Shropshire NHS chief pledges action on services

The boss of the NHS trust that runs Shropshire’s two acute hospitals today insisted he is taking “decisive action” to ensure services are sustainable.

Simon Wright, chief executive of the Shrewsbury and Telford Hospital NHS Trust
Simon Wright, chief executive of the Shrewsbury and Telford Hospital NHS Trust

Simon Wright, chief executive of the Shrewsbury and Telford Hospital NHS Trust, made his comments after the fragility of five services was highlighted at a joint council health overview and scrutiny committee meeting earlier this month.

And he said he was concerned at comments by NHS campaigners that suggested SaTH was not forward-thinking and working with other hospitals to ensure a sustainable future – when it has been working with neighbouring hospitals and other health organisations for many years.

Mr Wright said the report reiterated the fragility of some services at SaTH, which runs the Princess Royal Hospital in Telford and the Royal Shrewsbury Hospital.

It highlighted challenges in the emergency department, ophthalmology, neurology outpatients service, dermatology outpatients service and the spinal service.

The hospital revealed on March 10 that it has stopped taking on new eye patients and that glaucoma surgery has been suspended.

The neurology outpatient service is to close for six months, spine patients are being turned away because of staff sickness and the dermatology outpatient service was described by medics as “fragile”.

Mr Wright said: “I’m disappointed that this was portrayed as a ‘leak’ of a document. The document was not leaked – it was sent by our chief operating officer to the joint health overview and scrutiny committee of Shropshire and Telford & Wrekin Councils as the public have a right to know what steps we are taking with our healthcare commissioners to introduce permanent solutions to services which have been running at risk for over 10 years. The document is also available online.

“These sorts of issues have also been discussed by our board and are the driving force behind our plans to reconfigure hospital services and to work more closely with our GPs.

“We are taking decisive action, together with our partners, to remove these risks and to introduce permanent and sustainable solutions to keep these services here for future generations.

“A crisis only occurs when people ignore situations, would rather talk about it than act and have no answers. We have set out a clear future that will bring state-of-the-art services into our county, protect those already here and encourage health professionals to want to come here to work and live with their families.”

Mr Wright said the trust had always been committed to working with other organisations to provide the best care possible for patients and to ensure as many services as possible remain in the county of Shropshire.

He said the trust’s plans to ensure the sustainability of services would also bring some services back into the county, meaning more patients could be treated closer to home.

Mr Wright said: “Given some of the recent comments in the media, particularly by political activists, it might surprise some people to read that SaTH has been working in partnerships and networks with other hospitals for over 10 years including in Powys, Stoke, Birmingham and Wolverhampton for services such as A&E, surgery, stroke, heart conditions and cancer. As well as this, SaTH has strong partnerships with organisations in our own county, working closely with the Robert Jones and Agnes Hunt Orthopaedic Hospital, Shropdoc, Shropshire Community Health NHS Trust and primary care providers.

“These partnerships see our doctors working with other health professionals to deliver care in rural areas and to bring other clinical specialists into Shropshire and Telford & Wrekin to provide care closer to home for our patients. We already jointly employ consultants with other hospitals in many services.”

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Comments for: "Shropshire NHS chief pledges action on services"

johnfrederick

When will the Shropshire NHS Chief stop telling use fairy Tales about services in Shropshire like what the senate said about NHS in Shropshire where they are going to get the extra carers from to stop bed blocking ,How do get the WMAS to meet service times they promise us in 2011 and sill have not met after being given extra funding . lastly how are they going to make the saving that NHS ENGLAND wants if they do not cut SERVICES ? Can any one tell me NHS Shropshire can not ?

SDON

Mr Wright may not think it's a crisis. What about patients who have been waiting 30 weeks to see a neurologist who are now told the service is closed for the next 6 months? They might disagree.

Roger

Quote

"The hospital revealed on March 10 that it has stopped taking on new eye patients and that glaucoma surgery has been suspended".

