That was the comment at the end of the Joint CCG Future Fit meeting from Dr Julia Buckley, a councillor from Bridgnorth. From the glum faces of the CCG members sitting at the top table, they have no confidence at all that health outcomes will be better under the Future Fit regime they voted for this evening. They looked miserable and at times they looked scared.
They voted unanimously, and with no real discussion between CCG members, to go to public consultation with a ‘preferred option’ of closing the A&E, the Women’s and Children’s Centre, and acute care at Telford, and closing Planned Care at Shrewsbury. That was their preferred option, but not the preferred option from the 100 members of the public who were also in attendance. There was very little support for the top table’s option; muted applause for speakers who argued to keep the A&E at Telford and close it at Shrewsbury; and loud applause and cheers for the contributions calling for both A&Es, both hospitals, and for decent community services instead of the current cuts.
There were a few stunning evasions – and a few stunning admissions as well.
The evasions: in his introduction, Telford and Wrekin Accountable Officer David Evans worked hard to give the impression that Future Fit had been given a clean bill of health in an independent review carried out by KPMG. He devoted a single low-key sentence, in the middle of the presentation, to the great gaping holes identified by KPMG. David said ‘There were some minor points that it (the review) came up with: one was around the clarity around the funding availability and affordability and assurance around the proposed funding for the programme; one was around community models to address community and planned care…’
These are not, by any standards, ‘minor points’. The independent review actually said ‘It is essential that progress is made against each of these issues before the programme moves forward to public consultation and a decision-making business case’[1]. To describe these as ‘minor points’ is misleading in the extreme.
The Joint Committee has just voted to progress Future Fit when they haven’t a clue where the money is going to come from or whether or not the scheme is actually affordable. Frighteningly, hospital trust SaTH is talking in terms of a PFI-style deal, locking the NHS into an expensive 25 or 30 year contract – to pay for shiny new hospital buildings at the precise time that care is being moved out of hospitals into community settings. This makes no sense at all.
And the lack of solutions around community services is equally frightening. The review report said, ‘it is currently not yet clear how the local health economy will execute its community reconfiguration, nor how this will be funded’ – but this means that 30% of care is being moved out of acute hospital settings, when no one has any idea what will happen to those patients.
Those two facts alone mean that approval of Future Fit was a negligent decision. The independent review said it was essential to make progress on these things before public consultation takes place. That recommendation from the independent review was completely ignored.
The admissions were equally astonishing.
Health bosses have always claimed that closing an A&E and downgrading a hospital will miraculously solve staffing problems. This evening they changed their minds. Telford and Wrekin CCG member Geoff Braden commented on the ‘assumption’ that going to a single site would resolve the staffing issue, and asked ‘… what we need to do to assure is that the single site will provide us with a resolution’. Telford and Wrekin Accountable Officer David Evans replied ‘I don’t think moving to a single site necessarily resolves all the workforce problems’. He felt it would make it easier having staff in one place where they could support and mentor one another, but his main conclusion was ‘I think we need to look at the workforce model in a different way’ (without actually explaining what that was). Jo Leahy, at the end of the meeting, said ‘We’ve got to be really innovative about workforce’. Other Committee members shared concerns about the national shortage of consultants – and nobody expressed any belief that a single A&E or single acute site would end SaTH’s recruitment problems. In a two hour meeting, the claimed main reason for Future Fit disappeared in a puff of smoke.
The Committee recognised that Future Fit will put extra pressure on the ambulance service, and acknowledged that the ambulance service isn’t up to scratch now. It’s all right, though. Dr Jo Leahy, Chair of Telford and Wrekin CCG, explained ‘We’re going to require the ambulance service, including the Welsh ambulance service, to really up their game in terms of response times’. Meeting Chair Simon Brake commented that there were no plans to change the configuration of the ambulance service or the amount of finance they get. It’s hard to see how these improvements will come about. Sylvia Jones, a member of the public, commented on the recent two hour wait for an ambulance to attend a young man with head injuries following a motorbike accident. This is a service that is just not working. Wishful thinking will not resolve the problems with the ambulance service; it needs money.
