regular basis?
Our doctors and nurses recognise situations every day where care would have been provided to a much higher standard if we had separate sites for emergency and planned care. Research carried out by NHS England found that having a single Emergency Care site with a dedicated Emergency Department where specialise doctors treat the most serious cases is proven to be safer. It also provides better results for patients and reduces the amount of time they have to stay in hospital. We believe that by a single emergency department, patients would be seen quicker and more efficiently than they are now. A large unit called Ambulatory Emergency Care would also be created for patients that need same-day emergency care where they can be assessed, diagnoses, treated and go home the same day.

Do you know what the present percentage is of people coming into the A&E without a life-threatening injury or illness?
We know from our hospital figures that only around 40% of people who attend our A&E department need emergency care and therefore have a potential life- or limb-threatening injury or illness. The remaining 60% do not need emergency care and would be treated at their nearest 24-hour urgent care centre in the future.

If only a small proportion of the present load on the A&Es is in the 'serious' category, will that not mean the overcrowding in the A&Es will simply shift to the urgent care centres?
Detailed discussions have taken place with doctors, nurses and therapists who work at our hospitals, together with primary and community care staff, to look at the numbers of people who currently attend our A&Es and the type of conditions that they have. This has helped to develop the urgent care model and determine which patients in the future could be treated in an urgent centre and which would need to be treated in an Emergency Department.

Based on The Shrewsbury and Telford Hospital NHS Trust’s data of A&E attendances, we believe that, in the future, around 60-65% of patients who currently attend our A&Es would be able to be treated at one of our 24-hour urgent care centres. This includes patients who have a minor cut, sporting injury or chest infection. The new centres would be larger and offer more services than our existing centres, including a greater range of diagnostics and mental health assessment rooms. By having two urgent care centres that are open 24 hours a day, we believe that patients will be assessed, treated and be able to go home more quickly.

I accept the argument that consolidating the two A&Es makes good clinical sense.  What I am getting at here is the need to improve people's access to non-urgent care, either by beefing up the GP provision or creating community care centres.
Outside of this consultation, both CCGs have in place five year plans which show how we will bring together primary, community, mental health and learning disability services with local authority, voluntary and the independent care sector to deliver the right care in the right place. This includes developing staff and additional health services at GP practices, community teams working closely with GP practices to provide joined-up care out of hospital and care closer to home for those who are elderly or have a long term or multiple health conditions. You can read more about this on page 40 of our full consultation document

Planned care

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.

Opthalmology has moved to Shrewsbury site – is this permanent or temporary? Will it stay here under Future Fit or will it be relocated depending on where planned care ends up?
Opthalmology has been centralised at the Royal Shrewsbury Hospital. Under our proposals, Opthalmology would be delivered at the Planned Care site.

Will there be diabetes clinics at both hospitals?
Yes, there will be outpatient diabetic clinics at both hospitals.

Where will cataract treatment be provided? 
As with the majority of elective procedures, cataract surgery would be available at the Planned Care Site.

What would happen to a person in the planned care site who is undergoing a planned surgical operation and there are complications which need immediate urgent intervention?
The patient would be stabilised and then quickly and safely transferred to the Emergency Department. However, all patients would be screened prior to their operation to ensure that there are no clinical reasons why they could not have surgery on the Planned Care site. Any patient who for clinical reasons was classed as high risk would have their surgery at the Emergency Care site.

Can you guarantee that bed shortages at the Emergency Care site will never require transfers to beds at the planned care site and, in consequence, lead to the cancellation of planned care treatments?
Under our proposals, the size of the two hospitals has been modelled to allow for demographic growth, new ways of working and a much lower occupancy level. The lower the occupancy level, the greater the services will be able to respond to increases in demand, especially during the winter. At the Emergency Care site, the ‘front door’ will have more assessment areas for patients to be promptly treated with access to senior decision-makers seven days a week. This new way of working will prevent the need to put medical patients into beds that are allocated for planned procedures.

Where would bowel cancer surgery take place under the proposal?
This would depend on the patient’s pre-operation assessment. If the patient was consider high risk and would potentially need the support of the Critical Care Team, they would receive their surgery on the Emergency Site. However, for the majority of patients, they will be able to have their planned operation on the Planned Care Site.

I've heard that more than half of people having planned operations live nearer to the Royal Shrewsbury Hospital. Is this true?
This figure is not correct. During 2017/18, over half (54%) of adults who had a planned operation lived nearer to the Princess Royal Hospital, compared to 46% who lived nearer to the Royal Shrewsbury Hospital.

The consultation documents say that one site will be for Emergency Care and the other will be for Planned Care. Am I right in reading this that the Emergency Care site will NOT do any Planned Care?
Under our proposal, the majority of planned operations where adult patients have to stay in hospital overnight would take place at the Planned Care site. It is only if an adult is classed as high risk, or requires emergency surgery, that their operation would take place at the Emergency Care site. All children’s surgery would take place at the Emergency Care site. Outpatient appointments will still be available at both sites. 

What is the definition of ‘complex surgery’?
Every patient is assessed prior to them having any planned operation or procedure. There are a number of reasons why a patient may be classed as needing ‘complex planned surgery’, such as if they have a long term condition or multiple health needs, which could include heart and respiratory conditions.

Trauma services

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 as the preferred option for 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.

The Future Fit model of hospital care proposes significant changes. What does this mean in terms of staff? Is it true there will be 330 fewer nurses and 842 fewer hospital staff as has been claimed?
There is no intention to reduce the number of registered nurses employed by SaTH. Future Fit is all about improving local hospital services and our workforce is absolutely critical to delivering these important changes. Changing our hospitals by creating a separate Emergency Care site and Planned Care site will create new job opportunities, new roles and a much better working environment.

