The following letter has been sent to all our local MPs. We are calling on them to ask the Secretary of State to halt Future Fit. He can do that under the 2012 Health & Social Care Act because the decision has been referred to him by Telford & Wrekin Council. The Secretary of State has asked his Independent Reconfiguration Panel [IRP] to make recommendations, but the final decision is his. We made our own 124-page submission to the IRP which was accepted to be included in the Panel’s deliberations. You can download it from here.
On the 18th February, Telford and Wrekin Councillors voted unanimously to refer the decision on Future Fit to Matt Hancock, Secretary of State for Health and Social Care. That referral is now with the Independent Reconfiguration Panel.
The reality is that Future Fit will lead to worse healthcare not just for the people of Telford and Wrekin, but for Shropshire and Powys people too. It is also clear that Future Fit cannot solve the financial crisis in our local NHS, but will exacerbate it.
The national direction of travel in the NHS – rightly – is towards integration, and a reduction in hospital admissions through improved prevention and community-based services. These strands underpin the Five Year Forward View and the NHS Long Term Plan.
Future Fit is an entirely acute-centric project. In October 2015, the initial whole system approach was downgraded to become SaTH’s Sustainable Services Plan. The proposals were written by SaTH, were solely about acute hospital care, and were far, far removed from national priorities. You will recall that the public consultation was not about a vision of whole system healthcare, but was just about which town would have the Emergency Centre and which would have the Planned Care Centre. The late additions to Future Fit on community initiatives show just how embryonic this work is. The Future Fit approach is hopelessly out of step with nationally recognised good practice.
Our detailed submission[i] to the Independent Reconfiguration Panel (IRP) has been accepted for consideration as part of the Future Fit review. The submission analyses the history of Future Fit, the current Future Fit proposals, and the core components of an alternative to Future Fit. We request that you take the time to look at the full submission, but we include brief examples here:
- Original Future Fit plans stressed the need for joined up healthcare, with funding for community services and a transformed prevention and wellbeing agenda. There was a strong focus on local services: a network of rural Urgent Care Centres, Community Hubs and Local Planned Care Centres, and an enhanced role for community hospitals.[ii] These key strands have been lost.
- Future Fit treats access as an afterthought – but the evidence base shows that access to healthcare is strongly related to patient outcomes (for emergency[iii] and non-emergency[iv] care alike). Centralisation makes little sense in an area four times the size of Greater London. There will be an immense impact here on rural communities in Shropshire and Powys (as well as emergency patients and their relatives in Telford and Wrekin, of course).
- We have strong concerns over the clinical model proposed in Future Fit, many of them raised with us by clinicians. Neither Urgent Care Centre is likely to be able to safely treat 65% of A&E patients. Transfer arrangements from Telford to Shrewsbury that consist of dialling 999 and waiting for an ambulance carry avoidable risk.[v] The Planned Care Centre is to have no Critical Care facility and no out-of-hours anaesthetic cover, again creating risk.[vi]
- We are in a period of escalating demand[vii] for A&E and hospital beds – yet Future Fit closes an A&E, reduces the bed base, and cuts the number of staff. The numbers don’t add up – and we will have a single Emergency Department and a single acute hospital that are not fit for purpose.
- The finances do not stack up either.[viii] SaTH now expects to make cuts of £18.9m this year and over £48m by 2023/24.[ix] The new proposal to increase the number of A&E nurses is both overdue and welcome – but this small investment is far outweighed by an escalating financial crisis that will necessarily impact on patient care. And across Shropshire, Telford and Wrekin, we face NHS cuts of £51.6m this year, with a further £53m over the coming four years.[x] NHS England funding arrangements let down smaller hospital trusts like SaTH; Shropshire CCG, with its rural and older population; and Telford and Wrekin CCG, with above average health need but short-changed by £17m against the NHS England average funding.[xi] As Telford and Wrekin CCG cuts hospice funding and funding for services supporting older people, people with dementia, and people with disabilities, we have a glimpse of how NHS cuts will cause real harm.
We need two things to happen now. One is the replacement of Future Fit by a whole system approach, planned and coordinated, with prevention and care closer to home at its heart (as opposed to being underfunded post hoc ‘bolt-ons’). The second is a serious review of the NHS England allocations and national tariff systems and how these result in funding that cannot meet the health needs of people in our area.
Without these things, we risk an unmanaged slide into chaos: into £11m a year recurrent payments for new hospital buildings that have too few staff and too few beds; a crumbling community infrastructure; an acute ‘solution’ that cannot cope with escalating demand; and community and prevention initiatives that are about self-care, information, and sign-posting instead of high quality clinical care.
Local people deserve something better than this. This isn’t a beauty contest between Shrewsbury and Telford that Shrewsbury has ‘won’. This is about worse care for all of us: Shropshire, Telford and Wrekin, and Powys alike. Please take the time to look at the detail of Future Fit, and please use your influence with the Secretary of State for Health and Social Care to have this project scrutinised in detail. And please also raise with Matt Hancock the anomalies of funding that let down small hospitals, rural CCGs with older populations, and – for unclear reasons – Telford and Wrekin CCG. Good healthcare should not be a luxury reserved for people who live in big cities.
Please note that this is an open letter that will be shared with local media.
Gill George, Chair
Julia Evans, Secretary
Shropshire, Telford and Wrekin Defend Our NHS
[i] Shropshire, Telford and Wrekin Defend Our NHS. Future Fit: Unfit to Progress. 1st May 2019. https://shropshiredefendournhs.files.wordpress.com/2019/05/ff-irp-submission-v1.0.pdf
[ii] IRP Submission. 2. Future Fit: A History of Discontinuity and Chaos
[iii] IRP Submission. 3.7 Access and Emergency Care
[iv] IRP Submission. 3.8 Non-Emergency Access
[v] IRP Submission. 4.2 Urgent Care Centres/ Urgent Treatment Centres
[vi] IRP Submission. 4.3 The Planned Care Centre at Princess Royal Hospital
[vii] IRP Submission. 5.1.4. An unparalleled escalation in demand
[viii] IRP Submission. 5.3 Financial Sustainability
[ix] SaTH. Financial Strategy. Board papers for 30th May 2019. https://www.sath.nhs.uk/wp-content/uploads/2019/05/190530-25-Trusts-Financial-Strategy.pdf
[x] Telford and Wrekin CCG. System Plan. 14 May 2019. https://www.telfordccg.nhs.uk/who-we-are/publications/ccg-governance-board/governance-board-papers/2019/may-2019/5831-09-system-operating-plan/file
[xi] IRP Submission. 8.12. NHS Funding: Time for a re-think