And on Outpatient appointments and Diagnostics – who knows what’s happening, because the story keeps changing! SaTH’s December 2016 Outline Business Case states that Outpatients and Diagnostics will be available at both sites. Tonight, David Evans listed services to be offered at each site – and listed Outpatients and Diagnostics only at the Planned Care site. If he’s right, that means extraordinarily lengthy journeys for Shropshire patients to access very routine care. If he’s wrong, it’s a mistake that needs to be corrected.
We’ve always been told that Future Fit is about great care for everyone. Tonight, we heard the admission – for the first time in public – that there will be losers. David Evans summed up the debate by claiming a benefit for most people ‘while recognising of course that for some parts of the population there would be a disadvantage’. He went on to advise the Committee that ‘one of the founding principles was to try and make a decision based on the basis of the greatest good for the majority’. David Evans is completely wrong. The founding principles of the NHS are about comprehensive healthcare and universal healthcare – about all healthcare being available to all people. Tonight, David Evans reversed the ethos of the NHS, and CCG members voted with him. It’s no wonder that members of the public responded with real anger.
There were some powerful contributions from members of the public, including Councillor Julian Dean speaking for Shropshire, Telford and Wrekin Defend Our NHS; Sylvia Jones from Clunton Parish Council; and Dr Julia Buckley, a Bridgnorth Councillor.
Councillor Julian Dean said, to cheers, that the current plans are like ‘driving into Mordor and all the wheels have come off your vehicle’. He listed everything that has gone missing from the original Future Fit plans for community care: urgent care centres around the county, now dropped; extra money for community services, now gone; a crisis for community hospitals; a crisis for the ambulance service; a crisis for Shropdoc.
Councillor Dean spoke too of the £135 million cuts to NHS spending in the local Sustainability and Transformation Plan. He made a really key point – that ‘people shouldn’t be left fighting over the scraps, whether it should be Telford or Shrewsbury, because it should of course be both’. He urged the Committee to ‘go back and fight for more money, and to get our MPs to do the same’. It was just not fair with elderly people in Shropshire and deprived people in Telford that our area got so little funding.
Sylvia Jones particularly highlighted the concerns of rural communities – including abandoning the plans for rural urgent care centres, the threats to community hospital beds, and to Minor Injuries Units. Independent Committee member Dr Tabitha Randell had spoken in glowing terms about the potential to use Midwife Led Units. Sylvia pointed out ‘MLUs would be wonderful if we had them but let’s not forget they’ve been closed for 6 months, and in the last few weeks two babies have been born without midwife supervision’. On Shropdoc, Sylvia said ‘Shropdoc is under threat because of underfunding. It’s a brilliant award winning service but you’re not funding it properly’. Again, there was massive applause and cheering.
Dr Julia Buckley was the final speaker of the evening. She too drew attention to the closure of MLUs, saying ‘It is disingenuous for you to tell us in this review that you rely on the outreach from those units when you separately will be asked if you should keep them closed in the future’. She called for the CCGs to be honest and transparent with the public. She pointed out an uncomfortable fact that no one else had mentioned: ‘You are working to the assumption that when the second A&E is downgraded that somehow 65% of A&E admissions will evaporate. That’s not realistic’.
There was one thing Dr Buckley said that drew probably the biggest cheer of the evening: ‘I’m not going to say it’s unfair and fight against other councillors… because who here could say that a life in one town is worth any more than a life in another town’. It’s a basic statement of principle – but there is a danger of this being forgotten. She added that consultation must include the option of retaining both A&Es, not as ‘no change’ but under a different structure.
After Thursday’s meeting, three things are clear:
- Future Fit remains a desperately troubled project
- The public does not support the decisions of health bosses
- The fight for two A&Es, two hospital, and a properly funded NHS goes on
[1] Page 10 KPMG Independent Review, Appendix 2 of meeting paperwork
A video recording of the full meeting is here.
‘I think is it really important we remember that the best solution is to keep both A&E departments open’.
Shropshire, Telford & Wrekin Defend Our NHS 