Shropshire Star

Shropshire patients could die if A&E axed, MP warns Health Secretary

Axing A&E services in Shrewsbury could lead to the deaths of patients because of longer ambulance transfer times to Telford, a Shropshire MP claimed today.

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Daniel Kawczynski has written to Health Secretary Jeremy Hunt to express concerns that A&E could be moved to Telford "by stealth" this winter because of increased demand and chronic staff shortages.

It comes as MPs in Shropshire prepared for a meeting with health bosses today to discuss the dramatic breakdown in the Future Fit programme designed to shake up health services in the county.

A preferred option for the location of Shropshire's new single A&E unit – either at Telford's Princess Royal or the Royal Shrewsbury Hospital – was due to be announced by health bosses this month. But a decision has now been deferred until at least next summer after the programme board announced none of the options properly addressed a £20 million-plus deficit in hospital finances.

It has thrown the whole future of health services in the county into doubt – and Mr Kawcyznski is now calling on the Government to intervene. He says he has met doctors who fear patients' safety could be affected if there was only a single A&E at Telford and he has asked for a meeting with Mr Hunt at his "earliest convenience" to discuss "significant shortfalls" in the Future Fit process.

In the letter, the Shrewsbury & Atcham MP says: "One of my concerns is that due to the pressures we will see over this winter, given that this trust has not managed to sustainably achieve the A&E waiting time target for many years now, we will see a move from providing A&E services from Shrewsbury to the Telford site.

"I believe that this would amount to a restructuring by stealth, without public consultation. I have real concerns for the welfare of the population of Shropshire and Mid-Wales if a decision is made to move accident and emergency services away from Shrewsbury.

"The Shropshire population looks to the Royal Shrewsbury Hospital site to provide all of its acute and emergency care. Unlike most other areas in the country these patients do not have access to another provider on their border, whereas the Telford and Wrekin population already access Wolverhampton for a significant amount of their care out of choice.

"Travel times are also considerably different if the acute site is at Shrewsbury compared to Telford. The last data shared with me shows that at worst patients would travel approximately 30 minutes if the acute service were in Shrewsbury whereas if it were in Telford a significant percentage of the Shropshire population travels over and up to an hour. Patients could be put at risk of coming to harm."

Ludlow MP Philip Dunne was one of those meeting with Future Fit and other health bosses today to find out the next steps for health services in the county.

"Today I am meeting the county's NHS leaders, with other Shropshire MPs," he 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."

The Future Fit programme is said to have cost around £3 million so far in its two years since inception.

In full: Daniel Kawczynski's letter to Health Secretary Jeremy Hunt

Dear Mr Hunt,

I am writing to you to express my concerns over the way the FutureFit programme for Shropshire has been executed over the past two years and request a meeting with you at your earliest convenience to discuss what I consider to be significant shortfalls that have occurred throughout the whole process.

You will be aware from our previous discussions that I have real concerns for the welfare of the population of Shropshire and Mid Wales if a decision is made to move accident and emergency services away from Shrewsbury. As the MP for Shrewsbury and Atcham I have been struck over the past 10 years by the difficulties faced by both the local population, and clinicians, due to the configuration of the local health services, in particular that of the Shrewsbury and Telford Hospital NHS Trust. I have seen numerous attempts to change services in the past decade fail due to lack of patient, public and clinical support for the proposals.

In November 2013 the FutureFit programme was launched through the national 'Call to action' campaign. From the beginning, the approach I saw was fundamentally different to previous attempts. The programme started by consulting with the local population and clinicians on their thoughts of the current system and what future services might look like.

I recall three key principles underpinning the programme from the outset which were agreed by local people and clinicians. One, that any changes needed to create high quality, safe sustainable services; two, that the changes needed to urgently address the workforce crisis in particular that of A&E consultant shortages in 2013 and to enable substantive recruitment and retention of staff; and lastly, that local clinicians alongside local patients collectively build the future vision and model of health provision.

