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The Shrewsbury and Telford Hospital NHS Trust (SaTH), the organisation that runs the Royal Shrewsbury and Princess Royal Hospitals, is holding a Board meeting this Thursday, 31 March, to agree to close one of the A&Es and its associated acute hospital.

The Board meets in public so everyone has the opportunity to attend and say what they think of this proposal.

TRUST BOARD MEETING TO BE HELD IN PUBLIC at 2.00pm on Thursday 31 March 2016 Seminar Rooms 1&2, Shropshire Education & Conference Centre, RSH

The Agenda and Papers for the meeting can be downloaded from here. The key Agenda item is item 10 – To Receive and Approve the Sustainable Services Strategic Outline Case. The document itself is on the web page as Enclosure 5.

Now: unacceptable ambulance response times, ambulances stacked up outside A&E and patients waiting on trolleys inside, not enough A&E capacity, not enough acute hospital beds, and cuts in the coming year in social care and community NHS services (including a possible loss of even more community hospital beds).

The future: closure of one of our two A&Es, one of our acute hospitals replaced by a Diagnostic and Treatment Centre of 20 beds, around 30% of acute hospitals services shifted to community settings – and NO money at all to invest in new community services or Rural Urgent Care Centres because of inadequate funding for our local NHS.

Is this what we want?

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On 31^st March, the hospital trust, SaTH, is due to sign off the Future Fit ‘Strategic Outline Case’. This is effectively the blueprint for the closure of an A&E, and the downgrading of one of our District General Hospitals to become a ‘Diagnostic and Treatment Centre’ – a planned care centre of 20 beds. A second strand of Future Fit is the transfer of healthcare from acute hospitals to community NHS settings, with a 30% transfer of activity quoted many times by Future Fit leaders.

What was Future Fit?

Future Fit, though, was never intended to be just about closing an A&E and acute hospital, and cutting back on hospital care. This was always a much more ambitious project. A core system principle within Future Fit was that ‘home is normal’, that care should be provided closer to home, and that patients should be provided with the level of care they require to avoid unnecessary acute hospital admissions[1]. There has been no pretence (until now) that this will somehow happen of its own accord. The Clinical Models report emphasised ‘the absolute requirement to create community capacity to manage the shift in care closer to home’[2]. A little later, we are told ‘Community capacity must be built to accommodate this shift… there is an absolute need to shift resources into community care’[3].

There is no room for doubt here. Future Fit focuses on care in acute hospitals and community hospitals – but in order to work, it had to be supported by improved community services, and those services would require additional resources. That was always the vision. Future Fit was meant to be about whole system transformational change[4], delivering care closer to home for a majority of patients, as well as better care for people with frailty and/or long term conditions.

There is now no money for community services Continue reading →

Help us tell hospital bosses to STOP their plans to close an A&E and hospital. We expect their closure plans to be discussed and agreed on Thursday 31^st March at 2pm, at the Education and Conference Centre, Royal Shrewsbury Hospital. It’s a public meeting, and all of us are entitled to be there. Can you come along?

Remember the hype about ‘Future Fit’, the NHS cuts and closures plan? NHS bosses have always claimed that it was OK to close one of our A&Es and one of our hospitals, either Shrewsbury or Telford, because new services would take their place. They made some very concrete promises. They promised a ‘network of urgent care centres’. Last summer, they were still giving the impression at public workshops that there wouldn’t just be urban Urgent Care Centres at Telford and Shrewsbury. They told us that there would be rural Urgent Care Centres as well: in Oswestry, Whitchurch, Bridgnorth, Bishop’s Castle and Ludlow. These were going to give us sophisticated care 16 hours a day, 7 days a week. They were ‘closer to home’, so apparently it didn’t matter that the A&E might be much, much further away.

The promises weren’t just about the network of Urgent Care Centres. The Future Fit clinical model is about shifting 30% of activity out of hospital settings and into the community. The clinical model behind Future Fit makes it clear that this can’t work possibly without significant investment of resources. We’ve been promised a lot: preventative services, care planning, active case management offering ‘holistic and pro-active care with planned reviews and assessments’, palliative and end of life care… The consistent claim from NHS leaders has been that the funding will be there to make it work, and that care will get much better than it is now.

As recently as August 2015, Future Fit leaders pledged new investment of £5.3 million a year, each and every year, to pay for these new services. This commitment is in the minutes of the August Shropshire CCG Board meeting (page 19 of downloaded document) and was in a letter sent last summer to every GP in Shropshire.

