Shropshire’s NHS ends 2016 in deep trouble – but in better shape than it would be without the Defend Our NHS campaign.
It’s been an extraordinary year, with the scale of the attacks on the NHS becoming increasingly clear – but also with mounting evidence of ordinary people in Shropshire, Telford and Wrekin being willing to stand firm and defend the healthcare we all depend on.
In Shropshire, Telford and Wrekin Defend Our NHS, we reckon we’ve achieved a great deal in the last 12 months. We stopped ‘temporary’ A&E closure last winter, and overnight A&E closure in the spring. We forced the re-opening of Stroke Rehab at Shrewsbury, following the disgraceful unannounced closure of the service in June. We stopped the £670,000 cuts planned by Shropshire CCG in August, preventing savage cuts to services for people with mental health problems, and services for frail elderly people. In October, we organised the tremendous demonstration in Wellington against closure of A&E and Women’s and Children’s at the Princess Royal. And very, very importantly indeed, we’ve reduced the Future Fit cuts and closure plans to chaos. Currently we’re working alongside local groups to defend rural maternity services against shockingly brutal attacks, with some real victories behind us already. We believe we’ve saved lives this year, and we’re very proud of that.
Next year, though, will be even tougher as the NHS financial crisis deepens. We’re set to see the biggest cuts in the history of the NHS. In 2017, we’ll face the fight of our lives to stop the dismantling of local services.
We need your help. We need to build a network of campaigners in every town and village. We need people who can help organise petitioning and leafleting, lobby our MPs and councillors, write letters to local papers, talk to their neighbours, come to consultation events and argue the case for both our A&Es and hospitals and for the funding to make it happen… If you think you can take on a bit more of a role, please send a quick email to email@example.com . Our NHS may depend on you!
Future Fit – It’s Now Officially Future UNFIT
The biggest problem faced by the champions of Future Fit is that proposals to close an A&E and downgrade a hospital are patently daft, and almost no one supports them. Our two hospitals, in Shrewsbury and Telford, serve a population of well over half a million people living across an area of more than 2000 square miles. Size wise, that area is roughly equivalent to 19 Birminghams. It’s an area that’s 90% rural, with a poor road network in many areas, and shockingly bad public transport.
In an area like this, we need BOTH our A&Es, and we need BOTH our hospitals to remain as District General Hospitals. When health bosses argue for closure and downgrading, they’re deliberately ignoring the evidence that longer journeys to emergency care kill. They’re ignoring the evidence on the crucial importance of access to all healthcare, particularly for people in rural areas. They’re inventing complete fairy stories about the number of patients who can be treated in ‘Urgent Care Centres’, conjuring up statistics that have not been achieved anywhere else in the country (and that the national experts at the Royal College of Emergency Medicine regard as nonsense).
It’s no wonder that Future Fit is on its last legs. It deserves to be. The Local Medical Committee, representing GPs across the county, has described Future Fit as ‘naïve to the point of being dangerous’. Future Fit was rejected by Telford and Wrekin CCG on 12th April, and by Shropshire CCG on 13th April. It was brilliant to see both Boards being accountable to the communities they serve. On 26th April, Telford and Wrekin CCG bottled putting Future Fit to a vote following massive public protests that they had attempted to sneak it through by not advertising their ‘public’ meeting. In a magnificent display of common sense, Shropshire CCG voted down their own Chair and Accountable Officer to reject Future Fit at a Joint CCG Board meeting on 10th May. Telford and Wrekin CCG voted in favour at that same meeting, though on a split vote. Finally, after much arm twisting and some downright dishonest claims around finance, Shropshire CCG voted through the Future Fit ‘Strategic Outline Case’ on 29th June.
