Frequently asked questions

We know you'll have lots of questions about NHS Future Fit.  Here is a list of frequently asked questions and their answers. If you have a question that is not covered below, please send it to: This email address is being protected from spambots. You need JavaScript enabled to view it.

 

Topics

1. About NHS Future Fit

2. About the public consultation

3. Having your say

4. The preferred option

5. Reasons for change

6. Urgent care

7. Emergency care

8. Planned care

9. Trauma services

10. Recruiting and retaining staff

11. Travel and transport

12. Community services

13. Affordability and cost

14. Women and children's services

15. Stroke services

 

 

About NHS Future Fit

What is Future Fit?
The NHS Future Fit Programme was the name given to the project to review the future of health services in the county and the hospital services provided at the Royal Shrewsbury Hospital, Shrewsbury and the Princess Royal Hospital, Telford. The four year project has been led by NHS Shropshire Clinical Commissioning Group (CCG) and NHS Telford & Wrekin Clinical Commissioning Group (CCG) – the organisations that are responsible for buying and making decisions about healthcare services in Shropshire and Telford & Wrekin on your behalf.

How is the Programme governed?
Future Fit has a Programme Board whose role is to agree, lead and coordinate the Future Fit Programme. 17 partner organisations are part of this board which includes five sponsor member organisations (Shropshire CCG, T&WCCG, Powys Teaching Health Board, The Shrewsbury and Telford Hospital NHS Trust and Shropshire Community Health NHS Trust). The remaining stakeholder organisations are Shropshire and Telford & Wrekin Councils, Powys Teaching Health Board, West Midlands Ambulance Service and Welsh Ambulance Service, and patient representatives

Who is delivering the consultation?
There is a small team who have a specific role to deliver the NHS Future Fit consultation process on behalf of Shropshire and Telford & Wrekin CCGs. They are part of the Sustainability and Transformation Partnership (STP) team and work from offices based at Telford & Wrekin CCG in Telford and Shropshire CCG in Shrewsbury.

 

About the public consultation

What is a public consultation and why do we need one here?
Commissioners are required by law to involve the public when considering making significant changes to the provision of NHS healthcare. This is done through a formal public consultation process. We are proposing to make changes to the hospital services provided at the Royal Shrewsbury Hospital and the Princess Royal Hospital in Telford so it is important that we seek the views of people across Shropshire, Telford & Wrekin and mid Wales. Any alternative proposals or suggestions put forward as part of the consultation would, of course, be conscientiously taken into account and carefully considered as part of the process.

How can I find out more about the Future Fit consultation?
We have produced a full consultation document and summary version which explain the changes we are proposing, what these would mean for you and your family and the two options on which we want your views. We want to gather people’s views and will do this with our online survey and hard copy surveys. You can also share your thoughts with us by letter or email.

What will happen during the consultation?
Throughout the 14 week consultation we will be hosting a series of public exhibition events where you can meet our doctors, nurses and other healthcare staff, ask questions and discuss any concerns. We will also aim to come along to groups, meetings and events across the area to give a talk or have a stand. In addition, we will arrange around 50 pop-up roadshows at high footfall locations across Shropshire, Telford & Wrekin and mid Wales. You can let us know about your meeting or event by emailing This email address is being protected from spambots. You need JavaScript enabled to view it.

Why has it taken so long to get to consultation?
We started talking about Future Fit in 2013 and we know that local people are frustrated about how long it has taken to reach this point. Over the last four years, we have listened to and involved thousands of local people, including NHS staff, patients and community groups. There have been some very difficult decisions to make and we take these very seriously.

We have taken into account the views of people and organisations across a very large geographical area in England and Wales and that takes time. It also takes time to consider and develop new clinical models and collect all the data and evidence needed to make decisions. It also takes time to bring people together to analyse the evidence and the data. In addition, we have and continue to follow a robust NHS England assurance process, which involves a large number of meetings and assurance panels both locally, regionally and nationally. We have to follow these processes to ensure we conduct a safe and thorough public consultation. We have also had to ensure that the funding is in place to take our proposals forward before starting the consultation process. We can only consult on options that are affordable and able to be delivered. The funding has now been confirmed.

Who has been involved in the Future Fit process so far?
We have involved patient representatives, voluntary and community sector organisations, Shropshire and Telford & Wrekin Healthwatch organisations and Powys Community Health Council in forming and developing our proposals and plans. This is in addition to the extensive work we have carried out with local GPs and clinical staff working in the community and hospitals in Shrewsbury and Telford to ensure the model of care we will adopt meets the needs of local people, both now and in the future. We have engaged and involved NHS England, the Joint Health Overview and Scrutiny Committee of the two councils in Shropshire, Telford and Wrekin, MPs, councillors and partner organisations.

What hospital services are included in the consultation?
This public consultation is about the hospital services delivered at the Royal Shrewsbury Hospital and the Princess Royal Hospital.

This consultation does not ask you about community hospitals, community midwife-led units or community services. It also does not ask your views on the location of adult cancer day services, which are currently provided at the Royal Shrewsbury Hospital and would stay here whatever the outcome of this consultation. We are looking at how we best deliver all health services and much work is being done to look at these as part of a programme of work known as the Sustainability and Transformation Partnership (STP). In the future, we may need to ask for your views on any proposed changes to these services.

NEW: How confident are the CCGs that they comply with the Gunning Principles, which require that in any consultation the public must 'have enough information to make an intelligent choice and input in the process'?
We have organised a series of public exhibition events which are open to everyone to attend. We have, and continue to, work closely with the Consultation Institute who are quality assuring the consultation process. As part of this process, they are offering guidance to make sure we are meeting NHS England’s five tests for reconfiguration and following the Gunning principles. They have provided feedback on all of our consultation documents and our communication and engagement plan in order to make sure local people can receive the information they need to make an informed decision. As part of our commitment to following the Gunning principles, any alternative proposals or suggestions put forward as part of the consultation would, of course, be conscientiously taken into account and carefully considered as part of the process.

What are you asking my views on?
We are proposing to make changes to the hospital services provided at the Royal Shrewsbury Hospital and the Princess Royal Hospital, Telford, so that one hospital provides emergency care services and the other hospital provides planned care services. Both hospitals would have an Urgent Care Centre that is open 24 hours a day, seven days a week as well as Outpatient Services and diagnostics (x-rays, blood tests)

We are asking for your views on two options:

  • Option 1: The Royal Shrewsbury Hospital becomes the Emergency Care site and the Princess Royal Hospital becomes the Planned Care site.
  • Option 2: The Princess Royal Hospital becomes the Emergency Care site and the Royal Shrewsbury Hospital becomes the Planned Care site.

Option 1 is the CCGs’ preferred option. You can read more about the reasons for this on page 24 of our public consultation document.

Why do we have to include the views of people in Wales?
CCGs have a legal responsibility to involve and consult with all patients who use their hospital services. Our two hospitals serve a population of over half a million people which includes around 70,000 people who live in mid Wales. We therefore want as many people as possible from across Shropshire, Telford & Wrekin and mid Wales to provide their views during the formal public consultation. We are working closely with Powys Teaching Health Board, Powys Community Health Council, Powys County Council and Powys Association of Voluntary Organisations (PAVO) to help reach out to people across mid Wales.

NEW: Wales have their own finances. Why do they have to be included in the Future Fit plans?
CCGs have a legal responsibility to involve and consult with all patients who use their hospital services. Our two hospitals serve a population of over half a million people which includes around 70,000 people who live in mid Wales. 

If I have given you my views before the formal consultation started, will these be taken into account when decisions are made after the consultation or do I need to complete the consultation survey?
Since the Call to Action in 2013, local people and organisations have been sharing their views with us. Comments received during this pre-consultation engagement period were taken into account in developing the consultation options. We are now conducting a formal 14-week public consultation and are asking people to formally respond during this time for the views of people across Shropshire, Telford & Wrekin and mid Wales on two options to be taken into account.

If you would like to share your views then please fill out our survey. You can complete our online survey or download a hard copy survey to print and post to FREEPOST NHS FF CONSULTATION. You can also respond to us on This email address is being protected from spambots. You need JavaScript enabled to view it. or by letter. No final decision will be made until we have considered the views of everyone who responds to the consultation.

NEW: What response rate are your expecting in the consultation? 

Our consultation is asking for your views on the impact that either option will have on you and your family. Please remember that this is not a vote as it is all about hearing what patients and the public think about the proposals.

At the middle point of the consultation, more than 1600 surveys had been received; by 31 July 2018, this had risen to more than 2850. These figures, which do not include additional feedback received, represent more than 0.5% of the population served by the two hospitals and is considered by industry experts to be a good response rate for this stage of the consultation.

We know from local council and other NHS consultations across the country that we are on track to achieving a good response rate to the consultation. While some people might think that it doesn’t sound like a lot of responses, feedback for completed consultations often do not exceed the 1% figure, but naturally we’d like to see as many people as possible respond to the consultation.

It’s important that everyone has their say, so please download the consultation documents and take part in our online survey.

