This page provides answers to Frequently Asked Questions regarding the changes to local hospital services. It is updated regularly.
- What is ‘Keeping it in the County?
- What is the current situation?
- When is all this going to happen?
- Why do these changes need to be made?
- Is there a risk that some services will leave the county if we do not make difficult decisions?
- Why is it difficult to make sure that 24 hour acute surgery stays in the county?
- Specifically, why are changes needed to vascular surgery?
- Why is it difficult to make sure that inpatient children’s services stays in the county? How long can they be maintained as they are?
- Will inpatient children’s services move out of county if we do not create a single inpatient unit?
- Why do services need to move from the women and children’s building at the Royal Shrewsbury Hospital?
- Will maternity services move out of county?
- What are the principles that have shaped the proposals?
- What factors do we need to consider when solving these problems?
- What options have been considered?
- Why is “do nothing” (Option 1) not a realistic option?
- Why is a new site (Option 3) not a realistic option?
- Why is it not possible to concentrate the major and emergency work on one site and the planned activity on the other (Option 4)?
- What has changed since 2008/09?
- What options are there for moving services between sites (Option 2)?
- Are the number of available options decreasing?
- Is it important that the two hospitals work together?
If these proposals are implemented:
- What services will be changing?
- What services will be staying the same?
- What are the “urgent changes” you may need to make and in what services?
- Will there be any changes to A&E?
- Will there be any changes to outpatients?
- Will there be any changes to daycase surgery and procedures?
- Will there be any changes to midwife-led units?
- Will there be any changes to emergency medical care?
- Will there be any changes to fracture services?
- Will there be any changes to cancer services?
- What changes are being considered to stroke services?
- What additional issues arise because of these changes?
- What opportunities are we looking at to help address this?
- When will things change?
- What is the profile of hospital activity now? What will it be in the future?
- What are the challenges facing acute surgery?
- What is the difference between acute surgery and emergency surgery?
- What surgery will still be in Telford?
- Where will people have their emergency and acute surgery?
- Where will I go for my surgery?
- What about Intensive Care?
- How will the new arrangements actually work?
- What women’s services will be provided in Shrewsbury?
- What women’s services will be provided in Telford?
- How much space will the new Women’s and Children’s Centre at PRH need?
- How do the costs compare between providing a new maternity facility at RSH and at PRH?
- What will happen to the women and children’s building at RSH when the changes go ahead?
- What will the facilities be like in the new Women and Children's Unit at PRH?
- Why do we have to change our maternity services?
- Why are you moving maternity services to Telford? I thought the proposal in 2009 suggested they should stay in Shrewsbury?
- Can consultant-led maternity services and inpatient children’s services be provided on separate sites?
- What is the profile of maternity beds now? What is the planned profile of maternity beds and births if these proposals are implemented?
- What is the profile of ill baby, neonatal and special care baby services now? What is the planned profile of these services if these proposals are implemented?
- Who will be able to have their baby at the Royal Shrewsbury Hospital?
- Who will go to the Princess Royal Hospital to have their baby?
- Will I be able to choose to give birth at the new Women and Children's Unit?
- Will my partner be able to stay with me in the new unit at PRH?
- If a women develops complications during labour, how will you make sure that there is enough time to safely transport mother and baby to PRH?
- What will happen to the maternity units in Bridgnorth, Ludlow and Oswestry?
- How will the new arrangements actually work?
- Why is a second theatre needed for maternity? How often is it needed? When will a second theatre be put into place?
- Will I still be able to see my gynaecologist at RSH?
- What will the new facilities be like for gynaecology patients at PRH?
- How can I get involved in the changes to the Women and Children's Services?
- What are the challenges facing children’s services?
- Why do you need to create a single inpatient unit? What new opportunities does this offer?
- Why are you moving children’s services to Telford? I thought the proposal in 2009 suggested they should stay in Shrewsbury?
- What children’s services will be provided at the Royal Shrewsbury Hospital?
- What children’s services will be provided at the Princess Royal Hospital?