All of the promises are now shown to be worthless. In Shropshire there is NO money for investment in new community services, and no money for Rural Urgent Care Centres. This staggering admission was made last week in a letter written by CCG Chair Helen Herritty. You can find the letter here. Dr Herritty explains that the CCG’s priority is to restore its financial position and repay the deficit. She says this means ‘it is not likely that the CCG will have additional resource to invest in community services’. Hospital cuts are still to go ahead – and the CCG will be reduced to scrabbling around, in competition with every NHS organisation in England, trying to secure a few bob from a national fund that has multiple demands on its very limited resources. The notion that this will pay for adequate community services is a sick joke.

Is the NHS in Telford and Wrekin in a stronger situation? Only marginally! Shropshire is worse off because NHS funding policy discriminates against rural areas and areas with an older population – but the catastrophic national squeeze on NHS funding leaves Telford and Wrekin in crisis as well. In the coming financial year, Telford and Wrekin’s NHS will be making cuts of £5.2 million. There is no realistic prospect of Telford and Wrekin investing substantial resources into community NHS services at the same time as it makes deep cuts in spending. The only difference between Shropshire and Telford and Wrekin is in the degree of crisis facing the NHS.

Future Fit is bankrupt. It is financially bankrupt because the money to give it any chance of working has been snatched away; it is clinically bankrupt as well. All of the modelling work to ‘prove’ that Future Fit can work has been based on the assumption that there will be a network of Urgent Care Centres, combined with heavy investment in new community services. With no investment at all, the model falls apart. Future Fit cannot work without investment in alternatives to A&E and hospital care. What we now face are cuts, plain and simple: the closure of one of our A&Es; the replacement of one of our hospitals – Telford or Shrewsbury – with a 20 bed planned care unit; and a disastrous 30% of hospital activity dumped onto GPs, community NHS services and social care. All of these services are stretched to the limit already. It is ludicrous to think that they can simply absorb 30% of the work from our hospitals, with no funding at all to do it.

Bizarrely, it still looks as though NHS bosses will sign off the Future Fit plans. If they do, they are signing a death sentence for a significant number of local people. They still won’t say which A&E and hospital they want to close. We’re clear: we need both, and we have to campaign hard for both to stay open. Whichever A&E and hospital goes, the risks of unnecessary pain, suffering and death will escalate. We just can’t let this happen.

The next key date is 31^st March, when the Hospital Trust will sign off a Future Fit document called the ‘Strategic Outline Case’. This document commits them in principle to closing down one of the A&Es and one of the hospitals. Can you come to the meeting, and help make the voice of the public heard? The meeting will be at the Royal Shrewsbury Hospital, at 2.00 pm on Thursday 31^st March; we expect it to be in the Education and Conference Centre on the hospital site.

Shropdoc

Shropshire CCG and Telford and Wrekin CCG – the organisations that plan and buy local healthcare – met on 10^th February and took two very damaging decisions.

• They decided to turn off the Shropdoc direct phone number, forcing people to use the discredited NHS 111 call centre service instead. This takes away patient choice, and means people won’t be allowed to talk to a Shropdoc doctor unless the NHS 111 computer system and the call handler agree they can. This is likely to happen in the spring of next year.
• They also decided to put out to tender the GP Out of Hours service currently provided by Shropdoc. This means that Shropdoc could easily be replaced by a private company that puts profits before patient care.

These are both daft decisions. Shropdoc is a high quality service, provided by a local GP cooperative. A stunning 94% of Shropdoc users are satisfied with the service they get. Compare that with NHS 111: only 33% of NHS 111 users are satisfied with the service, and 52% are dissatisfied. Shropdoc, because it provides skilled and timely care, only has to refer 2% to 3% of patients to the ambulance or A&E services. NHS 111 – staffed by call centre operators with no clinical training at all – refers 10% of patients to these other services. We’re headed for a worse service, a more expensive service, and one that puts extra pressure on busy ambulances and A&Es. Ticking the bureaucratic boxes from NHS England is being put ahead of patient care.

Pressure from the public has made a difference. We got a promise that the Shropdoc number won’t be switched off unless the NHS 111 service is of good quality. We can’t rely on that, but it’s a small step in the right direction. More significantly, we won a ‘stay of execution’ for Shropdoc. The service will go out to tender in 2017, but Shropdoc is likely to continue providing the GP Out of Hours service for another 2½ years. The lesson here is that getting organised can make a difference. The campaign clearly has to go on. We’re talking to other organisations about what we can do to keep the Shropdoc number, and stop it being taken away next spring. There’s a petition here started by Ludlow GP Dr Beanland: http://bit.ly/shropdoc. Please sign and circulate.