"20,000 eye appointments cancelled at Shropshire hospitals"

“From speaking to patients and learning from letters of concern it became apparent that a large number of cancelled ophthalmology appointments were a result of patients not understanding the letter we sent them."

"Patients confused by appointment letters, consultants taking leave, patient sickness or being unavailable and slots being moved due to more urgent cases were among the reasons for cancellations"

"Now chiefs have rolled out a plan to improve communication with patients with conditions such as cataracts and glaucoma and make £500,000 in savings".

Put together and we get

The hospital revealed on March 10 that it has stopped taking on new eye patients and that glaucoma surgery has been suspended. Now chiefs have rolled out a plan to improve communication with patients with conditions such as cataracts and glaucoma and make £500,000 in savings.

So they save half a million by not taking on new patients? Do they have any idea how devastating it is to suffer cataracts and just what sort bad news it is to not get this operation. Now we know it was caused by having 40 different standard letters where one will the job better. Knowing that they going to save half a million a year by sending out the right letter is no consolation to those not getting their operation. The result of efficiency savings should be that they all get their operations as required. It is a life changing condition from dysfunction to better than ever.

"“We are taking decisive action, together with our partners, to remove these risks and to introduce permanent and sustainable solutions to keep these services here for future generations".

The only one we know about in any depth is A&E. Both together can not cope and closing one to consolidate on the other is impossible because neither is big enough at the moment. Therefore the new emergency centre must be built to deliver the plan. There are no authorised funds to build it so it is a non starter until they get the funds. So three to five years away. Outside the 2020 vision.

What the NHS at high level is saying from the trusts, it is impossible on the funds available to deliver this year, and NHS England that the STP will fix everything within the funds available. How to fix the system is to address Adult Social Care. The government say they are reviewing the situation and will report back later this year. They will provide funds to clear the bed blocking.

The reality is that Adult Social Care needs addressing to slow down the rate of presentation at A&E so there are not so many admissions and not so many bed blocking. That is not in the grant of the Hospital Trust.

Additional funding to clear the blocked beds is allowing failure and paying failure costs. We need to stop so many needing A&E through neglect.

Simon Wright seems to think our comments are political and he is right. it was political failure that taken the NHS to the verge of failure. The politicians have under funded the NHS for the last seven years and that is cumulative. We know from experience in other countries that a publicly funded and delivered health service is the cheapest and most effective option. The cost in an advanced economy for a universal service is 10% of GDP. with that funding in 2010 the NHS was the most efficient health service in the world. It was delivering at 8% of GDP but cuts below 8% will lead to gradual failure. That is political.

NHS England said if they nothing to improve efficiency and the level of demand was constant the NHS would need 30 billion more to stand still.

They proposed that they could make saving and deliver a better service through the Sustainability and Transformation Plans. These plans were based on the metropolitan and Urban scenario where if hospitals are approximately ten miles apart by specialising certain services in each hospital they produce centres of excellence in different hospitals but in all cases the patient would not need to travel any further than they would expect to access work, shopping or leisure services. That is that journey distances change from approximately 3.5 miles to 7.5 miles on average.

Drive passed to better treatment was the system it was based on. However we do know that that is an argument for services that benefit from drive passed and should be more the standard. We also know that some conditions are worse because of deterioration and need to go to the nearest hospital because time is critical. Calculation have been carried out that the advantages of drive passed to better care drop off if the journey exceeds 13 miles.

These are parameters that provide standard modelling for STP plans. Since the closest hospital to Shrewsbury is Telford at 15 miles we know the standard model is not appropriate and at 80 miles to Aberystwyth totally non applicable. For every condition there will be a different break even point in terms of mileage so for Maternity it will be different to other conditions. Driving passed a Community hospital mid wife led unit to a district hospital maternity unit means adding twenty miles to the journey. Babies are not predictable so is twenty miles added acceptable.? I think not, too many babies born in lay-bys at added risks. The same can apply for minor urgent care injuries. They are best dealt with in community hospitals because the time involved for patients and their carers becomes excessive to the cause and there will be reluctance to make the journey which can lead to complications which will cost the NHS more in the long term.

