This page provides archive information. If you would like up to date information please go to www.sath.nhs.uk/future
OVERVIEW
WHY ARE CHANGES NEEDED?
HOW ARE THESE PROBLEMS BEING SOLVED?
WHAT CHANGES ARE PROPOSED?
If these proposals are implemented:
ACUTE SURGERY
MATERNITY SERVICES
CHILDREN’S SERVICES
CHILDREN'S ASSESSMENT UNIT (PAU)
LEGISLATION AND RESOURCES
TRAVEL AND TRANSPORT
LOCAL COMMUNITIES
ABOUT THE CONSULTATION PROCESS
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"Keeping it in the County" was the name of the consultation on the future of hospital services in Shropshire and Telford & Wrekin which took place from 9 December 2010 to 14 March 2011 .
You can find out more by reading the consultation document or summary consultation document.
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The current situation, as of July 2011, is that following the 'Keeping it in the County' consultation on the future of local NHS services, the Boards of The Shrewsbury and Telford Hospital NHS Trust and local primary care trusts have agreed to move to the next phase of developing a plan that will see:
- Most hospital services for most patients continuing exactly where they are now
- Some services moving from the Royal Shrewsbury Hospital to the Princess Royal Hospital in Telford. The Princess Royal Hospital will become the main base for consultant-led maternity services, inpatient children's services and inpatient head and neck services
- Some services moving from the Princess Royal Hospital to the Royal Shrewsbury Hospital. Shrewsbury will become the main base for inpatient acute general surgery, and will continue to be our main centre for adult cancer services (strengthened by the new £5m cancer and haematology centre development)
The Trust is currently putting together its Outline Business Case, which includes our preferred option of where maternity and children's services will be based at the Princess Royal Hospital. This will be submitted to the Trust, Primary Care Trust and Health Authority boards ifor approval in the coming weeks.
If approved at the boards, we will then work on a more detailed plan as part of our Full Business Case which will be submitted for approval in February/ March next year.
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The Outline Business Case will be submitted to the Trust Board in August and the Primary Care Trust and Health Authority Boards in September. If approved we will then start work on our Full Business Case which will be submitted for approval at the same boards in February/ March 2012.
If the Full Business Case is approved, from April 2012 we will begin to put the changes in place, start building, training and moving services. We expect the new reconfigured service to start in 2014. Between now and then we want to involve patients and the public in helping to shape the new services. We will also make sure that there is widespread publicity about any changes nearer the time.
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The local NHS faces three major dilemmas that need to be resolved:
· Making sure that we can continue to provide 24 hour acute surgery in the county
· Making sure that we can keep inpatient children’s services in the county
· Planning to move out of the deteriorating maternity and children’s services building at the Royal Shrewsbury Hospital before this building fails – we need to plan to move out of this building within five to ten years
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Yes.
Over the past few years hospital services have begun to leave our area.
Some of the more complex gynaecology cancer surgery and upper gastro-intestinal cancer surgery are no longer provided at hospitals within the county which means that patients have to travel to centres outside the area for their care. The clinicians providing this care locally were found to have good clinical outcomes and high levels of patient satisfaction, but we lost these services because we could not demonstrate that we met nationally-set standards for providing these services and they have been moved from our hospitals to larger centres.
For example, in the case of Upper GI Cancer surgery, this service moved five years ago because of a national directive to centralise cancer services and not in any way a criticism of the Shropshire Upper GI team whose quality of care, survival rates and patient satisfaction levels were praised at each external peer review. So despite providing an excellent service Shropshire lost this facility largely because of a national directive not medical evidence. It is therefore entirely possible that other local, high quality clinical services in our county are at risk of a similar fate.
More complex surgery for gynaecological cancer is also no longer provided in the county. Even though we offered a high standard of care, we lost the service primarily because we did not serve a large enough population across our hospitals. Saying that we wanted to keep providing this surgery locally was simply not enough to keep it here. Many gynaecological cancers are treated without surgery, and most women do still received their treatment locally to a high standard from our multi-disciplinary team. This includes non-surgical treatment of cervical cancers, hysterectomy and non-surgical treatment for ovarian cancer. We also provide follow-up care locally wherever possible, along with screening, imaging and diagnosis, chemotherapy and radiotherapy.
But we do need to make sure that we keep these services local rather than see more women needing to travel outside Shropshire and Telford & Wrekin. We have a major strength in that we offer both chemotherapy and radiotherapy services locally. Many hospitals of a similar size do not do this. This puts us in a good position to keep services locally, and also to attract new services because treatments and technology do change.
More of our services face risks that they will move from the county if we don’t take action to keep them here for our patients.
In both of these cases the services have moved away not because of concerns about the outcomes of care or patient experience. Instead they have gone because we have not been able to meet externally set "Improving Outcomes Guidance" standards. Improving Outcomes Guidance is set by the National Institute for Health and Clinical Excellence and sets standards for the delivery, quality and organisation of cancer services.
Many patients who have heart attacks also are driven past our hospitals to Stoke or Wolverhampton to receive primary PCI, rather than having their treatment in our hospitals.
There is a risk that other services will also leave the area unless we take action and make some difficult decisions to keep them here. We need to respond now to changes that have taken place over a number of years and left some more of our services vulnerable. There are big question marks about whether all of our services can continue to be provided safely unless changes are made.
Available to download is the original proposal document from 2009 recommending that patients with ST elevated myocardial infarction should be take to heart centres in Wolverhampton and Stoke for primary PCI wherever possible and an overview of the Cancer Services Peer Review undertaken by the Greater Midlands Cancer Network, which includes the recommendation that some cancer surgery should discontinue in our hospitals.
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In short, we need a lot more doctors than we did in the past in order to run specialist services 24 hours a day. It is becoming more and more difficult to find enough doctors to keep service running safely. This is due to a combination of factors including the way doctors are trained, changes in working hours and changes in international recruitment. These are summarised below.
The way that doctors are trained:
The way that doctors are trained has changed significantly. Years ago, surgeons used to be trained in doing a very wide range of different operations on different parts of the body – breast, abdomen, intestines, arteries and veins, for example. Their lengthy training or ‘apprenticeship’ as a junior hospital doctor meant that, when they were eventually appointed as consultants (the most senior grade of doctor), they were able to undertake a broad range of work.
Gradually, things have changed. As new and more complex treatments and diagnostic technologies have become available, the delivery of healthcare has become increasingly more specialised. Today, junior doctors who wish to become surgeons have a shorter, more concentrated period of training in a more specialised field.
This means that, when they have completed their training, they are more expert in a narrower field of surgery.
As a result of this, most surgeons now carry out a smaller range of more complex operations than their predecessors would have done. This benefits patients because increasingly skilled surgeons are able to deliver better results.
However, it also means that they are less able to perform operations to the necessary standards in fields of surgery outside their specialist area. So, for example, a breast surgeon is not ordinarily expected to carry out abdominal surgery as part of his or her planned or ‘non-emergency’ operations. We have breast surgeons in our hospitals who have had a general training and can provide a range of surgery to a high standard, but when they retire we will not be able to replace them with surgeons with similar skills.
This, in turn, affects how emergencies are handled, especially at night when there needs to be a rota of doctors on call to perform surgery in potentially life-threatening situations.
It is better for a patient with major abdominal injuries brought in by 999 ambulance in the middle of the night to be operated on by an abdominal specialist, not a surgeon from another field who does not do this kind of work every day.
Whilst the hospitals of today generally have more doctors working in them than many years ago, the actual numbers of doctors doing specific, highly specialised tasks is relatively small.