Traditional medical and nursing roles are changing and we need to make sure our workforce is sustainable, so we are creating new roles and working hard to support our teams to grow and develop. One way in which we're doing this is by introducing Nurse Associates. This is a new role that will see staff – sourced predominantly from our Health Care Assistant workforce – trained to fill what are currently some of our Registered Nurse roles. Our first Nurse Associates will start at our hospitals this year following a two-year training programme and we plan to grow our Nurse Associate workforce to over 120 staff over the next 5 years.
At the moment, we have more than 120 nursing vacancies, and we’ve lost 17 nursing and midwifery registered staff in the past 12 months. This means we have to rely heavily on temporary staff, including agency workers. It shows how crucial the new Nurse Associate role is to helping us make our nursing teams sustainable. And, crucially, it also means our staff will benefit from opportunities to grow and develop their careers with us.

The Outline Business Case mentions that there will be a small reduction in staff numbers. Is this correct?
Under both options, there is a small reduction in staff numbers, as outlined in the Outline Business Case. Over the next five years, we will see huge developments in new technology. This includes moving to electronic patient records, which will have an effect on our workforce needs. There will also be fewer staff needed in some areas due to the reduced duplication of services across two sites. 

As we currently have a turnover of around 350 staff each year, we are not expecting these changes to mean anyone will have to be made redundant. We aim to deliver the necessary changes in a planned way that will allow us to retain our existing staff and attract new staff – and be able to deliver the best possible care to local people.

How many fewer registered nurses will there be under the Future Fit proposals?
There is no intention to reduce the number of registered nurses employed by SaTH. It’s important to remember that we currently have over 100 nursing vacancies. We always aim to recruit to full establishment, but recruitment challenges mean this has never been possible. This means we rely heavily on temporary nursing staff, including agency staff. What we want to do is reduce our reliance on temporary staff by building a sustainable substantive workforce. The introduction of Nurse Associates is one of the ways we will do this, and we expect that our new Nurse Associates will cover much of the work that we currently rely on temporary nursing staff for. SaTH is also working on a robust staff retention strategy, which includes career planning, flexible working and access to training and development.

There are rumours that hospital staff are not being given opportunities to express their views about Future Fit. Is this true?
Our people are our priority and it’s important that we hear all of their views. We have an intensive staff engagement programme to ensure that every member of staff can have their say. The programme includes weekly roadshows, newsletters and communication through payslips.

Many of our staff have worked together to develop the new model of care that will deliver improved services to the people that they serve. We have and continue to promote the Future Fit consultation to all our staff and would urge everyone to have their say as everybody’s views are crucial to us.

Why are you struggling to recruit doctors and nurses and how will Future Fit solve the problem?
Across the UK, there is a severe shortage of healthcare staff. It is becoming more difficult to make sure that we have enough doctors, nurses and other healthcare staff to provide a 24-hours a day, seven days a week service at both our hospitals. Although a similar picture can be seen across the country, this problem has a greater impact in Shropshire and Telford & Wrekin as we have two hospital sites that are less than 20 miles from each other that currently provide many of the same services. 

We are finding it harder to recruit and retain 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 three permanently employed consultants in post. We have recently made three offers to consultants following the news of the capital investment.
Staff shortages have meant that our doctors have had to be on-call more often or work extra hours across two hospital sites in order to keep patients safe. We have also had to recruit temporary staff that are not as familiar with our hospitals and have therefore needed additional support.

We’ve tried hard to address the recruitment challenge in a number of ways, including recruitment drives nationally and overseas and sharing posts and rotas with neighbouring trusts, but these have all failed to provide a sustainable solution. Day-to-day operational plans are in place to ensure the care and safety of patients within the Trust’s clinical services, but a long-term solution is urgently needed.

Future Fit is proposing a separate Planned Care site and Emergency Care site. We know that by changing our hospitals in this way we will become a more attractive place for people to work. This would enable us to recruit more doctors and nurses to work at both our hospitals in the future. Already, since the announcement that we are going out to consultation, we have had greater interest from staff wanting to work with us.

Will the savings achieved by reducing the number of agency staff employed by the Trust fund the employment of sufficient new permanent staff to make up the gap which now necessitates the employment of so many agency staff?
Future Fit is all about improving local hospital services and our workforce is absolutely critical to delivering these important changes. Traditional medical and nursing roles are changing and we need to make sure our workforce is sustainable, so we are creating new roles and working hard to support our teams to grow and develop.

We currently have over 100 nursing vacancies. We always aim to recruit to full establishment, but recruitment challenges mean this has never been possible. This means we rely heavily on temporary nursing staff, including agency staff.

What we want to do is reduce our reliance on temporary staff by building a sustainable substantive workforce. The introduction of Nurse Associates is one of the ways we will do this, and we expect that our new Nurse Associates will cover much of the work that we currently rely on temporary nursing staff for. We are also working on a robust staff retention strategy, which includes career planning, flexible working and access to training and development.

Can you please confirm whether or not any of the workforce data provided in the 'Future Fit Integrated Impact Assessment' document (November 2016) has been superseded? If there have been changes, could you please send me a reference for where I might find updated information on WTEs in the new hospital configuration?
The workforce data has not been superseded. An updated Workforce Plan will be finalised and published alongside the Full Business Case.

The SaTH Annual Report this year showed an average staffing whole time equivalent of 5515. The Future Fit resources plan reduces it to 4673, a reduction of over 15%. Within this, nursing staff is decreased from 1604 to 1308, a reduction of over 20%. Is this clinically viable?
Table 11.2b in the SaTH Annual Report shows the total WTE worked within year, and the figure includes significant use of temporary workforce, including bank, agency and locum staff. 

