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
There’s some good news as well. Over 50 members of the public attended the Board meeting to express our overwhelming opposition to closing either A&E, Shrewsbury or Telford, and our commitment to both of our hospitals remaining as District General Hospitals. It was a meeting with a buzz. Small children gave daffodils to Board members, urging them to think again. We held placards with slogans that included ‘Miles cost lives’, ‘Tell MPs, save both A&Es’, and ‘Keep our hospitals open’. We also tackled Board members with serious, evidence-based contributions. We told them about the national evidence that what they’re doing is wrong. We told them about the regional experts in the West Midlands Clinical Senate who said Future Fit is full of financial and clinical risk, and that there’s a need for a backup plan. We told them that the money for new community services has been taken away, and that there are to be no Rural Urgent Care Centres – making cuts to hospital services extraordinarily dangerous. We told them that longer ambulance journeys kill, and that increasing the average length of journeys would pile the pressure onto an ambulance service that is already in crisis.
We did our job, as informed and responsible members of the public, very well indeed. We were very pleased that most Board members seemed to be listening. They didn’t seem to have known about the absolute crisis in the funding of community services – and they said they would need to ‘Press the stop button’ and halt the cuts in hospital care if there wasn’t going to be the money for community-based alternatives. Importantly, they acknowledged that they might not have looked at all the evidence. They said they would find a way of talking to the public and giving serious consideration to evidence that they might have missed.
Can we trust them? Who knows – and it almost doesn’t matter. Whether we believe them or not, we’ve got an opportunity to put a serious, detailed alternative to Future Fit. We’ll base it on national guidance from expert bodies, on research evidence, and on best practice for areas that are largely rural and that have older than average populations. The challenge we’ve had all along is that SaTH has been stuck for several years in a rigid mind-set of ‘We must close an A&E’. Yesterday felt like a turning point in terms of at least a glimmer of a chance that they will put patients first and look at an alternative. That’s a big step forward.
Earlier in the week, we sent out around 700 letters to senior NHS staff and to MPs and councillors in Telford and Wrekin and Shropshire. The case we argued yesterday is spelled out in those letters – and you may want to take a look yourself. There’s a careful evidence-based letter for NHS staff here, while the more accessible version for MPs and councillors is here. We’ve had some very positive responses. It’s clear that GPs in particular are very, very unhappy with what’s happening in our local health service. If we end up with major cuts in hospital care with no community services in place, it’ll be GPs (and patients of course) who carry the can.
The Other News
A lot’s been happening this week. Shropshire Clinical Commissioning Group (CCG) met on Wednesday, and voted to push through cuts to spending on community hospital beds of between £3.6 million and £5.1 million. The loss of these beds would lead to a devastating reduction of care for people in Shropshire, particularly in rural areas and market towns. Cuts on this scale – coupled with the abandonment of Rural Urgent Care Centres – mean that that the viability of community hospitals themselves would be undermined. Most seriously of all, the Community Trust is a small organisation, and it simply can’t afford to lose such a large slice of its income. If the future of the Community Trust as an organisation isn’t secure, that leaves an uncertain future for all our community services: district nursing, physiotherapy, podiatry, continence advice; a whole host of unglamorous but essential services that contribute overwhelmingly to giving people a decent quality of life.
The CCG meeting was genuinely shocking. Board members at the CCG nodded through these devastating cuts with no apparent awareness of or even interest in the consequences for patients. From their perspective, it seemed that the meeting was a slightly irritating formality. We suspect that many of them had not actually bothered to read the paperwork, given that they seemed mildly surprised when we challenged them on cuts to community hospitals.
Bizarrely, today’s Shropshire Star carries a story denying that they have made a decision to close community hospital beds. Sorry, chaps – you need to do better than that. It’s in your own paperwork, and you all agreed with it two days ago. Check out pages 14 and 47 of the Operational Plan, in the papers for the 30 March meeting.
Fortunately, the community hospital cuts are not a done deal. Shropshire Community Trust met on Thursday morning. This wasn’t the embarrassing caricature of a meeting that we saw from Shropshire CCG the previous day. It was a thoughtful, transparent and principled meeting of Board members who cared about the future of local services. Board members talked about the dangers of cuts of this magnitude, said they couldn’t be associated with this, and described Shropshire CCG’s actions as ‘outrageous’.
To their absolute credit, Board members at Shropshire Community Trust are set to reject the contract offered by the CCG and to seek mediation. They have more discussions taking place next week, but we hope they stand firm. We offer them our sincere support. There has to be a point where NHS leaders say, ‘No, this is a cut too far’.
In yet another meeting – a briefing meeting on the Strategic Outline Case – we learned yesterday evening that the deficit across health organisations in Telford and Wrekin and Shropshire now stands at a staggering £40 million. Every single one of our NHS organisations is making cuts that will harm patients. This isn’t about bad management. It’s certainly not the fault of health workers, who are doing a heroic job in increasingly difficult circumstances.
So what is happening? The NHS nationally has been starved of core funding since 2010, and the NHS allocations policy discriminates against rural areas and areas with an older population. It’s a damaging combination. Our NHS locally has hit its ‘perfect storm’ moment. A local child was taken to A&E in a fire engine the other day, because there were no ambulances available. Ambulances are stacked up five deep outside our A&Es because there isn’t enough A&E capacity. Our A&Es are overflowing, with patients waiting for hours on trolleys in the corridor, because there aren’t enough beds for patients to be admitted to. And one of the key reasons for the shortage of beds is that community NHS services and social care are inadequate, so that patients cannot be discharged from hospital when they could be. The Princess Royal and the Royal Shrewsbury are in crisis.
The answer CAN’T be more cuts. There’s a desperate need for our MPs and councillors to drop their valiant attempts to ignore the financial crisis in the NHS, and to start fighting for adequate funding for our area. This isn’t Telford versus Shrewsbury. This is about having an NHS that works for all of us going forward. At the moment, that’s looking pretty questionable.