- How much space will the new Women’s and Children’s Unit at PRH need?
- How do the costs compare between providing a new maternity facility at RSH and at PRH?
- What will happen to the women and children’s building at RSH if the changes go ahead?
- Can consultant-led maternity services and inpatient children’s services be provided on separate sites?
- Why will head and neck inpatient services also need to move to PRH?
- What about the Rainbow Children’s Cancer Unit?
- What will the new Children's Cancer Unit be like?
- What is a PAU?
- When does a child go to the PAU?
- What will happen to the existing PAU at RSH?
- When will the PAU at RSH be open?
- What will happen when the PAU is closed?
- How will the new arrangements actually work?
- How can I get involved in the changes to children's inpatient services?
- Is this all about saving money?
- Is this about achieving Foundation Trust status?
- Why can’t we have a new hospital, so all services could be on one hospital site in between Telford and Shrewsbury?
- Why can’t we have one site with major and emergency work and one site with planned activity?
- What is the impact of recent legislation?
- What is the strategic case or business case for these changes?
- What is the background to the costs discussed in the consultation document (£28m and £60m)?
- How will you improve public transport between the two sites and from remote areas to the hospitals?
- Will there be enough car parking?
- How will patients in urgent need of complex treatment be transferred between the two hospitals?
- How long will it take?
- Have the ambulance service got the skills to take really sick babies or children the extra travel time?
- What about the times when there are road accidents or other factors that make it difficult to travel?
- What is likely to be the additional cost of transport and ambulances following these changes?
- How are the needs of people in Shropshire and Telford being taken into account?
- What does this mean for the future of the Royal Shrewsbury Hospital?
- What does this mean for the future of the Princess Royal Hospital?
- How are the needs of patients in Wales who use the hospitals in Shrewsbury and Telford being considered as part of these plans?
- How is the population changing?
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What is ‘Keeping it in the County?
"Keeping it in the County" was the name of the consultation on the future of hospital services in Shropshire and Telford & Wrekin which took place from 9 December 2010 to 14 March 2011 .
You can find out more by reading the consultation document or summary consultation document.
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What is the current situation?
The current situation, as of January 2012, is that our outline plans ('Outline Business Case') has been approved by the Trust, Primary Care Trust and Health Authority boards. We are now working towards our detailed plans ('Full Business Case') which will be submitted back to the relevant health boards in spring 2012.
In summary, our plans will see:
- Most hospital services for most patients continuing exactly where they are now
- Some services moving from the Royal Shrewsbury Hospital to the Princess Royal Hospital in Telford. The Princess Royal Hospital will become the main base for consultant-led maternity services, inpatient children's services and inpatient head and neck services
- Some services moving from the Princess Royal Hospital to the Royal Shrewsbury Hospital. Shrewsbury will become the main base for inpatient acute general surgery, and will continue to be our main centre for adult cancer services (strengthened by the new £5m cancer and haematology centre development)
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When is all this going to happen?
Providing that the Full Business Case is approved in spring 2012, then, from summer 2012 onwards, we will begin to put the changes in place, start building, training and moving services. We expect the new reconfigured services to be in place by summer 2014. Between now and then we want to involve as many patients, carers, families and the wider public as possible in helping to shape the new services. We will also make sure that there is widespread publicity about the changes nearer the time.
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Why are changes needed? Why do these changes need to be made?
The local NHS faces three major dilemmas that need to be resolved:
- Making sure that we can continue to provide 24 hour acute surgery in the county
- Making sure that we can keep inpatient children’s services in the county
- Planning to move out of the deteriorating maternity and children’s services building at the Royal Shrewsbury Hospital before this building fails – we need to plan to move outof this building within five to ten years
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Is there a risk that some services will leave the county if we do not make difficult decisions?
Yes. Over the past few years hospital services have begun to leave our area.
Some of the more complex gynaecology cancer surgery and upper gastro-intestinal cancer surgery are no longer provided at hospitals within the county which means that patients have to travel to centres outside the area for their care. The clinicians providing this care locally were found to have good clinical outcomes and high levels of patient satisfaction, but we lost these services because we could not demonstrate that we met nationally-set standards for providing these services and they have been moved from our hospitals to larger centres.