What will happen after the consultation finishes?
No final decision will be made until we have completed the formal public consultation. At the end of the consultation, all feedback will be collated and analysed by an independent company. They will then produce a report which will be considered by Shropshire and Telford & Wrekin CCGs as part of their decision-making process. It will be considered alongside other pieces of work that are underway. These include travel and transport considerations including ambulance travel times.
The views and suggestions of everyone who responds to this consultation are an important part of how we will make a decision. However, we also have to complete a number of pieces of work before any final decisions are made. These have been requested by the West Midlands Clinical Senate, NHS England and members of the CCG Governing Bodies. No decision can be made after the end of the formal public consultation until this work has been completed and considered. They include:

  • more work to model the care we will need to deliver in the community
  • ensure that the CCGs are confident that options are affordable
  • looking at what we might need to do to lessen the impact for women and children and older people, their families and carers, particularly around travel
  • understanding how the Urgent Care Centre at the Planned Care site will be staffed by skilled professionals to deliver the high level of care required for children
  • understanding the effect of the proposed changes on the demand for both emergency and non-emergency ambulance and patient transport services 
  • ensuring we are considering new ways of working in the future including new staff roles

You can read about the work we are doing on page 9 of our public consultation document.

Who will make the final decision?
At the end of the consultation, tTplayhe boards of the two CCGs will consider all of the evidence. A Joint Committee of Shropshire and Telford & Wrekin CCGs will be convened to make the final decision.

How long will it take before the changes happen?
It will take about five years before any changes are fully implemented. There will be lots of opportunities for patients, families and the public to get involved over the coming years.

 

Having your say

How can I have my say?
The easiest way to have your say is to fill out our online survey. Before you fill out the survey, please take time to read our consultation document, which explains the reasons why we need to change our hospitals, details our proposed model of hospital services and the two options we are asking for your views on. There is also a summary version of the consultation document. We will also be distributing these documents to public places across Shropshire, Telford & Wrekin and mid Wales. You can also find out more by attending one of our events or attending a meeting. You can also provide us with your views by letter and email and by attending one of our events.

What events will be held during the consultation?
We are holding a series of drop-in public exhibition events throughout the consultation which will offer people an opportunity to find out more about the proposed changes, meet our doctors, nurses and other healthcare staff and ask questions. There will be five ‘stalls’ at our events which will focus around emergency care, planned care, urgent care, women and children’s services and outpatient services and tests. Healthwatch or Powys CHC will also have a stall at each event. The consultation documents and survey will be available at all events and a box will be provided for you to post your completed survey.

The events will take place 3.30-7.30pm in Shrewsbury, Telford, Wellington, Oswestry, Market Drayton, Newtown, Ludlow and Bridgnorth. The events are open to everyone - there is no need to book your place - just turn up.

In addition, we will be holding pop-up events at public places across Shropshire, Telford & Wrekin and mid Wales, for example, shopping centres, town centres and supermarkets. 

Why are you holding events in Wales?
Our two hospitals cover a very large geographical area, from Oswestry and Market Drayton in the north to Cleobury Mortimer and Clun in the south; Welshpool and Llanidloes in the west and Bridgnorth and Newport in the east. As a county that borders Wales, many of the patients that come to the hospitals are from Wales, so we are making every effort to ensure that everyone affected by these proposed changes has an opportunity to give us their views.

What events are you holding in Wales?
We will be holding a public exhibition event in Newtown. In addition, there will pop-up events in community spaces and we will be attending existing meetings to provide regular updates.

NEW: Are you holding open public meetings where the issues can be questioned or debated?
Yes. We have organised ten public meetings for people to find out more, talk to clinicians and senior managers and ask any questions they choose. They have been very popular, with more than 400 people attending the first three events to find out the real facts about the Future Fit proposals. These meetings adopt a ‘market stall’ approach with expert staff hosting a range of stalls - Emergency Care, Planned Care, Urgent Care, Women and Children’s and Outpatients & Tests. We chose this approach rather than formal presentations so as to allow people to freely walk around and have individual conversations with our doctors, nurses and senior managers. In addition, Healthwatch has a stall at the English events and PAVO has a stall at the Wales event.

We are attending many more public meetings to provide the real facts about Future Fit and to answer people’s questions, including several Local Joint Committee meetings. SaTH and both Shropshire and Telford & Wrekin CCGs hold their board meetings in public, along with the Joint Health Overview and Scrutiny Committee (JHOSC). We regularly attend these meetings to provide updates and, at the discretion of the chairs, members of the public may ask questions. Where possible, we are also attending smaller meetings with different communities.

NEW: How can the CCGs be confident that the consultation will genuinely reflect public opinion?
We have worked closely with the Consultation Institute (tCI) and consultation specialists Participate Limited to develop our survey. Although not compulsory, our survey does ask people to give the first half of their postcode to enable to us to track the areas where our responses are coming from. It also asks for people to answer a range of questions about themselves to help make sure we are capturing the views of as many different people as possible.

Half way through the consultation, tCI will conduct a mid-point review. This will look at how well we have engaged and the responses to the survey to make sure we are gathering feedback from a wide range of people across Shropshire, Telford & Wrekin and mid Wales. This will allow us to make changes to our activity if necessary, to make sure everyone has a chance to be involved before the end of the consultation.

 

The preferred option

You are going out to consultation with a preferred option. Haven’t you already made a decision about what you will do?

No decision will be made until we have heard the views of our communities across Shropshire, Telford & Wrekin and mid Wales.

Choosing a preferred option has been a very difficult decision which was reached following lots of discussion and careful consideration of the results of the financial and non-financial analysis, along with the findings of several independent reports. In August 2017, the Joint Committee of the two CCGs voted unanimously to proceed to consultation with a preferred option of the Emergency Care site to be based at Shrewsbury and the Planned Care site to be at Telford.

Why did you choose Option 1 as the preferred option – for the Royal Shrewsbury Hospital to be the Emergency Care site and the Princess Royal Hospital to be the Planned Care site?
There are four main reasons why we chose Option 1 as the preferred option.
• Having the Emergency Care site at the Royal Shrewsbury Hospital would mean that it can continue to be a Trauma Unit
• Having the Emergency Care site at Shrewsbury would mean fewer people would have to travel further for emergency care
• It better meets the future needs of our older population, especially in Shropshire and mid Wales
• It offers the best value for money over the long term
You can read more about how we reached this decision on page 24 of the main consultation document.

Isn’t Option 2 the cheaper option?
As part of the decision-making process, a financial appraisal was carried out on the two options. Although Option 1 (the preferred option) has a projected capital cost of £312 million compared to £250 million for Option 2, in the overall economic analysis of the options, which combines the results of the financial and non-financial appraisal, it is estimated that Option 1 would offer the best value for money over the long term. You can read more about how we reached our preferred option on page 24 of the main consultation document.

NEW: If Option 2 is cheaper in the short term, why Option 1 cheaper in the long term?

Our Report on the Appraisal of Options  describes in more detail the financial appraisal. It sets out the 30-year and 60-year calculations, both of which ranked Option B (Option 2 in the consultation document) first by a margin of 0.8% on financial grounds. Once viewed from the perspective of whole life costs (as required by guidance), however, these differences become minimal. For example, although Option B has a capital requirement of £250m and Option C1 of £312m, the final difference in terms of equivalent annual cost is just £2.7m (0.8%).

Through the economic analysis, the appraisal sets out the two calculations we used to bring together the non-financial and financial evaluations. The overall conclusion is that Option C1 (Option 1 in the consultation document) provides the best value for money in the long term whether that be over 30 or 60 years.

How did you decide on the preferred option?
Choosing a preferred option was reached following lots of discussion and careful consideration of the results of the financial and non-financial analysis, along with the findings of several independent reports. This includes the two Integrated Impact Assessments (IIAs) which assess the potential impact and equality effects of the changes we are proposing. You can read these in the Documents section of the website.

In July 2017, the Future Fit Programme Board confirmed that Option 1 was its preferred option. In August 2017, this was then agreed unanimously by the Joint Committee of Shropshire and Telford & Wrekin.

Why aren’t you consulting with no change as an option?
Doing nothing was one of the options that were considered as part of a robust and thorough appraisal process which involved representatives from over 50 organisations from across Shropshire, Telford & Wrekin and mid Wales. Based on their feedback, the Future Fit Programme Board decided that doing nothing could not be an option. This was because it was considered neither safe nor sustainable to continue as we are now. You can read more about the reasons why we need to change our hospital services in our public consultation documents.

NEW: Why are there two options and no others?

In September 2016, an Options Appraisal workshop took place which invited representatives from over 50 organisations from across Shropshire, Telford & Wrekin and mid Wales to form a panel. This included health organisations, patient representatives and Shropshire and Telford & Wrekin Councils.

The panel’s criteria were accessibility, quality, workforce and deliverability. Panel members were asked to decide on the relative importance of each of the criteria and give them a weighting out of 100. Option C1 (now known as Option 1) and Option B (now known as Option 2) received the highest scores on all four criteria. Similarly, in the financial appraisal, which looked at capital costs, these two options were the most preferable.

In August 2017, the Joint Committee of the two clinical commissioning groups approved the preferred option for the Royal Shrewsbury Hospital to become the Emergency Care site and the Princess Royal Hospital to become the Planned Care site.

NEW: Surely with a growing population in Telford, there has to be an A&E there?
Our proposed model of hospital care takes into account the expected changes in our population over the coming years and how the best care can be provided for everyone.