This makes it more difficult to ensure that, at night in particular, there are enough doctors available with the full range of skills to provide emergency cover. It makes it even more important to organise services so that the right specialists are available, when needed, to assess and treat patients who arrive at hospital as emergencies at any time of day or night.
Changes in working arrangements:
There are European Union restrictions on the number of hours per week that doctors can work. This is good from the patient’s point of view. It means the junior who see them are not as tired from excessively long periods on duty, and are therefore better able to make the right decisions about their diagnosis and treatment.
But shorter working hours for doctors adds to the difficulties of organising services with the right number of the most appropriate doctors on duty 24 hours a day. Overall, we need more doctors in order to run the same service.
Also, additional restrictions have been put in place on international recruitment. A decade ago the NHS would have looked to other parts of the world to help us recruit the doctors we need. However, other countries need their doctors too so we cannot rely on international recruitment in the same way as in the past.
Experienced general surgeons
We currently have very experienced and capable older consultants surgeons who received a more general training across a range of sub-specialties. But they are increasingly difficult to replace when they retire. Newly qualified consultants have trained in specific sub-specialties so do not have the range of experience to replace them. We need to plan with the changing workforce in mind, which includes finding ways to maintain 24 hour acute surgery.
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Vascular surgery is specialist surgery on the veins and arteries, which supply blood to the heart, brain and other vital organs.
The Department of Health is setting up centres across the country to screen people for abdominal aortic aneurysms. This will screen people for a potentially life-threatening condition and offer them treatment. Normally these centres are set up for populations of about 800,000 people. This is much larger than the 550,000 that we serve. But we are arguing strongly that we should offer this service because of our geography.
We also want to offer the best quality of care and outcomes. Vascular surgery centres that see more patients generally have better outcomes of care.
We will only be approved as a centre for abdominal aortic aneurysm screening if we move to a single site for vascular surgery. If we do not do this then we would not be approved as a screening centre. It will be difficult to keep a local vascular surgery service if we are a screening centre. Vascular surgery for abdominal aortic aneurysms would normally take place out of the county, and it will be very difficult to attract and retain doctors to come to work in the type of service we are able to offer.
Without the proposed changes major vascular surgery would move out of county and this would also threaten a number of other services currently offered within the trust.
See also "Life Saving Screening Programme A Step Closer for RSH and the County"
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The issues facing acute surgery also face inpatient children’s services:
· More doctors are needed in order to keep services running 24 hours a day
· Fewer doctors are available in training roles and as middle grades, and these play a vital role in running 24 hour services
· At the same time, there have been reductions in the number of children’s specialists who have completed their training as junior doctors and are now seeking posts as consultants.
Because of this, we believe that the two inpatient paediatric units are becoming increasingly difficult to staff with the right level of doctor. All the children’s specialists (paediatricians) in the county agree that continuing to run two inpatient units will not be possible very far into the future. They face a continual struggle to ensure they have enough doctors available to look after the children in their care and it looks like this is going to get even more difficult in the future.
Although they know this is a difficult decision to make, they believe that creating a single inpatient unit is the only way we can protect this service for the future, although they do not necessarily agree on how and where this unit should be established. The alternative could be that children needing overnight care would have to be treated outside Shropshire, Telford and Wrekin.
It is not possible to give a precise answer about how long two inpatient children's services can be maintained, as this depends on many different factors many of which are not predictable. We need to have a clear plan in place so that services do not decline and so that we can protect services for the future.
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There is a real risk that this may happen.
All the children’s specialists (paediatricians) in the county agree that continuing to run two inpatient units will not be possible very far into the future. They face a continual struggle to ensure they have enough doctors available to look after the children in their care and it looks like this is going to get even more difficult in the future.
Although they know this is a difficult decision to make, they believe that creating a single inpatient unit is the only way we can protect this service for the future, although they do not necessarily agree how this should be achieved. The alternative could be that children needing overnight care would have to be treated outside Shropshire, Telford and Wrekin.
We do not want to stand by and watch services leave the county because we failed to take action to keep them here.
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Why do services need to move from the women and children’s building at the Royal Shrewsbury Hospital?
While we must pay tribute to the staff who work in the women and children’s unit at the Royal Shrewsbury Hospital site, we have become increasingly concerned about the building in which they provide care.
The maternity building at the Royal Shrewsbury Hospital was built in 1969 and is in a very poor condition. Services have outgrown the space available. The cramped environment is not good for patients and makes it difficult for staff to offer the best possible care. The neonatal intensive unit, which is also based in the maternity building, is very short of space.
The lack of space also means there is only one operating theatre. This is a safety concern. Ideally, there should be two operating theatres to deal with unforeseen problems that occur during labour and delivery. We are looking at ways to achieve this quickly, ahead of any changes to women and children’s services.
In 2008 we also put in place a major programme to re-encapsulate the asbestos in the roof of the women and children’s building. The asbestos continues to be sealed in, and advice from the Health and Safety Executive says that asbestos is safe if it is sealed in. But, we will need to keep on treating the asbestos every few years to make sure that it remains safe.
We want to provide a better patient environment for our patients. Even if money is spent on the deteriorating building, its future life span is limited to between five and ten years. This accommodation is simply not good enough for maternity care in the 21st century.
The previous options discussed in 2009 included plans to move from the women and children’s building at the Royal Shrewsbury Hospital. It is now even more important that we make a decision so that we can secure the future of this service.
Useful background information on the condition of the building can be found in the 2007 Site Survey of the Women and Children's Building. Please also refer to the ViewPoint article from Adam Cairns which discusses some of the maintenance work that has taken place since this survey.
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It is very unlikely that maternity services would move out the county, and we are not suggesting that this is likely as part of this consultation.
But we must plan to move out of the maternity building at the Royal Shrewsbury Hospital as this building is deteriorating and does not have a long term future.
Also:
- We also may lose some of the services that work together with maternity services (e.g. children’s services) if we do not take action
- If maternity services faced a crisis (e.g. because the building had failed) then we could lose our “licence” to run these services from the Care Quality Commission. We do not want this to happen.
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In order to solve these problems we aim:
· To keep two vibrant, well balanced, successful hospitals in the county. The Princess Royal Hospital and the Royal Shrewsbury Hospital should both have a healthy, long term future.
· To have an Accident and Emergency Department at both hospitals.
· To have access to acute surgery from both hospitals.
· To ensure that all communities across Shropshire, Telford & Wrekin and mid Wales are confident that they have timely access to safe services in an emergency
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We need to take into account a wide range of factors when solving these problems:
· The needs of the different communities we serve
· Clinical linkages between our services (e.g. between children’s services, neonatal services and maternity services)
· The fact that services are already drifting out of the county, and we expect to see more services leave if we do not take action
· The very real risk that some of our current services will become unsafe
· Restrictions in working hours for doctors
· Changes in the ways doctors are trained, leading them to specialise at an earlier stage
· Increasing external scrutiny and regulation of NHS services
· The availability of capital funding for building and equipment. We think that we can borrow up to £28m for these changes, which will still cost us around £3m every year to pay back on top of the other financial constraints and efficiency savings we need to make.
· The prolonged debate on the future shape of hospital services without resolution – the risks we face are getting harder to manage and the opportunities for solving them are reducing
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We have looked at four different options:
· Option 1: Do nothing and maintain all services as they are
· Option 2: Move some services from the Princess Royal Hospital to the Royal Shrewsbury Hospital and move some services from the Royal Shrewsbury Hospital to the Princess Royal Hospital (the proposed option)
· Option 3: Concentrate all services on one site – either a new single site or one of the existing hospitals
· Option 4: Major and emergency work on one site and planned activity on the other
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This will not tackle the dilemmas we face:
· Services may decline and reach crisis point. Emergency changes would need to be made.