For example, in the case of Upper GI Cancer surgery, this service moved five years ago because of a national directive to centralise cancer services and not in any way a criticism of the Shropshire Upper GI team whose quality of care, survival rates and patient satisfaction levels were praised at each external peer review. So despite providing an excellent service Shropshire lost this facility largely because of a national directive not medical evidence. It is therefore entirely possible that other local, high quality clinical services in our county are at risk of a similar fate.
More complex surgery for gynaecological cancer is also no longer provided in the county. Even though we offered a high standard of care, we lost the service primarily because we did not serve a large enough population across our hospitals. Saying that we wanted to keep providing this surgery locally was simply not enough to keep it here. Many gynaecological cancers are treated without surgery, and most women do still received their treatment locally to a high standard from our multi-disciplinary team. This includes non-surgical treatment of cervical cancers, hysterectomy and non-surgical treatment for ovarian cancer. We also provide follow-up care locally wherever possible, along with screening, imaging and diagnosis, chemotherapy and radiotherapy.
But we do need to make sure that we keep these services local rather than see more women needing to travel outside Shropshire and Telford & Wrekin. We have a major strength in that we offer both chemotherapy and radiotherapy services locally. Many hospitals of a similar size do not do this. This puts us in a good position to keep services locally, and also to attract new services because treatments and technology do change.
More of our services face risks that they will move from the county if we don’t take action to keep them here for our patients.
In both of these cases the services have moved away not because of concerns about the outcomes of care or patient experience. Instead they have gone because we have not been able to meet externally set "Improving Outcomes Guidance" standards. Improving Outcomes Guidance is set by the National Institute for Health and Clinical Excellence and sets standards for the delivery, quality and organisation of cancer services.
Many patients who have heart attacks also are driven past our hospitals to Stoke or Wolverhampton to receive primary PCI, rather than having their treatment in our hospitals.
There is a risk that other services will also leave the area unless we take action and make some difficult decisions to keep them here. We need to respond now to changes that have taken place over a number of years and left some more of our services vulnerable. There are big question marks about whether all of our services can continue to be provided safely unless changes are made.
Available to download:
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Why is it difficult to make sure that 24 hour acute surgery stays in the county?
In short, we need a lot more doctors than we did in the past in order to run specialist services 24 hours a day. It is becoming more and more difficult to find enough doctors to keep service running safely. This is due to a combination of factors including the way doctors are trained, changes in working hours and changes in international recruitment. These are summarised below.
The way that doctors are trained:
The way that doctors are trained has changed significantly. Years ago, surgeons used to be trained in doing a very wide range of different operations on different parts of the body – breast, abdomen, intestines, arteries and veins, for example. Their lengthy training or ‘apprenticeship’ as a junior hospital doctor meant that, when they were eventually appointed as consultants (the most senior grade of doctor), they were able to undertake a broad range of work.
Gradually, things have changed. As new and more complex treatments and diagnostic technologies have become available, the delivery of healthcare has become increasingly more specialised. Today, junior doctors who wish to become surgeons have a shorter, more concentrated period of training in a more specialised field.
This means that, when they have completed their training, they are more expert in a narrower field of surgery.
As a result of this, most surgeons now carry out a smaller range of more complex operations than their predecessors would have done. This benefits patients because increasingly skilled surgeons are able to deliver better results.
However, it also means that they are less able to perform operations to the necessary standards in fields of surgery outside their specialist area. So, for example, a breast surgeon is not ordinarily expected to carry out abdominal surgery as part of his or her planned or ‘non-emergency’ operations. We have breast surgeons in our hospitals who have had a general training and can provide a range of surgery to a high standard, but when they retire we will not be able to replace them with surgeons with similar skills.
This, in turn, affects how emergencies are handled, especially at night when there needs to be a rota of doctors on call to perform surgery in potentially life-threatening situations.
