Is this all about saving money?
No, these proposals are about keeping safe services in the county now and into the future. They are not aimed at saving money. We want to make sure that health services remain safe into the future and offer the best possible care and the best outcomes.
This involves building on our current strengths, and making sure they match the best practice as recommended in clinical guidelines for the whole country. It also aims to solve issues such as increasing medical specialisation and regulations about how many hours staff can work. These issues mean we have to find a different way of working in some specialities in order to be sure we can carry on providing them.
Our proposals will need to be implemented within the total money we get from taxpayers.
Detailed information about the Trust’s financial position can be found in the monthly financial reports to the Trust Board, which are available here.
Is this about achieving Foundation Trust status?
No.
These proposals are about patient safety, keeping services in the county and giving our local hospitals a long term future. They are not being put forward to achieve NHS Foundation Trust status.
Foundation Trust status has a part to play:
- If we do not make our services safe and sustainable then we will not become a local Foundation Trust.
- If we do not become a Foundation Trust then local hospital services will be run by other organisations – either together, or “de-merged” and run by different organisations.
- If our hospitals “de-merge” then services in Telford are likely to drift to the east, and RSH would not serve a big enough population to keep its current range of services. Overall, we are likely to see more services drift out of the county.
- If our hospitals are taken over by another organisation then the future is also uncertain
Why can’t we have a new hospital, so all services could be on one hospital site in between Telford and Shrewsbury?
To build a new hospital would cost between £350 million and £400 million, and possibly more. This was looked at in a feasibility study in 2009. In the financial climate now facing the nation, this money is just not available and so this is not an option we can progress.
Why can’t we have one site with major and emergency work and one site with planned activity?
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.
What is the impact of recent legislation?
All providers of NHS services must be registered with the Care Quality Commission.
In order to be registered, we need to demonstrate that we meet a range of quality standards.
If we are not able to demonstrate that we meet quality standards then we will not be registered to provide the service.
If this happens then we will not be permitted to provide the service, which means that the service may be lost from the county.
What is the strategic case or business case for these changes?
The Strategic Outline Case Proposal document was approved by the Boards of the PCTs and the Hospital Trust on 2 December 2010. The paper presented to the Boards is available from the Board Papers page. Note that whilst this is called a draft proposal it was approved by the Boards as the basis for consultation.
Further information about the proposals for consultation is available in the consultation document and consultation summary document.
The consultation process is a vital period to listen to the issues and concerns raised by patients, the public and partner organisations. These views will influence the decisions made following consultation.
Following consideration of the outcome of the public consultation by the Boards, planning for implementation would take place between April 2011 and April 2012 and would include the development of the Outline Business Case and Full Business Case.
In order to develop an Outline Business Case, detailed information is required on the capital and revenue implications of any proposal. This detailed information can only be developed based on the outcome of consultation, and building on detailed patient pathways work that enables us to identify the resources (including staff, space, equipment etc) needed and options for the delivery of each service. It is vital that we have patient, public and staff involvement in designing those pathways, and following the end of consultation we will be involving patients and the public in taking this work forward.
What is the background to the costs discussed in the consultation document (£28m and £60m)?
Costings for major NHS capital programmes are developed in accordance with guidance from NHS Estates based on providing services to modern healthcare buildings and space standards (rather than simply reproviding the current standards of service). The costs include appropriate contingencies for factors such as site condition, infrastructure costs, on-costs and other contingencies.
Guidance for NHS Trusts on costing for major NHS capital programmes is available from various sources, but the following documents will be useful if you are keen to understand how costings are developed:
Page 12 of the consultation document states that "the cost of rebuilding the maternity unit at the Royal Shrewsbury Hospital is estimated to be close to £60m". These costings were developed as part of the Developing Health and Health Care programme and can be found in the background documentation from that work. Specifically, the site plans for the £60m new build option at RSH can be found from pp81-84 and the cost schedule can be found from p180 to the end of the portfolio.
Page 12 of the consultation document states that "The Princess Royal Hospital has space that can be made available to relocate services from Shrewsbury. Some additional new facilities could also be built at the Princess Royal Hospital. The cost of this scheme ... is estimated to be £28million". Information about these costings is available here. A range of site options is being considered, for example building adjacent to the current children's services near the A&E department and main theatres.