Lucy Allan: Telford's Princess Royal Hospital to keep Women and Children's Centre

Telford’s £28 million Women and Children’s Centre will stay at Princess Royal Hospital, an MP has claimed.

allan-prh
MP Lucy Allan says she has been assured the Women and Children's Centre will be staying at the Princess Royal Hospital

Lucy Allan said she has received a letter from Simon Wright, chief executive of the Shrewsbury and Telford Hospital NHS Trust, outlining the promise.

It follows a recent meeting between Mr Wright, Ms Allan and Telford & Wrekin councillor Nicola Lowery.

The Future Fit review of health care in the region had suggested the centre would move to Royal Shrewsbury Hospital as part of changes to create a single A&E at the RSH.

But Mr Wright appears to contradict that in a letter to Ms Allan, saying it would stay and would keep most of its current functions.

In it, Mr Wright says the Women and Children’s Centre would be retained at PRH and speaks of introducing a specialist centre on the same site, as well as a new ‘A&E front end model’.

He says: “We will retain our Women and Children’s Centre, delivering ante and post natal care, gynaecology, paediatric assessment, a birthing centre, breast surgery and reconstruction and a women’s bleed unit.

"The strategic plan describes a vibrant hospital for both PRH and RSH that focuses on the unique health needs of each community.

“We wish to introduce a specialist centre on the PRH site and a new A&E front end model. There are additional new services proposed at PRH relating to planned care.”

The Future Fit decision-making process about the long-term future of hospital services in Telford and Wrekin and Shropshire is currently being independently reviewed.

Telford & Wrekin Council threatened legal action to retain A&E services. It was also critical of plans to move the Women and Children’s Centre just a couple of years after it was opened by the Princess Royal.

Ms Allan said: “I have this week received assurances that the Women and Children’s Centre will remain at PRH and that Telford will have a walk-in accident and emergency department, as well as a range of additional new services. The council has also received these same assurances. This is all welcome.”

Councillor Lowery said she was “encouraged”, adding: “SaTH has proposed to retain the Women and Children’s Centre delivering breast surgery and reconstruction, birthing centre, ante natal and post natal care, gynaecology, paediatric assessment and a women’s bleed unit.

"Only the specialist emergency care would need to move and co-locate with ITU. This is proposed to represent seven out of 10 contacts and treatments remaining at PRH alongside all of the new services arriving.”

SaTH was unavailable for comment.

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Comments for: "Lucy Allan: Telford's Princess Royal Hospital to keep Women and Children's Centre"

n3bpml

At last something positive well done Lucy.

Derp

Yeah, well done to a Tory MP saving a service from being shut by their own Tory government.

PJS

This is how we end up with a closed proper A&E and a downgraded, probably not 24 hour, walk in unit instead. They threaten to close both the A&E and the Women's unit, then back off in the hope that we will accept the closure of A&E as the lesser of two evils.

The local Tories have always preferred the Shrewsbury option of a full A and E, and Lucy has simply gone along with the carve up...

Cassfergy

Well done Lucy? Well done Lucy? You been on the gas and air? She's done nothing but stand by for a bit of glory, why didn't she add, 'And I'll now be fighting to keep our A & E' to her message? My guess, because the lady from London doesn't really care, the people of Telford shouldn't be fooled for a second time, by this politician, or this uncaring Government.

Roger

It is no different to anything that has been said previously. It was already established that Telford would be the centre for elective procedures and Shrewsbury for emergency procedures. This is no different to that. What it means is that the Consultant Maternity unit moves to Shrewsbury together with Children and adult A&E for major injuries. But all aspects of minor injuries or walk in services stay at Telford in their 24 hour Urgent Care Centre.

Saying that A&E would close and the Whole women and Children functionality would go to Shrewsbury was never proposed. Most of what happens in the Women and Children Unit is Midwife led maternity or elective procedures. Exactly how working Childrens A&E needs to be refined is unclear, but is much the same as was before except that the Shrewsbury A&E Function for Children will be restored and they take all major injuries. The specialist care of Children with major injuries or serious conditions will still be the same. ie transfer to Birmingham Childrens Hospital. Just as they would Major Traumas to Birmingham and Stoke. I don't think it has ever been different to that, Personally I think they are trying to fit too much into Telford and some of it will need to be carried out in Shrewsbury as matter of how much space is available where. My thoughts on that are that the Shrewsbury day surgery unit and outpatient clinics will be as they are in both Shrewsbury and Telford wit Telford elective teams travelling to Shrewsbury for clinics and day surgery and the patients for admission going to Telford from Shrewsbury. I can also see that elective orthopaedics would all go to Oswestry. We won't know before they publish the STP.