It is better for a patient with major abdominal injuries brought in by 999 ambulance in the middle of the night to be operated on by an abdominal specialist, not a surgeon from another field who does not do this kind of work every day.
Whilst the hospitals of today generally have more doctors working in them than many years ago, the actual numbers of doctors doing specific, highly specialised tasks is relatively small.
This makes it more difficult to ensure that, at night in particular, there are enough doctors available with the full range of skills to provide emergency cover. It makes it even more important to organise services so that the right specialists are available, when needed, to assess and treat patients who arrive at hospital as emergencies at any time of day or night.
Changes in working arrangements:
There are European Union restrictions on the number of hours per week that doctors can work. This is good from the patient’s point of view. It means the junior who see them are not as tired from excessively long periods on duty, and are therefore better able to make the right decisions about their diagnosis and treatment.
But shorter working hours for doctors adds to the difficulties of organising services with the right number of the most appropriate doctors on duty 24 hours a day. Overall, we need more doctors in order to run the same service.
Also, additional restrictions have been put in place on international recruitment. A decade ago the NHS would have looked to other parts of the world to help us recruit the doctors we need. However, other countries need their doctors too so we cannot rely on international recruitment in the same way as in the past.
Experienced general surgeons:
We currently have very experienced and capable older consultants surgeons who received a more general training across a range of sub-specialties. But they are increasingly difficult to replace when they retire. Newly qualified consultants have trained in specific sub-specialties so do not have the range of experience to replace them. We need to plan with the changing workforce in mind, which includes finding ways to maintain 24 hour acute surgery.
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Specifically, why are changes needed to vascular surgery?
Vascular surgery is specialist surgery on the veins and arteries, which supply blood to the heart, brain and other vital organs.
The Department of Health is setting up centres across the country to screen people for abdominal aortic aneurysms. This will screen people for a potentially life-threatening condition and offer them treatment. Normally these centres are set up for populations of about 800,000 people. This is much larger than the 550,000 that we serve. But we are arguing strongly that we should offer this service because of our geography.
We also want to offer the best quality of care and outcomes. Vascular surgery centres that see more patients generally have better outcomes of care.
We will only be approved as a centre for abdominal aortic aneurysm screening if we move to a single site for vascular surgery. If we do not do this then we would not be approved as a screening centre. It will be difficult to keep a local vascular surgery service if we are a screening centre. Vascular surgery for abdominal aortic aneurysms would normally take place out of the county, and it will be very difficult to attract and retain doctors to come to work in the type of service we are able to offer.
Without the proposed changes major vascular surgery would move out of county and this would also threaten a number of other services currently offered within the trust.
See also "Life Saving Screening Programme A Step Closer for RSH and the County"
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Why is it difficult to make sure that inpatient children’s services stays in the county? How long can they be maintained as they are?
The issues facing acute surgery also face inpatient children’s services:
- More doctors are needed in order to keep services running 24 hours a day
- Fewer doctors are available in training roles and as middle grades, and these play a vital role in running 24 hour services
- At the same time, there have been reductions in the number of children’s specialists who have completed their training as junior doctors and are now seeking posts as consultants.
Because of this, we believe that the two inpatient paediatric units are becoming increasingly difficult to staff with the right level of doctor. All the children’s specialists (paediatricians) in the county agree that continuing to run two inpatient units will not be possible very far into the future. They face a continual struggle to ensure they have enough doctors available to look after the children in their care and it looks like this is going to get even more difficult in the future.
Although they know this is a difficult decision to make, they believe that creating a single inpatient unit is the only way we can protect this service for the future, although they do not necessarily agree on how and where this unit should be established. The alternative could be that children needing overnight care would have to be treated outside Shropshire, Telford and Wrekin.
It is not possible to give a precise answer about how long two inpatient children's services can be maintained, as this depends on many different factors many of which are not predictable. We need to have a clear plan in place so that services do not decline and so that we can protect services for the future.
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Will inpatient children’s services move out of county if we do not create a single inpatient unit?
There is a real risk that this may happen.