· More services are likely to drift out of the county because we have not taken action to keep them here.
· We will not have a plan to move out of the women and children’s building at the Royal Shrewsbury Hospital. The building is likely to fail.
· If services decline then we may lose our “licence” to run them and decisions about their future will be taken out of our hands.
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A new site will cost £350m to £400m. Developing one of the existing sites would require a similar amount of investment.
This is not possible in the current economic climate:
· Who would lend us this money for major building work?
· How would we pay back the capital loan – in the region of £40m a year on a £400m building project? This is more than a sixth of our annual turnover and paying back this money would have a major impact on other services.
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Most planned work does not require a long stay in hospital. It is the unplanned and emergency work that leads to long stays in hospital. The amount of emergency work is far larger than the planned work, so it requires far more beds.
This means that we would need one very large hospital for the major and emergency work and one small hospital for the planned activity. It would require a lot of investment to develop either of our hospitals to provide the major and emergency work.
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Very little has changed since 2008/09.
We still face risks to our services, and these risks are getting bigger.
The main thing that has changed is the economic climate. This means that our opportunities for major building schemes have reduced.
In 2009 we were looking at a set of short term options (for 2012/13) as a stepping stone to a single major acute site. This included having a longer term plan for getting out of the women and children’s building at RSH.
We cannot plan for a single acute site so we need to find a lasting solution based on our current hospitals with minimal capital building work.
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At the Royal Shrewsbury Hospital:
· We need to move out of the deteriorating women and children’s building. The life of the building is limited to five to ten years.
· There are few alternative buildings to clinical standards or land opportunities
· It would be expensive to rebuild a women and children’s unit – in the region of £60m in addition to any other changes that might be needed as part of these proposals.
At the Princess Royal Hospital
· There are no inherent problems with the buildings, so capital investment would be going into productive facilities.
· There is flexibility as to where the facilities could be developed – including clinical space that is being vacated (e.g. decontamination unit) and space that could be vacated for clinical use.
· It is estimated that total works for these proposals, including developing a new women and children’s centre at PRH, would cost in the region of £26m to £28m
At both hospitals:
· We would need to find space for car parking.
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Yes.
It is less easy to borrow capital for major building works and it is more difficult to pay this back.
In 2009 we looked at a range of short-term options (2012/13) as a stepping stone to a new single acute site (at PRH, RSH or in between). Now we cannot plan for a single acute site because this is not affordable in the current economic climate.
The clinical risks we face have not gone away. In fact, they are getting more likely and we have fewer options for tackling them. We have to find lasting options to solve these problems, with fewer resources available to us.
We can secure up to £28m capital funding now, but we do not know how long this will be available so we need to agree a way forward soon before our options reduce even further.
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Yes.
Together the two hospitals serve over half a million people. This puts us in a strong position to provide specialist services and keep services locally that a smaller hospital could maintain on its own.
But, the hospitals do have to work together to do this. Not all services can be provided at both hospitals. This is currently the case and will continue to be so in the future.
For example, radiotherapy is provided at the Royal Shrewsbury Hospital in the Lingen Davies Cancer Centre.
If the hospitals “de-merge” the we would expect:
· PRH would have to work more closely with hospitals to the east, and it is likely that it would start to lose services to these hospitals.
· RSH would not be big enough on its own to carry on providing the same range of services that it does now.
· Overall, we expect that more services would move further away than the proposals in the “Keeping It In The County” consultation
By working together, we aim to keep as many safe services as local as possible and reduce travel for people in Shropshire, Telford & Wrekin and mid Wales who otherwise would need to go to hospitals further afield.
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If these proposals are implemented:
We need to make changes to the following services to keep them safe and keep them in Shrewsbury or Telford:
· Some types of inpatient surgery involving operations where people need to stay in hospital for at least one night.
· Inpatient care for children who need to stay in hospital for tests and treatment.
· Services provided in the maternity building at the Royal Shrewsbury Hospital. These include inpatient obstetric care for pregnant women whose deliveries are higher risk and therefore need to be overseen by hospital consultants, and neonatal intensive care. Midwife-led care would continue to be available in Shrewsbury.
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Most services for most patients will stay the same:
· Most outpatient appointments, including diagnostics and procedures.
· Most day case surgery
· Most orthopaedic surgery
· Most emergency medical appointments
· A&E departments at both sites
· Children’s Assessment Units at both sites (the hours of opening are being considered as part the clinical development work taking place during this consultation)
· Midwife-led maternity units at both hospitals
· Lingen Davies Cancer Centre at the Royal Shrewsbury Hospital
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The problems facing acute surgery are so severe that if we faced a crisis then we may need to make changes very quickly. However, we want to make changes in a planned way based on the outcome of consultation, so that we can safely put in the new services in place and make sure that everyone – doctors, nurses, other health professionals, ambulance services, GPs and patients – understands how the new services work.
We do not expect to have to make changes before the end of consultation, but we do need to plan so that we can make acute surgery as safe as possible as quickly as possible after the end of consultation.
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Both hospitals will continue to have a 24-hour accident and emergency department. This means that patients arriving at accident & emergency departments will, as now, be assessed, monitored, treated, discharged, admitted and/or stabilised and transferred.
The proposals outlined in the consultation document would lead to some changes to the shape of services such as acute surgery. This would mean that there would be some changes in the way ambulance and other emergency services deal with critically ill patients - for example, RSH would be the acute surgery centre for vascular surgery, colorectal surgery, upper GI surgery and major trauma (the most severe trauma is already taken outside the area to regional specialist hospitals e.g. Stoke and Birmingham, and this will continue to be the case). So, as now, patients would be taken as quickly as possible to the hospital best able to provide the care that they need.
However, both hospitals would continue to offer 24 hour A&E services to provide emergency care for people who attend.
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Both hospitals will continue to offer outpatient appointments. The majority of outpatient care will continue where it is now.
One of the principles underlying this consultation is that we aim to keep the majority of services where they are now if this is clinically appropriate and feasible. We propose that the majority of outpatients will remain where it is now, aiming to bring our specialist staff to the patient rather than the other way round. The future profile of all services will depend on the outcome of consultation.
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Both hospitals will continue to offer daycase surgery and procedures. The majority of daycase surgery and procedures will continue where they are now.
One of the principles underlying this consultation is that we aim to keep the majority of services where they are now if this is clinically appropriate and feasible. We propose that the majority of daycase surgery will remain where it is now, aiming to bring our specialist staff to the patient rather than the other way round. The future profile of all services will depend on the outcome of consultation.
As now, a risk assessment would take place to decide the best location for this surgery to take place which may be the site where the inpatient specialty is based. Some changes may be needed on an individual basis, for example, where it is considered that a patient is at higher risk of requiring emergency inpatient treatment as a result of day case surgery.
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There will continue to be midwife-led units in Bridgnorth, Ludlow, Oswestry, Shrewsbury and Telford.
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Both hospitals will continue to offer emergency medical care. The majority of emergency medical care will continue where it is now.
We do need to consider some changes in order to keep our services safe or develop new services that we are not currently able to offer. For example, we do not currently provide 24-hour stroke thrombolysis at both hospitals and we are piloting it at PRH. We are looking at ways of providing rapid access to this treatment in the long term.