Having the Emergency Care site at Shrewsbury would mean fewer people would have to travel further for emergency care. More people would be disadvantaged under Option 2 (if the Emergency Care site was based at Telford) as they would have to travel further to access emergency services. This includes communities across Oswestry, South Shropshire and mid Wales.

We also have an older population, especially in Shropshire and mid Wales. The majority of our older population live in Shropshire and mid Wales and these numbers are growing at a faster rate than across Telford & Wrekin. Population projections estimate that by 2036, people aged 70 and over will account for 25% of the population of Shropshire and 29% in mid Wales, compared to 18% in Telford & Wrekin. This has been another factor in deciding our preferred option of having the Emergency Care site at Shrewsbury.

Over half a million people across Shropshire, Telford & Wrekin and mid Wales use our two hospitals. This covers a very large geographical area of approximately 2,500 square miles. Shropshire, Telford & Wrekin and mid Wales are three very different areas with different populations and therefore different health needs. There is also huge variation in where our communities live, ranging from areas of densely populated housing to sparsely populated rural villages.

NEW: If emergency care is moved to Royal Shrewsbury Hospital, this is a much older building that Princess Royal Hospital. Surely Princess Royal Hospital has more ground to build on?
Both our existing hospital sites were built many years ago. Although we have invested in some new buildings in recent years, we now have many outdated areas that have become more difficult and more costly to look after. They do not provide the modern environment for delivering high quality services that our patients rightly expect and need. We know that building standards have now greatly improved and new hospitals are built to higher specifications that are based around the needs of the patient.

Our proposed model of hospital care would allow us to improve our existing buildings and create some new buildings. Facilities would be designed to meet the needs of our patients, their families and staff. Having the Emergency Care site at the Royal Shrewsbury Hospital would mean that it can continue to be a Trauma Unit, fewer people would have to travel further for emergency care, it better meets the future needs of our older population, especially in Shropshire and mid Wales and it offers the best value for money over the long term.

NEW: Will Option 2 allow the NHS to invest in a second state-of-the-art cancer centre?
Whatever the outcome of the consultation, adult cancer day services would remain at the Royal Shrewsbury Hospital. Outside of this consultation, The Shrewsbury and Telford Hospital NHS Trust is exploring opportunities around how some adult cancer day services could be provided at the Princess Royal Hospital.

 

Reasons for change

Why do you want to change hospital services?
We need to make changes to the hospital services at the Princess Royal Hospital in Telford and the Royal Shrewsbury Hospital so that we can make sure we can provide high quality, safe services for all patients for the long term.

Having a separate Emergency Care site and Planned Care site with a 24-hour urgent care centre at both hospitals would help to make sure that:
• Patients receive the very best care in the right place at the right time
• Patients’ operations are highly unlikely to be cancelled due to an emergency admission
• Waiting times are reduced for our patients across both hospitals
• We can provide much improved facilities for our patients and staff
• We attract the very best doctors to work at our hospitals
• We can be more efficient with our resources
• We can plan ahead for expected changes in our population, with more people living longer and with long-term conditions
• We can help reduce the time people spend in hospital
• We can continue to have two vibrant hospitals in our county

You can read more about the reasons we need to change our hospital services on page 10 of the main consultation document and page 6 of the summary consultation document.

NEW: Why can't we stay as we are?

The main reason we need to change our hospital services is to make sure our hospitals provide high quality, safe services for all patients for the long term. We want to make sure that, wherever possible, patients are seen by the right person at the right time in the right place. At the moment, we know that this is not always happening.

All our hospital staff work extremely hard to deliver the very best service to our patients across Shropshire, Telford & Wrekin and mid Wales. However, it is becoming more difficult to make sure that we have enough doctors, nurses and other healthcare staff to provide a 24-hours a day, seven days a week service at both our hospitals. We have also had to recruit temporary staff that are not as familiar with our hospitals and have therefore needed additional support.

Why can’t you just ask the Government for more money to stay as we are?
Money on its own will not address the problems we are facing. This is not just about money. Staying as we are is not an option. We have to change the way we deliver the services at our two hospitals to make sure we provide high quality, safe services for all patients for the long term.

Across the UK, there is a severe shortage of healthcare staff. When we look at certain services, such as A&E, the situation is even worse. Having two hospitals so close together offering the majority of the same services on both sites means that some of our consultants are providing support ‘out of hours’ far more frequently than their colleagues in other hospitals. This makes our hospitals a less desirable place to work and therefore difficult to recruit new staff. It is also difficult to keep our staff as some leave to take up jobs at other hospitals where they can enjoy a better balance between their work and their personal lives.

In addition to this, the needs of people and their expectations have also changed. Evidence and guidance tells us that we need to deliver as much of the care people need at home or as close to home as possible. When people come to hospital, we need to have all the relevant specialists in the same place so we can see, assess and treat them as safely and quickly as possible, and where appropriate help them to get home without delay.

You can read more about the reasons we need to change in the consultation document.

Why can't you just ask the Government for more money so that we can keep our two A&Es?
The main reason we need to change our hospital services is to make sure high quality, safe services are provided for all patients for the long term. Patients need to be seen by the right person at the right time in the right place and at the moment we know that this is not always happening. At the moment, lots of patients attending our A&Es do not need specialist emergency care, they need urgent care. Urgent care would continue to be provided at both hospital sites.

Like many other hospitals, we face enormous challenges around recruiting and keeping staff, particularly within our Accident and Emergency (A&E) departments and critical care services. The Royal College Guidance states we need 20 consultant doctors to run our two A&E departments, 24-hours a day, seven days a week. Currently we only have five permanently employed consultants in post. We have had to rely on a high number of temporary consultants which is expensive and they need additional resource to support them to carry out their duties. Over the years a huge amount of work has taken place to recruit new consultants, however, we did not successfully recruit a consultant for over five years. We believe that, by having a separate Planned Care site and Emergency Care site, we would be able to recruit more doctors and nurses to work at both our hospitals in the future.

In addition, the existing model of A&Es is becoming outdated. At our two A&Es, we are treating patients with minor injuries, for example a sprained ankle, alongside those with a life-threatening illness, such as a stroke. By creating a separate Emergency Care site with a dedicated Emergency Department and a 24-hour Urgent Care Centre at both hospital sites, patients would be safely and quickly seen in the right place by the right doctors, nurses and other healthcare professionals.

Why can’t we have one hospital in the middle?
Due to the large geography of the area our hospitals serve, it would not be possible to have one hospital in the middle that offered all services for all patients across Shropshire, Telford & Wrekin and mid Wales. We would still have to provide some services locally. As part of our robust appraisal process, we carefully considered four options which would involve building a third hospital site which had an emergency department.

A full cost analysis was carried out and as a result of this, it was decided that all four options would be unaffordable. In addition, the Trust is finding it increasingly difficult to staff just two hospitals so it would not be feasible to staff a third hospital. Having listened to the views of our communities, keeping two vibrant hospitals in Shrewsbury and Telford was one of the key messages that came through. Our doctors and nurses believe that our proposed model of transforming our existing hospital sites into Emergency Care and Planned Care sites is the best solution for all our communities.

 

Urgent Care

What is an Urgent Care Centre?
An urgent care centre provides care and treatment for illnesses and injuries that are not life or limb-threatening but require urgent attention. Examples of this include a suspected broken arm, minor burn or scald, or a cut that needs stitches.

Under either option, both hospitals would have a 24-hour 7 days a week Urgent Care Centre which would be staffed by highly skilled senior health professionals who are specifically trained to deliver urgent care for adults and children.

How will I know whether to go to my local urgent care centre or to the Emergency Department? 
The Emergency Department would be based at the Emergency Care site and provide care for patients in a life or limb-threatening situation. The Urgent Care Centres at both hospital sites is for illnesses and injuries that are not life or limb-threatening but require urgent attention.

We understand that it is sometimes difficult to know how serious your condition is. If you call an ambulance then the paramedics would assess you and decide on the most appropriate place for your care. This may be the Emergency Department or your nearest Urgent Care Centre. In some cases (as is the case now), you would be taken out of county to a Trauma Centre at Stoke or Birmingham.

If you walk in to an Urgent Care Centre and have a condition that requires emergency care, or in the unlikely event that you became critically unwell in an urgent care centre, then you would be assessed and cared for by skilled clinical staff. If needed, you would be safely transferred to the Emergency Department, or out of the county to a Trauma Centre, as now. 

At the Emergency Care site, there will be one entrance for both the Emergency Department and the Urgent Care Centre. On arrival, you would be quickly assessed and doctors and nurses would decide on the best place for your care.

NEW: Who decides what an urgent care case is and what's emergency care?
If you walk in to an Urgent Care Centre and have a condition that requires emergency care, or in the unlikely event that you became critically unwell in an urgent care centre, then you would be assessed and cared for by skilled clinical staff. If needed, you would be safely transferred to the Emergency Department or out of the county to a Trauma Centre, as now. 

At the Emergency Care site, there will be one entrance for both the Emergency Department and the Urgent Care Centre. On arrival, you would be quickly assessed and doctors and nurses would decide on the best place for your care.

It says in the consultation document that under our proposal, almost 80% (8 out of 10 people) would continue to go the same hospital as they do now for emergency and urgent care. How is this worked out?
These numbers are based on the fact that around half of the people who currently attend our A&Es go to the Princess Royal Hospital and the other half go to the Royal Shrewsbury Hospital.