In my view the really controversial part might be the role of community hospitals and how much of that goes to Shrewsbury or Telford. But again we don't know because they have not published the STP in full. Just these snippets they feed out to people like Lucy Allan. Of course they may now have got some feedback on the STP as submitted which might harden up their proposals. My guess would be how the STP can be achieved without new buildings because there is no money to build them. If true that would mean a much slower process as the functions churn between hospitals. More evolution than revolution.

Things like the Cancer care unit will be different because the outsourcing of cancer care, preferred contractor has now walked away from the contract. So back to "in house" treatment, not sending patients vast distances. Cancer could and probably should be considered urgent care, so the existing unit in Shrewsbury. What it was built for by public donations. But again speculation based on the moving scenario.

Of course they also have to deal with the investigation into unnecessary deaths in the Maternity set up. That will influence some of the final STP.

Publishing the STP would always have helped to avert some of Telford Council's massive overreactions but they didn't so we are where we are. Approval of the STP will mean publication for public consultations. After the accountants have moderated it, I suspect there will be less and slower change. But I don't think it will ever give them the savings they wanted so service withdrawal is likely to feature high and that is the next battle. Who does what, where , when and how. Then the staffing and budget issues. Basically underfunding means reductions in services and the answer is in high level politics to restore proper funding. Proper staff training and proper recruitment and retention policies. Issues all at a level above which the STP has been carried out. An admission of failure at the highest levels in which heads will fall at the highest levels of politics and NHS management. Scapegoats to cover the underfunding.

jonjo

So it looks like there is no need for the proposed protest march, could save some public money. Your report states that T&WC had issued a threat to retain A&E services, most people would believe that the law does not take kindly to threats but it is obvious that they have ignored that and being advised by someone who is a member of what has been proved both locally and nationally as a corrupt legal profession.

johnfrederick

We could end up with know A and Es if you read the NHS papers ?

Roger

Not possible. The catchment is too big to leave uncovered.

It would cause a tremendous stink but in that circumstance they would put in armed forces personnel in to bridge the gap. The appointment process would have to be taken over by NHS providers. It is my view that the problem is the uncertainty in how A&E services will be reorganised given the out burst from Telford Council pushing the decision down the road again and doubts about id the emergency centre will ever be built. Again personally I think it can be provided within the existing structure but a lot of work would be required to shuffle space to make enough room for it. Obviously the consultant Maternity Unit can go back to whence it came in the Maternity Hospital, now refurbished. There are enough operating theatres if the elective work goes to Telford. So that leaves beds on wards, again if elective surgery goes to Telford there should be enough of that. That leaves only staffing as an issue.

It will just take a lot longer to deliver but it can be done. Other potential locations are the Day surgery Unit or the medical assessment wards. I expect the STP will have to be modified to adapt to what ever restrictions are applied but that is what they employed to do.

My Knee surgeon is an Army Colonel working at Gobowen and I refer him to an NHS surgeon. Always on time and straight talking. Im sure there are plenty Service A&E Consultants who can deal with far worse that we see here normally.. As the reserves are NHS Surgeons they could be mobilised and used on rotating deployment in Shrewsbury until the crisis is resolved.

If we are desperate for space we can make better use of the community hospitals or create a temporary halfway house for bed blockers. The army could even put one of their mobile hospitals on the car park.

Where there is a will there is a way. But the most important thing is a decision on what will actually happen.

Flam Trotted

Of course before the then Labour government ordered the closure of the RAF Cosford Hospital there was that to help cover this part of Shropshire.

Roger

It was a part of the justification for Telford District Hospital that with Cosford closing the services to be re-provided could not be absorbed into Shrewsbury so something needed to be built somewhere. The other reasons were the inability of Wrekin Cottage Hospital to cope the local needs and the population of Telford predicted to rise to 200,000 before 1990. It was last factor that settled the size and configuration of Telford Hospital. Of course the Towns developments were then shut down and the newtown population did reach 200,000 but is now only 130,000. So the hospital was oversized and that stopped the growth in Shrewsbury because they need to move services to Telford to fully utilise the space. Telford was not big enough to support it's own hospital trust as became rapidly obvious and the two trusts at Shrewsbury and Telford were amalgamated. Shrewsbury has been losing out ever since, despite having the larger catchment. Oswestry general hospital was forced into closure to justify Telfords new hospital as a part of the financinf deal. A district hospital back then needed a minimu catchment of 300,000 which Telford has actually never met because the new town Authority shut down before finishing the job. But I digress.

