We had another small but important victory on Monday. We’re winning a lot of the individual skirmishes just now, but it’s overwhelmingly clear that the war goes on.
Tuesday was the Governing Board meeting of Telford and Wrekin CCG. You’ll probably have seen the anger that preceded this. The meeting was not listed on the Meetings page of the CCG website, which meant it was almost impossible for members of the public to know that it was taking place. This was for a meeting that was intended to sign off the Future Fit Strategic Outline Case, the blueprint for closing an A&E and downgrading a hospital (either the Royal Shrewsbury or Telford’s Princess Royal). Senior managers of the CCG will have known how contentious this decision was going to be. Continue reading
Local health leaders are desperate to force through A&E closure, no matter what. Constitutions and Standing Orders? Transparency? Accountability to the public they are meant to serve? No, these are details, and to be disregarded if they get in the way of a cuts and closures agenda.
Tomorrow’s meeting of Telford and Wrekin Clinical Commissioning Group WILL be happening. This is meant to be a meeting held in public – but less than 24 hours before the meeting, it is STILL not advertised on the CCG web page that lists Governance Board meetings! The purpose of the meeting is to sign off the Future Fit ‘Strategic Outline Case’, the blueprint for closing an A&E and downgrading a hospital. They know that this is an incredibly controversial decision, but are apparently unconcerned by their failure to advertise the meeting properly.
Can you come to the meeting? It will be at 9.15 am on Tuesday 26th April, at the Reynolds Suite, Holiday Inn, Telford International Centre, St Quentin Gate, Telford TF3 4EH.
We need people there for two reasons:
- To tell them that the contempt for the public that is now on display is 100% unacceptable;
- To remind them that one A&E – wherever it is, the Princess Royal or the Royal Shrewsbury – is inadequate to meet the needs of Shropshire, Telford and Wrekin, and Powys. A&E closure WILL mean unnecessary deaths.
Below is the Editorial from the Thursday, 14 April 2016 edition of the Shropshire Star. It makes a complete break with the former position of the paper by suggesting it would be mad to close one of our two A&Es. With both CCG Boards refusing to automatically support the SaTH plans last week, the tide is turning. Support for the Future Fit programme is at an all time low.
We make no apology for returning to a familiar subject, Future Fit, which must be one of the most ponderous and protracted decision-making processes in Shropshire’s history.
And why are we revisiting it? Because nothing has happened. It is the theme of Future Fit that nothing happens.
But in the nothing that has happened we fancy that we detect a change in the quality of that nothingness. With Future Fit everything has been put off so often that it has virtually become the agreed policy by which Future Fit should become characterised. After all, it is not titled Present Fit, is it?
This week’s decisions by Shropshire’s health commissioning bodies are entirely in keeping. Shropshire’s Clinical Commissioning Group has deferred a decision on an outline strategy for the county’s two main hospitals. It follows a similar decision by Telford’s CCG. Both are asking for more details on how the plans would work.
Nothing to report from the front, then. However, this decision, or rather non-decision, may be a lot more significant than it might appear at first sight.
Perhaps for the first time in the whole process there is a sense of wavering about what the Shropshire and Mid-Wales public has been told repeatedly – that the only workable model would see just one accident and emergency department for the whole county.
The idea is that the lone A&E department would be supported by local urgent care centres. The questions and the doubts are multiplying. There is a tidal wave of need and redirecting it away from the hospitals will simply mean that somebody else gets swamped, unless they are given the extra resources to cope – an unlikely prospect.
Future historians will look back on what is happening now. Their research will reveal how hugely overworked Shropshire’s two A&E departments were, to such an extent that a little boy had to be taken to hospital by fire engine because there were no ambulances, and the reason for that was that ambulance crews were unable to get away from the Shrewsbury and Telford hospitals because paramedics were treating patients in the corridors.
They will take from the archives the faded Future Fit proposals and note that in these circumstances the central proposal was to close one of Shropshire’s A&E departments. And they will wonder if we were all mad.
There are two important meetings this week where ‘Future Fit’ plans for cuts and closure will be progressed – but one of them is going to be in a different place! Wednesday’s Board meeting of Shropshire Clinical Commissioning Group will now be at Shire Hall, Abbey Foregate – NOT at William Farr House, Mytton Oak Road.