All the children’s specialists (paediatricians) in the county agree that continuing to run two inpatient units will not be possible very far into the future. They face a continual struggle to ensure they have enough doctors available to look after the children in their care and it looks like this is going to get even more difficult in the future.
Although they know this is a difficult decision to make, they believe that creating a single inpatient unit is the only way we can protect this service for the future, although they do not necessarily agree how this should be achieved. The alternative could be that children needing overnight care would have to be treated outside Shropshire, Telford and Wrekin.
We do not want to stand by and watch services leave the county because we failed to take action to keep them here.
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Why do services need to move from the women and children’s building at the Royal Shrewsbury Hospital?
While we must pay tribute to the staff who work in the women and children’s unit at the Royal Shrewsbury Hospital site, we have become increasingly concerned about the building in which they provide care.
The maternity building at the Royal Shrewsbury Hospital was built in 1969 and is in a very poor condition. Services have outgrown the space available. The cramped environment is not good for patients and makes it difficult for staff to offer the best possible care. The neonatal intensive unit, which is also based in the maternity building, is very short of space.
The lack of space also means there is only one operating theatre. This is a safety concern. Ideally, there should be two operating theatres to deal with unforeseen problems that occur during labour and delivery. We are looking at ways to achieve this quickly, ahead of any changes to women and children’s services.
In 2008 we also put in place a major programme to re-encapsulate the asbestos in the roof of the women and children’s building. The asbestos continues to be sealed in, and advice from the Health and Safety Executive says that asbestos is safe if it is sealed in. But, we will need to keep on treating the asbestos every few years to make sure that it remains safe.
We want to provide a better patient environment for our patients. Even if money is spent on the deteriorating building, its future life span is limited to between five and ten years. This accommodation is simply not good enough for maternity care in the 21st century.
The previous options discussed in 2009 included plans to move from the women and children’s building at the Royal Shrewsbury Hospital. It is now even more important that we make a decision so that we can secure the future of this service.
Useful background information on the condition of the building can be found in the 2007 Site Survey of the Women and Children's Building. Please also refer to the ViewPoint article from Adam Cairns which discusses some of the maintenance work that has taken place since this survey.
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Will maternity services move out of county?
It is very unlikely that maternity services would move out the county, and we are not suggesting that this is likely as part of this consultation.
But we must plan to move out of the maternity building at the Royal Shrewsbury Hospital as this building is deteriorating and does not have a long term future.
Also:
- We also may lose some of the services that work together with maternity services (e.g. children’s services) if we do not take action
- If maternity services faced a crisis (e.g. because the building had failed) then we could lose our “licence” to run these services from the Care Quality Commission. We do not want this to happen.
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How are these problems being solved? What are the principles that have shaped the proposals?
In order to solve these problems we aim:
- To keep two vibrant, well balanced, successful hospitals in the county. The Princess Royal Hospital and the Royal Shrewsbury Hospital should both have a healthy, long term future.
- To have an Accident and Emergency Department at both hospitals.
- To have access to acute surgery from both hospitals.
- To ensure that all communities across Shropshire, Telford & Wrekin and mid Wales are confident that they have timely access to safe services in an emergency
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What factors do we need to consider when solving these problems?
We need to take into account a wide range of factors when solving these problems:
- The needs of the different communities we serve
- Clinical linkages between our services (e.g. between children’s services, neonatal services and maternity services)
- The fact that services are already drifting out of the county, and we expect to see more services leave if we do not take action
- The very real risk that some of our current services will become unsafe
- Restrictions in working hours for doctors
- Changes in the ways doctors are trained, leading them to specialise at an earlier stage
- Increasing external scrutiny and regulation of NHS services
- The availability of capital funding for building and equipment. We think that we can borrow up to £28m for these changes, which will still cost us around £3m every year to pay back on top of the other financial constraints and efficiency savings we need to make.
- The prolonged debate on the future shape of hospital services without resolution – the risks we face are getting harder to manage and the opportunities for solving them are reducing
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What options have been considered?