One of the principles underlying this consultation is that we aim to keep the majority of services where they are now if this is clinically appropriate and feasible. We propose that the majority of medical care will remain where it is now. The future profile of all services will depend on the outcome of consultation.
As now, a risk assessment would take place to decide the best location for someone to be admitted. Some changes may be needed on an individual basis where they need specific specialist input.
See also "What changes are being considered to stroke services?"
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Both hospitals will continue to offer orthopaedic surgery. The majority of orthopaedic surgery will continue where it is now. The majority of major trauma that is seen in our hospitals is already taken to RSH, and this will continue to be the case.
The most serious injuries are already taken outside the county (e.g. to Stoke, Birmingham) and this will continue to be the case.
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The Royal Shrewsbury Hospital will continue to develop as a cancer centre, with valuable support from the Lingen Davies Cancer Fund and local fundraisers. Because of them we are very fortunate to have such excellent cancer services in a small-to-medium sized district general hospital and we want to keep these services locally. We have already seen some types of cancer surgery leave the county and we want to protect ourselves to prevent more and more services leaving the county.
Inpatient services for children with cancer will need to be alongside the main inpatient children’s unit. It is proposed that this will be in Telford. See below for more information about the Rainbow Children’s Cancer Unit.
See £3.2m cancer centre development at the Royal Shrewsbury Hospital for more information about the next steps for cancer services.
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We are looking at ways of providing safe, 24-hour access to emergency treatment for stroke services. This includes finding a way to provide 24-hour thrombolysis for eligible patients with FAST-positive strokes. We do not currently provide this at both of our hospitals, but we are piloting it at PRH. It is very challenging to put in place 24-hour arrangements in hospitals of our size, with a rota of skilled and experienced stroke physicians who see enough FAST-positive stroke patients suitable for thrombolysis for them to feel confident that they are making the best decisions that will offer the patient the best clinical outcomes.
Putting in place 24-hour thrombolysis is challenging but we are looking at a range of ways to achieve this, including having a regional specialist rota with neighbouring hospitals (e.g. Stoke) and using telemedicine to provide clinical support and advice to local clinicians. This type of solution could mean that 24-hour thrombolysis could be provided at both hospitals rather than from a single site as now.
We would need to pilot this approach, using clear clinical protocols, and audit the results to see whether it could offer a long term solution to keeping as many services as possible as local as possible.
However, on the basis of this work we believe that we will be able to recommend to the Primary Care Trusts that 24-hour hyper-acute stroke services can be provided at both the Princess Royal Hospital and the Royal Shrewsbury Hospital in future.
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The main new issue resulting from these proposals is additional travel time:
· people in western Shropshire and mid Wales travelling for consultant maternity care and for inpatient children’s services that are provided locally rather than in regional specialist hospitals
· people in eastern Shropshire and Telford & Wrekin travelling for acute surgery
We need to make sure that clear pathways are in place that reassure patients and families that they have timely access to safe services in an emergency.
Let us know what your concerns are, so that we can plan the new services in ways that reassure you.
Groups of clinicians – doctors, nurses, midwives, other hospital staff, ambulance services, GPs etc. – are working together to develop the new models of care. Your comments will help them to do this.
If you are interested in helping to test the new models of care – for maternity services, for children’s services or for acute surgery – please contact the Consultation Office on ournhsinsat@nhs.net
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Helping people in non-emergency situations
· Using technology and telemedicine so that fewer people need to visit hospital for planned care
· A shuttle bus between sites
· Improvements to public transport
Helping people in emergencies
· Reviewing the way we use air ambulance
· Further developing community hospitals services, including using telehealthcare to provide support for urgent care
Helping women and children in emergencies
· Reviewing the way we assess and offer choice of delivery
· Enhanced training and skills for all staff groups including GPs
· Ensuring that women and children are taken quickly to the best place to provide care in an emergency
Developing a Rural Advisory Group:
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Changes will start to be made from 2012. Full implementation would not be complete until 2014.
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An indicative profile of current hospital activity and beds is set out in the Data Pack for the Clinical Problem Solving Workshop on 10 August 2010. This is indicative only, for example in some cases specialty surgery has been coded and recorded as general surgery. The Data Pack is available from the Events and Assurance Reports page.
A list of our consultants and their main hospital base is also available to download (as at October 2010).
We aim to continue to provide the majority of care in the same place as now, with both hospitals providing outpatient care, day case, diagnostics, Accident and Emergency, medical admissions, orthopaedic surgery and midwife-led units. The future profile will depend on the outcome of consultation. After consultation, further work would take place to develop an Outline Business Case and Full Business Case for implementation.
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See the section above about the problems we face for information about the challenges facing acute surgery.
See the section above about “how are these problems being solved” to find out about some of the options we have looked at and the constraints we face.
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Emergency surgery is unplanned surgery performed when the patient's life is in direct and immediate jeopardy. Emergency surgery is not necessarily provided by a surgeon with expertise in a specialty such as vascular, colorectal or upper-gastro-intestinal. For example, it may be performed by a consultant in emergency medicine or in trauma. Under the consultation proposals we will retain two Accident and Emergency Departments, and both hospitals will need to provide immediate life-saving surgery for patients who arrive through their doors.
Acute surgery is urgent surgery needing to be performed within hours or days. We aim to ensure that patients receive this surgery from surgeons with expertise in the relevant speciality (e.g. vascular, colorectal, upper gastro-intestinal) as this gives us the best chance to offer patients the best possible outcomes of care. Under the consultation proposals we are looking to concentrate three surgical specialties (vascular, colorectal, upper gastro-intestinal) at the Royal Shrewsbury Hospital.
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Under these proposals, the Princess Royal Hospital will offer:
· emergency immediate life-saving surgery as part of its Accident and Emergency services
· day-case surgery
· head and neck surgery
· gynaecological and breast surgery
· orthopaedic surgery
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These proposals will ensure that we can continue to provide the current range of emergency and acute surgery locally, although in some cases this will need to be based at one of our two hospitals. In fact, we hope this will put is in a strong position to attract more surgical services in the area rather than risk seeing services leave the county.
Both hospitals will have A&E departments, offering emergency immediate life-saving surgery.
A significant amount of surgery for children does not take place in our hospitals but in regional specialist centres such as Birmingham. Where we provide emergency and acute surgery for children locally then this will be in Telford. The surgery that we currently conduct on children, such as appendicectomy, would be performed at Telford by trained surgeons supported by the consultant surgeon travelling from Shrewsbury when required.
As now, the most complex acute surgery for adults will continue to take place outside our hospitals in regional centres such as Birmingham and Stoke.
The majority of adults needing local acute surgery would be taken to Shrewsbury. However, if a patient is at the PRH and requires emergency immediate life-saving surgery or is not stable enough to travel then this type of surgery would continue to be available in Telford. For example, the general abdominal/vascular surgeon would travel to Telford to perform the operation
Women having emergency and acute gynaecological surgery would have their operations at Telford. If the gynaecologist needs specialist emergency support, the general abdominal/vascular surgeon would travel to Telford to support the operation.
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Both hospitals will need to have intensive care and high dependency services to support the clinical services they offer.
We already plan to make improvements to intensive care at the Royal Shrewsbury Hospital, and these changes are needed regardless of the outcome of this consultation. They are already included in our capital programme and are therefore not included in the overall costs of the consultation proposals.
The detailed model for critical care at each hospital will be developed based on the outcome of consultation.
