Hospitals Transformation Programme

Improving the way we deliver hospital care across Shropshire, Telford and Wrekin, and mid-Wales, has been talked about for many years. We are getting closer to making our vision to deliver better care for patients a reality. We are going through the final check with the national agencies, who will review our detailed clinical, financial and operational plans. These will deliver the commitments we made and consulted upon before the COVID-19 pandemic.

Local clinicians (doctors, nurses, and allied health professionals), other specialists and local healthcare partners, developed the proposed new way of delivering care with advice and guidance from regional and national teams and hospitals who have made similar, successful changes. This work started in 2013 as we know we need to work differently if we are to deliver the best care for patients across Shropshire, Telford & Wrekin and mid-Wales.

Our clinicians are clear we must make these changes now and we are doing everything we can to make these changes a reality for local patients and staff. We are committed to being open and transparent throughout the development of our plans and then as we start the building works (subject to national approval) – we will keep you informed and involved as we reach key milestones. Importantly, we want to listen to your views as we design the look, feel and experiences of future services.

Upcoming community drop-in events

Clinicians and the programme team will attend each session to answer questions, explain the proposed clinically led model of care, and encourage members of the public to stay involved through the Trust’s regular focus groups.

  • Montgomery Market: Thursday 14 March, 10am – 2pm
  • Wem Town Market: Thursday 4 April, 9.30am – 12pm

In the 2018, the Future Fit consultation set out the very real challenges we face as a hospital trust, and wider health and care system. The COVID-19 pandemic, and especially the pressures we face each Winter, have shown that we need to make these changes as quickly as possible to deliver the best care possible for patients.

In summary:

• Our emergency patients experience delays in accessing the right specialist teams when they attend A&E, as our specialist teams work across two hospital sites but there are different types of service provided at each. Often patients have to be transferred between hospitals because we do not have the right clinical teams and services working alongside each other. Some of our specialist inpatient services are already only delivered from just one of our hospital sites, for example cardiology, emergency adult abdominal surgery, head and neck and stroke services

• Many patients attending our A&Es need urgent care that can be delivered more effectively

• Our hospitals were not built for delivering modern day healthcare. Our Emergency Departments in particular are small and cramped

• Our patients currently face significant ambulance handover delays and delays in accessing the clinical services that they need (emergency, urgent and planned care). Delays have many causes but our overly complex model of care with inadequate provision worsens the problem

• Our two small intensive care units are difficult to staff with specialist intensive care doctors 24/7

• Many of our patients booked for planned care (surgery) have this cancelled as our two hospitals accept both emergency and planned care patients and essentially compete for the resource

• We need to separate planned and emergency care to ensure there is no competition for beds and we can deliver the best of both services

• Services on both sites need to be more resilient to seasonal demand pressures and future pandemics

• We do not have enough doctors, nurses and other professionals to cover duplicated services delivering seven-day services.

We are committed to delivering two thriving hospitals, maximising our clinical services, specialist staff and space (estates) at both sites.

By separating planned care and emergency care we can deliver better care for local people and a healthier and more attractive work environment for our staff.

We’ve have a significant additional investment in services which will help us deliver these much-needed changes and we need to use this funding in the best possible way.

Most patients who use our current A&E services will still use their local hospital.

We are improving the urgent care services at both hospitals, with an enhanced range of services. Urgent care is when you need to be seen urgently, however your injuries or illness are not life threatening and you are unlikely to be admitted to hospital. At the Princess Royal Hospital this will be known as an A&E Local
model. Around two-thirds of patients who currently use the A&E in Telford and Wrekin will be able to use this service, 24 hours a day, seven days a week.

By phoning 111 or using 111 Online you will be signposted to the right place for your needs. If you need to go to hospital for urgent care, then you could be given a timeslot when clinically appropriate.

Patients needing urgent care at the Princess Royal Hospital and the Royal Shrewsbury Hospital will experience:

• Urgent advice and treatment available 24 hours a day, 7 days a week
• Enhanced access to diagnostic tests and scanning equipment (X-ray, scans, blood and urine tests)
• Ambulances are able to take patients direct to these centres for nonlife- threatening care when appropriate
• Direct access to other teams that work alongside urgent care
• Improved care from the right teams of specialists                                                                                                                                                                                                        • Dedicated urgent care from doctors, nurses and other professionals that are on-site
• Shorter waits and a much better experience for patients who will not be in the same queue as emergency patients.

Whether you live in Shropshire, Telford and Wrekin or Mid-Wales you will be able to access these urgent care services at either the Princess Royal Hospital or Royal Shrewsbury Hospital.

Improved emergency care services will be delivered from a specialist modern Emergency Department, that will have the right staff and facilities and be the right size for our population needs, at the Royal Shrewsbury Hospital. People with the most serious life or limb-threatening conditions (strokes, sepsis, internal bleeding, severe chest infection, and many patients with trauma) will be taken by ambulance to this centre. With the development of improved and enhanced urgent care centres our emergency medicine teams will be able to concentrate on these most serious of our patients in a department that is the right size for what we need. For all emergency and urgent patients, we hope there will be shorter waiting times and reduced ambulance handover delays. Shorter ambulance waiting times will also be supported by having the right number of beds available for our patients who are admitted.

