The Shrewsbury and Telford Hospital NHS Trust’s (SaTH)Strategic Outline Case (SOC) for its Sustainable Services Programme describes potential solutions to the challenges of Accident & Emergency and Critical Care provision in Shropshire, Telford & Wrekin and mid Wales. Here, SaTH Chief Executive Simon Wright describes the document and why change is needed:

simon-wright-chief-executiveWe’re committed to providing the best service possible for our patients, who are at the heart of everything our staff do, every single day of the year. It’s been well documented that we – like many acute Trusts across the country – are facing daily challenges that impact on the services we provide for our patients.

Our Accident and Emergency (A&E) Departments, in particular, have seen unprecedented demand over the winter. Patients are waiting longer than they should to be admitted, treated or discharged and we regularly have dozens of patients who no longer need the specialist care that hospitals provide, but for whom there is no bed available in the community. During 2015 we had 4,767 patients medically fit to transfer resulting in 24,062 lost bed days as they were unable to be discharged because no beds were available in the community. This can’t continue and we need to explore more sustainable ways of providing not just A&E and Critical Care services but all health and community services in the county. We are committed to working closely in partnership with colleagues in social care, primary care and community care to achieve a better solution.

Whilst for many patients, acute hospital care is the very best place for them to be cared for and treated, large numbers of people attending our A&E departments do not need this high-level specialist care. Lots of minor illnesses and injuries can be treated in the Urgent Care Centre, Walk–in Centre and Minor Injury Units we have within the counties.

Although we need to work together to find solutions, each of us is a part of a jigsaw and we must each look internally as well as externally. So, we have produced a Strategic Outline Case (SOC) for our Sustainable Services Programme, which looks at potential solutions to the challenges we face in A&E and Critical Care provision. The SOC describes the Trust’s plans to address the significant challenges to the safety and sustainability of patient services specifically in Emergency and Critical Care.

Firstly, it’s important to recognise what a SOC is and what it is not; there appears to be some misunderstanding which has created some unnecessary concern among patients and the wider public. The key is in the word “outline”. This is not the final, fully polished, plan for our future, any more than a draughtsman’s initial sketches represent a finished building. Rather, it’s a relatively brief preliminary document that introduces a basic project concept and contains enough detail to support an informed decision on whether to proceed to an Outline Business Case. It is effectively the first stage of a project and no final decisions are made at this point. For a project to become a reality after a SOC, we would produce an Outline Business Case – which would include more detail and analysis – and the Full Business Case which would include the final proposals.

I fully recognise that any changes to hospital services, particularly to A&E and Critical Care, cause concern and that the people of Shropshire, Telford & Wrekin and mid Wales want to let us know their views, hopes and concerns. There will, I assure you, be plenty of time for this to happen.

There will be a full public consultation during 2016/17 on the firmer solution proposals, when everyone will be able to see the solutions we propose in more detail, and I look forward to hearing people’s views at that time. Now, we need to firm up these plans in more detail so that we can share with everyone the information they need about the proposals later in the year.
The SOC builds on the discussion and feedback from staff, patients and the public within the NHS Future Fit Programme to address the most significant of workforce challenges. The Trust was specifically requested to progress this work by the NHS Future Fit Programme Board in October 2015.

Our SOC demonstrates that there are potential solutions which address the Trust’s workforce challenges in A&E, Critical Care and Acute Medicine by developing a single Emergency Centre, a single Critical Care Unit and a Diagnostic and Treatment Centre with Urgent and Planned Care service provision at both the Princess Royal Hospital in Telford and the Royal Shrewsbury Hospital.

This is in line with the NHS Future Fit Clinical Model and the options developed in partnership with clinicians, staff, patients and the general public. The proposed solutions describe an alternative way of implementing the options previously identified within NHS Future Fit. Previous solutions proved unaffordable. They were also viewed as being too stark in terms of the differences between the two hospital sites; with one very large and busy and one much smaller with lots of redundant space.

The revised solutions provide a much more evenly balanced distribution of services which would deliver recognisable, vibrant hospital sites 24/7 within the communities we serve.

We acknowledge and recognise the impact these changes will have on patients and the public and are committed to working hard to understand and mitigate this impact where possible over the coming months. However, we believe we have identified solutions that could address our most significant workforce challenges, be affordable and maintain and improve patient experience in vibrant hospital services in both Shrewsbury and Telford.

These developments keep health services in our counties, support some services being able to return and protect us from future risks too.

Our hospitals need to modernise and this SOC will help us ensure we have two vibrant hospitals fit for current and future generations.