The meetings are therefore:
- Telford and Wrekin CCG: Tuesday 12th April at 1.30 pm, Park Lane Centre, Woodside, Telford, TF7 5QZ
- Shropshire CCG: Wednesday 13th April at 9.00 am, The Shrewsbury Room, The Shirehall, Abbey Foregate, Shrewsbury SY2 6ND
In a genuinely extraordinary development, the CCGs (the decision makers in the local NHS) are admitting the desperate squeeze on cash, they’re worried about how Future Fit can be delivered, they’ve realised the need to assess the impact on ambulance services, they seem to have at least some suspicion that the modelling work behind Future Fit is nonsensical, and they’re starting to question the ‘efficiency assumptions’ in Future Fit (the jolly pretence that thousands of people will miraculously stop getting ill and won’t need any money spent on them). The language is polite, but the content says ‘Oh dear, we’ve suddenly realised this isn’t going to work’.
It would make more sense if they stopped flogging the ‘Future Fit’ dead horse and worked with the public and GPs on a Plan B – but nevertheless this is real progress. We now have to redouble our efforts to convince them of the evidence-based case that closing an A&E and downgrading a hospital, particularly in a largely rural area like our own, is the wrong way forward. There’s a simple logic behind this: A&E closure leads to people dying unnecessarily. That’s not what the NHS should be about.
Come to the meetings on Tuesday and Wednesday if you can.
The letter below was sent to Shropshire Clinical Commissioning Group, the people who get the money to spend on NHS service here, in response to their decision to almost halve the number of beds in our four community hospitals: Whitchurch, Bridgnorth, Ludlow, and Bishop’s Castle. The letter, from GP practices in the south west of the county, appears to have had a real impact.
We’ve heard from a meeting today that the CCG have backed off and the beds are no longer under immediate threat. There are still cuts to fight, but this victory shows opposition pays. Continue reading
Every time you think it can’t get any worse – it does
Shropshire CCG has now been placed under ‘Legal Directions’ by NHS England. This means what it says, basically. NHS England is now telling local NHS bosses what they can and can’t do. The Directions have been imposed because the cuts to our local NHS weren’t fast enough or deep enough to satisfy the bureaucrats at NHS England. The Directions aren’t about patient care or high quality services; they’re primarily concerned with ‘financial recovery’. The NHS England takeover is about driving through deep cuts to spending on NHS services. It’s particularly outrageous that these cuts are happening at a time when NHS England owes Shropshire £8.7m as part of its ‘fair share’ funding target.
It’s shocking that two of Shropshire’s MPs, Philip Dunne and Daniel Kawczynski, have welcomed this development. Which services do they think should be cut, then? You might want to ask them!
‘We might owe you £8.7 million – but you’ve got to make NHS cuts anyway’.
This is the brutal message from NHS England, as it takes over the running of Shropshire’s NHS. In February this year, the Interim Accountable Officer of Shropshire Clinical Commissioning Group (CCG) reported a ‘spending gap’ – a gap between income and expenditure – of £19 million[i]. She talked openly about making the cuts that were necessary to close the gap. At last week’s CCG Board, a paper was approved that proposed £18 million ‘efficiency opportunities’ and an overlapping programme of £10.1 million savings. The figures are dizzying. The cuts plans from local NHS bosses haven’t been enough. NHS England has intervened to ensure that ‘financial recovery’ is achieved.
Shropshire CCG was placed under ‘Legal Directions’ today. This means that the organisation than buys NHS care for the people of Shropshire is effectively run now by NHS England. There will continue to be a pretence that local GPs are in charge – but every single key decision will be scrutinised by bureaucrats from NHS England, senior members of staff will be appointed by NHS England, and, most seriously of all, deep cuts will be demanded by NHS England. The decisions on local NHS care for Shropshire will be made by NHS England bureaucrats.
The Bad News
Yesterday, the Board of the Hospital Trust (SaTH) voted for something called a ‘Strategic Outline Case’. It sounds like meaningless jargon – but this is the blueprint for closing an A&E and getting rid of most services at one of our hospitals. Yesterday we took a big step towards those incredibly damaging cuts to local healthcare. That’s the bad news.
Edwin Borman, Medical Director of SaTH, is quoted in the on-line issue of the Shropshire Star as saying ‘We can’t sustain two A&E departments currently due to being unable to attract the workforce we need.” This is also bad news. It’s a stance that shows a disregard for the guidance from the Royal College of Emergency Medicine, for one thing. These national experts in emergency care are clear that staff shortages are ‘poor justification’ for closing an A&E, and that you have to start from the needs of patients instead. Edwin’s stance also shows a disregard for the public consultation due to start in December this year. A position from SaTH that ‘We’re going to close an A&E whatever you and the national experts say because we’ve decided’ is not particularly helpful.
The Good News