The project staggered on, with umpteen re-writes, a third model of acute care, ever-changing proposals about the number of hospital beds and what would happen to cancer care – and an eventual announcement that Telford’s Princess Royal Hospital would lose its A&E and Women’s and Children’s Centre, and Shrewsbury would lose its planned care. The plan had been to nod through an ‘Outline Business Case’ in secret, delegating decision making powers to a small joint CCG committee. Defend Our NHS pointed out that they’d be acting illegally if they didn’t hold that meeting in public. And when the meeting was finally held on 12th December, over 150 members of the public attended – and many of us spoke passionately about the need for adequate funding of our NHS and on the need for both our A&Es and hospitals. Telford and Wrekin CCG, to their absolute credit, voted against progressing Future Fit. Shropshire CCG, sadly, nodded it through – but without the support of both CCGs, Future Fit cannot be progressed.
Where are we now? Who knows. They could cobble together the next quick fix to Future Fit, and they’ve done that many times before. They could and should walk away from a failed project. Telford and Wrekin Council has agreed, in a unanimous cross-party vote, to seek legal action against the CCGs if they take forward the planned closures at Telford’s Princess Royal Hospital. The level of crisis is unparalleled.
The project’s in chaos. We’ve done a brilliant job in helping it get there. The public view is clear. It would be a disaster to close the A&E and Womens and Children’s at Telford, and downgrade the hospital. Equally, it would be a disaster to close the A&E at Shrewsbury and downgrade the hospital. We need BOTH – and we need our NHS to be properly funded to pay for them. Cuts kill. Why should we pay with our lives because a decision has been taken to starve the NHS of essential funding?
Future Fit is Being Quietly Buried
Health bosses know Future Fit is a completely discredited shambles, so they’ve been engaged in a quiet rebranding exercise. The hospital trust, SaTH, now talks about its Sustainable Services Programme rather than Future Fit. The content is the same, though: slashing costs, closing an A&E, downgrading one hospital to a planned care centre (and taking away planned care at the other) – and also cutting hospital services by around 30%.
The same content is there in a cuts document called the Sustainability and Transformation Plan (STP). There are 44 of these STPs across England, meant between them to slash NHS costs by £22 billion. Our local plan is genuinely shocking. It’s meant to cut NHS spending in Shropshire, Telford and Wrekin by around £150 million a year and to cut a staggering 2000 local NHS jobs. It’s OK though – because someone’s decided that the vision is for Shropshire, Telford and Wrekin, and mid Wales to be the healthiest half million people on the planet. Yes, seriously. That’s the claim.
There’s some genuinely whacky stuff in the document. Remember the planned 30% reduction in hospital activity? A lot of that work will be magically picked up by something called ‘community resilience’. Families, friends and neighbours are to fill the gaps left by the loss of 2000 health workers, £150 million a year cuts, and adult social care that is now recognised as being at a ‘tipping point’. This is sheer nonsense. Of course we all want to live in communities where we look out for one another and help one another out – but that has to be as well as statutory services, not instead of them.
There is to be an increased emphasis on prevention – which is great, and welcome. The problem is that public health spending has been slashed. To make big public health changes at population level, you need national commitment, serious funding – and often a couple of decades to see real change. There are no quick fixes around prevention.
The third strand of the solution is a nice cheap one. There will be more ‘self-management’ of health problems. That costs a lot less than paying health workers!
The leader of one of the organisations working on the STP let slip that it would need £100 million to make the community-based solutions work. The amount actually available is around £6 million. It’s no wonder that many GPs are desperately concerned. They’re already stretched to the limit. When self-management and community resilience fail, it’s GPs who will be expected to pick up the work.
The STP relies on £311 million capital investment, not for healthcare but for new hospital buildings. The government has pushed through a sharp real terms reduction in NHS capital spending, so there’s very little funding available centrally. The STP raises the spectre of the hospital trust entering ‘joint venture partnership arrangements with private partners’. There is a very real risk of our local NHS being locked into a PFI scheme or a variation of PFI. This would amount to pouring money down the drain for the next 25 or 30 years, and would be one of the stupidest decisions they could possibly make.
The whole thing is a car crash in slow motion. Many people working on the plans will admit quietly that this can’t possibly work. Tellingly, the leaders of both our councils – Shropshire and Telford and Wrekin – regard the STP as nowhere near being a workable document.