We know that around 6 out of every 10 people who currently attend our A&Es do not actually need emergency care. They need urgent care. In the future, these people would be treated at one of our 24-hour urgent care centres at either the Princess Royal Hospital or the Royal Shrewsbury Hospital. In other words, they would be going to the same hospital as they do now for their urgent care.

Around 4 out of 10 people who attend our A&Es do need emergency care as they have a life or limb-threatening illness or injury. In the future, all of these people would need to be seen at our new Emergency Care site. For around half of these people (that’s 2 in 10 people) they would go to the same hospital for emergency care as they do now. This means that the other half (2 in 10 people) may have to travel further than they do now for emergency care.

How long will I have to wait to be seen in the urgent care centre?
In our new model of care, we are aiming for all patients to be seen, treated and discharged as efficiently as possible and within the national standard of four hours.

What will happen if I arrive at an Urgent Care Centre and I need emergency care?
If a seriously ill patient arrived at an Urgent Care Centre or in the unlikely event that a patient became critically unwell in the centre, they would be assessed and cared for by skilled clinical staff. If needed, then they would be and safely transferred to the Emergency Department at the Emergency Care site or out of the county to a Trauma Centre, as they are now.

NEW: Where would you go if you had an epileptic fit?
This would be dependent on the patients’ medical history, severity of the seizure and presentation to the department. If an ambulance is in attendance, the paramedics would begin treatment and assess where the most appropriate treatment could be provided. If a patient presents at the Urgent Care Centre on the Planned Care Site, they will be assessed by the team. If, on assessment, they determine that the Emergency Department was required, they would arrange an emergency ambulance to transfer the patient safely for ongoing treatment. Otherwise, they would be treated at the Urgent Care Centre.

NEW: Given the difficulties experienced in the local recruitment of doctors and nurses to work in urgent/emergency care, how do the CCGs anticipate that SaTH will fill posts in the Urgent Care Centre? 

SaTH has an extensive five-year workforce plan that is well underway which incorporates clinical posts that will support the urgent care centres at both hospitals.

NEW: Who will staff the Urgent Care Centres and what qualificatiosn and experience will they have?
The Urgent Care Centres will be staffed by highly skilled senior health professionals who are specifically trained to deliver urgent care for adults and children. This will include Advanced Practitioners, GPs and nurses.

NEW: The CCGs claim that up to 60% of urgent/emergency cases can be treated at Urgent Care Centres. How is this possible?
Detailed discussions have taken place with doctors, nurses and therapists who work at our hospitals, together primary and community care staff, to look at the numbers of people who currently attend our A&Es and the type of conditions that they have. This has helped to develop the urgent care model and determine which patients in the future could be treated in an urgent centre and which would need to be treated in an Emergency Department. 

Based on SaTH’s data of A&E attendances, we believe that, in the future, around 60-65% of patients who currently attend our A&Es would be able to be treated at one of our 24-hour urgent care centres. This includes patients who have a minor cut, sporting injury or chest infection. The new centres would offer more services than our existing centres, including a greater range of diagnostics and mental health assessment rooms.

NEW: What is the CCGs' contingency plan and its cost should the Urgent Care Centres fail to meet their 60% target?
Although we believe that 60% of patients who currently attend our A&E departments would be able to be treated at one of our new urgent care centres, our clinical model will be designed to be flexible if this number decreases or increases.

NEW: Is it the case that the proposed Urgent Care Centres will be run by a private company?
There has been no decision which organisation will run the Urgent Care Centre. This will be agreed following the outcome of the consultation.

 

Emergency Care

What are the benefits of having a dedicated Emergency Care site?
There are lots of benefits to separating out planned care and emergency care and having a single dedicated Emergency Department on an Emergency Care site. It would mean that:

  • Patients are seen quicker by a variety of specialist doctors and nurses 24-hours a day, seven days a week who are all located on one site 
  • Patients are less likely to have their operation cancelled due to a bed not being available due to an emergency admission 
  • More patients would be able to be quickly assessed, observed, treated and discharged the same day, avoiding the need to stay in hospital overnight


How would I be treated in an emergency?
Our proposed changes to the way we deliver emergency care would mean that, in a life or limb-threatening emergency, patients from across Shropshire, Telford & Wrekin and mid Wales would be treated in a single, dedicated, purpose-built Emergency Department. Here, you would receive 24-hours-a-day, seven-days-a-week care from specialist emergency doctors and nurses. This would improve the recovery of our patients and lead to faster diagnosis, earlier treatment and improved clinical outcomes.

As happens now with our existing A&E departments, in an emergency situation, you would either arrive by ambulance or be brought to the Emergency Department at the Emergency Care site. As soon as you arrive, you would be assessed by the emergency clinical team who would decide on the best place for your care:

  • If doctors decide that you do not need emergency care then you would be directed to the 24-hour Urgent Care Centre which would be based alongside the Emergency Department
  • If needed, you would receive emergency care and treatment in the Emergency Department without delay.
  • As is the case now, if you suffer a major trauma, you may be brought to the Emergency Department to receive immediate lifesaving treatment before being transferred to a Trauma Centre.


NEW: Where would I go if I was having a suspected heart attack?
If you are ahving a suspected ehart attack and call an ambulance, the paramedics would quickly diagnose your condition and, if necessary, initiate emergency treatment. They would then decide on the best place for you to receive further care or treatment. Currently, that would be the nearest A&E department or, in more severe cases, a specialist cardiac centre, for example in Stoke or New Cross. Under our proposals, in the future you would either be taken to the Emergency Department or, as now, a specialist cardiac centre like Stoke or New Cross.

NEW: What would happen if I had a cardiac arrest?
If you have a cardiac arrest (i.e. your heart stops), paramedics would initiate emergency resuscitation. They would then decide on the best place for you to receive further care and treatment. Currently, that would be the nearest A&E department. Under our proposals, in the future you would be taken to the Emergency Department where you would be treated by specialist emergency doctors.

If I have to have an emergency operation, would I be able to stay at the Emergency Care site for my recovery if this was nearer to my home?
Following your emergency care, our aim would be to get you back home as soon as possible. However, depending on your condition, the doctors and nurses looking after you may decide that you need ongoing hospital care. Where this ongoing care takes place will depend on your condition and the care services you need. For many patients, this will mean they are transferred to the Planned Care site.

NEW: Will both hospitals have pathology labs and MRI/CT scanners or in urgent cases will patients and samples have to be transferred between hospitals? 
Both hospitals will have diagnostics (including MRI/CT scanners) and pathology to support the need for urgent tests to be carried out. 

NEW: Under the Option 1 proposal are you saying that one hospital is being changed to a regional “trauma centre” and the other will still be a normal A&E?
Having the Emergency Care site at the Royal Shrewsbury Hospital would mean it can continue to be a Trauma Unit and Princess Royal Hospital at Telford would be a planned care centre. As CCGs, it is our responsibility to commission (buy) the appropriate emergency and Trauma Unit services for our patients. It is the responsibility of NHS England to commission the services delivered at Major Trauma Centres.

When deciding on our preferred option, we had to consider what this would mean to patients who suffer a major trauma and need life-saving emergency care. A major trauma is defined as serious injuries that are life-changing and could result in death or severe disability. At the moment, if a patient suffers a major trauma in Shropshire, Telford & Wrekin or mid Wales, the most severely injured patients are taken straight to a Major Trauma Centre out of county, such as the University Hospitals of North Midlands in Stoke-on-Trent, Birmingham Children’s Hospital or the Queen Elizabeth Hospital in Birmingham.

A small number of patients are taken to a Trauma Unit to be stabilised before being transferred to a Major Trauma Centre. The Royal Shrewsbury Hospital is a Trauma Unit. Other nearby Trauma Units are based at Wolverhampton, Wrexham, Worcester and Hereford. After assessment, some trauma patients do not require a transfer to a Major Trauma Centre and can safely receive ongoing treatment in a Trauma Unit.

NEW: How would the one hospital that has the emergency care centre cope with all the demand?
We know that around 6 out of every 10 people who currently attend our A&Es do not actually need emergency care. They need urgent care. In the future, these people would be treated at one of our 24-hour urgent care centres at either the Princess Royal Hospital or the Royal Shrewsbury Hospital.

NEW: Shropshire, Telford & Wrekin and mid Wales is an area larger than Greater London and yet just one A&E is now being proposed. How can this be justified?
Our proposal for one emergency care site would improve the recovery of our patients and lead to faster diagnosis, earlier treatment and improved clinical outcomes. We know that around 6 out of every 10 people who currently attend our A&Es do not actually need emergency care. They need urgent care. In the future, these people would be treated at one of our 24-hour urgent care centres at either the Princess Royal Hospital or the Royal Shrewsbury Hospital.

 

Planned care

Where would I go if I need to have a planned operation?
Most patients now have their planned surgery as a day case and most day case surgery will take place on the Planned Care site. However, if you are classed as high risk, or in the case of a child, surgery would take place at the Emergency Care site.

Where would I go if I have an existing health condition and need to have a planned operation?
This will depend on the clinical assessment by the doctor who is carrying out your operation. Depending on your needs and the risk assessment, you may still have your operation on the planned care site. If your doctor feels that you may need the support of the critical care team, for example, if you’re having a complex planned operation, then your operation would take place at the Emergency Care site.