We have looked at four different options:
- Option 1: Do nothing and maintain all services as they are
- Option 2: Move some services from the Princess Royal Hospital to the Royal Shrewsbury Hospital and move some services from the Royal Shrewsbury Hospital to the Princess Royal Hospital (the proposed option)
- Option 3: Concentrate all services on one site – either a new single site or one of the existing hospitals
- Option 4: Major and emergency work on one site and planned activity on the other
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Why is “do nothing” (Option 1) not a realistic option?
This will not tackle the dilemmas we face:
- Services may decline and reach crisis point. Emergency changes would need to be made.
- More services are likely to drift out of the county because we have not taken action to keep them here.
- We will not have a plan to move out of the women and children’s building at the Royal Shrewsbury Hospital. The building is likely to fail.
- If services decline then we may lose our “licence” to run them and decisions about their future will be taken out of our hands.
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Why is a new site (Option 3) not a realistic option?
A new site will cost £350m to £400m. Developing one of the existing sites would require a similar amount of investment.
This is not possible in the current economic climate:
- Who would lend us this money for major building work?
- How would we pay back the capital loan – in the region of £40m a year on a £400m building project? This is more than a sixth of our annual turnover and paying back this money would have a major impact on other services.
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Why is it not possible to concentrate the major and emergency work on one site and the planned activity on the other (Option 4)?
Most planned work does not require a long stay in hospital. It is the unplanned and emergency work that leads to long stays in hospital. The amount of emergency work is far larger than the planned work, so it requires far more beds.
This means that we would need one very large hospital for the major and emergency work and one small hospital for the planned activity. It would require a lot of investment to develop either of our hospitals to provide the major and emergency work.
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What has changed since 2008/09?
Very little has changed since 2008/09.
We still face risks to our services, and these risks are getting bigger.
The main thing that has changed is the economic climate. This means that our opportunities for major building schemes have reduced.
In 2009 we were looking at a set of short term options (for 2012/13) as a stepping stone to a single major acute site. This included having a longer term plan for getting out of the women and children’s building at RSH.
We cannot plan for a single acute site so we need to find a lasting solution based on our current hospitals with minimal capital building work.
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What options are there for moving services between sites (Option 2)?
At the Royal Shrewsbury Hospital:
- We need to move out of the deteriorating women and children’s building. The life of the building is limited to five to ten years.
- There are few alternative buildings to clinical standards or land opportunities
- It would be expensive to rebuild a women and children’s unit – in the region of £60m in addition to any other changes that might be needed as part of these proposals.
At the Princess Royal Hospital
- There are no inherent problems with the buildings, so capital investment would be going into productive facilities.
- There is flexibility as to where the facilities could be developed – including clinical space that is being vacated (e.g. decontamination unit) and space that could be vacated for clinical use.
- It is estimated that total works for these proposals, including developing a new women and children’s centre at PRH, would cost in the region of £26m to £28m
At both hospitals:
- We would need to find space for car parking.
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Are the number of available options decreasing?
Yes.
It is less easy to borrow capital for major building works and it is more difficult to pay this back.
In 2009 we looked at a range of short-term options (2012/13) as a stepping stone to a new single acute site (at PRH, RSH or in between). Now we cannot plan for a single acute site because this is not affordable in the current economic climate.
The clinical risks we face have not gone away. In fact, they are getting more likely and we have fewer options for tackling them. We have to find lasting options to solve these problems, with fewer resources available to us.
We can secure up to £28m capital funding now, but we do not know how long this will be available so we need to agree a way forward soon before our options reduce even further.
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Is it important that the two hospitals work together?
Yes.
Together the two hospitals serve over half a million people. This puts us in a strong position to provide specialist services and keep services locally that a smaller hospital could maintain on its own.
But, the hospitals do have to work together to do this. Not all services can be provided at both hospitals. This is currently the case and will continue to be so in the future.
For example, radiotherapy is provided at the Royal Shrewsbury Hospital in the Lingen Davies Cancer Centre.