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We are confident that our plans to move women's and children's services to the Princess Royal Hospital and consolidate inpatient surgery at the Royal Shrewsbury Hospital will work effectively and ensure that we continue to have safe and sustainable hospital services in our county.
We have set up clinical working groups to develop the models of care in detail.
These groups include consultants, GPs, nurses, therapists, ambulance and other staff who work directly or indirectly in surgery and women’s and children’s services.
We are also continuing to work with patients and the public to help shape the future of our local hospital services.
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See the section above about the problems we face for information about the challenges facing maternity services.
See the section above about “how are these problems being solved” to find out about some of the options we have looked at and the constraints we face.
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Why are you moving maternity services to Telford? I thought the proposal in 2009 suggested they should stay in Shrewsbury?
In 2009 we were looking at a set of options and these did not get to the stage of public consultation. One of these options – which would have seen women and children’s services based in Shrewsbury in the short term – attracted a lot of media attention before any consultation was underway.
The option of women’s and children’s services being based in Shrewsbury was one of four options that was being considered as a short term change from 2012/13 to 2020. In some options, obstetric maternity services were based in Shrewsbury. In others they were based in Telford.
As mentioned these options were intended as a short term change from 2012/13 until 2020. The NHS was looking at options for moving major health services to a single site by 2020. These options included major redevelopment of RSH as the main acute site (including obstetrics and inpatient children's services), major redevelopment of PRH as the main acute site (including obstetrics and inpatient children's services) or creating a new acute hospital site between Shrewsbury and Telford (including obstetrics and inpatient children's services). All of these options included moving from the deteriorating women and children’s building at RSH.
More information about the options discussed in 2009 is available from the Archive section of this website.
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We have done some initial modeling that suggests that a Women and Children’s Centre could be established at PRH, along with the other work needed as part of these proposals, for £26m to £28m.
As part of this consultation we are working this up in more detail, building on the feedback we receive from patients and carers to design the services in more detail which will in turn help us to plan the space we will need.
There are a number of options for the development which could include part new-build and part refurbishment of the existing hospital.
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We estimate that it will cost around £60m to create a new women and children’s facility at RSH. This is because the current building only has a working life as a clinical environment for a further five to ten years and we need to plan to move services from this building in the near future. In the Developing Health and Health Care work in 2008/09 we were also proposing to move from this building as part of the longer term 2020 options.
It will cost in the region of £26m to £28m to create a women and children’s centre at PRH, as well as the other changes needed as part of these proposals. The newer estate at PRH, as well as options for using existing space, means that there are more options for creating this facility at PRH.
There is a very big difference in cost which we have to take into consideration when deciding how to solve the dilemmas facing local NHS services.
We have to borrow money to develop our buildings. The more money we borrow the more we have to pay back with interest taking money away from delivering care, not only to women and children but all the patients entering our doors.
It is also very doubtful that anyone would lend us the sum of money required for a totally new building in Shrewsbury and it would be very difficult to pay this back.
The costings have been developed in accordance with the NHS Estates Healthcare Capital Investment Manual based on providing services to modern healthcare buildings and space standards (rather than simply reproviding the current standards of service). The costs include appropriate contingencies for factors such as site condition, infrastructure costs, on-costs and other contingencies.
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Options for what would happen to the maternity building at RSH will also be explored. We will have to make sure that the asbestos in the roof of the building remains safe.
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We cannot provide these services on separate sites.
Firstly, neonatal services must be on the same site as consultant maternity services.
Secondly, we have strong clinical links between neonatal services and children’s services, including doctor’s rotas, skills and training. We would find it very difficult to provide the same level of neonatal services if these were not working in partnership with on-site inpatient children’s services.
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We propose that a wide range of services will continue to be provided in Shrewsbury. This includes:
· Midwife-led delivery unit
· Consultant and midwifery antenatal care
· Gynaecology outpatients and daycase surgery
· Scanning services
· Early pregnancy assessment
· Antenatal day assessment
· Consultant opinions on patients already in hospital.
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We will provide an inpatient women’s centre in Telford. This includes:
· Midwife-led delivery unit
· Consultant obstetric maternity unit and neonatal care
· Consultant and midwifery antenatal care
· Gynaecology outpatients and daycase surgery
· Scanning services
· Early pregnancy assessment
· Antenatal day assessment
· Consultant opinions on patients already in hospital.
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An indicative profile of the beds and services in The Shrewsbury and Telford Hospital NHS Trust can be found in the Data Pack developed for the Clinical Problem Solving Workshop in August 2010. This is available from the Event and Assurance Reports page.
The profile of beds and births will be developed based on the outcome of consultation. After consultation, planning for implementation would take place between April 2011 and April 2012 and this would include the development of an Outline Business Case and Full Business Case.
Also available to download is a profile of births from Shropshire, Telford & Wrekin and mid Wales in NHS services in England between April 2008 and March 2010 showing location (RSH, PRH, other MLU, other English NHS Trust) and GP practice.
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An indicative profile of the beds and services in the The Shrewsbury and Telford Hospital NHS Trust can be found in the Data Pack developed for the Clinical Problem Solving Workshop in August 2010. This is available from the Event and Assurance Reports page.
The profile of ill baby, neonatal and special care baby services will be developed based on the outcome of consultation. After consultation, planning for implementation would take place between April 2011 and April 2010 and this would include the development of an Outline Business Case and Full Business Case
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If the consultant obstetric unit moves to Telford there would still be a midwife-led unit in Shrewsbury. Any woman who is at low risk of complications would be able to choose to have her baby in the Shrewsbury Midwifery Led Unit , at home or in any of our four other midwifery led units.
As part of these proposals an improved midwife-led unit would be created at the Royal Shrewsbury Hospital.
Part of this work includes making sure that maternity services have access to the range of support services they need, particularly in an emergency - such as surgical support and blood transfusions.
Draft models of care were presented to the Local Assurance Panel on 28 February 2011.
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Who will go to the Princess Royal Hospital to have their baby?
Any woman who needs a consultant-led delivery would give birth at the PRH. Women at high risk include those expecting twins, women with diabetes, women who have had previous caesareans, women whose babies are in the breech position or women whose babies are premature.
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The midwifery led units in Bridgnorth, Ludlow and Oswestry will continue to provide services to women as now. In fact, it is hoped that by continuing to raise awareness of the excellent service women, their babies and their families receive, more women would choose to have their babies in one of our midwifery-led units.
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We have set up clinical working groups to develop the models of care in detail.
These groups include consultants, GPs, nurses, therapists, ambulance and other staff who work directly or indirectly in surgery and women’s and children’s services. We are also testing the ideas developed by these groups with patient representatives.
Part of this work includes making sure that maternity services have access to the range of support services they need, particularly in an emergency - such as surgical support and blood transfusions.
Draft models of care were presented to the Local Assurance Panel on 28 February 2011.
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Because of the number of births we see in our obstetric unit, we should have a second theatre. This is so that we can handle obstetric emergencies when planned operations (e.g. planned caesareans) are taking place. At present there are rare occasions where we need to make emergency arrangements because there is an obstetric emergency when a planned operation is underway.
This is a significant risk on the Hospital Trust's risk register. We are looking at ways of putting a second theatre in place as an interim arrangement, before any changes are made as a result of the "Keeping It In The County" consultation. But, this would be an interim arrangement at RSH as the maternity building is already cramped and the building is deteriorating and does not have a long term future. It will be important to plan for a second theatre as part of the future shape of services.
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See the section above about the problems we face for information about the challenges facing inpatient children’s services.