There is no intention to reduce the number of registered nurses employed by SaTH. It’s important to remember that we currently have over 100 nursing vacancies. We always aim to recruit to full establishment, but recruitment challenges mean this has never been possible. This means we rely heavily on temporary nursing staff, including agency staff. What we want to do is reduce our reliance on temporary staff by building a sustainable substantive workforce. The introduction of Nurse Associates is one of the ways we will do this, and we expect that our new Nurse Associates will cover much of the work that we currently rely on temporary nursing staff for. We are also working on a robust staff retention strategy, which includes career planning, flexible working and access to training and development.

We are confident that our workforce plans will enable us to provide safe and clinically effective care.

The PCBC states that there will be a reduction of the pay bill of £4.1m, not relating to WTE reduction, achieved through reducing the average cost of each WTE. Given statements from SaTH that staff WTE reduction will be achieved without redundancies, does this imply an AfC down-banding of some of the remaining full-time staff? The PCBC states that this will not be universally applied, so, in your modelling, which job roles and grades have been targeted?
There is not a down-banding exercise planned. At present, the Trust has a series of workforce inefficiencies that reconfiguration will address, which will reduce the pay bill. For example, the frequency of on-call for some of our staff is very high and expensive, and we have additional hours and agency workers due to current workforce gaps. We also know that we lose time due to the duplication of services that are being undertaken on both sites.

On July 3, @NHSFutureFit stated on Twitter that ‘there is a plan to publish more details of the workforce plan shortly’ and ‘yes during the consultation period’. When will it be published?
The full Workforce Plan will be released alongside the Full Business Case. 

NEW Now that SaTH has managed to recruit enough doctors to keep Telford A&E open overnight, why is Future Fit needed?
Future Fit is much broader than the difficulties in sustaining safe medical rotas in both A&E departments, although this is a symptom contributing to the current situation. Our proposal to have separate emergency and planned care sites will help make sure that beds are protected for emergency patients and those with planned operations. It will also prevent the difficulties our doctors are facing with the duplication of rotas across sites in Intensive Care, Emergency and Acute medicine, and help us to create a sustainable substantive workforce. The capital investment will enable modern equipment and facilities to be developed and older buildings to be refurbished, ensuring better environments for patients and staff. We know that to run both A&E s 24/7 we would need 20 consultants, we currently have four with three more starting in the new year, and recruitment to these posts is on the understanding that hospital services will be reconfigured in the future.
The confidence in the future of health services in Shropshire, Telford and Wrekin and mid Wales that has been confirmed by the Government pledge of £312m for the Future Fit programme has attracted Emergency Department consultants and other staff to be part of shaping the future of service delivery.

Travel and transport

Won't travelling a greater distance to the Emergency Care site jeopardise patient care or, in the most serious cases, survival?
Clinical evidence tells us that in an emergency, such as a heart attack or stroke, getting patients to the right hospital to receive the right treatment leads to better outcomes. Paramedics routinely diagnose patients in an ambulance to make sure that a patient is taken to the right hospital for the most advanced treatment. This often means that a patient will travel further and may drive past an A&E department to get them to the right place. This is happening now as ambulances take patients from across Shropshire, Telford & Wrekin and mid Wales who have had a stroke and need specialist care to the Stroke Unit at the Princess Royal Hospital. Similarly, patients who need heart or lung surgery are taken out of county to Stoke-on-Trent. 

Ambulance services are equipped to deal with longer distance journeys keeping the patient safe and stable, both in equipment and skills. For example, West Midlands Ambulance Service is a paramedic led service with over 90% of their ambulances now having a paramedic on board. In addition, to support the specialist centres these paramedics have access to more equipment and drugs intended to keep patients safe for longer distances to the best place of care for their condition.

A new study from the University of Sheffield has found that any negative effects caused by an increase in journey time to an Emergency Department can be offset by other factors. For example, if new specialised services are introduced or if the care received at the now nearest hospital is more effective than that provided at the hospital where the Emergency Department closed. The report is available at https://bit.ly/2MQBeQl

The CCGs have commissioned a specific ambulance modelling activity exercise to explore and determine what impact both options would have on ambulance/ patient transport activity and travel times, and produce a formal report. An assessment has now been carried out into how the Future Fit plans are expected to impact ambulance services. The work has been done by consultancy firm Operational Research In Health, an organisation experienced in modelling ambulance responses. Twelve months of data has been provided which will help to identify any gaps in ambulance provision based on either one of the options being adopted.

West Midlands Ambulance Service, Midlands Air Ambulance, Welsh Ambulance Service and Falck (Non-emergency Transport services) are all engaged in this exercise. The outcome of this exercise will form part of the decision-making process following the end of the consultation.

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.

Travel would be an issue for those who do not drive. For most of these people, they would have to catch 2-3 buses or they may have to use a taxi. How can you justify this?
Transport is an issue that is coming up in quite a lot of our consultation conversations. We understand that travelling to our hospitals is already an issue for some people, especially given the rural nature of our county.

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. This is why we have set up a Travel and Transport Group to look at this issue in more detail. This group, which includes all key transport stakeholders and a group of patient representatives, will work together to review current transport services, including bus and train timetables as well as volunteer arrangements. They will then identify ways in which travel and transport could be improved across the catchment areas. More information will be shared about the progress of this group over the coming months.

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.
Under our proposal, most people would continue to go the same hospital as they do now. And around 8 out of 10 people (or 80%) would continue to go to the same hospital as now for emergency and urgent 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. 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.