The services do not have a customer demand for A&E but need to maintain their skills between deployments so they work in the NHS. They are also augmented by Territorial Army Units in times of warfare. The TA Units are drawn from the NHS. Interestingly;

202 (MIDLANDS) FIELD HOSPITAL, RHQ – Birmingham

Squadrons: Coventry, Stoke-on-Trent, Shrewsbury, Abingdon.

So in theory we have the army medics there now. Unfortunately the Army is probably dependent on the NHS having the people from NHS Shrewsbury. But the structure certainly exists to reverse the system and put Army Medics into the NHS. It would of course be a last resort after the Trust had failed to fill the vacancies.

johnfrederick

Roger look what was at safh meeting on 30 -3 -17 at about 5 o clock ?

Roger

Do you mean

"Costs pressures have been incurred in recent months associated with the Clinical Reviews and Gateway Review.

Further costs pressures for 17/18 relate to the need to do the Independent Review of the option appraisal process and the additional IIA work on W&C impact.

Subject to necessary approvals to proceed, the costs of formal consultation will also be a cost pressure in 2017/18. Budgets are currently being agreed and consideration looking to opportunity to integrate some Future Fit functions within the STP programme management office (PMO)"

In "English" Future Fit A&E is being integrated with the STP and Managed through the STP Project Management Office. The big problem is Capital expenditure in 17/18. That is when the plan is to build the Emergency Centre but there is no money to do it. So they need to rethink the how and when. That is what I said above.

I do wish they could use clear English instead of their own specialised jargon which is meaningless to the public.

The statement in item 7 "complete" is rather odd for something complete;

Draft OBC approved by SaTH Board in December 2016. Further work required in light of Clinical Senate recommendations for inclusion in final OBC for CCG approval"

As I recall the Senate querried the cost effectiveness of the propsals. IE They don't save enough money to justify the capital spend. Therefore a cost reduction exercise is required.

You can have two exective boards for the same thing or they end up in conflict which is why Furure Fit A&E is now to be run from the STP Project office.

The reality is that we need a new emergency centre to meet the clinical and building needs of the 21st century. It is not really about Future fit or the STP It about Shrewsbury A&E not being big enough or modern enought to meet the clinical need. Neither is Telford big enough. Future fit and the STP both indicate a need to change the operational model so modernisation of Shrewsbury A&E has been rolled ito the efficiency programmes. That is not about where or not Shrewsbury A&E needs a face lift and expansion, that is the situation without future fit or the STP. Seperate issue. However if they modernise Shrewsbury A&E it needs to able to meet the requirements of both Future Fit and the STP. The upgrade of Shrewsbury A&E is now piggybacking the STP it was never meant to have a pay back but the STP is. The need for the emergency centre should be a part of the "Do nothing" option of the STP. Telford had 8 examination cubicles added last year. That was not Future Fit or the STP, if was it would not have been done because Telford Major injuries unit is moving to Shrewsbury. In effect a waste of Money like moving the Materity Consultant unit to Telford. Another waste of money by reference to the STP but of course there was no STP when it was done. They are now sunk costs to be written off in the STP. A different way of saying expensive mistakes in the old STHT think, now being replaced with STP New Think.

What the board now need to point out is that where other A&Es were consolidated in the West Midlands, consolidation without capital investment put both Worcester and Stoke into special measures as the existing brand new A&E departments were over loaded. Existing A&Es need to be modernised and if the policy is to close every other A&E then the receiving A&E needs to be expanded to take the extra workload. Shrewsbury's Emergency centre is not just modernisation and natural growth but also growth to accommodate Telford Major Injuries unit work flows, The consultant Maternity Emergencies and Cardiac emergencies. Not moving them is not an option because closing services at Shrewsbury is placing care out of reach by too many miles and too much time. Drive past to better care in not applicable here, the distances are too great. It is too far to drive past. The new building is to correct those errors of the past when the NHS policy was different. The STP principles require the new building, but it was required anyway. All this was confirmed by the senior consultant in emergency medicine when the STP was discussed by the Senate.