If the hospitals “de-merge” the we would expect:
- PRH would have to work more closely with hospitals to the east, and it is likely that it would start to lose services to these hospitals.
- RSH would not be big enough on its own to carry on providing the same range of services that it does now.
- Overall, we expect that more services would move further away than the proposals in the “Keeping It In The County” consultation
By working together, we aim to keep as many safe services as local as possible and reduce travel for people in Shropshire, Telford & Wrekin and mid Wales who otherwise would need to go to hospitals further afield.
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What services will be changing?
We need to make changes to the following services to keep them safe and keep them in Shrewsbury or Telford:
- Some types of inpatient surgery involving operations where people need to stay in hospital for at least one night.
- Inpatient care for children who need to stay in hospital for tests and treatment.
- Services provided in the maternity building at the Royal Shrewsbury Hospital. These include inpatient obstetric care for pregnant women whose deliveries are higher risk and therefore need to be overseen by hospital consultants, and neonatal intensive care. Midwife-led care would continue to be available in Shrewsbury.
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What services will be staying the same?
- Most services for most patients will stay the same:
- Most outpatient appointments, including diagnostics and procedures.
- Most day case surgery
- Most orthopaedic surgery
- Most emergency medical appointments
- A&E departments at both sites
- Children’s Assessment Units at both sites (the hours of opening are being considered as part the clinical development work taking place during this consultation)
- Midwife-led maternity units at both hospitals
- Lingen Davies Cancer Centre at the Royal Shrewsbury Hospital
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What are the “urgent changes” you may need to make and in what services?
The problems facing acute surgery are so severe that if we faced a crisis then we may need to make changes very quickly. However, we want to make changes in a planned way based on the outcome of consultation, so that we can safely put in the new services in place and make sure that everyone – doctors, nurses, other health professionals, ambulance services, GPs and patients – understands how the new services work.
We do not expect to have to make changes before the end of consultation, but we do need to plan so that we can make acute surgery as safe as possible as quickly as possible after the end of consultation.
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Will there be any changes to A&E?
Both hospitals will continue to have a 24-hour accident and emergency department. This means that patients arriving at accident & emergency departments will, as now, be assessed, monitored, treated, discharged, admitted and/or stabilised and transferred.
The proposals outlined in the consultation document would lead to some changes to the shape of services such as acute surgery. This would mean that there would be some changes in the way ambulance and other emergency services deal with critically ill patients - for example, RSH would be the acute surgery centre for vascular surgery, colorectal surgery, upper GI surgery and major trauma (the most severe trauma is already taken outside the area to regional specialist hospitals e.g. Stoke and Birmingham, and this will continue to be the case). So, as now, patients would be taken as quickly as possible to the hospital best able to provide the care that they need.
However, both hospitals would continue to offer 24 hour A&E services to provide emergency care for people who attend.
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Will there be any changes to outpatients?
Both hospitals will continue to offer outpatient appointments. The majority of outpatient care will continue where it is now.
One of the principles underlying this consultation is that we aim to keep the majority of services where they are now if this is clinically appropriate and feasible. We propose that the majority of outpatients will remain where it is now, aiming to bring our specialist staff to the patient rather than the other way round. The future profile of all services will depend on the outcome of consultation.
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Will there be any changes to daycase surgery and procedures?
Both hospitals will continue to offer daycase surgery and procedures. The majority of daycase surgery and procedures will continue where they are now.
One of the principles underlying this consultation is that we aim to keep the majority of services where they are now if this is clinically appropriate and feasible. We propose that the majority of daycase surgery will remain where it is now, aiming to bring our specialist staff to the patient rather than the other way round. The future profile of all services will depend on the outcome of consultation.
As now, a risk assessment would take place to decide the best location for this surgery to take place which may be the site where the inpatient specialty is based. Some changes may be needed on an individual basis, for example, where it is considered that a patient is at higher risk of requiring emergency inpatient treatment as a result of day case surgery.
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Will there be any changes to midwife-led units?
There will continue to be midwife-led units in Bridgnorth, Ludlow, Oswestry, Shrewsbury and Telford.