If the Planned Care site is at Telford, would I have to stay there after my operation, even if I live in mid Wales? 
Most patients now have their planned surgery as a day case and most day case surgery will take place on the Planned Care site. This would mean that you should be able to go home afterwards. If you are having your operation as an inpatient then you will have to remain at the Planned Care site until you are well enough to go home.

NEW: Opthalmology has moved to Shrewsbury site – is this permanent or temporary? Will it stay here under Future Fit or will it be relocated depending on where planned care ends up?
Opthalmology has been centralised at the Royal Shrewsbury Hospital. Under our proposals, Opthalmology would be delivered at the Planned Care site.

NEW: Will there be diabetes clinics at both hospitals?
Yes, there will be outpatient diabetic clinics at both hospitals.

NEW: Where will cataract treatment be provided? 
As with the majority of elective procedures, cataract surgery would be available at the Planned Care Site.

NEW: What would happen to a person in the planned care site who is undergoing a planned surgical operation and there are complications which need immediate urgent intervention?
The patient would be stabilised and then quickly and safely transferred to the Emergency Department. However, all patients would be screened prior to their operation to ensure that there are no clinical reasons why they could not have surgery on the Planned Care site. Any patient who for clinical reasons was classed as high risk would have their surgery at the Emergency Care site.

NEW: Can you guarantee that bed shortages at the Emergency Care site will never require transfers to beds at the planned care site and, in consequence, lead to the cancellation of planned care treatments?
Under our proposals, the size of the two hospitals has been modelled to allow for demographic growth, new ways of working and a much lower occupancy level. The lower the occupancy level, the greater the services will be able to respond to increases in demand, especially during the winter. At the Emergency Care site, the ‘front door’ will have more assessment areas for patients to be promptly treated with access to senior decision-makers seven days a week. This new way of working will prevent the need to put medical patients into beds that are allocated for planned procedures.

NEW: Where would bowel cancer surgery take place under the proposal?
This would depend on the patient’s pre-operation assessment. If the patient was consider high risk and would potentially need the support of the Critical Care Team, they would receive their surgery on the Emergency Site. However, for the majority of patients, they will be able to have their planned operation on the Planned Care Site.

NEWI've heard that more than half of people having planned operations live nearer to the Royal Shrewsbury Hospital. Is this true?
This figure is not correct. During 2017/18, over half (54%) of adults who had a planned operation lived nearer to the Princess Royal Hospital, compared to 46% who lived nearer to the Royal Shrewsbury Hospital.

 

Trauma services

I’ve heard one of the reasons that the Royal Shrewsbury Hospital is the preferred option for the Emergency Care site is because it’s a Trauma Unit. What is a Trauma Unit and why is it at Shrewsbury not Telford?

The role of a Trauma Unit in each region is to accept and manage, at any time, arrival of patients from the following two groups:

  • Those considered to have injuries not requiring expertise of a Major Trauma Centre
  • Those critically injured for whom direct transfer to a Major Trauma Centre could adversely affect outcome (with subsequent plans to transfer)

Following assessment, if a patient no longer requires management by the Trauma Team, they will then come under the care of the appropriate clinical speciality.

A Trauma Unit could be the primary receiver of seriously injured patients and are responsible (for up to 2 days when patients should refer on to a Major Trauma Centre) for resuscitating and caring for patients who require optimisation as they were too unstable and unable to cope with a 45 minute transfer to a Major Trauma Centre.

A Trauma Unit may receive local trauma patients with less serious injuries which will include simple fractures of one limb, lacerations and minor head injuries. In addition, Trauma Units need to have the expertise to recognise patients who are beyond their capacity to treat and to be able to transfer them rapidly to a Major Trauma Centre.

It is correct that one of the reasons why the CCGs have chosen the Royal Shrewsbury Hospital as the preferred option for the Emergency Care site is so that it can continue to be a Trauma Unit. If a patient suffers a major trauma, for example a serious head injury, severe wound or multiple fractures, they may be taken to a Trauma Unit to be treated, or, in the most severe cases, stabilised and then transferred to Major Trauma Centre.

The North West Midlands and North Wales Trauma Network coordinates trauma care services across our region and it is their view that a Trauma Unit should be at the Royal Shrewsbury Hospital. This is because of its location and access for patients in the west of the region, mainly residents of mid Wales. They have advised that, if the Trauma Unit was at Telford, there would be an increased risk for the group of patients from Powys as their transfer times to a Trauma Unit would be significantly increased. However, if Telford was chosen as the Emergency Care site, it could apply to become a Trauma Unit. It would have to meet a number of quality standards and requirements in order to do that.

 

Recruiting and retaining staff

Why is it so difficult to recruit and retain staff?
Across the country, there is a national shortage of nurses and doctors, especially within paediatrics, psychiatry, neurology, obstetrics and gynaecology and emergency department specialties.

Whilst some specialities are predicted to have adequate national training numbers coming through over the next five years (obstetrics and gynaecology, for example) to meet anticipated staffing needs, it still does not guarantee recruitment to Shropshire at all, or in a timely manner; nor is it reflected in all specialties.

Locally we have additional problems by having nearly all the same services at both hospitals. This means that we need to have staff to cover both sites 24/7, seven days a week. This means that staff on a rota are working many more unsociable hours (on call rota) than their colleagues in other hospitals. This causes a lack of balance between work and home life. Other hospitals are therefore more attractive to work at, so we struggle to recruit and keep staff. In addition, potential staff are concerned the lack of certainty about the future of the hospitals. Until we complete a consultation, consider the feedback and make a decision, we cannot reassure many potential recruits.

How hard are you trying to recruit and what are you doing?
Since July 2015, the Trust has been running a recruitment campaign to attract new staff to Shropshire. Shropshire, Telford & Wrekin and mid Wales are attractive places to live and anecdotally, we have a number of people we know would like to work for us, but they are unwilling to leave their current jobs while the future of the two hospitals is undecided and the rotas mean that they would probably have a worse balance between work and life.

Have you had any success in recruitment?
Yes we have in some areas but in our key emergency services we are still unable to recruit doctors (for example in A&E and Acute Medicine). We are also struggling to recruit nurses to work in our A&Es.
The Royal College of Emergency Medicine (RCEM) considers the proper staffing of the Emergency Department as the single most important factor in providing a high quality, timely and clinically effective service to patients.
There are 5 full time substantive Consultants in post, covering both sites. The Royal College of Emergency Medicine (RCEM) recommends that all A&E departments should have an establishment of at least 10 Emergency Medicine Consultants to provide up to 16 hours a day of consultant cover. There are 4 Locum Consultants in post following a decision by the Board in December 2016 to over-recruit Locum Doctors to provide additional resilience to the On Call rota as there had been no applicants for the substantive posts.
Due to the challenges of the current workforce configuration across two sites the On Call rota is particularly demanding for our substantive workforce some of whom will consistently provide cover twice a week.


If you have had success in recruiting, why do we still need to change?
Despite these successes, the scale of the staffing problem locally is still enormous. Changes also need to be made for other reasons, such as quality concerns which were raised by the Care Quality Commission in their 2017 report:

  • Changing healthcare needs of the population now and into the future
  • Quality standards that are required and that individuals and organisations aspire to deliver
  • A need for improved productivity and a reduction in inefficiencies (in line with the Carter Review 2016 and the Trust’s work with the Virginia Mason Institute)
  • On-going developments in medicine and technology
  • Workforce changes in terms of skills, availability and training
  • Poor quality existing facilities and level of backlog maintenance.


What about keeping and developing existing staff?
Whilst we quite rightly are concentrating on recruitment, we also work hard to keep our existing staff through development, engagement and culture change initiatives. As the proposals for Shropshire, Telford & Wrekin and mid Wales become reality, staff will be supported to develop and adapt to any required new ways of working.

NEW: The Future Fit model of hospital care proposes significant changes. What does this mean in terms of staff? Is it true there will be 330 fewer nurses and 842 fewer hospital staff as has been claimed?
Future Fit is all about improving local hospital services and our workforce is absolutely critical to delivering these important changes. Changing our hospitals by creating a separate Emergency Care site and Planned Care site will create new job opportunities, new roles and a much better working environment.

Traditional medical and nursing roles are changing and we need to make sure our workforce is sustainable, so we are creating new roles and working hard to support our teams to grow and develop.
While our plans show a decrease in Registered Nurses, they also show an increase in Nurse Associates. This is a new role that will see staff – sourced predominantly from our Health Care Assistant workforce – trained to fill what are currently some of our Registered Nurse roles. Our first Nurse Associates will start at our hospitals this year following a two-year training programme and we plan to grow our Nurse Associate workforce to over 120 staff over the next 5 years.
At the moment, we have more than 120 nursing vacancies, and we’ve lost 17 nursing and midwifery registered staff in the past 12 months. This means we have to rely heavily on temporary staff, including agency workers. It shows how crucial the new Nurse Associate role is to helping us make our nursing teams sustainable. And, crucially, it also means our staff will benefit from opportunities to grow and develop their careers with us.

NEW: The Outline Business Case mentions that there will be a small reduction in staff numbers. Is this correct?
Under both options, there is a small reduction in staff numbers, as outlined in the Outline Business Case. Over the next five years, we will see huge developments in new technology. This includes moving to electronic patient records, which will have an effect on our workforce needs. There will also be fewer staff needed in some areas due to the reduced duplication of services across two sites. 