See the section above about “how are these problems being solved” to find out about some of the options we have looked at and the constraints we face.
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All the children’s specialists (paediatricians) in the county agree that continuing to run two inpatient units will not be possible very far into the future. They face a continual struggle to ensure they have enough doctors available to look after the children in their care and it looks like this is going to get even more difficult in the future.
Although they know this is a difficult decision to make, they believe that creating a single inpatient unit is the only way we can protect this service for the future. The alternative could be that children needing overnight care would have to be treated outside Shropshire, Telford and Wrekin.
We have to consider a wide range of factors, including:
· The resources available to us
· The profile of the population now and into the future
· Emergency access and providing care for children and families with complex needs
We propose to create a single inpatient unit at Telford. As well as keeping inpatient children’s services in the county, this could:
· Offer more privacy for boys and girls
· Create a better environment for teenagers
· Continue to offer a special environment for children with cancer
· Offer new opportunities to work in partnership with Birmingham Children’s Hospital, so that we can provide more services more locally and reduce the need for some children and families to travel to Birmingham.
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In 2009 we were looking at a set of options and these did not get to the stage of public consultation. One of these options – which would have seen women and children’s services based in Shrewsbury in the short term – attracted a lot of media attention before any consultation was underway.
The option of women’s and children’s services being based in Shrewsbury was one of four options that was being considered as a short term change from 2012/13 to 2020. In some options, inpatient children's services were based in Shrewsbury. In others they were based in Telford.
As mentioned these options were intended as a short term change from 2012/13 until 2020. The NHS was looking at options for moving major health services to a single site by 2020. These options included major redevelopment of RSH as the main acute site (including obstetrics and inpatient children's services), major redevelopment of PRH as the main acute site (including obstetrics and inpatient children's services) or creating a new acute hospital site between Shrewsbury and Telford (including obstetrics and inpatient children's services). All of these options included moving from the deteriorating women and children’s building at RSH.
More information about the options discussed in 2009 is available from the Archive section of this website.
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We have done some initial modeling that suggests that a Women and Children’s Centre could be established at PRH, along with the other work needed as part of these proposals, for £26m to £28m.
As part of this consultation we are working this up in more detail, building on the feedback we receive from patients and carers to design the services in more detail which will in turn help us to plan the space we will need.
There are a number of options for the development which could include part new-build and part refurbishment of the existing hospital.
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We estimate that it will cost around £60m to create a new women and children’s facility at RSH
It will cost in the region of £26m to £28m to create a women and children’s centre at PRH, as well as the other changes needed as part of these proposals. The newer estate at PRH, as well as options for using existing space, means that there are more options for creating this facility at PRH.
There is a very big difference in cost which we have to take into consideration when deciding how to solve the dilemmas facing local NHS services.
We have to borrow money to develop our buildings. The more money we borrow the more we have to pay back with interest taking money away from delivering care, not only to women and children but all the patients entering our doors.
It is also very doubtful that anyone would lend us the sum of money required for a totally new building in Shrewsbury and it would be very difficult to pay this back.
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Options for what would happen to the maternity building at RSH are also being explored. Even though the building will not be fit for inpatient clinical care in the near future, there may be other support services that could be accommodated in the building in the medium term and so free up space within the main hospital buildings. We will have to make sure that the asbestos in the roof of the building remains safe.
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We cannot provide these services on separate sites.
Firstly, neonatal services must be on the same site as consultant maternity services.
Secondly, we have strong clinical links between neonatal services and children’s services, including doctor’s rotas, skills and training. We would find it very difficult to provide the same level of neonatal services if these were not working in partnership with on-site inpatient children’s services.
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We propose that a wide range of services will continue to be provided in Shrewsbury. This includes:
· Children’s assessment unit, offering tests, treatment and monitoring
· Outpatient clinics
· A&E department
This means that the majority of children needing to use our hospital services will continue to receive these from the same place as now. Children needing an overnight stay in hospital would as now continue to attend regional specialist hospitals (e.g. Birmingham) or where we provide the inpatient care they need locally, would receive their care in our single inpatient unit in Telford.
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The Princess Royal Hospital will offer an inpatient children’s centre. This includes:
· Children’s assessment unit, offering tests, treatment and monitoring
· Outpatient clinics
· A&E department
· Children’s inpatient care including inpatient cancer care
This means that the majority of children needing to use our hospital services will continue to receive these from the same place as now. Children needing an overnight stay in hospital would as now continue to attend regional specialist hospitals (e.g. Birmingham) or where we provide the inpatient care they need locally, they would receive their care in our single inpatient unit in Telford.
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The exact opening hours have not been decided. Most children’s assessment units are open between 8am and 10pm as that is when most children come in to hospital for assessment and treatment. We are listening to the feedback from the public and considering carefully what type of service we need to provide and how this could be staffed.
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We perform over 800 ENT procedures on children each year and the doctors delivering that care believe they should be located alongside children’s services to be able to safely deliver this service.
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We are incredibly grateful for the hard work by parents and members of the community to raise money to create this important unit.
However, it is attached to a building that is deteriorating. We need to plan to move out of the women and children’s building at RSH before it fails. This means that we also need to plan to move the children’s cancer unit from its current location.
We also need to move to a single inpatient children’s unit, which means that in future inpatient children’s services can only be provided at one of our hospitals. The Cancer Unit must be at the same location as our other inpatient children’s services.
So, the Children’s Cancer Unit needs to move from its current location (because the adjoining building is failing) and it must be located on the site with inpatient children’s services. Wherever it is relocated we will ensure that it is provided to at least the same standards as the current facilities, carrying on the fantastic legacy from everyone who has helped to bring this unit to the county. We will also not be asking people for additional fundraising to relocate the unit, and we invite the involvement of parents and families to help design the care environment.
We have carefully looked at the possible options within the resources available to us. We propose to establish a new Women and Children’s Centre at the Princess Royal Hospital. This will include the Children’s Cancer Unit.
We recognise that people will have concerns about moving from the current facilities. With the benefit of hindsight we would not make the same decision now to provide this unit in its current location because of the condition of the building it is attached to. It is important that we move forward and keep safe children’s services in the county, and continue to provide these vital children’s cancer services locally.
If we do not take action then we risk losing these facilities from the county, and children and families would need to travel further for their care.
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We have set up clinical working groups to develop the models of care in detail.
These groups include consultants, GPs, nurses, therapists, ambulance and other staff who work directly or indirectly in surgery and women’s and children’s services. We are also testing the ideas developed by these groups with patient representatives.
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PAU stands for Paediatric Assessment Unit (or Children's Unit). It is a special unit where children can be quickly assessed and treated. We will have a PAU at both RSH and PRH.
Unless it is an emergency situation, children are brought to the A&E department are directed to the PAU during opening hous to be assessed and treated. This will continue in the new PAUs.
There will still be a PAU at RSH, however the plan is for it to be relocated next to A&E.
I have been involved in a special group which has been set up to discuss the opening hours of the PAU, and we have looked at a wide range of factors such as the numbers of children who attend hospital at night. Due to the very low numbers of children seen at night, we have decided that we should not aim to keep the PAU open 24 hours a day at RSH.
The current thinking is that the PAU will be open for 13 hours each day. This will mean that the PAU is open during the hours when nearly all children needing the type of care provided by a PAU attend hospital. We are still developing these plans and welcome feedback.
When the PAU is not open there will still be a 24-hour A&E department at the RSH. Working with GPs, Shropdoc, ambulance services and other health services we will make sure that there is a clear plan to bring children children quickly to the best place to provide the treatment that they need.
