Future Fit: What now for Shropshire A&E shake-up?

It was today reignited by

in which he calls for an urgent meeting to discuss the situation.

The Future Fit programme board, charged with leading a shake-up of health services in Shropshire, is spending an estimated £3 million on the way forward after coming to the conclusion the county could not continue with two A&E departments.

Senior Future Fit member David Evans responds to today's concerns in Mr Kawczysnki's letter

On the underlying financial deficit: While patients and clinical safety come first we do also have to acknowledge financial realities. The financial climate for the NHS has changed dramatically in the last year. We must live within our means and not bankrupt future generations.

Current options help but there are wider financial issues in the local NHS that also need to be tackled. We can't identify a preferred option to discuss with the public until these wider issues are addressed.

The view of the NHS Programme Board was until the work is completed that delivers a five-year plan to eliminate the health economy financial deficit, it was unlikely that the strategic outline case would be approved by central bodies like NHS England, the Trust Development Authority and the Treasury.

We still have an opportunity to create something that will deliver for several decades to come. We plan to be able to say something further within the next month.

On staffing: The key to tackling issues around staffing is the implementation of the clinical model – one emergency department, supported by urgent care centres and a diagnostic and treatment centre. This is supported by over 300 clinicians drawn from all sectors of health and social care as well as all professional disciplines involved in the work to develop the clinical model.

This is also entirely consistent with the Urgent and Emergency Care review nationally that is being led by Keith Willetts.

In the short term, the SaTH has advised us it has a number of actions in place to support the workforce challenges it faces, including securing long term locums and temporary staff. In addition recruitment overseas continues and new roles such as physicians assistants have been developed to relieve doctors.

On the timeline: The target to go to public consultation in December was extremely tight, and there were risks associated that always meant it may not be possible. Programme board has been made aware of this on a number of occasions.

All of the programme board and the programme team are disappointed that we are not now in a position to do that. However, the view of the board is that the leaders in the health economy need to conclude the financial plan for the health economy as quickly as practicable.

On pressures this winter: Future Fit is a long-term programme aimed at bringing benefits for at least the next three decades. The relatively short delay to Future Fit will have no relevance to how local health services are able to meet demands this winter.

But, after ruling out building a new £500 million facility on greenfield land because it was too expensive, the board ultimately could not decide whether the single A&E should be in Telford or Shrewsbury.

The board blamed the fact none of the options addressed a growing £20 million-plus deficit in the finances of the two hospitals.

The issue will not go away – the county's five MPs were set to meet with Future Fit bosses today to demand answers and discuss the way forward.

Ludlow MP Philip Dunne, who was attending, said: "Our intended briefing on recommendations emerging from the Future Fit exercise is now shaping up to be more of a grand inquisition, to hold them to account.

"People will share my exasperation that yet again NHS bosses in Shropshire have failed to deliver sufficiently robust plans to be able to announce their preference, resulting in a lack of clarity over future emergency care in Shropshire.

"I will expect proper explanations and a clear plan on how to proceed.

"I regret that this latest delay does little to maintain confidence in NHS leaders in Shropshire in the eyes of the local residents they serve."

As today's meeting was being held, the arguments between Telford and Shrewsbury for the right to host the A&E department continued.

And, as Mr Hunt was being called on to intervene, all sides of the argument expressed their concerns about the whole Future Fit process.

Telford & Wrekin Council deputy leader, Councillor Richard Overton, said Future Fit had lost the confidence and trust of the public.

He said: "Telford & Wrekin Council remains very clear on its position – 24/7 full A&E services must be retained at the Princess Royal Hospital.

"We also need services that help prevent people from going to hospital in the first place.

"This is not a Telford versus Shrewsbury issue.

"It is a reflection of the needs of our borough and the surrounding area and towns that the PRH serves.

"Telford is the biggest town in Shropshire and Telford and Wrekin is growing.

"The PRH is a site with much greater potential, and space, for development, and one that we believe would be financially easier to develop. Indeed the NHS's own figures seemed to confirm this a little while ago.

"For SaTH's deficit to be addressed, the PRH's advantages must be given fair weight. For example, being clearer on rural urgent care provision would give us a much fuller and fairer picture.

"While any decision must make sense clinically, they must also make sense to communities. Moving a very successful £28m Women and Children's Centre from the PRH only months after it has opened would rightly be derided as pure folly. The solution must not only keep 24/7 A&E at the PRH, it must also give us improved and sustainable health care in our borough."

Keith Barrow, leader of Shropshire Council, argued the case for centralising A&E at the Royal Shrewsbury Hospital.

"I am disappointed that the decision of Future Fit has been deferred, and very disappointed that it was decided not to publish the decision on the Future Fit consultation, as I strongly feel members of the public have the right to know," he said.

"Now that the Future Fit board has deferred its decision, I believe that it is appropriate for me to comment on Shropshire Council's preferred option.

"I believe that the people of Shropshire will be best served with the main A&E services being located at the Royal Shrewsbury Hospital.

"For our communities living in the east of the county and closer to A&E departments in Newcastle/Stoke, Wolverhampton and Kidderminster a choice is available.

"For our communities in the west of Shropshire such choice is limited. The NHS chose the RSH to be a major A&E department because of the geography of Shropshire and the neighbouring area of Powys.

"I believe that it remains the best option, and I will be urging the Secretary of State for Health to enable this essential programme to go ahead."

Gill George, from campaign group Shropshire Defend Our NHS, said Future Fit was a "mechanism to find savings".

She added: "Moving to one A&E instead of two and one acute hospital instead of two would have meant worse care for all of us, whichever hospital lost out.

"I think Daniel Kawczynski is right to approach Jeremy Hunt, though. The crisis in our local healthcare is ultimately a political one, and it needs sorting out at ministerial level.

"There's an important underlying issue, one that has tended to be overlooked.

"The way NHS funding works means that rural areas are now starved of money.

"Budgets are being squeezed across the whole of the NHS, which is why we're starting to see cuts and closures across the country – but it's particularly bad for rural communities."

She continued: "There just isn't enough money going into our local NHS to keep day-to-day NHS care going.

"Future Fit was about making cuts – and it's collapsed because the cuts it proposed were not deep enough or fast enough.

"That should worry us."