What about winter when it is bad weather and ambulances have tot ravel further or there are major traffic delays?Traffic, weather and geography are always a challenge and an assessment has now been carried out into how the Future Fit plans are expected to impact ambulance services. The work has been done by consultancy firm Operational Research In Health, an organisation experienced in modelling ambulance responses. Twelve months of data has been provided which will help to identify any gaps in ambulance provision based on either one of the options being adopted.

The ambulance services are changing rapidly in how they respond to patients, nationally a new standard is now in place (called the ambulance response programme) and this has resulted in ambulance service reducing the number of cars and significantly increasing ambulances to ensure that the vehicle that arrives is capable of moving patients if necessary.

Previously a car would often be backed up by an ambulance but now just a single response is often sent to each incident resulting in better use of resources. For example, West Midlands Ambulance Service is a paramedic led service with over 90% or their ambulances now having a paramedic on board. In addition, to support the specialist centres these paramedics have access to more equipment and drugs intended to keep patients safe for longer travel to the best place of care for their condition.

Clinical evidence tells us that in an emergency, such as a heart attack or stroke, getting patients to the right hospital to receive the right treatment leads to better outcomes. Paramedics routinely diagnose patients in an ambulance to make sure that a patient is taken to the right hospital for the most advanced treatment. This often means that a patient will travel further and may drive past an A&E department to get them to the right place.

This is happening now as ambulances take patients from across Shropshire, Telford & Wrekin and mid Wales who have had a stroke and need specialist care to the Stroke Unit at the Princess Royal Hospital. Similarly, patients who need heart or lung surgery are taken out of county to Stoke. Both the West Midlands and Welsh ambulance services have been involved in the Future Fit process and support the delivery of this public consultation. We are continuing to have detailed discussions with them around developing detailed pathways and ensuring the best possible care for our patients.

In what ways are you looking to improve public transport with the changes having an impact on some patients who may have to travel further?
We understand that travelling to our hospitals is already an issue for some people, especially given the rural nature of our county, so a Travel and Transport Group has been established. 

This group, which includes all key transport stakeholders and a group of patient representatives, will work together to review current transport services, including bus and train timetables as well as volunteer arrangements. They will then identify ways in which travel and transport could be improved across our catchment areas. More information will be shared about the progress of this group over the coming months.

The centralisation of non-serious accident and illness cases in the two urgent care centres will mean for many people throughout the county a great dependence on either a non-emergency ambulance or a bus to get them to Telford or Shrewsbury.  Have you negotiated with the providers of bus services in Shropshire and North Wales an agreement for them to fund an enhancement to local bus services?
We understand that travelling to our hospitals is already an issue for some people, especially given the rural nature of our county. Under our proposal, most people would continue to go the same hospital as they do now. And around 8 out of 10 people (or 80%) would continue to go to the same hospital as now for emergency and urgent care.

We have set up a Travel and Transport Group to look at this issue in more detail. This group, which includes all key transport stakeholders and a group of patient representatives, will work together to review current transport services and identify ways in which travel and transport could be improved across Shropshire and Telford & Wrekin. More information will be shared about the progress of this group over the coming weeks. We are also very keen to hear your views and experiences about travel and transport so please include your comments in your survey response.

What car parking will be provided at the emergency and planned care sites?
Currently, this is being reviewed by The Shrewsbury and Telford Hospital NHS Trust (SaTH) alongside the Future Fit Travel & Transport working group to ensure that there is adequate access for patients using all forms of transport.

It's 22 miles from the centre of Bishop's Castle to Royal Shrewsbury Hospital and people live all over south-west Shropshire and East Montgomeryshire. Why do we have to travel all that distance to hospital?

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. We recognise that any change to our hospital services would have an impact on travel for some of our patients, visitors and staff. Although you have told us that you want the best possible care when you have to go to hospital, we also understand that travel and transport will be an important factor for you and your family.

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 on our website.

There is a recognition in the consultation document that some people will be disadvantaged by the proposed changes because of inadequate transport, particularly in rural areas. Why are proposals to ameliorate this only going to be considered in the decision-making process and are not being considered in the consultation itself?

We understand that travelling to our hospitals is already an issue for some people, especially given the rural nature of our county. Under our proposal, most people would continue to go the same hospital as they do now. And around 8 out of 10 people (or 80%) would continue to go to the same hospital as now for emergency and urgent care.

A Travel and Transport Group has been established and all key transport stakeholders and patient representative groups are involved in this group. They are working together to review current transport services and identify ways in which travel and transport could be improved across Shropshire and Telford & Wrekin. More information will be shared about the progress of this group over the coming weeks.

Throughout the consultation, we want to hear more about the impact on travel and transport that the two options may have on people across Shropshire, Telford & Wrekin and mid Wales. No decision will be made until we have looked 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.

The West Midlands Clinical Senate recommended in November 2016 that a full modelling exercise should be carried out by the West Midlands Ambulance Service and the Welsh Ambulance Service to consider the implications of the Future Fit proposed configuration of services and predicted activity. The PCBC states the intent that ‘this work is completed by the end of the consultation period’. When will it be published?
This reference relates to the report that the CCGs commissioned the management consultancy ORH to carry out. The first phase, an ‘Impact of Change’ report, will be available on 11th September and will be presented to the CCGs shortly after that date. The final report will be available on 8th October. This will then form part of a wider Travel and Transport activity and Mitigation Plan that will be included in the Decision Making Business Case and considered by the Programme Board and the Joint Committee of the CCGs.

Given the Clinical Senate was of the view that this modelling activity was key ‘because travel times and distance may be significant’, how does Future Fit believe it is possible for either option to be properly considered by the public without key information being available?
Since its inception, the Future Fit programme has engaged fully with the West Midlands and Welsh Ambulance Services and the Welsh Emergency Medical Retrieval and Transfer Service (EMERTS) in its decision making processes.