If you call an ambulance for your child during the night when the PAU at RSH is closed, in the vast majority of cases they will be taken straight to PRH. In rare and extreme cases when ambulance paramedics believe that the child cannot get to PRH safely (airway obstruction for example), then they will be taken to the nearest hospital.
It's important to remember that no child will be ever turned away from A&E at RSH.
Any child who is brought to RSH during the night will be quickly seen and assessed by doctors and nurses in A&E. If the child needs to stay in hospital overnight, then, only when it is safe to do so, they will be quickly transported to PRH or, as now, to a regional specialist hospital if they need care that connot be provided in Shrewsbury or Telford.
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No, these proposals are about keeping safe services in the county now and into the future. They are not aimed at saving money.
We want to make sure that health services remain safe into the future and offer the best possible care and the best outcomes
This involves building on our current strengths, and making sure they match the best practice as recommended in clinical guidelines for the whole country. It also aims to solve issues such as increasing medical specialisation and regulations about how many hours staff can work. These issues mean we have to find a different way of working in some specialities in order to be sure we can carry on providing them.
Our proposals will need to be implemented within the total money we get from taxpayers.
Detailed information about the Trust’s financial position can be found in the monthly financial reports to the Trust Board, which are available from the Trust website.
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No.
These proposals are about patient safety, keeping services in the county and giving our local hospitals a long term future. They are not being put forward to achieve NHS Foundation Trust status.
Foundation Trust status has a part to play:
· If we do not make our services safe and sustainable then we will not become a local Foundation Trust.
· If we do not become a Foundation Trust then local hospital services will be run by other organisations – either together, or “de-merged” and run by different organisations.
· If our hospitals “de-merge” then services in Telford are likely to drift to the east, and RSH would not serve a big enough population to keep its current range of services. Overall, we are likely to see more services drift out of the county.
· If our hospitals are taken over by another organisation then the future is also uncertain
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To build a new hospital would cost between £350 million and £400 million, and possibly more. This was looked at in a feasibility study in 2009. In the financial climate now facing the nation, this money is just not available and so this is not an option we can progress.
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Most planned work does not require a long stay in hospital. It is the unplanned and emergency work that leads to long stays in hospital. The amount of emergency work is far larger than the planned work, so it requires far more beds.
This means that we would need one very large hospital for the major and emergency work and one small hospital for the planned activity. It would require a lot of investment to develop either of our hospitals to provide the major and emergency work.
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All providers of NHS services must be registered with the Care Quality Commission.
In order to be registered, we need to demonstrate that we meet a range of quality standards.
If we are not able to demonstrate that we meet quality standards then we will not be registered to provide the service.
If this happens then we will not be permitted to provide the service, which means that the service may be lost from the county.
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The Strategic Outline Case Proposal document was approved by the Boards of the PCTs and the Hospital Trust on 2 December 2010. The paper presented to the Boards is available from the Board Papers page. Note that whilst this is called a draft proposal it was approved by the Boards as the basis for consultation.
Further information about the proposals for consultation is available in the consultation document and consultation summary document which are available from the consultation website at www.ournhsinshropshireandtelford.nhs.uk
The consultation process is a vital period to listen to the issues and concerns raised by patients, the public and partner organisations. These views will influence the decisions made following consultation.
Following consideration of the outcome of the public consultation by the Boards, planning for implementation would take place between April 2011 and April 2012 and would include the development of the Outline Business Case and Full Business Case.
In order to develop an Outline Business Case, detailed information is required on the capital and revenue implications of any proposal. This detailed information can only be developed based on the outcome of consultation, and building on detailed patient pathways work that enables us to identify the resources (including staff, space, equipment etc) needed and options for the delivery of each service. It is vital that we have patient, public and staff involvement in designing those pathways, and following the end of consultation we will be involving patients and the public in taking this work forward. If you are interested in being involved in patient pathway work after the end of consultation please contact the consultation office at mailto:ournhsinsat@nhs.net?subject=Patient Pathway with "Patient Pathway" as the subject of your email.
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Costings for major NHS capital programmes are developed in accordance with guidance from NHS Estates based on providing services to modern healthcare buildings and space standards (rather than simply reproviding the current standards of service). The costs include appropriate contingencies for factors such as site condition, infrastructure costs, on-costs and other contingencies.
Guidance for NHS Trusts on costing for major NHS capital programmes is available from various sources, but the following documents will be useful if you are keen to understand how costings are developed:
Page 12 of the consultation document states that "the cost of rebuilding the maternity unit at the Royal Shrewsbury Hospital is estimated to be close to £60m". These costings were developed as part of the Developing Health and Health Care programme and can be found in the background documentation from that work. Specifically, the site plans for the £60m new build option at RSH can be found from pp81-84 and the cost schedule can be found from p180 to the end of the portfolio.
Page 12 of the consultation document states that "The Princess Royal Hospital has space that can be made available to relocate services from Shrewsbury. Some additional new facilities could also be built at the Princess Royal Hospital. The cost of this scheme ... is estimated to be £28million". Information about these costings is available here. A range of site options is being considered, for example building adjacent to the current children's services near the A&E department and main theatres.
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We are investigating running a shuttle bus service between the two hospitals for patients, visitors and staff.
We are talking to the local authorities about public transport.
We are looking at the possibility of having an air ambulance in operation at night.
We are also investigating telemedicine which would enable a patient at one hospital to have a consultation with a doctor at the other hospital without having to move. We have appointed two clinicians to lead a programme to increase the way we use telemedicine to provide planned care and emergency care, and reduce the need for patients to travel to hospital.
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We will need to review car parking as part of these proposals. Royal Shrewsbury Hospital is likely to have more patients who need to stay for extended periods following emergency surgery. Princess Royal Hospital is likely to have more mums and children, who normally stay for a short time in hospital. The average length of stay for children in our hospitals is one night.
We would continue to encourage people to use public transport where possible and we are looking at running a shuttle bus service between the two hospitals.
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Any patient in urgent need of complex treatment would be transferred by ambulance between the two hospitals.
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An emergency ambulance takes between 15 and 20 minutes to travel between the Princess Royal Hospital and the Royal Shrewsbury Hospital.
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Yes.
We are working with the ambulance services to understand the implications from these proposals on travel time and the care people receive before they get to hospital.
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If these proposals are implemented then the majority of patients will continue to receive the majority of their care in the same hospital as now. We are also protecting our hospitals from the risk that some of these services would drift out of county in future, resulting in longer travel times for patients.
Together, the PRH and RSH serve a very large geographical catchment area. It includes many sparsely populated rural areas where some people live quite long distances – and travel times – from both hospitals.
Although, after the changes we are proposing, the vast majority of patients would still go the same hospital as now, some of them would need to travel to a different hospital that is further away from where they live.
On average, it takes about 25 to 30 minutes for someone to drive from the RSH to PRH site and vice versa. So, depending on where they live, some patients or visitors would take that additional length of time.
For an emergency 999 ambulance, the average time taken between the two hospitals – depending on traffic conditions – is 15 to 20 minutes.
Ambulance services already plan to take patients to the most appropriate hospital depending on travel conditions, and this will continue to be the case. We are also looking at other options such as extending air ambulance cover including options of flying at night (e.g. illuminated sites in more remote parts of Shropshire and at designated points in Powys).
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Most patients will continue to receive their care at the same hospital as now, so for most journeys to hospital there will be no change from now.