A&E and Hospital Closure

The ‘Future Fit’ project, with its plans for closing one of our A&Es and hospitals, is moving ahead at speed. One of our A&Es, either at Shrewsbury or Telford, will be closed down if health chiefs get their way. One of the two hospitals will also go. It will no longer be an acute hospital, dealing with a range of medical conditions. Instead, it’ll be downgraded to a centre for planned care such as cataract surgery, hip or knee replacements – and will only have 20 beds!

The timetable is for a ‘Strategic Outline Case’ to be signed off this month, but they seem to be behind schedule on this. Health bosses are due to take a decision on which A&E to close – Shrewsbury or Telford – in July. Consultation on A&E and hospital closure will take place from December 2016 to March 2017.

The project is in utter crisis. The original plans promised new community services, care closer to home, local planned care centres, and better services for frailty and long-term conditions – but work on these things has barely begun. As health services spin into financial crisis, it’s now clear that the money is just not there for the new services that were promised in place of the A&E and hospital. In practice, the grand plans of ‘Future Fit’ have been reduced to taking away the A&E and hospital. It’s no wonder there’s so much public opposition.

Campaigning is 100% worthwhile. They’d wanted to close one of the A&Es on a ‘temporary’ basis over the winter – and we stopped this happening. Very importantly, we’ve just learned that we’ve also succeeded in stopping the dangerous plan of closing one of the A&Es overnight. Hospital leaders planned to do a ‘live test’ of overnight closure in April, and to set up an ongoing policy of overnight A&E closure if the A&Es hit a crisis and couldn’t cope. Under pressure, they’ve acknowledged that the risks of overnight A&E closure are just too great. The new agreement is that in the event of a crisis, they’ll call on help from neighbouring hospitals. That’s the right decision.

We’re proud of those achievements – but we know there’s a bigger and tougher fight ahead. You can download our petition and other material about the threats to our A&E and hospital from our Resources page: https://shropshiredefendournhs.org/resources/ .

Cuts

Shropshire Clinical Commissioning Group is planning to make a frightening £19 million cuts this year. We’ve asked about the impact on services – and each time, we’re told ‘It’s early days’. This is for cuts that will take place from 1^st April this year! It’s already harder to get hip and knee replacements in Shropshire, with restrictions imposed to save money. We know that there’s a risk to inpatient beds at community hospitals. There are likely to be new restrictions on bariatric surgery (surgery that helps people manage their weight). There’s no question that there will be many, many more cuts ahead. In Telford and Wrekin Clinical Commissioning Group, there are plans for £5.2 million cuts to local services. The impact on patients will be significant – but we don’t yet know which services will be hit.

It’s going to be harder and harder for the public to keep track of what’s happening. In Shropshire, a lot of the cuts have been suggested by a management consultancy called Deloitte. Across Shropshire and Telford and Wrekin together, the cuts plan is being steered through by Price Waterhouse Cooper, another management consultancy. The decisions about what to cut are then taken by a new body called the ‘Sustainability and Transformation Board’. This is made up only of the Chief Executives of local NHS organisations and a senior representative from each of Shropshire Council and Telford and Wrekin Council. The Sustainability and Transformation Board meets in private, its paperwork is not publicly available, and it does not publish minutes. Although its recommendations then go out to CCG and NHS Trust Board meetings, these will just sign off decisions that have been taken behind closed doors.

This is downright disgraceful. It’s our NHS, and our money that pays for it. Secret meetings are unacceptable. It’s essential that these meetings are held in public, so that we at least know what’s happening and have the right to challenge bad decisions. We have asked the leaders of Shropshire CCG, Telford and Wrekin CCG, and SaTH, the organisation running the two hospitals, to make sure that these meetings are public, and with members of the public entitled to ask questions. You might want to email your views to

• Dr Helen Herritty, Chair of Shropshire CCG: Helen.Herritty@shropshireccg.nhs.uk
• or to Dr Mike Innes, Chair of Telford and Wrekin CCG: Michael.Innes@nhs.net

The next opportunity to find out about next year’s cuts in Shropshire’s NHS will be at an Extraordinary Meeting of Shropshire CCG: March 30^th at 9am, at the Education and Conference Centre, Royal Shrewsbury Hospital. Come along to this meeting if you can.