The ORH data (as explained in the question above) is a more detailed analysis of a demand and capacity model to ensure the CCGs commission ambulance services effectively to support the new proposed clinical model. It is therefore a key part of impact assessment and mitigation work.

Travel time modelling information has been utilised by the Future Fit programme in its decision-making to date. It has been available for the public to consider on the Future Fit website throughout the consultation period.

As part of the option appraisal process and in the development of the two Integrated Impact Assessments (IIAs), the Future Fit Programme used access and travel time data for car and public transport for planned care, emergency care and women & children’s services. We examined actual activity data and included an analysis of displaced journeys and how much further and longer people who were displaced would have to travel to the alternative sites under the different options. It also included an analysis of time-critical journeys with data from the ambulance services. This was broken down by time intervals and examined in terms of the potential impact of each option on longer journey times, particularly highlighting journeys over 45 minutes. This was used to influence the evaluation of the options.

Our view is that we have already properly considered journey times and distance in our decision making on the options we are consulting on, including the preferred option.

Is Future Fit aware that in the Dorset Emergency Department reorganisation currently facing a Judicial Review, the judge asked the CCG, based on a similar ambulance modelling report, to calculate the number of patients ‘facing increased clinical risk’? Will the CCGs be conducting a similar exercise for Future Fit?

The analysis being undertaken will set out the impact that the two options have in relation to emergency and non-emergency patient transport service providers.

Previous work within the Future Fit Programme has examined any increased risks related to travel time and has been considered by the CCGs in determining their preferred option. This has been supported by views from the West Midlands Clinical Senate and the Trauma Network, with the latter including an analysis and understanding of trauma activity data and flows.

Under your proposals, a patient from Broseley who requires emergency treatment will have to travel an additional 18 miles to the A&E department in Shrewsbury. That could be an additional 20 minutes even in an ambulance. How can you claim that this is an improvement in service?
Ambulances are well equipped to deal with all kinds of challenging emergency situations. West Midlands Ambulance Service is fully committed to achieving its aim of having at least one paramedic on every emergency vehicle. In the case of an emergency, such as a heart attack or stroke, getting patients to the right hospital to receive the right treatment leads to better outcomes. Paramedics routinely diagnose patients in an ambulance to make sure that a patient is taken to the right hospital for the most advanced treatment. This often means that a patient will travel further and may drive past an A&E department to get them to the right place.

This is happening now as ambulances take patients from across Shropshire, Telford & Wrekin and mid Wales who have had a stroke and need specialist care to the Stroke Unit at the Princess Royal Hospital. Similarly, patients who need heart or lung surgery are taken out of county to Stoke. Both the West Midlands and Welsh ambulance services have been involved in the Future Fit process and support the delivery of this public consultation.

A new study from the University of Sheffield has found that any negative effects caused by an increase in journey time to an Emergency Department can be offset by other factors. For example, if new specialised services are introduced or if the care received at the now nearest hospital is more effective than that provided at the hospital where the Emergency Department closed. The report is available at https://bit.ly/2MQBeQl

Has Future Fit modelled the potential issues associated with longer travel for planned appointments, DNAs etc., and the increase in unplanned admission of patients furthest from hospitals?There is research into the potential issues associated with longer travel for planned appointments, but that research concerns outpatient appointment in maternity services. Under the proposed clinical model, these services, alongside other outpatient clinics, will continue to be provided on both sites, meaning people won’t have to travel further than they do now. Currently, SaTH has a very good DNA rate as a benchmark nationally and across peers, which we wouldn’t expect to deteriorate as a result of the reconfiguration of services.

Community services

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.

How do the Future Fit changes being proposed fit in with Shropshire Care Closer to Home?

Shropshire Care Closer to Home is a programme of change that is being organised and coordinated by Shropshire Clinical Commissioning Group to achieve better value care for the population. In order for Future Fit to work as is planned, Shropshire Care Closer to Home must also work as this will ensure that only those people who absolutely need to be in hospital are admitted.

In Shropshire, just like many other parts of the UK, we have developed an unhealthy dependence upon our general hospital. The CCG has engaged with stakeholders and has reached the conclusion that we have a duty to address this over-dependence, and bring Shropshire Care Closer to Home.

Shropshire Care Closer to Home is being aimed therefore at improving health outcomes for people with multiple long-term health conditions aged 65 and over.

What changes will we see as a result of Shropshire Care Closer to Home?

Shropshire Care Closer to Home will initially be comprised of three high-level phases. 

Phase 1 is already in place. It is the Frailty Intervention Team (FIT) based at the A&E department at the Royal Shrewsbury Hospital. This team works to ensure that where possible people with complex needs (also referred to as frail) have their needs met quickly either to prevent a hospital admission from occurring, or to achieve a shorter stay in hospital than would otherwise have been expected by coordinating discharge requirements more effectively.

Phase 2 is about delivering a model of care called “Case Management”. This model has two parts. The first is about our community-based NHS workforce working closely with GP practices across Shropshire to get a clear understanding of how many people over the age of 65 have complex care needs. A crucial part of this process relates to categorising the people identified in terms of whether their need complexity is low, moderate or severe - a process known as “Risk Stratification”.

Once Risk Stratification is complete, those identified as being in severe need will be given the opportunity to work with a designated professional (also known as a “Case Manager”).

Phase 3 is made up of three high-level models. The first is called “Hospital at Home”. The aim of Hospital at Home is to provide diagnostic testing and treatment interventions that are traditionally associated with care in a hospital setting either in peoples own homes or from places close-by. The second model of the third phase of Shropshire Care Closer to Home is about creating a Health Crisis Response Team. The provision of “Step-up beds” is the final model of the third phase of moving Shropshire Care Closer to Home and involves the provision of bed-based care in the localities in which people live, albeit away from their usual place of residence.