These are all problems that would exist in a city scenario They are the different problems of a rural catchment where different rules need to apply. The Hospitals are not ten miles apart. In reality they are up to 85 miles apart. The studies on A&E never took that into account.

johnfrederick

Roger You still have not answered my question ?

Roger

I thought I had. I was not at the meeting, but what I quoted above was the discussion on Future Fit and how the A7E ASPECTS HAD MOVED TO THE stp project office and the capital investment requirement had been submitted as a part of the 311 million bid.

Could you quote exactly what it is that bothers you and I will comment. I think we would all be interested in any threat to move A&E out altogether. Apart from the inability of the trust to recruit and retain consults I see no way we could any worse than current arrangements without serious threat to life of our population.

Recruit and Retain is both a local and national issue brought about by too much change and not enough medical university places leading to junior doctors opting out after the imposed pay and conditions settlement. It is a Hunt problem caused entirely politically and will therefore require a political solution. Not even privatisation can create more doctors overnight. Hunt must act to make the specialisation more popular but backing off on the Doctor's settlement and settling the national A&E structure as a practical working model.

But again I don't know exactly what you are referring to.

johnfrederick

What bothers are plans to cut hospital beds in Shropshire , plans to move parts of cancer treatment out of Shropshire , Why WMAS service do not do what they say they are going , Lastly not being told the truth a bout the better care fund and care in the community and how the people of Shropshire will get a third rate SERVICE out of all of this ?

Roger

Cutting hospital beds

There is an entry in the STP about this;

"The community bed review.

Neighbourhood working will require some access to locally provided beds for patients. At present these are provided through community hospitals, local authorities and care homes. As Neighbourhood working develops, the local provision of beds will be reviewed. The development and use of “virtual wards” will provide the vehicle for this initiative".

I have a little difficulty in the term "Virtual bed". I don't know it means. It could mean closing the community hospitals and renting beds in private nursing homes. That would be very expensive but is not unknown. Shropshire CCG do have a contract to provide beds in private care homes allocated by the CCG. I can see how it works but can't help thinking that it will be more expensive. The alternative would be close the community hos[pital and reallocate beds in Shrewsbury or Telford Hospital as virtually in the community.ie. allocated to say Ludlow but actually in Shrewsbury. That would be crazy because in reality it is not in the community. So one is too expensive and the other unreal. I think it is a concern I would share with you until we know what a virtual bed is. The objective as I see it would be to close all community hospitals and sell off the buildings. Replace them with Community Health Centers as wider aspect GP Surgery and rent beds as required. Logical but impractical. They are buying into a shrinking market of care home closing because the fees are not big enough. The beds might become available by Adult Social care not supporting them so the the NHS could. However it does not miraculously reduce the number needing care homes just moves the payments from SCC to NHS. But a higher fee for standby beds which we could more for to keep some empty. It reduces hospital costs and increases CCG costs. In narrow terms it reduces the beds by closing the community hospital but it would actually increase CCG costs. I obviously do not under stand what virtual bed is but i hope the patient finds a bed to sleep in.

Cancer care

Again I agree with you. The NHS had a rather over optimistic view of how they could outsource this service in North Staffordshire and that might be the specialised care organisation to which Shropshire patients must travel. That has now fallen apart because the preferred contractor has walked away saying the specification not not be met within the funds available. Of course that must be true because so much of the cancer care facilities are supported by charity in Shropshire. By moving it away the charity support would not follow so it would be more expensive if the NHS has to meet the whole cost. The whole purpose of the Lingen Davies Cancer Relief Fund is to ensure that cancer is delivered in Shropshire so that people don't have to travel. That represents millions of pounds of support to cancer treatment in Shropshire including what Macmillan nurses do in the treatment centre. In effect shifting care out of Shropshire would be walking away from those millions. It makes no sense at all.

Of course there are some specialised treatments that Shrewsbury can not provide. Some are done at Gobowen and others in regional centres. That would have to carry as it is now. New treatments like Proton beam radiotherapy made famous in the Ashya King case are only going to available in five or six centres nationally so Don't see us getting one of them. At the same time I don't think it's beyond ambition that the Lingen Davies Cancer Relief Fund might not try to raise the money to provide one. I suspect that the STP is based on national templates that do not account for the charitable contributions on the scale of the Lingen Davies Cancer Relief Fund. In combination with the failure to privatise I see another review coming up that is more locally specific. Like so many I have every reason to support the cancer unit in Shrewsbury as my Partner was treated there . Unfortunately not successfully but I would never go anywhere by choice. Best ward in the Hospital.