The NHS Reinstatement Bill

This bill attempts to return the NHS to being a universal service, publicly owned and publically accountable. It has its second reading on 11^th March. Find out more here: http://www.nhsbill2015.org/

Events

• One of the big threats to the NHS is a proposed new trade deal called TTIP, currently being negotiated by the USA and the EU. Privatisation of the NHS is already progressing quickly. The plans for NHS 111 and Shropdoc reflect this. TTIP threatens to make things much, much worse. A recent expert opinion is that the whole of the NHS will be opened up to competition by TTIP – and individual governments will lose the right to veto or reverse privatisation.
  Find out more about TTIP. John Hilary, Executive Director of War on Want, is speaking at Ludlow Methodist Church, Broad Street at 7.30 pm on Thursday 10^th
• Shropshire & Telford and Wrekin Defend Our NHS is not affiliated to any political organisation – but we publicise meetings and events that are relevant to our campaign to keep good quality NHS services.
  Shropshire Labour Party is organising a Community Conference on ‘The Crisis in Health and Social Care in Shropshire’ on Saturday 16^th April, from 10 am to 4 pm. This will be at the Lantern, Meadow Farm Drive, Shrewsbury SY1 4NG. Speakers include Lord Philip Hunt, Shadow Health Minister; Tony O’Sullivan, Consultant Paediatrician and one of the champions of the victorious fight to keep Lewisham Hospital’s A&E; local GP Dr Mary McCarthy; and speakers from Shropshire Patient Group and Shropshire Defend Our NHS. There will be workshops on Adult Social Care, Mental Health, and Palliative and Hospice Care. Book your place in advance by contacting Martin Jones: martin.jones@shropshirelabour.org.uk

Shropshire’s Health bosses have launched a new charm offensive to try and convince us that closing down one of our A&Es and acute hospitals is a good idea. They’ve got a lot of work to do if their first contribution to the new strategy is anything to go by!

A few days ago, the Future Fit website published an important article[i]. They say ‘The following blog provides the views of the three clinicians leading NHS Future Fit in Shropshire and Telford & Wrekin. It is a discussion on the balance between travel time access and clinical outcomes in advance of the planned future consultation on the reconfiguration of hospital services within the county. It is from Dr Stephen James, Clinical Director of Information and Enhanced Technologies, Shropshire Clinical Commissioning Group; Dr Michael Innes, from Telford and Wrekin Clinical Commissioning Group; and Dr Edwin Borman, Medical Director at The Shrewsbury and Telford Hospital NHS Trust’.

Unfortunately, these three leading clinicians make an astonishingly basic error that could put lives at risk. Part of their justification for increasing the journey times to A&E is that paramedics will treat patients with clot busting drugs, so the time taken to get to hospital doesn’t matter. They say, ‘With the professional support of a paramedic comes the opportunity to start treatment at the scene, bringing care closer to people and reducing time to treatment. Increasing amounts of evidence, especially from rural Scotland, have demonstrated that this can actually improve care further. For example, people living further away from a hospital can have clot-busting treatment administered at home faster than those conveyed to hospital… This is particularly relevant for the county of Shropshire and beyond, where travel times and distance can be significant.’

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SHROPDOC

Back in 2005, GP practices lost the responsibility for providing their own Out of Hours GP care. A variety of new approaches sprang up around the country – some of them good, some of them absolutely rotten. When GP Out of Hours services don’t work well, patients can die. It’s important that GP Out of Hours care is effective. This is the service you contact when you’re ill, scared – and you don’t know whether to go to A&E or go back to bed. Good clinical advice from a doctor you trust is as important as it gets.

In Shropshire and Telford and Wrekin, we’re very, very lucky.  Our GP Out of Hours service is provided by Shropdoc. It’s a GP cooperative, staffed by local doctors who know their patients and know the area. When we ring Shropdoc, we can pretty much rely on speaking to a doctor with little or no delay. Shropdoc provides phone advice, and face to face appointments. It’s a valued and trusted service. A CCG survey found that 88% of respondents know about Shropdoc, and 82% of those had used Shropdoc themselves. Satisfaction rates were extraordinarily high: 94% of those who had used the service were satisfied or very satisfied, with just shy of four out of five being ‘very satisfied’. It’s a service that works well. The 94% of users satisfied with Shropdoc stands in sharp contrast to the 33% satisfaction rate of NHS 111 users.

Shropdoc under threat

Most of us will have found this out by accident – but our two NHS Clinical Commissioning Groups (‘CCGs’, the local organisations that plan and buy NHS care) have been discussing changes that could lead to the end of Shropdoc. They think they’ve run ‘an extensive engagement programme’ with the public. Feedback from members of the public is that most of us regard this as a ‘semi-secret engagement programme’. It’s particularly remarkable that their engagement exercise didn’t actually mention that Shropdoc was at risk! The feedback they’ve had from the public, once we worked out what the plans were, is that Shropdoc has to stay.