What is happening with Shropshire Care Closer to Home right now?

As this is a rapidly developing programme of work, things are changing all of the time. Shropshire CCG is working with the public and all stakeholders in the process of designing how Shropshire Care Closer to Home is enabled on an ongoing basis.

It is planned that the first stage of Phase 2 (Risk Stratification) will begin to take place by the beginning of 2019. It is not agreed at this stage of the process where the change will begin in the county.

How can plans for the radical reform of hospital services proceed in isolation from improvements to local GP, social care, community and public health services?
Shropshire, Telford & Wrekin Sustainability and Transformation Partnership (STP) includes all partners from across health and social care, as well as the voluntary sector and patient groups. Together, we continue to work to drive system improvements and have identified a number of local priorities. These include Shropshire’s Care Closer to Home Programme, Telford & Wrekin’s Neighbourhood Programme and Future Fit, as well as other priorities which include primary care, frailty, mental health and cancer.

None of these delivery programmes work in isolation of each other as many have interdependencies which require close working arrangements and collaboration. They are also aligned to other work programmes, including strategic workforce developments, digital enablement and estates, and together they are working to deliver system transformation. Progress is captured and reported bi-monthly through the system governance framework with system leaders including NHS England and NHS Improvement.

What does Future Fit mean for local NHS providers of services in the community, especially the medical practice and the Community Hospital in Bishops Castle?
Please be assured that both CCGs continually review community services to ensure they offer the quality needed and involve members of the public in finding out their views and asking for their suggestions. Should they identify areas where significant change may offer better services for the future, a formal process of public consultation will be undertaken which will give patients opportunities to have their say,

The Future Fit consultation is all about the services delivered at the Royal Shrewsbury Hospital and the Princess Royal Hospital and therefore is not asking for people’s views about community hospitals, community midwife-led units or community services. Alongside this consultation, we are working with patients, carers, members of the public and the voluntary sector to look at ways in which we can improve our local health services. This work is part of the Shropshire and Telford & Wrekin Sustainability and Transformation Partnership (STP) and includes making it easier for people to see a GP, speeding up cancer diagnoses and treating people closer to home.

Shropshire, Telford & Wrekin Sustainability and Transformation Partnership (STP) includes all partners from across health and social care, as well as the voluntary sector and patient groups. Together, we continue to work to drive system improvements and have identified a number of local priorities. These include Shropshire’s Care Closer to Home Programme, Telford & Wrekin’s Neighbourhood Programme and Future Fit, as well as other priorities which include primary care, frailty, mental health and cancer.

The PCBC states that the community model must be delivered to support the ‘activity and capacity assumptions set out in the PCBC’. Shropshire CCG decided at its August 2018 Governing Body meeting to include annual cuts of £8.5m for community services, including community hospitals and MLUs, in its financial recovery plan. What impact does Future Fit believe this will have on the community model’s ability to deliver the changes required to support the acute assumptions?
Shropshire CCG did not decide to include annual cuts for community services of £8.5m. The dialogue at the meeting reflected that the savings related to community services were in part delivered by a reduction in emergency admissions to our hospitals. This is a well-known requirement of the Future Fit planning assumptions. The figures are based on the work that external consultancy Optimity carried out on behalf of the CCGs to benchmark the use of acute services. There are also efficiencies and improvements to be made in community services that Shropshire CCG is working with Shropcomm on, which will also contribute to any overall savings. These improvements will ensure the community services deliver the required care to underpin the Future Fit proposed model.

The Shropshire Care Closer to Home Overview states ‘SCCG has no additional money to pay for this way of working but the aim will be to redirect existing money from services…and reinvest it into creating new services’. Which existing community services are necessary to ensure the validity of the acute modelling assumptions?
Within the CCG financial recovery assumptions, it has been stated that 80% of the savings made as a result of the Care Closer To Home work in admission avoidance will be re-invested into the community services required for the proposed new model of hospital care. All of these planning assumptions will be included as supporting information to the final business case.

The PCBC states that in funding for community services ‘modelling has therefore assumed an overall reinvestment level of 70%’ ‘of the savings made from the acute setting’. 70% of what? And where is this shown numerically in the PCBC?
The following is taken from section 10 of the PCBC p116 and p119:

For T&W CCG
Work undertaken by the Kings Fund and Monitor indicate that the development of new community services will require investment of up to 80% of the savings made from the acute setting. Telford and Wrekin already have a wide range of community delivered services so it is assumed that there will be economies of scale delivered. The modelling has therefore assumed an overall reinvestment level of 70%.

For Shropshire CCG
The Kings Fund and Monitor suggest that when developing new community services an investment requirement of up to 80% of the savings generated from the acute setting are required. The CCG has taken a prudent view in its modelling at this stage and set aside funding for the full 80% (£5.4m). It is noted however that there may be some duplication here with existing services and growth assumptions. This will be explored further and figures refined as the business case develops.

These assumptions will have been incorporated into the financial analysis in section 12 of the PCBC and will be reflected in tables 42 and 43. 

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.

What will the £312 million be spent on?

Both our existing hospital sites were built many years ago. Although we have invested in some new buildings in recent years, we now have many outdated areas that have become more difficult and more costly to look after. They do not provide the modern environment for delivering high quality services that our patients rightly expect and need. We know that building standards have now greatly improved and new hospitals are built to higher specifications that are based around the needs of the patient. 