Up until October 1, 2015 the programme has continued progressing with a focus on these three aspects. However, it has been brought to an abrupt halt on October 1, 2015 based on an underlying financial deficit that has been known to both the local and national teams for many months and years.

As the MP for the area my concerns are outlined below:

1. The FutureFit programme was set up to address staff shortages which were a growing concern to the trust and commissioners. Over the two years of the programme these staff shortages have got worse and now include not only A&E consultants and senior clinicians but also acute medicine and intensive care. As recently as July this year I was informed by the trust that they were nearing a tipping point in relation to senior doctors and on at least one occasion had to deal with no intensive care consultant cover for one of the two units, in this case the Royal Shrewsbury Hospital.

2. Over the past 12 months the timeline has changed several times to 'telescope' the approvals process and ensure that an agreed model be consulted on in early 2016. The explanation given for this shortening of timescales has consistently been that any delay would jeopardise the ability of the acute trust to continue functioning safely in relation to staff shortages and configuration.

3. The explanation given on every occasion by the trust for reaching an agreed model was that this would secure recruitment of clinical staff as seen by the impact that the new Women and Children's unit had, when it was agreed, on recruitment of clinical staff to those services.

Taking into consideration these three points my question now has to be, how will the current staff shortages that have been so critical be mitigated now? One of my concerns is that due to the pressures we will see over this winter, given that this trust has not managed to sustainably achieve the A&E waiting time target for many years now, we will see a move from providing A&E services from Shrewsbury to the Telford site. I believe that this would amount to a restructuring by stealth, without public consultation, when in fact the Future Fit option appraisal that was before the board on October 1, 2015 recommended the Royal Shrewsbury Hospital as the preferred option for the county's new Emergency Centre.

The Shropshire population looks to the RSH site to provide all of its acute and emergency care. Unlike most other areas in the country these patients do not have access to another provider on their border whereas the Telford and Wrekin population already access Wolverhampton for a significant amount of their care out of choice.

The move in 2013 of the Women and Children's Services to Telford and consolidation of vascular surgery on the Shrewsbury site was based on the demographic of each population and population need. I believe that these demographics have not changed in the past five years with an ongoing higher proportion of the overall population across the whole county living in, and around, Shrewsbury and a younger population residing in and around Telford. A move to provide acute and emergency care will therefore be counter-intuitive to the population needs of the local people of Shropshire.

Travel times are also considerably different if the acute site is at Shrewsbury compared to Telford. The last data shared with me shows that at worst patients would travel approximately 30 minutes if the acute service were in Shrewsbury whereas if it were in Telford a significant percentage of the Shropshire population travels over and up to an hour. I have been told and given evidence that the advances in ambulance care mean that longer travel times are better tolerated by patients now than in the past, and therefore the threshold of an hour 'door to door' is not seen as critical to overall survival. However the morbidity outcomes I am told are not clear and hence patients could be put at risk of coming to harm. Why would it be seen as reasonable to remove all access to acute services from the population that has no other feasible alternative?

The majority of patients that will be cared for in an acute site with emergency care will be the elderly as most of the high risk trauma will transfer out of county as it does already. It makes no sense to me to move these services even further away from this population.

Although travel times aren't as critical as in the past, again it makes no sense to ask patients to travel almost an hour when they could feasibly travel less than 30 minutes, but can there be absolute certainty that patients having to travel these additional times will not come to greater harm – either mortality or increased morbidity with poorer patient outcomes?

On balance I therefore raise my concerns that a reconfiguration programme based on the best clinical outcomes for patients has been stalled due to a potential financial gap which in itself has been caused by the current configuration and therefore not moving to a new model will only result in increasing this financial deficit. Furthermore, the decision not to approach the Treasury to progress the preferred option for the location of the emergency centre in Shrewsbury, means that the potential saving of £2 million to £4 million will not now materialise.

Daniel Kawczynski MP

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