Where are we now?

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Many of us will have used ShropDoc at night or at weekends when we’re ill, scared, and don’t know what to do. We phone ShropDoc because we trust the GPs who run it. Our Out of Hours GP service is a good one. It’s run by local GPs who know the area (and who quite often personally know the patient they’re talking to). The advice they give isn’t from someone with a few hours training who’s being told what to do by a computer programme. It’s high quality medical care – over the phone or at a local base or at home – and it’s based on a wealth of knowledge and skill.

ShropDoc is massively under threat.

The service is going to be put out to tender. That’s bad enough, because we want a service that we trust, not the service that’s the cheapest. It’s much, much worse than this though. The plan is to bundle the GP Out of Hours service together with the discredited NHS 111 phone line, and to put out a regional tender across the whole of the West Midlands.

This means that ShropDoc – a local service run by local GPs – will almost certainly be squeezed out. We’ll end up with a very cheap and very remote service. Many of us know that the ambulance service got worse when the control room was centralised in Brierley Hill, and local knowledge was lost. It makes no sense at all to repeat that mistake all over again with our GP Out of Hours service.

The NHS bosses at Shropshire Clinical Commissioning Group and Telford and Wrekin Clinical Commissioning Group say that doing this is about ‘reducing duplication and increasing efficiency and effectiveness’. It may look like a good way of saving money – but replacing a trusted service with an unproven phone line will just lead to more people travelling to A&E. We’ll end up with worse care for patients – and more expense for the NHS. This is short sighted nonsense.

What can you do?

1. Most importantly, act now. The consultation on this ends on 22^nd
2. Email your thoughts to eggby-jones@shropshireccg.nhs.uk if you live in Shropshire and to Angie.Porter@Telfordccg.nhs.uk if you live in Telford and Wrekin.
3. Complete the online survey here: http://tinyurl.com/111-outofhours-engage-survey
4. HealthWatch has put together a petition on the threat to ShropDoc. You can download this by clicking here. If you can, print this out and ask your friends and neighbours to sign it. Perhaps you can take it to work, or to any club or society you belong to. Make sure your GP surgery has a copy at reception. Remember, though – it MUST be returned in time for the closing date of 22^nd There’s also a HealthWatch poster.

Please make every effort to do these things. If we don’t get organised and stand up for our NHS, then slice by slice we’re going to lose it. 

We discovered a week ago that SaTH, the organisation running the Royal Shrewsbury and Princess Royal Hospitals, had firm plans to close one of the A&Es soon. We’d suspected this for a while. One of the SaTH Directors saying they could close an A&E ‘within weeks or months’ was a bit of a give-away!

At the weekend, though, we found out just how immediate the threat was. We were approached by someone who has to remain anonymous, but who had very good information on what was happening in the hospitals. This person told us that a decision had been taken to close one of the A&Es as part of ‘winter pressures planning’. It seems completely perverse to close an A&E department at the start of the winter, and this ‘quick and dirty’ approach would have caused absolute chaos for patients seeking emergency care – but it really does seem certain that this is what hospital bosses had decided to do. A disgraceful, disgraceful decision.

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Whatever we call it, Future Fit is a project in chaos – but health bosses STILL plan to close an A&E

It’s been clear for many, many months that the Future Fit NHS project has been failing. All the good ideas of care closer to home, joined up care, proactive management of long term conditions and so on have long since disappeared. Investment into community services is intended to be negligible. Community hospitals are being run down. Rural Urgent Care Centres have been kicked into touch. Most recently, the two very senior NHS bosses who are the architects of Future Fit have suddenly disappeared from their jobs. It’s become crystal clear that Future Fit is about two things: closing an A&E and closing a hospital, to save money, and with no regard at all for the needs of our area.

On October 1 local NHS leaders were due to take a decision on which A&E and hospital they were going to close down – the Royal Shrewsbury or Telford’s Princess Royal. Their decision was… no decision! After two years of work and endless glossy events trying to convince the public that closing an A&E is a good idea, they have achieved – precisely nothing. Their only conclusion is that they don’t know what to do. Even the timetable for implementation is in chaos, with public consultation delayed from early December this year to the summer or autumn of 2016. What a disgraceful waste of public money – and what an insult to the members of the public and the overworked NHS staff who have sat through the time-wasting meetings and engagement events.

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