As we currently have a turnover of around 350 staff each year, we are not expecting these changes to mean anyone will have to be made redundant. We aim to deliver the necessary changes in a planned way that will allow us to retain our existing staff and attract new staff – and be able to deliver the best possible care to local people.

NEW: How many fewer registered nurses will there be under the Future Fit proposals?
There is no intention to reduce the number of registered nurses employed by SaTH. It’s important to remember that we currently have over 100 nursing vacancies. We always aim to recruit to full establishment, but recruitment challenges mean this has never been possible. This means we rely heavily on temporary nursing staff, including agency staff. What we want to do is reduce our reliance on temporary staff by building a sustainable substantive workforce. The introduction of Nurse Associates is one of the ways we will do this, and we expect that our new Nurse Associates will cover much of the work that we currently rely on temporary nursing staff for. SaTH is also working on a robust staff retention strategy, which includes career planning, flexible working and access to training and development.

NEW: There are rumours that hospital staff are not being given opportunities to express their views about Future Fit. Is this true?
Our people are our priority and it’s important that we hear all of their views. We have an intensive staff engagement programme to ensure that every member of staff can have their say. The programme includes weekly roadshows, newsletters and communication through payslips.

Many of our staff have worked together to develop the new model of care that will deliver improved services to the people that they serve. We have and continue to promote the Future Fit consultation to all our staff and would urge everyone to have their say as everybody’s views are crucial to us.

NEW: Why are you struggling to recruit doctors and nurses and how will Future Fit solve the problem?
Across the UK, there is a severe shortage of healthcare staff. It is becoming more difficult to make sure that we have enough doctors, nurses and other healthcare staff to provide a 24-hours a day, seven days a week service at both our hospitals. Although a similar picture can be seen across the country, this problem has a greater impact in Shropshire and Telford & Wrekin as we have two hospital sites that are less than 20 miles from each other that currently provide many of the same services. 

We are finding it harder to recruit and retain staff, particularly within our Accident and Emergency (A&E) departments and critical care services. The Royal College Guidance states we need 20 consultant doctors to run our two A&E departments, 24-hours a day, seven days a week. Currently we only have three permanently employed consultants in post. We have recently made three offers to consultants following the news of the capital investment.
Staff shortages have meant that our doctors have had to be on-call more often or work extra hours across two hospital sites in order to keep patients safe. We have also had to recruit temporary staff that are not as familiar with our hospitals and have therefore needed additional support.

We’ve tried hard to address the recruitment challenge in a number of ways, including recruitment drives nationally and overseas and sharing posts and rotas with neighbouring trusts, but these have all failed to provide a sustainable solution. Day-to-day operational plans are in place to ensure the care and safety of patients within the Trust’s clinical services, but a long-term solution is urgently needed.

Future Fit is proposing a separate Planned Care site and Emergency Care site. We know that by changing our hospitals in this way we will become a more attractive place for people to work. This would enable us to recruit more doctors and nurses to work at both our hospitals in the future. Already, since the announcement that we are going out to consultation, we have had greater interest from staff wanting to work with us.

 

Travel and transport

NEW: Won't travelling a greater distance to the Emergency Care site jeopardise patient care or, in the most serious cases, survival?
National evidence tells us that in an emergency, such as a heart attack or stroke, getting patients to the right hospital to receive the right treatment leads to better outcomes. Paramedics routinely diagnose patients in an ambulance to make sure that a patient is taken to the right hospital for the most advanced treatment. This often means that a patient will travel further and may drive past an A&E department to get them to the right place.

This is happening now as ambulances take patients from across Shropshire, Telford & Wrekin and mid Wales who have had a stroke and need specialist care to the Stroke Unit at the Princess Royal Hospital. Similarly, patients who need heart or lung surgery are taken out of county to Stoke. Both the West Midlands and Welsh ambulance services have been involved in the Future Fit process and support the delivery of this public consultation. We are continuing to have detailed discussions with them around developing detailed pathways and ensuring the best possible care for our patients.

The CCGs have commissioned a specific ambulance modelling activity exercise to explore and determine what impact both options would have on ambulance/ patient transport activity and travel times, and produce a formal report. West Midlands Ambulance Service, Midlands Air Ambulance, Welsh Ambulance Service and Falck (Non-emergency Transport services) are all engaged in this exercise. The outcome of this exercise will form part of the decision-making process following the end of the consultation.

What if I don't have any transport and I can't get from Telford to Shrewsbury for my care or vice versa?
As now, if you are unable to get to or from one of our hospitals, there are a number of options available and these will continue in the future.

If your reason for going to hospital is not an emergency, you'll normally be expected to make your own way there. Wherever possible, patients are advised to make their own arrangements with a relative or friend, or to use public transport.

If there is difficulty in meeting the cost of transport to and from hospital, you may be able to claim a refund of the cost of travelling under the ‘Healthcare Travel Costs Scheme’ (HTCS). This is part of the NHS Low Income Scheme and was set up to provide financial assistance to those patients who do not have a medical need for ambulance transport, but who require assistance with their travel costs to attend NHS appointments. For more information please visit https://www.nhs.uk/nhsengland/healthcosts/pages/travelcosts.aspx or ask your GP or the healthcare professional who referred you to hospital.

Alternatively, some people are eligible for non-emergency patient transport services. These services provide free transport to and from hospital for:
• people whose condition means they need additional medical support during their journey
• people who find it difficult to walk
• parents or guardians of children who are being transported

To find out if you are eligible for patient transport services and how to access it, you will need to speak to your GP or the healthcare professional who referred you to hospital.

We do understand that travel and transport are important considerations for people and that any change to our hospital services would have an impact on travel for some of our patients, visitors and staff.

Travel and transport has been a key factor in developing our proposed model of hospital care and deciding our preferred option. We have undertaken a Travel Impact Analysis to understand the impact any changes to our hospital services would have on patients across Shropshire, Telford & Wrekin and mid Wales. You can read this in our Integrated Impact Assessment.

Whatever the outcome of this consultation, the majority of patients would continue to go to the same hospital as they do now. However it will mean that some people will have to travel shorter distances and some will have to travel further for their care.

NEW: Travel would be an issue for those who do not drive. For most of these people, they would have to catch 2-3 buses or they may have to use a taxi. How can you justify this?
We understand that travelling to our hospitals is already an issue for some people, especially given the rural nature of our county. Under our proposal, most people would continue to go the same hospital as they do now. And around 8 out of 10 people (or 80%) would continue to go to the same hospital as now for emergency and urgent care.

We have set up a Travel and Transport Group to look at this issue in more detail.. This group, which includes all key transport stakeholders and a group of patient representatives, will work together to review current transport services and identify ways in which travel and transport could be improved across Shropshire and Telford & Wrekin. More information will be shared about the progress of this group over the coming months. We are also very keen to hear your views and experiences about travel and transport so please include your comments in your survey response.

What are you planning to do to help people to travel for treatment or to visit relatives at each of the hospitals?
We have a number of ideas that we are looking at, but we want to hear people’s views during consultation. We will then consider these suggestions and see whether we can work with partners or make some changes to how we organise appointments to make it easier for people. You can read more about this in the consultation document.

Won’t the ambulance services struggle if we only have one Emergency Care site?
Both the West Midlands Ambulance Service and the Welsh Ambulance Service currently transport patients across Shropshire and mid Wales. Paramedics assess patients and decide on the best place for them to go to receive the care and treatment they need. For example, many patients from Powys, Oswestry and surrounding areas are taken to the Princess Royal Hospital to the stroke unit or Wrexham Maelor Hospital and some patients from Telford area are taken to the Royal Shrewsbury Hospital. Equally, it a patient suffers a major trauma, they may be taken out of county to the Royal Stoke Hospital or University Hospitals Birmingham.
We have been and continue to work closely with both Welsh and West Midlands Ambulance services on the processes and pathways for the future and both ambulance services are supportive of the need to change and our proposed model of care.

Will the ambulance services take people to the Planned Care site?
If paramedics decide that a patient can be treated in one of the two Urgent Care Centres, they will take them directly to the nearest Urgent Care Centre, which may be the Urgent Care Centre at the Planned Care site. If paramedics decide that they need emergency care then they would be taken directly to the Emergency Care site.

NEW: What about winter when it is bad weather and ambulances have tot ravel further or there are major traffic delays?
National evidence tells us that in an emergency, such as a heart attack or stroke, getting patients to the right hospital to receive the right treatment leads to better outcomes. Paramedics routinely diagnose patients in an ambulance to make sure that a patient is taken to the right hospital for the most advanced treatment. This often means that a patient will travel further and may drive past an A&E department to get them to the right place.

This is happening now as ambulances take patients from across Shropshire, Telford & Wrekin and mid Wales who have had a stroke and need specialist care to the Stroke Unit at the Princess Royal Hospital. Similarly, patients who need heart or lung surgery are taken out of county to Stoke. Both the West Midlands and Welsh ambulance services have been involved in the Future Fit process and support the delivery of this public consultation. We are continuing to have detailed discussions with them around developing detailed pathways and ensuring the best possible care for our patients.

