An experienced and long-standing servant of the NHS in Shropshire sets out his reasons for opposing current plans to Dave Morris.

Former Shropshire hospital boss David Sandbach is a man on a mission. He is challenging proposals for a major overhaul of the way healthcare is delivered in Shropshire and which could see A&E downgraded at Telford and some key services transferred to Shrewsbury.

Mr Sandbach agrees that change is necessary if services are to be sustained and improved, but he believes that the current options put forward by a forum of the county’s top doctors and nurses – and finding support within the hierarchy of the Shropshire NHS – are flawed and a waste of money.

He is urging careful consideration of his own plans which he is circulating to health chiefs and NHS stakeholders.

Mr Sandbach’s views should carry some considerable weight.

David Sandbach

He spent more than 20 years in general mangement and a chief executive’s role within the county health service, first at Shelton Hospital in Shrewsbury and then as chief executive of Telford’s Princess Royal, from which he officially retired in 2003.

He took the top job at Telford in June 1990 and remained in that role until 2000 when he undertook specialist work in digital learning and e-medicine.

Mr Sandbach holds a Masters Degree in Health Services Management and Local Government and has lived in Shropshire for about 30 years.

Why, when he no longer works in the Shropshire health service, is he bothering to challenge the healthcare proposals?

“I think I have a duty to point out flaws in a plan that is not adequate and, what is more, nobody is paying me to do so,” he told me in an interview at his home.

“There is something inside me that says I can’t walk away from this, not until people have had their say and made their judgement.

“I will not back down. I feel I should say something based on my years of experience and qualification.”

I asked if it was possible to maintain the status quo in our two main hospitals.

Mr Sandbach replied: “Yes we can. Should we? A big no. We should go for better quality services in this county and they can be achieved without any shadow of a doubt.”

What about the idea of a brand new hospital being built in Shropshire. Is that achieveable I wondered, given the tough times ahead financially for the NHS.

“It’s a dead duck,” Mr Sandbach answered without hesitation.

“The country is a busted flush. We have debt coming out of ears for years to come. The cost of a new hospital for Shropshire is put at £355 million. Forget it.

“But if we are shrewd in the way we use our buildings and resources, we could get very, very close to having key services centralised.”

I then put the following questions to Mr Sandbach.

• How will your super surgical and A&E department at Telford benefit people across the county?

DS: My plan has an emergency surgical ward next to A&E and will reduce the initial A&E assessment process time – I think by as much as 60 to 120 minutes. So time taken from an accident to receiving emergency treatment and an operation is significantly reduced for everyone, no matter where they live in Shropshire.

The other benefit is the capacity to have two affordable surgical rotas, one for general surgery and one for vascular surgery. The ability to get to the right type of surgeon quickly and without being passed from one type of doctor to another, is a major benefit of this proposal. This is not rocket science organisationally but it will require changes in how doctors organise themselves.

• Can your proposal be modified?

DS: Most certainly. For example, planned inpatient surgical work could be based at the Royal Shrewsbury Hospital rather than the Princess Royal. We would lose some economy of scale regarding rotas but in my opinion this is not a deal breaker.

• What about children if inpatient paediatric beds are moved to Shrewsbury?

DS: The paediatric service could work on an outreach basis from Shrewsbury to supply the PRH during the night-time hours.

A simple principle of taking the specialist doctor to the patient for the immediate emergency element of the hospital stay, rather than vice versa, would apply. It is also worth remembering that already at PRH the level of out-of-hours (ie late-night or early-morning) surgery is relatively low because of the way surgical patients are managed – because of the ready access to emergency theatre time.

• Out of all your proposals, which one would you choose if you could only have one?

I would say build a new consultant maternity unit. I say this for three reasons. First we now know the existing building (Shrewsbury) is not fit for purpose anymore, so it is a waste of money trying to patch it up as per the current plans.

Second, papers in the public domain demonstrate that there is pretty well enough capital in the system to build a new consultant maternity unit. NHS cost-estimate papers show the basic cost of an obstetric unit would be £17.25 million. Option 1 (the favoured option of the developing healthcare proposals due to go out for public consultation) has a capital allocation of £18.2 million. Clearly the primary care trusts have a blind spot when it comes to maternity issues.

Third, we know that the surgical rota problem can be worked round for at least a few more years yet. I believe the same is true of the paediatric rota which of course would get an indirect recruitment spin-off from an agreement to build a new maternity unit and have one department at the end of, say, 2014 or 2015.

• Do you think local NHS management can deliver all or parts of your plans?

Well it is no secret that I have been quite caustic about the local NHS management of late – and to my own shame, I am sorry to say, to the point of rudeness. The bottom line however is that there are a lot of very able management people in the local NHS and with a positive leadership culture at the top, change can be delivered – especially if there is general support for the change in the communities across the county.

• What is it that you dislike about Option 1 put forward by the primary care trusts and the Shrewsbury and Telford Hospital Trust?

It is a waste of money and quality space. For an investment of £18.2 million we get investment in propping up a worn-out building which must be replaced as soon as possible. My plan uses spaces effectively and costs a massive £15 million less in capital than Option 1.

I think before we shell out large lumps of public money we need an answer to the 2020 vision put forward by the PCTs – where will we site the super-hospital? Once that question is answered you know where capital monies are best spent.

Finally, I am sorry to say that I think the financial figures used by the PCTs were incorrect. For example under Option 2, which has more services going to the PRH, a sum of £3.155 million was inserted in order to build a paediatric unit. I think some people may have forgotten that the PRH already has a purpose-built paediatric unit with 46 beds and is able to take all the inpatient workload for the whole of Shropshire. Therefore the £3.155 million figure is not correct.

Other capital figures in the costing can be easily demolished if one knows how hospital space can be flexed for greater efficiency. It took me two minutes to reduce the Option 2 capital figure from £47.2 million to £22.68 million.