This letter was handed to Matt Hancock, the current Secretary of State for Health at the Conservative Party Conference in Birmingham by a number of supporters of Shropshire, Telford & Wrekin Defend Our NHS. It contains specific proposals that would ensure there was no need to close either A&E.
2nd October 2018
Matt Hancock MP
Secretary of State for Health
Dear Mr Hancock
As residents of Shropshire, Telford and Wrekin, we are asking for your help.
You will know about the massive crisis in our local hospital trust, ‘SaTH’. The trust runs two A&Es and hospitals, at Shrewsbury and Telford. You are of course aware of the independent review of avoidable deaths and occurrences of harm in maternity. Our experience is that there is a continuing culture of denial at Board level. How is it possible to learn from mistakes if they are not acknowledged in the first place?
We assume, too, that you will know of the CQC inspection that has just finished. The leaked CQC letter has been widely reported, and it identified serious risks to patient safety. It cannot be acceptable ever in the NHS for a diabetic patient to be left without food or fluid for 15 hours, for a high dependency area to be left completely unstaffed for 15 minutes, or for a patient with signs of deteriorating sepsis to be left on a trolley in the corridor without adequate care. There is a desperate shortage of staff and beds at both hospitals, and current reconfiguration plans will make this much worse.
The CQC letter revealed that ‘staff across all areas and grades raised concerns with us’. Had those staff lost confidence in the Trust’s internal reporting mechanisms? And did Trust leaders not know about the totally unacceptable standards of patient care – or did they know and tolerate this?
Most recently (last Thursday), the SaTH Board decided on overnight closure of the A&E at Telford’s Princess Royal Hospital. This will create a healthcare desert in Telford between 8pm and 8am, with no local access to emergency or urgent care. The Urgent Care Centre already closes at 8pm, and the GP Out of Hours service has been sharply cut. People are frightened about what’s happening.
It’s not just an issue for Telford. The Board’s plan is that ambulance patients will be diverted to Wolverhampton or Stoke. The configuration of services means this will affect patients across Powys and Shropshire too – around 540,000 people across a vast area of over 2000 square miles. Lives are at risk if patients with time critical conditions have to travel from Powys or South Shropshire to Wolverhampton. In any case, Stoke and Wolverhampton don’t have capacity; and the Welsh and West Midlands Ambulance Services don’t have capacity.
Self-conveyed patients from the Telford area are now intended to go to the A&E in Shrewsbury overnight. This is nonsense. Currently Shrewsbury routinely closes its doors and diverts patients to Telford. This happened last Saturday and Sunday, for example. What on earth is going to happen when Telford is closed, and many Telford patients are directed to Shrewsbury? We are very scared, too, for children, who face fragmented and unsafe care.
We believe this decision on overnight A&E closure is grotesquely unsafe. This is not about patient safety. Chief Executive Simon Wright said recently that the intention is ‘spreading the risk to other parties’ – but it’s patients who in reality carry that risk and suffer the adverse consequences.
SaTH is now acting without the support of local communities, and without our trust. We respect and value the brilliant work of doctors, nurses and other healthcare staff – but at Executive level, our hospital leaders have lost their way. The problems at SaTH are systemic. They are simply not going to be resolved by the current leadership team. We have lost confidence in the Chief Executive and the Medical Director because they have failed to ensure patient safety, and they are unable to acknowledge this.
We are asking you to intervene. Without change, the lives of our families, our friends, and our communities will increasingly be at risk.
Concretely, we know from the Chief Executive of SaTH that there is a need for five to seven middle-grade doctors to stabilise the A&Es and enable both to stay open. We urge you, as Secretary of State for Health, to help. We spoke to a senior doctor for ideas and advice. He thought that an immediate short-term plan, between now and the end of the year, would be to work with the RCEM to identify any Emergency Medicine doctors who would be available – for example, by working through their holidays or returning briefly from retirement – who could keep the service going. They are there. It would not be an ideal arrangement – but would be safer than closure. This would also require identification of the remuneration required to make it worth their while.
The medium-term solution relies on Health Education England. HEE could seek to allocate more trainees to SaTH. HEE also has a strong recent record of locating and supporting overseas doctors into NHS work. There is a pool of Commonwealth doctors, particularly from India and Pakistan, who have applied for and been accepted for NHS jobs over the last year, but have not been able to obtain visa. HEE could work with the Home Office, obtain a list of these individuals, and through multi-agency working ensure that their visas are expedited and visa costs are paid. These doctors are needed here. There are also Greek doctors who will work here, given support; again, they are needed.
And the longer-term solution lies with SaTH. There are experienced middle-grade Emergency Medicine doctors working in the UK who would welcome support in making the transition to Consultant level. Contracts with significant protected time for supervision and training from Consultants attract applicants; those staff develop their skills and function at a higher level; there is a win-win situation. Those staff often have families, and would need a ‘golden hello’, and support with relocation and accommodation costs.
The doctor we spoke to said ‘SaTH is in complete bloody melt down’. With its current leadership and its current practice of staff who are undervalued and bullied, there is no long-term solution. Morale is rock bottom, and SaTH has become a Trust to avoid.
Another strand in achieving real change could be a very senior Emergency Medicine doctor from a different organisation – seconded perhaps half time, on a fixed term basis – to give the leadership that is needed. We also know that there is an exodus of experienced nurses and midwives from SaTH. The solution to this is also likely to be external: experienced clinical leadership by a colleague from a high performing organisation.
And we need certainty: not the decade-long threat of A&E closure and hospital downgrading, but a commitment to retaining BOTH our A&Es and BOTH our hospitals. One A&E in an area of over 2000 square miles cannot work. If this takes additional funding, please help secure it. This is a Trust that has been failing for a good few years now, but ‘melt down’ is now the most appropriate description. Over half a million of us rely on this organisation for our care. Please help.