All these added miles are not significant in the Urban setting but are more significant in the rural setting. A&E is self evident, but out patients visits and visitors for in patients are all part of the treatment. It costs the NHS nothing directly, but does increase the cost to the public and the shear amount of time spent travelling. The rural environment changes the actual parameters in ways that standard model do not account for. Because they scenario is not within the parameters we have no way of knowing the impacts on patient care. The nearest we can get to it is on A&E patients. Nicholl and others (2007) have shown that an increase in straight-line ambulance journey distances is associated with an increased risk of death. This association is not changed by adjustment for confounding factors related to age, sex, clinical category or illness severity. The authors suggest that an increase of 10 km in straight-line distance is associated with around a one per cent absolute increase in mortality.

4,133 subjects died following incident MI in the community (i.e. were not hospitalised), 6,408 patients survived to be hospitalised and 1,010 of these (15.8%) died in hospital. Of 5,398 discharged from hospital, 1,907 (35.3%) died during a median of 3.2 years of follow-up. After adjustment for rurality and other known risk factors, distance between home and admitting hospital was significantly associated with increased mortality both prior to hospital admission (adjusted OR, 2.05, 95% CI 1.00-4.21 for >9 miles and 1.46, 1.09-1.95 for 3-9 miles when compared to <3 miles) and after hospitalisation (adjusted HR 1.90, 1.19-3.02 and 1.27 0.96-1.68). However, there was no effect of distance on in-hospital mortality (adjusted OR 0.95, 0.45-2.03 and 1.02 0.66-1.58).

Of 5,441 Newark patients admitted for emergency treatment last year, 264 died – 4.85 per cent. Yet in 2009, when there were 5,431 emergency cases, just 192 patients died – 3.53 per cent. That was the year before NHS chiefs decided to close Newark A&E, promising ‘more lives being saved’. If the percentage rate had stayed the same after the closure, that would have meant 72 fewer deaths last year – in just one area, and in just one year.

All the above data would seem to conflict with assurance offered locally.

We are also aware of the under funding of the CCG where we suspect the same problem. The methodology of NHS planning models is an urban one and Shropshire is a rural area.

The public have not seen the full STP because it remains confidential so we are entitles to see it with some doubts about whether or not it can deliver a better service with less resources. There is a credibility gap on the political input, the NHS input and the financial aspects. We have no idea if there even enough doctors and nurses to deliver the plan. We have no idea of the role of community hospitals or maternity services within the plan. To us it is not about health services from the hospital door but a totality of services with the communities and hospitals.

Telling us that the hospitals will be more efficient does depend on arriving in one alive. The public has every right to be cynical about the STP. We can be more specific when it’s published and the funds have been secured to deliver it. Our more urgent concerns are how we get through this year.

There are 2 big issues. First the resolution of how to provide adaquate Adult Social Care and Second how we match funding with our European comparitors at 10% of GDP.

Without these two issues the NHS is on a “mission impossible” set by politicians with reference the more expensive dogma of privatisation. More from our wallets but less public spending. Smaller government including the NHS. So the biggest issue of all is Politicians playing politics with the NHS to achieve the unachievable. The Public will not agree to privatisation for the sake of it. We want our NHS at the right cost which is a health system that costs 10% of GDP. 8% and less will not cut it, that is reorganisation as effective as moving the deck chair on the Titanic. Just like the last multi billion pound, top down reorganisation by Lansley. Wasting our money to make the NHS less efficient.

johnfrederick

Roger it is cost cutting and the public will suffer ? ROGER has you are good facts can you tell me how much the Shropshire CCG Board get paid for the sitting on the Board ? It was stated this week that the Vice Chairman of Liverpool CCG would get £100 .000 plus benfits .

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