Two senior A&E Consultants at the Trust which runs Shropshire’s two acute hospitals have written an open letter in which they outline why changes are needed to emergency care in the county.

The letter comes from Mr Subramanian Kumaran, Consultant and Clinical Director for Emergency Medicine at The Shrewsbury and Telford Hospital NHS Trust (SaTH), and Dr Adrian Marsh, Consultant and Clinical Lead for Emergency Medicine at SaTH.

In it they highlight how having services in one place would benefit patients, help to attract more staff and help to ensure services are not lost from the county.

Their letter looks at SaTH’s Strategic Outline Case (SOC) for its Sustainable Services Programme, which describes potential solutions to the challenges of accident and emergency and critical care provision in Shropshire, Telford & Wrekin and mid Wales.

The SOC proposes one single fully-staffed and equipped Emergency Centre with a Diagnostic Treatment Centre on the alternative hospital site supported by a network of Urgent Care Centres (including one at both Telford and Shrewsbury hospital sites) as well as a network of Rural Urgent Care Services to provide broader and deeper ways of providing healthcare.

No decisions have been made and several options are suggested in the SOC, which is effectively the first stage of the project.

The letter can be read in full below or click the link: Open here

We, the undersigned Emergency Medicine Consultants, would like to take this opportunity to clarify our views on NHS Future Fit, The Shrewsbury and Telford Hospital NHS Trust’s (SaTH) Strategic Outline Case (SOC) for its Sustainable Services Programme, and the portrayal of “Accident and Emergency” in the media.

NHS Future Fit and the SOC are an attempt to redefine high level medical care to the population that we serve.

We know that having all the services a patient requires on the same site improves the care delivered to that patient and the clinical outcome. We already send patients with major injuries or who have had heart attacks to Royal Stoke University Hospital. These patients have a lower risk of dying and an increased quality of life after being discharged.

Within SaTH we have already concentrated emergency surgery onto one site in Shrewsbury and this has led to better outcomes. We now have a death rate below the national average. Acute stroke services are on one site in Telford and again this has improved the care and quality of life for patients who have suffered a stroke. Concentrating the paediatric inpatients at one site in Telford has increased our ability to recruit and retain high quality medical staff, which is better for our patients.

We acknowledge concerns about the increased transport time for patients. However, whilst getting a patient to hospital quickly is important, it’s more important that patients are seen in the right place, by the right person as soon as possible. A bigger more specialist site will mean more high quality staff, meaning patients can be seen by the right person much more quickly.

It’s all very well saying that we should employ more people at our sites, but the fact is our Emergency Departments are not attractive because they are small, with staff preferring to work in bigger state-of-the-art units. A single but larger Emergency Centre will help us to recruit.

At present the majority of patients who present to our A&E do not actually need to be seen there and would be equally well treated in an Urgent Care Centre/Minor Injury Centre (e.g. cuts, fractures, stitches etc), which would remain at both sites if the SOC moves forward to Outline and then Full Business Case, as we hope. People would be seen, diagnosed and treated with local follow-up arranged, if required.

The proposals would ensure that a high quality service is provided on both sites for the majority of patients who don’t need treatment in an A&E and the remaining patients would be cared for in an Emergency Centre. The Emergency Centre would be able to deliver high quality, life-saving care through a dedicated Emergency Team well supported by other relevant specialities.

Having one Emergency Centre would allow the Trust to ensure there is always one of our own senior doctors present 24-hours-a-day, seven-days-a-week to deliver care compared to the current situation of locum doctors more frequently delivering the care.

This model would also help to keep services in the area rather than moved to the bigger centres in Stoke or Wolverhampton. In addition, it would allow the Trust to be at the forefront of medical research, which it cannot currently do with the present configuration.

Following consultation with colleges from across the region, the ability to recruit and retain experienced, highly skilled staff would be increased – ensuring our patients receive the safest and kindest care possible in the county, rather than having to travel outside of Shropshire and Telford & Wrekin.

Doing nothing is not an option. The current model is not sustainable and change is needed. We must ensure patients now and in generations to come have the best services possible.


Mr Subramanian Kumaran FRCS, FRCEM
Consultant and Clinical Director for Emergency Medicine


Dr Adrian Marsh FRCEM
Consultant and Clinical Lead for Emergency Medicine