The STP for our area was rejected by NHS England. The NHS England criticism has been leaked, and it’s damning. Astonishingly, the feedback is officially regarded as top secret, and hasn’t even been shared with the Boards of local NHS organisations. The NHS England comments include:
- Regionally there is little confidence in the STP as the basis for operational planning
- The STP remains very acute focused and does not articulate a clear plan for out of hospital and place based care
- There is no exposition of how the system will address the capital requirement or how other effectively alternative scenarios have been considered
- ….limited description of impact on community, MH (mental health) services and RJAH (Robert Jones and Agnes Hunt)
- There is limited evidence of real engagement with the non-acute clinical community, particularly GPs
And so on, and so on. It’s a devastating critique. As it happens, these are very accurate comments – and in line with what we’ve been saying for a while. Sadly, though, the biggest concern from NHS England seems to be that the STP ‘does not address the CCG deficit position’. NHS England told local health bosses to go away and re-write the document by 23rd December – and to come back with a plan for even bigger cuts. The new version isn’t in the public domain yet.
The STP is a proposal for cuts that will devastate NHS services in Shropshire, Telford and Wrekin. There is a tough, tough fight ahead of us. Yes, we’ve got to fight the cuts service by service, but there’s no real solution there. We also need our MPs – and especially Philip Dunne as Health Minister – to acknowledge the financial crisis in the NHS, and lobby hard for additional funding.
A Major Threat to Maternity Services
There was no room at the inn in Shropshire this Christmas. Bridgnorth Midwife-Led Unit (MLU) was closed on Christmas Day. Shrewsbury’s MLU was closed on Christmas night. Oswestry’s MLU was closed overnight on 29th December, and Ludlow’s MLU will close tonight, on New Year’s Eve. The closures are needed because Telford’s Maternity Unit is understaffed. Women and babies who are receiving postnatal care get kicked out when the MLUs are closed. Women who may go into labour are contacted and offered an alternative place to give birth. Women who need advice or support from their local team of midwives just have to do without.
We’ve been told this is about ‘short-term staffing issues’. We don’t believe this, because we now know from local mothers that the closures have been going on at least since March. This is about a hospital trust that’s just not employing enough midwives. The clinical risks are significant, and we are challenging this policy hard. This creates a lottery with the safety of mothers and babies. It’s completely unacceptable.
The news of closure follows huge public protests (and a demo of 10% of Ludlow’s population) that forced the re-opening of Ludlow’s Maternity Unit, following what was intended to be permanent closure in October. We’ve also seen the beating back of threats to close all three of our rural MLUs from 1st April 2017, and a successful challenge that reversed the hospital trust’s decision to scrap postnatal care at Oswestry, Bridgnorth and Ludlow, and make midwives available only on an on-call basis overnight. These fights have been won through a brilliant united approach from new campaigns: Save Ludlow Maternity Unit, Save Bridgnorth Maternity Unit, and save Oswestry Maternity Unit. We’re really pleased to be working with these groups in safeguarding maternity care. Sadly, the threats have not gone away. Hospital bosses refuse to make any commitments to a long term – or even medium term – future for these essential local units. They’ve been clear that this is about cutting costs, and they think rural maternity care is too expensive. So much for care closer to home!
We’ll end where we started. It’s been a tough year, but a hugely successful one in resisting – at least in part –some of the attacks on healthcare. Next year will be tougher. The hospital trust plans £6 million cuts before April. Telford and Wrekin CCG plans £6 million cuts next financial year and £6 million cuts the year after that. Shropshire CCG continues to be in a dire financial position, with planned cuts of £21.6 million in this financial year, a deterioration of £16.7 million on top of their existing deficit, and plans to ‘accelerate the pace of delivery of savings’. There are proposals in the STP for £3.8 million cuts to community hospitals, and for a further £3.8 million cuts to orthopaedic care (including hip and knee replacement surgery). We cannot do nothing while essential services are lost.
We know there are some big fights ahead. If you can get more involved in the campaign, send us an email: firstname.lastname@example.org