26 September 2018

The Shrewsbury and Telford Hospital NHS Trust (SaTH) Board will decide tomorrow (27 September) whether there should be a temporary suspension of overnight Accident and Emergency services at Princess Royal Hospital (PRH), Telford, to ensure services remain safe for patients.

The suspension between the hours of 8pm and 8am would be a response to the significant and prolonged shortages in specialist A&E staff stretching back to 2015, which has affected SaTH’s two Emergency Department sites in Telford and Royal Shrewsbury Hospital, Shrewsbury. Despite some recent success in recruiting consultants the position remains fragile. A&E staff have shown huge discretionary effort to maintain services at both sites but that pressure cannot be sustained any longer.

The Royal College of Medicine (RCEM) recommends that SaTH’s two A&E Departments should have between them:

  • 20 Emergency Medicine Consultants – when they have just 10 (four permanent and six locums)
  • 32 middle grade doctors – when they have just 11
  • And nurse staffing levels are a concern with the level of temporary and permanent vacancies meaning a heavy reliance on agency nurses or shifts left unfilled.

Doctors, nurses and other health professionals in emergency care, critical care and acute medicine, as well as other specialties, believe there are simply not enough doctors to safely staff both A&E sites 24-hours-a-day, seven-days-a-week.

After a careful consideration of all the clinical issues it is being recommended that SaTH’s Board meeting on 27 September agrees to a temporary suspension of A&E services between 8pm and 8am at Princess Royal Hospital, Telford.

This is a recommendation taken on balance considering the numbers of patients attending both sites overnight, as well as the mix and dependencies of other patient services at each hospital. If accepted it will mean that:

  • PRH A&E department will be closed to ambulance admissions at 8pm. Ambulances will be diverted to neighbouring Trusts
  • The Urgent Care Centre will accept patients until 8pm
  • PRH will continue to accept GP referred admissions in those specialities managed at PRH between 8am and 8pm, seven-days-a-week
  • Stroke patients arriving by ambulance will be admitted via a direct pathway to the appropriate clinical ward.

Simon Wright, Chief Executive at SaTH, said: “Though this is a very complex change to make, we’re doing it for patient safety. We haven’t arrived at this position lightly.”

“We must once again emphasise that we have done everything we can to avoid reaching this point, including continued national and international recruitment for medical and nursing staff and extending the recruitment of Emergency Nurse Practitioners. We have reviewed shift patterns in order to best meet times of high demand.”

Dr Kevin Eardley, Consultant Renal Physician and Medical Director for Unscheduled Care, said: “We will be taking all steps possible to ensure that our plan minimises the impact of additional travel for patients, but we have to put patient safety first.

“The proposal will clearly have an impact on other services – including Women and Children’s services, stroke services, critical care and head and neck services – but our plans have been created and tested to ensure the impact on our patients is kept to the absolute minimum.”

“This is not something we ever wanted to implement, however, the care of our patients must come before every other consideration, and we cannot continue to look after our population safely, kindly and with the dignity they deserve with our current staffing levels and the demand we face every day.”

Should the recommendation be approved by the Board, detailed plans and protocols will be put in place, along with communications to patients and staff explaining the changes.

A date for the temporary overnight closure is still to be decided but it is most likely to be in the second half of October or early November.

The overnight suspension of A&E services at PRH will be kept under review.