What are the challenges facing Surgery services?
See the previous page about the problems we face for information about the challenges facing inpatient Surgery Services.
See the previous page about “how are these problems being solved” to find out about some of the options we have looked at and the constraints we face.
What is the difference between acute surgery and emergency surgery?
Emergency surgery is unplanned surgery performed when the patient's life is in direct and immediate jeopardy. Emergency surgery is not necessarily provided by a surgeon with expertise in a specialty such as vascular, colorectal or upper-gastro-intestinal. For example, it may be performed by a consultant in emergency medicine or in trauma. Under the consultation proposals we will retain two Accident and Emergency Departments, and both hospitals will need to provide immediate life-saving surgery for patients who arrive through their doors.
Acute surgery is urgent surgery needing to be performed within hours or days. We aim to ensure that patients receive this surgery from surgeons with expertise in the relevant speciality (e.g. vascular, colorectal, upper gastro-intestinal) as this gives us the best chance to offer patients the best possible outcomes of care. Under the consultation proposals we are looking to concentrate three surgical specialties (vascular, colorectal, upper gastro-intestinal) at the Royal Shrewsbury Hospital.
What surgery will still be in Telford?
The Princess Royal Hospital will still provide:
- emergency immediate life-saving surgery as part of its Accident and Emergency services
- day-case surgery
- head and neck surgery
- gynaecological and breast surgery
- orthopaedic surgery
Where will people have their emergency and acute surgery?
These proposals will ensure that we can continue to provide the current range of emergency and acute surgery locally, although in some cases this will need to be based at one of our two hospitals. In fact, we hope this will put us in a strong position to attract more surgical services in the area rather than risk seeing services leave the county.
Both hospitals will have A&E departments, offering emergency immediate life-saving surgery.
A significant amount of surgery for children does not take place in our hospitals but in regional specialist centres such as Birmingham. Where we provide emergency and acute surgery for children locally then this will be in Telford. The surgery that we currently conduct on children, such as appendicectomy, would be performed at Telford by trained surgeons supported by the consultant surgeon travelling from Shrewsbury when required.
As now, the most complex acute surgery for adults will continue to take place outside our hospitals in regional centres such as Birmingham and Stoke.
The majority of adults needing local acute surgery would be taken to Shrewsbury, however, if a patient is at the PRH and requires emergency immediate life-saving surgery or is not stable enough to travel then this type of surgery would continue to be available in Telford. For example, the general abdominal/vascular surgeon would travel to Telford to perform the operation
Women having emergency and acute gynaecological surgery would have their operations at Telford. If the gynaecologist needs specialist emergency support, the general abdominal/vascular surgeon would travel to Telford to support the operation.
Where will I go for my surgery?
Most surgery takes place as a daycase procedure, and most surgery will continue to be provided in the same place as now. Most inpatient surgery requiring an overnight stay will be carried out RSH, which will become a Centre for Adult Surgery. However, inpatient breast and gynaecology surgery will take place at PRH.
What about Intensive/Critical Care?
Both hospitals will need to have intensive care and high dependency services to support the clinical services they offer.
We already plan to make improvements to intensive care at the Royal Shrewsbury Hospital, and these changes are needed regardless of the outcome of this consultation. They are already included in our capital programme and are therefore not included in the overall costs of the consultation proposals.
The detailed model for critical care at each hospital will be developed based on the outcome of consultation.
How will the new arrangements actually work?
We are confident that our plans to move women's and children's services to the Princess Royal Hospital and consolidate inpatient surgery at the Royal Shrewsbury Hospital will work effectively and ensure that we continue to have safe and sustainable hospital services in our county.
We have set up clinical working groups to develop the models of care in detail.
These groups include consultants, GPs, nurses, therapists, ambulance and other staff who work directly or indirectly in surgery and women’s and children’s services.
We are also continuing to work with patients and the public to help shape the future of our local hospital services. If you would like to be involved in a focus group to share your concerns and ideas on the future of surgery then please email the project team via future@sath.nhs.uk