‘Care Closer to Home’: Another Nail in the Coffin of Future Fit?

Today, Wednesday (1^st August), we have finally learned the plans for ‘Shropshire Care Closer to Home’ – community services in Shropshire – and the plans are as bad as they could be.

Future Fit relies on moving care out of the remaining acute hospital, whether that’s at Shrewsbury or Telford, and into community settings. There is a need for new and better community services. The bed, workforce and financial modelling of Future Fit are all dependent on this. The Pre-Consultation Business Case outlines plans for a 35,738 reduction in bed days, a reduction of 5,054 emergency admissions, and a bed base reduction of 110 beds[1]. If community services fail to prevent poor health and to treat people in the community when they do become ill, then Future Fit will also fail.

Then and now – what a difference. In August 2015, Dr Caron Morton – as Chief Officer of Shropshire CCG – wrote to local GPs to inform them of new investment in community services[2]. The plan was for the ‘transfer of financial resources into community provision – identified as £5.3 million recurrently per annum’.

And what has that £5.3m a year been replaced with? The ‘Care Closer to Home’ overview[3] released by Shropshire CCG today states bluntly, ‘SCCG has no additional money to pay for this way of working’! Instead, the plan is to close existing community services to pay for new services – but that means taking community NHS care away from people who depend on it now.

The plans themselves are limited. A frailty intervention team is located at the A&E at the Royal Shrewsbury Hospital – but for our rural communities, would be far better based at community hospitals. There are plans for improved case management for people with complex needs – welcome, but it is unacceptable that other patients will have their care taken away to pay for this. And there are entirely vague commitments to hospital at home provision, crisis response, and ‘step up’ beds. There are no costings and no budget. There are no details of what the provision will be in practice and how new staff will be paid for. There is no commitment to a future for Community Hospitals and Minor Injuries Units. Timescales are as vague as they can be – and we are even told ‘In fact it is difficult to provide an exact time frame for how long this change will take’.

These extremely sketchy proposals are put forward against a backdrop of financial crisis. The income of Shropshire Community NHS Trust – the main local provider of community services – has fallen by over 6% in the last 2 years. The Trust is attempting to make a further £3.062m annual recurrent cost savings this year. The money for new or improved community services is simply not in their budget.

Future Fit has had a bad week. The non-promise around community care is just one more example that we have seen this week of Future Fit being in crisis .

On Monday (30^th July), the Future Fit cuts and closure plans were discussed at a ‘Joint HOSC’ – the Health Overview and Scrutiny Committees from both Shropshire and Telford and Wrekin coming together to consider Future Fit at the mid-point of public consultation. It’s fair to say that many Councillors were deeply cynical – across both local authority areas, and across the political spectrum. The meeting was attended by SaTH’s Simon Wright, Simon Freeman and Julian Povey of Shropshire CCG, David Evans of Telford and Wrekin CCG, and Debbie Vogler and Pam Schreier from Future Fit. None of them will have been comfortable with the meeting.

Councillor Andy Burford (Chair of the Telford and Wrekin HOSC) asked ‘How can you really claim this is a consultation?’ and said that it appeared to be much more a process of ‘telling and selling’, and that ‘many feel it’s a foregone conclusion’. Councillor Heather Kidd talked about Shropshire’s rural communities, saying ‘The ambulance service fails us all the time’, and adding (on Future Fit) ‘The scepticism is huge’. Councillor Stephen Burrell said he was disturbed to hear Future Fit representatives ‘patting yourselves on the back for a turnout of less than half of one per cent at midpoint’. He challenged health bosses to ‘Come out on the record and say you have a predisposition to Option 1’. Repeatedly, Councillors raised the problems around transport in our area. Repeatedly, they raised the cynicism of the public where Future Fit is concerned.

On Tuesday (31^st July), Shropshire, Telford & Wrekin Defend Our NHS was passed information from a senior doctor at SaTH. The person concerned had attended a meeting – also on Tuesday – on the planned overnight closure of the A&E at Telford’s Princess Royal Hospital. The senior medic is very clear that SaTH intends this closure to happen, is angry about this, and believes that the Future Fit consultation is a sham. We have had separate and independent confirmation (from a SaTH Consultant) that the meeting took place.

Why would a senior staff member make this up? We believe them. A process of running down facilities at Princess Royal Hospital now will be seen by most members of the public, very reasonably, as pre-judging the outcome of the Future Fit consultation. The timing is extraordinary. We believe the plan from SaTH senior managers is to take a recommendation for overnight closure to the SaTH Board meeting of 30^th August. This is a matter of days before the end of the Future Fit consultation, and the intention was surely that this would be too late for the public to take the information into account in their consultation responses. The revelation of planned A&E closure causes huge damage to the credibility of Future Fit.

Gill George, Chair of Shropshire, Telford and Wrekin Defend Our NHS, said:

Future Fit is about hospital cuts – many fewer staff, and very brave assumptions about a reduction in people getting sick and needing hospital treatment. Looking after people at home or close to home instead is absolutely right – but it can only work if the staff and resources are available. Three years ago, the Future Fit plan was for an extra £5.3m a year for community services in Shropshire – and now the plan is for absolutely nothing, no money at all. This is genuinely shocking.

The attempts from SaTH to secretly take forward the overnight closure of the A&E at Princess Royal are an absolute disgrace. There’s no transparency in the Future Fit consultation. Thank goodness for staff members having the courage to come forward and speak out about this.

Behind all the empty rhetoric about better care, people’s lives are at stake here. Future Fit is a shambles, and that gets more obvious day by day. It really is time to pull the plug on Future Fit. We need money for patient care and frontline staff – not PFI schemes and vanity projects’.

[1] Future Fit Pre-Consultation Business Case. Capacity requirements. 10.1.1 and 10.1.2

[2] Letter from Caron Morton to GPs

[3] Shropshire CCG’s Care Closer to Home