Whichever option is taken forward, the Future Fit proposals will require capital investment at both the Princess Royal Hospital in Telford and the Royal Shrewsbury Hospital in Shrewsbury. Our proposed model of hospital care would allow us to improve our existing buildings and create some new buildings. Facilities would be designed to meet the needs of our patients, their families and staff. This would help to make sure that patients are kept as comfortable as possible during their stay in hospital. This includes wards with more space for patients, nurses and visitors and more single rooms with en-suite facilities, improving privacy and dignity for patients. 

We know that we can deliver a solution for £312 million under either of the two options. Once a decision about which option to take forward has been made, more detailed planning will begin. 

How are you going to pay for it?
Patients and the public can be assured that both options are affordable and sufficient funding is available to deliver either option currently being considered. it is important to stress that we ca only consult on options that are affordable and able to be delivered. 

Subject to the outcome of the consultation, the Department of Health and Social Care (DHSC) has confirmed its support for the Future Fit programme by making available up to £312 million for the recongifuration of our two local hospitals. Further to the outcome of the formal public consultation, this will provide funding to improve our hospital services for people in Shropshire, Telford & Wrekin and mid Wales. 

This funding has been approved by DHSC because it has passed the clinical and affordability tests of NHS England and NHS Improvement (our regulators), NHS Telford & Wrekin Clinical Commissioning Group (CCG) and NHS Shropshire CCG. 

How much of the £312 million cost of Future Fit will be raised from private finance? 
The £312 million will be made of up a number of different sources but a significant amount will be Public Dividend Capital. It is expected that the national and regional NHS organisations involved will be working on the exact breakdown of the funding.

The Shrewsbury and Telford Hospital NHS Trust (SaTH) will pay 3.5% interest on the Department of Health and Social Care public capital. This is standard accounting practice in the NHS and has been included in all our calculations, assuring us on the affordability of both options on which we are consulting.

Where will the rest of the money come from?
It is expected that SaTH will self-finance a smaller amount over a 10 year period from its annual capital allocation, which is made available to all trusts each year. A further contribution will be made up from land disposal of excess land currently owned by the Trust and alternative financing mechanisms. SaTH is currently exploring these alternative funding mechanisms which include support from a Regional Health Infrastructure Company (RHIC). The scheme has yet to be launched by HM Treasury so details are not yet confirmed.  Our interpretation of this is that one identifiable aspect of the build will be financed from this route.

How much of the £312 million will be spent on repairing or converting existing buildings and how much on new buildings?
The £312m is associated with new build and refurbishment. This is currently allocated as £222m for new build and £90m for refurbishment of existing facilities. This will be confirmed as part of the detailed design development process.

Why not wait five years for more money and do a proper job?
This is not about money. Staying as we are is not an option. We have to change the way we are deliver the services at our two hospitals to make sure we provide high quality, safe services for all patients for the long term.

We are told that the NHS does not have money to waste so why would we spend more than we need to with Option 1 rather than choosing the less expensive Option 2?
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.

Our Report on the Appraisal of Options describes in more detail the financial appraisal. It sets out the 30-year and 60-year calculations, both of which ranked Option B (Option 2 in the consultation document) first by a margin of 0.8% on financial grounds. Once viewed from the perspective of whole life costs (as required by guidance), however, these differences become minimal. For example, although Option B has a capital requirement of £250m and Option C1 (or Option 1 in the consultation document) of £312m, the final difference in terms of equivalent annual cost is just £2.7m (0.8%).

Through the economic analysis, the appraisal sets out the two calculations we used to bring together the non-financial and financial evaluations. The overall conclusion is that Option C1 (Option 1 in the consultation document) provides the best value for money in the long term, whether that be over 30 or 60 years.

Will going for the cheaper short term solution avoid expensive borrowings and allow for expansion in service delivery such as GP Services, adult social care or cancer services which are not "hospital based"?
The £312 million capital will be made available from a number of sources including central government capital, internally generated funds and external finance. If option 2 were to go ahead, with a capital requirement of £250 million, we would look to obtain less funds either by reducing the external financing or by not drawing down the government funds. If we did not utilise the government funds, these would not be available locally as they would be redirected to other priority schemes across the country.

The cost of capital or repayment of the debt will be generated from the running costs of the hospital through reallocation of current depreciation and cost of capital budgets and through internal efficiencies. Whilst it is true that the debt repayments would be less for option 2, the current financial modelling indicates that both options are affordable in the hospitals financial plan. As the CCGs pay for services based on a fixed tariff, option 2 would not generate savings for the CCG to be reinvested into GPs and nurses in the community.

NEW What impact will the Chancellor's announcement to abolish PFI have on Future Fit?
We have never intended that PFI would be a basis for funding the Future Fit proposals.

 

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

Campaigners claim that two thirds of all children and pregnant women admitted to hospital live nearer to the Princess Royal Hospital. This means that the impact Option 1 will have on mothers in Telford will be significant. Is this true?
We do not recognise that figure. The 2017/18 data shows that 57% of the women admitted under obstetrics and children admitted as inpatients lived closer to the Princess Royal Hospital (PRH), while 43% lived closer to the Royal Shrewsbury Hospital (RSH). 

Why are you moving the Women and Children’s Unit from Telford, an area with a high population density and a high proportion of young families, to an area that is less populated and has a higher proportion of old people?
Our proposed model of hospital care takes into account the expected changes in our population over the coming years and how the best care can be provided for everyone.

No decision will be made about moving the Women and Children’s Unit until we know the outcome of the consultation. However, we do know that in the future, for clinical and safety reasons, the Women and Children’s Unit has to remain alongside the Emergency Department. Our preferred option is for the Emergency Department to be situated at the Royal Shrewsbury Hospital.