The new Emergency Medicine and Urgent Care Centres will not have the cramped environment many of our patients have come to see as the norm. We will make the most of new technology to improve care for patients.

For the most serious injuries (road crashes with major trauma and heart attacks) patients will continue to go to the larger regional hospital sites in Stoke-on-Trent or Birmingham.

For an Emergency Department to be effective it needs to be be supported by specialist medical and surgical teams that are on the same site so once the immediate diagnosis and care of our patients has been delivered by our emergency medicine teams, our specialist teams can take over the ongoing care of our patients. Often the specialists’ teams need to work together to deliver the right care at the right time and that is why it is so important to have all the
specialist teams available at the Emergency Hospital.

When you travel in an ambulance your diagnosis and treatment has already started. The moment you enter the hospital the role of our ED teams is to assess and stabilise you and if you need ongoing care, ensure you are seen by the right specialists as quickly as possible.

By phoning 111 or 999 in an emergency, our trained call handlers can signpost you to the right service for your needs. If patients walk-in to the Princess Royal Hospital and are assessed as needing to be admitted to the Royal Shrewsbury Hospital, they will be treated by our trained staff, stabilised and transferred by ambulance.

Delays to planned surgery (operations) have a real impact on the quality of people’s lives and their ability to recover or start further treatment. The way our services and resources are currently set-up means our staff struggle to provide the quality of care that our patients need.

By having a dedicated planned care hospital in Telford, we can:

• Have dedicated beds and wards for surgery, including day case surgery

• Operations and procedures will be able to take place all year round utilising dedicated theatres and wards. This reduces the risk of your operation being cancelled due to pressures in emergency care

• Reduced cancellations, adequate capacity and dedicated pathways and staff will result in shorter waiting times will mean people can have treatment sooner, improving their recovery

• The right staff, right equipment and right facilities are available and prioritised for planned care

• Patients will have a much better experience of the care they receive

Where it makes clinical sense to do so, to provide the best possible care to our people, services and specialties will be based at the same site as the new
Emergency Department.

This includes:

• Cardiology

• Stroke services (for the first 72 hours, rehab will be available at both sites)

• Consultant-led maternity care

• Inpatient services for women and children

• Chemotherapy services. A brand new day-case chemotherapy service will also run from the Princess Royal Hospital site.

Both sites will continue to have a full range of outpatient and clinical support services, including diagnostics, pharmacy and therapies to support as many people as close to home as possible.

Dr Ed Rysdale, Consultant in Emergency Medicine and Clinical Director for the Hospitals Transformation Programme: “We can’t continue as we are. Our patients regularly experience delays in accessing the right specialist teams and it is vital that our facilities support modern healthcare practices.

“These changes will help us to make sure that everyone has access to the right care, at the right time, from the right clinicians when they need it most. Changing the way our services are set-up will also help us to attract more of the right specialist staff and to retain those we have now across two thriving hospitals.”

Dr Steve McKew, Divisional Medical Director for Surgery, Anaesthetics and Cancer: “These changes will result in genuine improvements for our patients, modernising our services and significantly reducing delays to planned surgery and cancer treatment, whilst also making the services much more resilient to future pressures.

“Investing in dedicated planned care facilities will reduce delays and help people to get the care they need, sooner. This is incredibly important for those needing urgent treatment, particularly for cancer, where earlier treatment leads to much better prospects for recovery.”

It is fantastic to have been selected for a significant investment in improving local hospital services. The assurance checks we are going through this year will demonstrate we are making the most of our taxpayer’s funding.

We recognise the significant financial pressures currently experienced and are committed to maximising every pound and have been working closely with our doctors and nurses to design our services within this budget. This is why we are working as fast as we can.

This investment does not stop us from seeking investment for other, ongoing projects, for example our planned Energy Centre that will help us achieve our carbon neutral targets and the £24m development of a planned care hub in Telford.

During 2023/4 we will be taking our detailed plans through the national assurance process, with NHS England and HM Treasury. This is a requirement for all NHS trusts that are spending over £50 million.

Our focus is now on taking forward the enabling works and preparing the Final Business Case (FBC), which we hope to submit in Summer 2024. These include the commitments we made in the 2018 consultation, but are more detailed including financial plans, architect designs and our clinical strategy.

Once we have this final green-light from the national team we can then begin main building works with our aim is to be ready in a number of years. This is an ambitious timeline, and is subject to change, but we know these changes are needed.

In the meantime, we are continuing to invest in both hospitals. This includes £24 million being invested in a new, purpose-built, planned care hub at the Princess Royal Hospital site in Telford, which will provide greater access to theatres and recovery beds and increase the number of same day operations all year round.

We are committed to keeping local people, staff, partners and other interested groups informed and involved at every stage of this exciting journey.

The consultation was carried out in 2018 and our clinical model agreed to proceed to these final national checks. There are still many ways you can help us, as we prepare for these changes. We are keen to hear your feedback and experiences to help us:

• Develop the right pathways (connections between our services) for patients from your community

• Help us with the look, feel and experience of our new clinical areas

• Share any positive or negative impact that our plans may have on your experience that we should consider. Let us know by emailing us at sath.engagement@nhs.net

To find out more about how to get involved and join our workstream focus groups, see here.

All Latest News about the programme can be found here.