Where changes to services have been proposed, to maintain their safety and keep them secure for the future, the detailed care pathways will be developed based on the outcome of consultation. During 2011 and 2012 an outline business case and full business case will be developed for implementation, which will provide more detail of the anticipated costs once the model of care has been defined.
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Patient and public representatives from across Shropshire and Telford have been involved in developing these proposals (see below).
The consultation process took place from 9 December 2010 to 14 March 2011 and was an important opportunity for patients and residents to tell us their hopes and concerns about these proposals, and for the NHS and local Health Overview and Scrutiny Committees to listen to the issues you raise and make the best possible decisions based on this.
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These proposals aim to ensure a vibrant and long-term future for the Royal Shrewsbury Hospital. Most patients will continue to receive most of their care as they do now and the hospital would be strengthened as an acute surgery centre for Shropshire, Telford & Wrekin and mid Wales for vascular surgery, upper gastrointestinal surgery and colorectal surgery as well as the main centre for major trauma. The hospital will continue to build and grow as a Centre Centre offering diagnosis, treatment and follow-on care including radiotherapy and chemotherapy. This includes the major cancer development starting this spring thanks to £3.2m of donations from local communities through the Lingen Davies Cancer Relief Fund.
This will ensure a safe, sustainable and long-term future for the Royal Shrewsbury Hospital.
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These proposals aim to ensure a vibrant and long-term future for the Princess Royal Hospital. Most patients will continue to receive most of their care as they do now and the hospital would be strengthened as a women and children's centre for Shropshire, Telford & Wrekin and mid Wales providing obstetric maternity, neonatal & special care baby and inpatient children's services.
This will ensure a safe, sustainable and long-term future for the Princess Royal Hospital
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How are the needs of patients in Wales who use the hospitals in Shrewsbury and Telford being considered as part of these plans? Does the Trust get paid for Welsh patients?
Powys GPs have been part of the Clinical Problem Solving Workshops and will be part of the Clinical Assurance Group, and there have been ongoing discussions with planners, providers and the CHC in Wales to ensure that the needs of patients in Wales continue to be considered.
There are no acute hospitals in Mid Wales and the nearest hospital for people in eastern Montgomeryshire and north east Radnorshire is in Shrewsbury. The population of mid Wales is too small and it is too sparsely populated to maintain a district general hospital in mid Wales. The Shrewsbury and Telford Hospital NHS Trust receives funding for each Welsh patient it treats, which supports the services it offers to patients.
The issue of payment for services across the border was resolved from the 1st April 2009 when Welsh Commissioners were provided with sufficient funding to pay English Trusts at the English Payment by Results tariff. There is therefore now no difference between what Powys Local Health Board pays and what English Primary Care Trusts pay for hospital services.
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The number of people over 65 will increase by 18% in Telford and Wrekin by 2012 (53% by 2022) and 17% in Shropshire County (44% by 2022).
The number of people under 15 is expected to decline in Shropshire County (7% by 2022) whilst it will grow in Telford & Wrekin (9% by 2022), although the absolute number of people under 15 in Shropshire County will continue to be higher than in Telford and Wrekin.
The increasing number of people over 65 and the increase in life expectancy has major implications for services which support independent living (e.g. for people with long term conditions) and where treatment is needed for conditions which are more common in the elderly (e.g. musco-skeletal services, cancer and heart disease).
When compared to national figures, Shropshire County is generally less deprived, with a low violent crime rate and a lower rate of teenage pregnancies. However, there are significant areas of localised deprivation within Shropshire County such as Oswestry and parts of Shrewsbury.
Available to download is a series of population pyramids showing how the profile of the population is projected to change in Shropshire, Telford & Wrekin and Powys.
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Yes. Throughout the process we have sought input and feedback from patients, the public and other key stakeholders.
Also, two pre-consultation meetings were held, one in Shrewsbury and one in Telford, where the proposal was also discussed and people gave their thought and opinions.
We will continue to seek the views of patients and the public throughout the process.
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Many people have been involved in putting the proposal together including GPs, hospital doctors, nurses, midwife, allied health professionals, other NHS staff, patient and public representatives, and partner organisations. Their ideas have been tested by members of the public and experienced clinicians and staff from outside of the area. All of this work was brought together to form the proposal that is now subject to public consultation.
Some of the steps in the process have included:
- Building on the clinical analysis and development that took place for the Developing Health and Healthcare process in 2008 and 2009. More information about this process is available in the Archive section of this website.
- Moving on from this to reflect the changing economic climate facing the country, the public sector and the NHS (e.g. See Briefing 15, February 2010)
- Clinical Problem Solving Workshops in August and November, involving hospital consultants, GPs and other staff. The papers for, and reports from, the first Clinical Problem Solving Workshop are available from the Event and Assurance Reports page.
- Discussion of the ideas emerging from the Clinical Problem Solving Workshop amongst hospital staff, primary care staff, public representatives, partner organisations. For example, this included Patient and and Public involvement workshops in Shrewsbury and Telford.
- Review of the proposals by a Local Assurance Panel with an independent chair, external clinicians from outside the area, patient and public representatives, local PCT representatives and observers from the Health Overview and Scrutiny Committees. The outcomes from the Local Assurance Panel were presented to the PCT and Trust Boards on 2 December 2010 (see Board Papers page), and the Local Assurance Panel will meet again on 28 February 2010 to receive an update on the further assurances they have requested.
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We cannot say that every single hospital consultant and GP in Shropshire, Telford & Wrekin and mid Wales necessarily agrees with all the proposals. Indeed, the majority of them would probably feel that bringing all our general hospital services together in a brand-new single hospital serving the whole of our area would be the ideal solution. However, given that there is no foreseeable prospect of the money being available to build a new hospital or a new women’s and children’s unit at Shrewsbury, we believe that this is the best option available to address the very real dilemmas faced by local NHS services.
Where difficult decisions need to be made it is rarely possible to reach complete consensus - indeed, differences of opinion help us to understand what the risks and concerns might be so that we can make sure that these are addressed.
Some people have asked us specifically which consultants, GPs and other staff support or oppose the proposals. We have not asked people inside or outside the NHS to formally record their views prior to consultation. The consultation process provides individuals and organisations with the opportunity to let us know their views on the proposals set out in the consultation document.
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Yes. We have involved GPs in the discussions. This includes GP representatives at the Clinical Problem Solving Workshops on 10 August and 17 November 2010 that developed the ideas for safe and sustainable hospital care.
GPs are also part of the groups looking at the detailed care pathways that are being discussed which describe the care patients would receive if this proposal was implemented.
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This programme built on the previous Developing Health and Health Care Programme, which was referred to in the introduction to the Trust Annual Report as well as in more detail in Section 4.3, in the risks in Section 5.2 (Availability of capital to renew estate and equipment, and Delivery of "Developing Health and Health Care") and in the forward plan in Section 5.3 (agreeing strategies for the challenged clinical specialities including inpatient paediatrics and emergency & vascular surgery).
The Trust's Annual Report is available from the Annual Report page of the Trust website.
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You can find out more from this website. It includes information about the consultation process, opportunities to become involved and have your say. Please feel free to link to this site from your public websites and intranets.
We are looking for volunteers to take part in focus groups for surgery, children's services, maternity services, gynaecology services and children's cancer services. The aim of these focus groups is to look at issues such as transport and clinical services in more detail. If you would like to get involved please email cath.mccomb@sath.nhs.uk
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We welcome invitations to attend your meetings and events to update and involve you in the changes to local hospital services.
If you would like us to attend your group please email cath.mccomb@sath.nhs.uk
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