Attendance figures during 2017/18 show that around 19,500 pregnant women and children were admitted to the Women and Children’s Centre. Out of these, a significant proportion (42%) live nearer to the Royal Shrewsbury Hospital compared to 56% who live nearer to the Princess Royal Hospital. The remaining 2% live out of the area.

We know that older people, especially those aged over 75, use emergency hospital services more than any other age group. The majority of our older population live in Shropshire and mid Wales and these are growing at a faster rate than across Telford & Wrekin. This is a key factor in deciding our preferred option of having the Emergency Care site at Shrewsbury. You can read more about reasons for our preferred option in our consultation document

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.

Stroke 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.

For a stroke don't you need quick intervention and yet Shrewsbury is more than an hour away for some patients?
National evidence tells us that in an emergency, such as a heart attack or stroke, getting patients to the right hospital to receive the right treatment leads to better outcomes. Paramedics routinely diagnose patients in an ambulance to make sure that a patient is taken to the right hospital for the most advanced treatment. This often means that a patient will travel further and may drive past an A&E department to get them to the right place.

This is happening now as ambulances take patients from across Shropshire, Telford & Wrekin and mid Wales who have had a stroke and need specialist care to the Stroke Unit at the Princess Royal Hospital.

Where will stroke services be? Who makes the decision where people are taken and isn't speed of the essence?
Stroke is a life-threatening emergency and so it is vital that our stroke unit is based alongside the Emergency Department. It therefore has to be on the Emergency Care site. Option 1 would mean this service moves from Telford to Shrewsbury, whilst Option 2 would mean the service stays in Telford.

National evidence tells us that in an emergency, such as a heart attack or stroke, getting patients to the right hospital to receive the right treatment leads to better outcomes. Paramedics routinely diagnose patients in an ambulance to make sure that a patient is taken to the right hospital for the most advanced treatment. This often means that a patient will travel further and may drive past an A&E department to get them to the right place. This is happening now as ambulances take patients from across Shropshire, Telford & Wrekin and mid Wales who have had a stroke and need specialist care to the Stroke Unit at the Princess Royal Hospital.
Following a stroke, some patients need ongoing rehabilitation. 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 happen at the hospital nearest to where they live.

Your answer to one frequently asked question states that 'national evidence tells us that in an emergency such as heart attack or stroke, getting patients to the right hospital to receive the right treatment leads to better outcomes.' What specific pieces of evidence are there for stroke cases?
The Royal College of Physicians (RCP) 2016 Guidelines state 'patients with suspected acute stroke (including when occurring in people already in hospital) should be admitted directly to a hyper acute stroke unit and be assessed for emergency stroke treatments by a specialist physician without delay.' The National Institute for Health and Care Excellence (NICE) guidelines state: 'All people with suspected stroke should be admitted directly to a specialist acute stroke unit following initial assessment, either from the community or from the A&E department.' SaTH is fully committed to following RCP and NICE guidelines.

Why, according to The Sentinel Stroke National Audit Programme (SSNAP) figures, was the Princess Royal Hospital the 14th worst stroke centre out of 146 routinely admitting stroke centres in the country in 2016/17 in terms of Standardised Mortality Ratios? Could the reason be because PRH has the fourth worst median time symptom onset to scan in the country?
There are a number of factors that have influenced the mortality rate reported by SSNAP. SaTH forecasts a significant improvement in its standardised mortality rate over that previously reported. SaTH is committed to continually improving the care it provides to our patients. In addition, there have been improvements in reporting methodology and better correlation between SaTH's standardised mortality rate and crude mortality rate.

Whilst there is no direct correlation between scanning and mortality, it is widely accepted that patient outcomes improve with early intervention. As such, SaTH is actively working to ensure that processes through which suspected stroke patients are, upon arrival at hospital, clinically assessed are streamlined to facilitate early treatment.

Do you have an explanation for a median symptom onset to scan time of 08h32 and upper quartile of 29h03? 
Unfortunately, it is not possible to provide a detailed explanation of what delays have contributed, as this is dependent on when the patient seeks medical advice.

Can you tell us about your current staffing difficulties in the Stroke Unit and what is their underlying cause?
The workforce issues within the stroke unit are reflective of the Trust overall, which is faced with recruitment difficulties for essential medical and nursing roles and a heavy reliance on agency and temporary staff. 

Why do you plan for stroke rehab to take place only at PRH and RSH not at our community hospitals?
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 happen at the hospital nearest to where they live. This is the current service model and is in line with NICE guidelines. There are no current plans to change this service model.

Feedback from the consultation

 

NEW What meetings have to take place before a decision is made?

Further meetings will take place over the coming weeks to enable all key stakeholders to reflect and comment on the feedback. This includes the Joint HOSC of Telford & Wrekin and Shropshire Councils, Powys Community Health Council (CHC), Powys Teaching Health Board, The Shrewsbury and Telford Hospital NHS Trust (SaTH) board and Shropshire Community Health NHS Trust board. These meetings all form part of the process towards the Joint Committee of the two CCGs meeting early in 2019 to make a decision on the future of local hospital services.

NEW What is the purpose of these meetings?

The purpose of these meetings is to give key stakeholders the opportunity to comment on all the feedback from the consultation, along with the additional work that is ongoing, including community and non-emergency travel and transport activity, ambulance modelling, the impact that any changes to hospital services may have on seldom heard groups and the proposed plans to improve community services for health and care closer to home. Feedback from these meetings will be presented to the Joint Committee of the two CCGs which will meet in early 2019 to make a final decision on the future of local hospital services.

NEW When will the public feedback of the Future Fit consultation be made public?

The report, produced by consultation specialists, Participate Limited, on the public feedback of the Future Fit consultation will be made public on 26 November.