NEW: In what ways are you looking to improve public transport with the changes having an impact on some patients who may have to travel further?
A Travel and Transport Group has been established and all key transport stakeholders and patient representative groups are involved in this group.  This group will work together to review transport services and identify ways in which travel and transport could be improved.  This will form part of the decision-making process after the consultation.

NEW: What car parking will be provided at the emergency and planned care sites?
Currently, this is being reviewed by The Shrewsbury and Telford Hospital NHS Trust (SaTH) alongside the Future Fit Travel & Transport working group to ensure that there is adequate access for patients using all forms of transport.

NEW: It's 22 miles from the centre of Bishop's Castle to Royal Shrewsbury Hospital and people live all over south-west Shropshire and East Montgomeryshire. Why do we have to travel all that distance to hospital?

Our two hospitals cover a very large geographical area, from Oswestry and Market Drayton in the north to Cleobury Mortimer and Clun in the south; Welshpool and Llanidloes in the west and Bridgnorth and Newport in the east. We recognise that any change to our hospital services would have an impact on travel for some of our patients, visitors and staff. Although you have told us that you want the best possible care when you have to go to hospital, we also understand that travel and transport will be an important factor for you and your family.

Travel and transport has been a key factor in developing our proposed model of hospital care and deciding our preferred option. We have undertaken a Travel Impact Analysis to understand the impact any changes to our hospital services would have on patients across Shropshire, Telford & Wrekin and mid Wales. You can read this on our website.

 


Community services

If more care is to be provided in the community so I don't need to go to hospital, what will that be and how will I access it? I can never get a same day appointment with my own GP practice now.
Our vision puts the needs of patients at the centre of our neighbourhood model. This will operate in a more efficient, focused manner, steering away from bed based services to a more community centered style of care.

The proposed model of care aims to provide and design services that work more effectively around the patient. This involves integrated health and social care community services that provide alternatives to hospital care for mild, moderate and severe long term conditions, with rapid access to urgent and crisis care. It will also aim to ensure as much as is clinically safe and efficient to do so, that patients receive the right care in the right place and do not have to travel to a hospital for treatment unnecessarily.

The Sustainability and Transformation Partnership (STP) for Shropshire and Telford & Wrekin has a range of coordinated activities that focus on looking at ways we can develop neighbourhood care services, where patients are seen and treated in their local community by a co-ordinated team of medical, nursing, therapy, mental health and learning disabilities teams. They are also looking at how we can reduce the number of times patients need to come to hospital and when people need hospital care, how we can more rapidly assess, treat and discharge those who are well enough back to home or into community care.

Our neighbourhood care model will remove existing barriers and bring together all the services that patients may need. These include:

  • primary care (such as your GP practice) 
  • community care
  • mental health services
  • learning disabilities services
  • local authority services such as the Housing Association
  • voluntary sector such as Help the Aged and the
  • independent care sector such as Nursing Homes
  • social care

This approach will ensure the public receive the right care in the right place and maximise the efficiency and effectiveness of local services.

As we continue to work to develop healthcare services, we will continue to review the services we currently provide. Where we believe that a change in the way we deliver services may lead to better, higher quality care for patients and therefore significant change may be identified as an option then we will follow due process. This may require further public consultations in the future as with any other significant changes to your services.

NEW: How do the Future Fit changes being proposed fit in with Shropshire Care Closer to Home?

Shropshire Care Closer to Home is a programme of change that is being organised and coordinated by Shropshire Clinical Commissioning Group to achieve better value care for the population. In order for Future Fit to work as is planned, Shropshire Care Closer to Home must also work as this will ensure that only those people who absolutely need to be in hospital are admitted.

In Shropshire, just like many other parts of the UK, we have developed an unhealthy dependence upon our general hospital. The CCG has engaged with stakeholders and has reached the conclusion that we have a duty to address this over-dependence, and bring Shropshire Care Closer to Home.

Shropshire Care Closer to Home is being aimed therefore at improving health outcomes for people with multiple long-term health conditions aged 65 and over.

NEW: What changes will we see as a result of Shropshire Care Closer to Home?

Shropshire Care Closer to Home will initially be comprised of three high-level phases. 

Phase 1 is already in place. It is the Frailty Intervention Team (FIT) based at the A&E department at the Royal Shrewsbury Hospital. This team works to ensure that where possible people with complex needs (also referred to as frail) have their needs met quickly either to prevent a hospital admission from occurring, or to achieve a shorter stay in hospital than would otherwise have been expected by coordinating discharge requirements more effectively.

Phase 2 is about delivering a model of care called “Case Management”. This model has two parts. The first is about our community-based NHS workforce working closely with GP practices across Shropshire to get a clear understanding of how many people over the age of 65 have complex care needs. A crucial part of this process relates to categorising the people identified in terms of whether their need complexity is low, moderate or severe - a process known as “Risk Stratification”.

Once Risk Stratification is complete, those identified as being in severe need will be given the opportunity to work with a designated professional (also known as a “Case Manager”).

Phase 3 is made up of three high-level models. The first is called “Hospital at Home”. The aim of Hospital at Home is to provide diagnostic testing and treatment interventions that are traditionally associated with care in a hospital setting either in peoples own homes or from places close-by. The second model of the third phase of Shropshire Care Closer to Home is about creating a Health Crisis Response Team. The provision of “Step-up beds” is the final model of the third phase of moving Shropshire Care Closer to Home and involves the provision of bed-based care in the localities in which people live, albeit away from their usual place of residence.

NEW: What is happening with Shropshire Care Closer to Home right now?

As this is a rapidly developing programme of work, things are changing all of the time. Shropshire CCG is working with the public and all stakeholders in the process of designing how Shropshire Care Closer to Home is enabled on an ongoing basis.

It is planned that the first stage of Phase 2 (Risk Stratification) will begin to take place by the beginning of 2019. It is not agreed at this stage of the process where the change will begin in the county.

NEW: How can plans for the radical reform of hospital services proceed in isolation from improvements to local GP, social care, community and public health services?
Shropshire, Telford & Wrekin Sustainability and Transformation Partnership (STP) includes all partners from across health and social care, as well as the voluntary sector and patient groups. Together, we continue to work to drive system improvements and have identified a number of local priorities. These include Shropshire’s Care Closer to Home Programme, Telford & Wrekin’s Neighbourhood Programme and Future Fit, as well as other priorities which include primary care, frailty, mental health and cancer.

None of these delivery programmes work in isolation of each other as many have interdependencies which require close working arrangements and collaboration. They are also aligned to other work programmes, including strategic workforce developments, digital enablement and estates, and together they are working to deliver system transformation. Progress is captured and reported bi-monthly through the system governance framework with system leaders including NHS England and NHS Improvement.



Affordability and cost

Why are you spending £312m of public money to change our hospitals?
In order to secure the future of our two hospitals, we need make changes and this costs money. The hospitals were built many years ago and are no longer organised in the right way for the number of patients the hospitals treat. Having explored a number of options, we feel that investing this money into our hospitals is the best way to secure the future of our two hospitals in the future.

NEW: How are you going to pay for it?
Patients and the public can be assured that both options are affordable and sufficient funding is available to deliver either option currently being considered. it is important to stress that we ca only consult on options that are affordable and able to be delivered. 

Subject to the outcome of the consultation, the Department of Health and Social Care (DHSC) has confirmed its support for the Future Fit programme by making available up to £312 million for the recongifuration of our two local hospitals. Further to the outcome of the formal public consultation, this will provide funding to improve our hospital services for people in Shropshire, Telford & Wrekin and mid Wales. 

This funding has been approved by DHSC because it has passed the clinical and affordability tests of NHS England and NHS Improvement (our regulators), NHS Telford & Wrekin Clinical Commissioning Group (CCG) and NHS Shropshire CCG. 

NEW: How much of the £312 million cost of Future Fit will be raised from private finance? 
The £312 million will be made of up a number of different sources but a significant amount will be Public Dividend Capital. It is expected that the national and regional NHS organisations involved will be working on the exact breakdown of the funding.

The Shrewsbury and Telford Hospital NHS Trust (SaTH) will pay 3.5% interest on the Department of Health and Social Care public capital. This is standard accounting practice in the NHS and has been included in all our calculations, assuring us on the affordability of both options on which we are consulting.

NEW: Where will the rest of the money come from?
It is expected that SaTH will self-finance a smaller amount over a 10 year period from its annual capital allocation, which is made available to all trusts each year. A further contribution will be made up from land disposal of excess land currently owned by the Trust and alternative financing mechanisms. SaTH is currently exploring these alternative funding mechanisms which include support from a Regional Health Infrastructure Company (RHIC). The scheme has yet to be launched by HM Treasury so details are not yet confirmed.  Our interpretation of this is that one identifiable aspect of the build will be financed from this route.

NEW: How much of the £312 million will be spent on repairing or converting existing buildings and how much on new buildings?
The £312m is associated with new build and refurbishment. This is currently allocated as £222m for new build and £90m for refurbishment of existing facilities. This will be confirmed as part of the detailed design development process.

NEW: Why not wait five years for more money and do a proper job?
This is not about money. Staying as we are is not an option. We have to change the way we are deliver the services at our two hospitals to make sure we provide high quality, safe services for all patients for the long term.

 

Women and children’s services

What is a consultant-led maternity unit?
This is where there are both doctors (obstetricians) and midwives available to support women and their babies. Obstetricians are doctors who specialise in pregnancies and births where there are complications. Obstetric units offer epidural pain relief, and have an operating theatre nearby in case a baby needs to be delivered by caesarean section. They also have special care baby units.