Money

Again I agree with you. The STP is a cost reduction exercise not intended to improve care. Future Fit was a care improvement exercise but that is now as subject to cost controls as the STP. Where it spreads out to the government's initiative on improving Adult Social care and pushing more funds into the community aspects there is some visibly. At least the two years on council tax increases of 1.99% to fund it. But like most money that goes into Shropshire council it enters as money in bulk but how it is spent is not clear. At the end of the day we know that government has found money through us paying more taxes but amount is not half of what is required to take the pressure off the NHS and care the elderly. It is a political issue of a government mistake trying to be covered up with only half the funds required. It is going to be "fudged" to look like they have addressed the issue whilst actually only half what needed and far less than was taken out. It can only get worse as councils are required to be self sufficient by 2020 with all grants removed. They are not going to own up to such catastrophy so it will be fudged.

There is a wider issue which is the CCG overspend of budget. The more it goes on and the more MHS experts that look at it the more it obvious that the the CCG was underfunded. It appears that with no government money available the budget will not be increased because there is no new money and to increase it would mean taking off other CCGs which they not prepared to do. In these circumstance the extra 2 million for Telford CCG was appalling. I can't see any NHS policy that can accept the budget was wrong and will be corrected. So we have to live with it until there is political change at the very top. As it is I can't see the STP delivering the saving they projected and the capital cost is financially unjustifiable.

Hunt and Simon Stevens will have to go before change can be brought in because they are both over invested in the plan that will not work. Only Theresa May can do that and she is very reluctant to admit it failed if it costs more to stand still. It makes the government look incompetent. Therefore the whole blame must be loaded on Hunt and a new Health Secretary appointed as the White knight to ride in and sort it. He won't but timing is important. He has to look as if he is by May 2020.

So I agree with you, you have identified three holes in the plan. I fear there are many more holes which why the flower language of the STP. High level objectives with no details of how to deliver them leaving everybody wondering. The first requirement of the plan is £311 million in capital investment. Without that the plan is no more that a fairy story of ambitions without the means of converting them to achievements. It is simply aspirational.

Take a look at;

https://www.hah.co.uk/wp-content/uploads/Virtual-Hospital-Report_AW_Final2.pdf

Personally I think it has missed the point about what causes Bed Blocking, but interesting.

Roger

Everything changes. The announcement of the General Election changes everything. May wants a clear mandate to get a hard Brexit rather the the soft one the brexiteers promised and that means not letting the economy or the NHS stand oin the way. Nobody is going to vote the party that wrecked the NHS so she needs to deflect the NHS issue and could well do that by saying The STP is a dud, Sack Hunt and it's architect Simon Stevens and promise a white knight review as predicted above. It will of course be empty promises so we can longer depend on anything they say. STP could be scrubbed but nothing detailed in it's place and therefore a much more aggressive policy after the election.

Phrases like we can only afford the NHS if the economy is successful will disappear because they will also play down the failing economic recovery and failure to close the deficit. So I am expecting promises galore none of which are credible. They have to shut down the NHS and Economic arguments.

The danger of course is that Brexit will now be a hard brexit with full blown Henry the Eiigth power and no common veto on the final agreement.. It will now become a manifesto promise so the Lords can not block it. The other minor issue is education which heading for a similar crisis. they were halted on compulsory academisation and will be on grammar schools because they were not in the manifesto. Expect some small print that can be activated after the election. I think we suspend belief on the NHS for the time being but keep a close eye on the small print of the manifesto. Remember they put a seven day NHS in the manifesto and used that to impose the junior doctor's settlement but there is no sign of a seven day NHS. I think May will start believing the NHS is not a big issue but I think that would be a mistake. One they will seek to put to sleep by week two. Just remember there are lies absolute lies and political promises. Locally I think the NHS is going to be a big issue for our MPs. Lucy Alan thinks this, the STP clarification, a victory where in reality it is nothing new. She has gone from a glass half empty to a glass half full, we can expect her glass to seem to overflow in the next few weeks. That of course means big promises to Telford that DK will have to countre with even bigger promises for Shrewsbury. It will be a battle royal of the ability to make Tories look good wherever they defend a seat. Personally I think all Shropshire and Telford MPs are at risk because they have actually delivered nothing but cuts out here in the badlands. They will be playing a vacuum for all it's worth. Door step conversations could be very interesting. Existing redressing of the news will be as nothing compared with the next six weeks.

I think we can suspend belief until June 9th now.

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