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Will there be any changes to emergency medical care?
Both hospitals will continue to offer emergency medical care. The majority of emergency medical care will continue where it is now.
We do need to consider some changes in order to keep our services safe or develop new services that we are not currently able to offer. For example, we do not currently provide 24-hour stroke thrombolysis at both hospitals and we are piloting it at PRH. We are looking at ways of providing rapid access to this treatment in the long term.
One of the principles underlying this consultation is that we aim to keep the majority of services where they are now if this is clinically appropriate and feasible. We propose that the majority of medical care will remain where it is now. The future profile of all services will depend on the outcome of consultation.
As now, a risk assessment would take place to decide the best location for someone to be admitted. Some changes may be needed on an individual basis where they need specific specialist input.
See also "What changes are being considered to stroke services?"
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Will there be any changes to fracture services?
Both hospitals will continue to offer orthopaedic surgery. The majority of orthopaedic surgery will continue where it is now. The majority of major trauma that is seen in our hospitals is already taken to RSH, and this will continue to be the case.
The most serious injuries are already taken outside the county (e.g. to Stoke, Birmingham) and this will continue to be the case.
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Will there be any changes to cancer services?
The Royal Shrewsbury Hospital will continue to develop as a cancer centre, with valuable support from the Lingen Davies Cancer Fund and local fundraisers. Because of them we are very fortunate to have such excellent cancer services in a small-to-medium sized district general hospital and we want to keep these services locally. We have already seen some types of cancer surgery leave the county and we want to protect ourselves to prevent more and more services leaving the county.
Inpatient services for children with cancer will need to be alongside the main inpatient children’s unit. It is proposed that this will be in Telford. See the Children's Services FAQs for more information about the Rainbow Children’s Cancer Unit.
See £3.2m cancer centre development at the Royal Shrewsbury Hospital for more information about the next steps for cancer services.
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What additional issues arise because of these changes?
The main new issue resulting from these proposals is additional travel time:
- people in western Shropshire and mid Wales travelling for consultant maternity care and for inpatient children’s services that are provided locally rather than in regional specialist hospitals
- people in eastern Shropshire and Telford & Wrekin travelling for acute surgery
We need to make sure that clear pathways are in place that reassure patients and families that they have timely access to safe services in an emergency.
Let us know what your concerns are, so that we can plan the new services in ways that reassure you.
Groups of clinicians – doctors, nurses, midwives, other hospital staff, ambulance services, GPs etc. – are working together to develop the new models of care. Your comments will help them to do this.
If you are interested in helping to test the new models of care – for women's services, for children’s services or for acute surgery please contact the project team via future@sath.nhs.uk or 01743 261275.
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What opportunities are we looking at to help address this?
- Helping people in non-emergency situations
- Using technology and telemedicine so that fewer people need to visit hospital for planned care
- A shuttle bus between sites
- Improvements to public transport
- Helping people in emergencies
- Reviewing the way we use air ambulance
- Further developing community hospitals services, including using telehealthcare to provide support for urgent care
- Helping women and children in emergencies
- Reviewing the way we assess and offer choice of delivery
- Enhanced training and skills for all staff groups including GPs
- Ensuring that women and children are taken quickly to the best place to provide care in an emergency
- Developing a Rural Advisory Group
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When will things change?
Changes will start to be made from 2012. Full implementation would not be complete until 2014.
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An indicative profile of current hospital activity and beds is set out in the Data Pack for the Clinical Problem Solving Workshop on 10 August 2010. This is indicative only, for example in some cases specialty surgery has been coded and recorded as general surgery. The Data Pack is available from the Events and Assurance Reports page.
A list of our consultants and their main hospital base is also available.
We aim to continue to provide the majority of care in the same place as now, with both hospitals providing outpatient care, day case, diagnostics, Accident and Emergency, medical admissions, orthopaedic surgery and midwife-led units. The future profile will depend on the outcome of consultation. After consultation, further work would take place to develop an Outline Business Case and Full Business Case for implementation.
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