The consultant-led unit is currently based at the Women and Children’s Centre at the Princess Royal Hospital. All births classed as high-risk, for example, multiple births, caesarean sections or women with complex health needs, give birth at the consultant-led maternity unit. However, expectant mothers can choose to have their baby at the consultant-led unit.

What is a midwife-led unit and what services are offered there?
If you are having a low-risk pregnancy, then you can choose to give birth at a midwife-led unit. These are run by highly skilled midwives who provide care for women before, during and after the birth of their baby.

If you are having your baby in a midwife-led unit and the labour doesn’t progress as it should or if you or your baby needs extra support, you would be transferred to the women and children’s consultant unit. This would mean that a doctor and medical equipment would be on hand if needed.

What types of births happen in midwife-led units or at home?
Women with no ongoing health problems who have been assessed as low risk can choose to give birth at a midwife-led unit or plan a homebirth.

You decided in 2012 to build the women and children’s centre at Telford at cost of £28 million. You said it was the right place for it. Why is Shrewsbury now the best place for it less than 5 years later?
The changes to women and children’s services in 2014 were needed because the previous accommodation that housed these services had become unfit for purpose.
Sustaining inpatient paediatric services on two sites, providing senior paediatric input and maintaining accreditation for doctors in training was a risk. The challenge of maintaining smaller inpatient paediatric units within 30 minutes of each other is well documented by the Royal College of Paediatrics and Child Health (RCPCH) who recommended the consolidation of services into larger single site centres.

Following a public consultation, it was decided that the Telford was the right place for the new building. If, following this consultation, the decision is made to base the Emergency Care site at Shrewsbury; then the acute, inpatient element of women and children’s services would need to be based on the Emergency Care site. Clinical adjacencies are essential for patients to access safe and high quality care and critical when considering the co-location of services such as Women and Children’s and the Emergency Department. The firm view of the Trust’s clinicians is that Women and Children’s and Emergency services need to be on the same site.

The Women and Children’s Centre has accommodation for parents, if you move it where will we be able to stay?
If women and children’s inpatient services moved to Shrewsbury there would be the same standard and type of on-site accommodation available for families.

Would I still be able to go to Telford if women and children’s services move to Shrewsbury?
If Shrewsbury became the Emergency Care site (Option 1) then women and children’s consultant-led services would move to Shrewsbury. This includes consultant led births, children’s inpatient services and children’s cancer and haematology. However, many women and children’s services would still be available at Telford. This includes adult, children’s and neonatal outpatient appointments, midwife-led unit, Antenatal Day Assessment Unit, gynaecology outpatient appointments, maternity outpatients and scanning and tests.

Most women and children would still receive care and treatment in the same place as they do now. The following women and children’s services would be available at both sites:

  • Midwife-led unit, including low-risk births and postnatal care
  • Maternity outpatients, including antenatal appointments and scanning
  • Gynaecology outpatient appointments
  • Early Pregnancy Assessment Service (EPAS)
  • Antenatal Day Assessment
  • Children’s outpatient appointments
  • Neonatal outpatient appointments

NEW: Campaigners claim that two thirds of all children and pregnant women admitted to hospital live nearer to the Princess Royal Hospital. This means that the impact Option 1 will have on mothers in Telford will be significant. Is this true?
No, not at all. The figures below show that there were more women from Shrewsbury postcodes from the ages of 26 to 45 that were admitted into maternity care in 2016/17. 

Number of women admitted by age group into maternity services as a % total for 2016/17.

               
  19 & under  20 to 25   26 to 30   31 to 35   36 to 40   41 to 45   46+ 
Other postcodes    2.2 17.0 30.4 28.9 19.3 2.2 0.0
SY postcode total    3.6 22.3 32.3 27.0 12.2 2.5 0.1
TF postcode total    4.9 27.1 30.3 24.8 10.9 1.7 0.2

 

What are you going to do with the building if women and children’s services inpatient services move to Shrewsbury?
The building will not be wasted and the plan is that it will be used for the women and children’s services that will remain at Telford along with other essential planned care services.

What will happen to children’s cancer and haematology services?
This service will be based at the Emergency Care site alongside children’s inpatients, surgery and assessment services.

If I have my baby at the consultant-led women and children’s unit at the Emergency Care site and I live closer to the Planned Care site, will I be transferred closer to home if I need ongoing hospital care?
If it is clinically safe for you and your baby to transfer to the midwife-led unit at the Planned Care site and there is a bed available, then yes, you will be able to transfer.

Why do women and children’s inpatient services have to stay with emergency services?
The West Midlands Clinical Senate (expert clinical leaders who provide independent advice and guidance to CCGs) recommended that emergency care and women and children’s inpatient services should be located on one site. This is so that emergency doctors, nurses and other healthcare staff are on hand if needed. Under Option 1, this would mean that women and children’s inpatient services moves from Telford to Shrewsbury.

What changes would there be for women and children’s services?
Whatever the outcome of this consultation, most women and children would still receive care and treatment in the same place as they do now. The following women and children’s services would be available at both sites:

  • Midwife-led unit, including low-risk births and postnatal care
  • Maternity outpatients, including antenatal appointments and scanning
  • Gynaecology outpatient appointments
  • Early Pregnancy Assessment Service (EPAS)
  • Antenatal Day Assessment
  • Children’s outpatient appointments
  • Neonatal outpatient appointments

All women and children’s consultant-led inpatient services would take place at the Emergency Care site. This includes:

Consultant-led maternity and neonatal services: Inpatient facilities would be provided for pregnant women who need consultant-led care. This includes antenatal and postnatal wards, delivery suites and a neonatal intensive care unit

Children’s inpatient services: Children’s inpatient services (if a child has to stay in hospital overnight) would take place here. The children’s ward cares for children with serious illness and complex problems who need care from specialist doctors and nurses. This includes children’s surgery and children’s cancer and haematology services.

 

Stroke Services

Why might stroke services move following this consultation?
Prior to summer 2013, stroke services were provided at both hospitals. In response to staffing challenges during summer 2013, The Shrewsbury and Telford Hospital NHS Trust acted promptly, with the support of the CCGs, to secure safe, dignified stroke services for our patients and communities. This involved bringing together hyper-acute and acute stroke services to create one stroke service at Telford. Telford was chosen as it offered the best facilities and staffing model at that time. In early 2014, the Trust board and the CCGs approved the continuation of the single-site stroke service at Telford until the longer term plans were agreed through the Future Fit programme.
Research shows that patients are more likely to have a better outcome if they receive care and treatment in a dedicated stroke unit. If following a consultation it was decided to base the Emergency Care site at Shrewsbury then the stroke unit would need to move to Shrewsbury to be alongside all critical care.

You moved stroke services to Telford in 2013. Why are you now considering moving it again?
We had to consolidate stroke services onto one site in 2013 due to staffing challenges and at the time, Telford was chosen as the best location as it offered the best facilities and staffing model.
Stroke is a life-threatening emergency so it is vital that our stroke unit is based alongside the Emergency Department. It therefore has to be on the Emergency Care site. Following this consultation, if option 1 is approved, this would mean that the stroke unit moves to Shrewsbury.

If I had a stroke, would I be able to have my rehabilitation at my nearest hospital?
Whatever the outcome of this consultation, stroke rehabilitation services would continue to be provided at both hospitals and at home, wherever possible. For those patients whose rehabilitation needs to be at hospital, we would aim for this to take place at the hospital nearest to where they live.

NEW: For a stroke don't you need quick intervention and yet Shrewsbury is more than an hour away for some patients?
National evidence tells us that in an emergency, such as a heart attack or stroke, getting patients to the right hospital to receive the right treatment leads to better outcomes. Paramedics routinely diagnose patients in an ambulance to make sure that a patient is taken to the right hospital for the most advanced treatment. This often means that a patient will travel further and may drive past an A&E department to get them to the right place.

This is happening now as ambulances take patients from across Shropshire, Telford & Wrekin and mid Wales who have had a stroke and need specialist care to the Stroke Unit at the Princess Royal Hospital.

NEW: Where will stroke services be? Who makes the decision where people are taken and isn't speed of the essence?
Stroke is a life-threatening emergency and so it is vital that our stroke unit is based alongside the Emergency Department. It therefore has to be on the Emergency Care site. Option 1 would mean this service moves from Telford to Shrewsbury, whilst Option 2 would mean the service stays in Telford.

National evidence tells us that in an emergency, such as a heart attack or stroke, getting patients to the right hospital to receive the right treatment leads to better outcomes. Paramedics routinely diagnose patients in an ambulance to make sure that a patient is taken to the right hospital for the most advanced treatment. This often means that a patient will travel further and may drive past an A&E department to get them to the right place. This is happening now as ambulances take patients from across Shropshire, Telford & Wrekin and mid Wales who have had a stroke and need specialist care to the Stroke Unit at the Princess Royal Hospital.
Following a stroke, some patients need ongoing rehabilitation. Whatever the outcome of this consultation, stroke rehabilitation services would continue to be provided at both hospitals and at home, wherever possible. For those patients whose rehabilitation needs to be at hospital, we would aim for this to happen at the hospital nearest to where they live.