New Future Fit report considers 'hospital in the middle' solution

The Shrewsbury and Telford Hospital NHS Trust (SaTH) and the Future Fit Programme Board published a report yesterday (24 July) that considers whether having three hospitals would address the challenges facing hospital services in Shropshire.

The report, which was commissioned by SaTH, presents a detailed comparison of the model of emergency care used in Northumbria with the model of hospital care proposed for Shropshire, Telford & Wrekin and mid Wales as part of the NHS Future Fit programme.

The model of hospital care in Northumbria consists of a new build hospital called the Northbumbria Specialist Emergency Care Hospital (NSECH) and a network of non-emergency care hospitals.

The report looks at the costs and the impact of two options:

  1. replicating the Northumbria model exactly (which would include not providing all of the services planned under the Future Fit proposals)
  2. extending the Northumbria model to keep services planned under the Future Fit proposals

The report found that adopting the Northumbria model would not be feasible and would create substantial risk for SaTH due to a number of factors – and would result in some services being delivered outside of the county.

The findings support the earlier decisions in the Future Fit options appraisal process to discount options involving a third hospital site.

There are key differences in the services that Northumbria Healthcare NHS Foundation Trust provides and that SaTH provides. The Royal Shrewsbury and Princess Royal hospitals currently provide more services, including urology, nephrology, oncology and haematology and 24-hour urgent care centres.

Adopting the exact same model as Northumbria would result in SaTH not delivering hese services, meaning patients would have to travel out of county to access those services in other hospital trusts.

The report also found that the Northumbria model would have an adverse impact on the Trust’s workforce, with operating services across three sites rather than two making the current inefficiencies caused by split-site working even worse. There would also be a significant risk of the Trust being unable to recruit and staff a safe workforce model across three sites. Recruiting enough staff to cover the two current hospitals is already a significant challenge for the hospital trust.

The report also finds that adopting the Northumbria model would cost around £400-500 million, not including infrastructure costs (e.g. roads) and the cost of land. This is significantly higher than the £312 million allocated to the programme from the Department of Health and Social Care (DHSC), and significant backlog of maintenance work would remain at the two hospitals due to less investment at the existing sites.

Dr Simon Freeman, accountable officer for NHS Shropshire Clinical Commissioning Group (CCG), who chaired the programme board meeting, said: “People have asked us why we can’t reproduce the Northumbria model of building a new single emergency care hospital here in Shropshire and Telford & Wrekin.

“We want to transform the way we deliver emergency services and we believe that having a dedicated emergency care site – similar to Northumbria – is the best solution.

“But assessments have found that adopting the Northumbria model would not be feasible and would create substantial risks for the hospital trust, including some services not being provided within the county.

“Our proposed model of hospital care is for one hospital to provide emergency care services and the other hospital to provide planned care services, with 24-hour urgent care centres at both sites.

“We’d like to encourage people to find out more about our proposals and have their say as part of the consultation. It’s important that people share with us what the options mean for them and what we need to consider putting in place or changing so that they can receive the best possible care in the future.”

Future Fit considered the option of having a single new hospital to replace the Royal Shrewsbury and Princess Royal hospitals as part of the options appraisal process, but it was excluded on affordability grounds.

SaTH shared the report with the Future Fit Programme Board yesterday (Tuesday 24 July), who took the decision to release it into the public domain. It is now available to read in full on the Future Fit website.

The Future Fit public consultation will now run until 11 September 2018.