It is unclear how serious the latest developments in the Future Fit saga are, and what impact they will have on the overall plan, but they make plain that hospital bosses have been asked to prepare for the possibility they will be unable to carry out their vision in full.
The proposals to re-organise both Princess Royal Hospital in Telford and Royal Shrewsbury Hospital – both managed by Shrewsbury & Telford Hospital NHS Trust (SaTH) – date back nearly 10 years.
The protracted process had appeared to be reaching its final stage with the submission of a "strategic outline business case" in October last year.
The SOC details the plans for the hospitals and the cost of doing the work to make it a reality. It needs to be approved before the government officially hands over the money needed for the plan.
It is understood that the costs of the proposals for the hospitals have now risen considerably from the £312 million allocated by the government in 2018 to somewhere north of £500m.
The comments after Health Minister Edward Argar confirmed that the NHS wanted more information within the business case submitted by SaTH – specifically an option that meets the £312m funding previously allocated.
It does not mean that will be the only option considered by the NHS, with the more expensive reorganisation to remain as part of the proposal.
Mr Argar said he expects the revised submission to be in within the first quarter of the year.
SaTH's official response to the latest news gives little away – confirming only that it is looking to see how best its plan can be achieved with "the funding that will be made available".
A spokesman said: “We are continuing to work closely and collaboratively with NHSEI and our local health system partners on the iterative review and approval process.
"We’ve already addressed the vast majority of the questions raised through the initial feedback and are continuing to explore how the outputs of the extensive public consultation and current national standards can be best met with the funding that will be made available.”
Local health campaigner, Gill George of Shropshire Defend our NHS, has been opposed to the Future Fit reorganisation for some time, and she said the latest news was more evidence of time for a re-think.
She said: "This just confirms that Future Fit is in utter chaos. This is a complete shambles of a project and the only sensible course of action at this stage is to pull the plug completely and set up a health system that meets people's needs."
Under the scheme, Royal Shrewsbury Hospital will house the county’s main A&E with PRH losing its consultant-led women and children’s services and becoming the site for planned care.
Both hospitals were also originally due to get urgent care centres, but after the plans were reviewed in 2019 former health secretary Matt Hancock asked NHS England to provide advice on how the "urgent care model" at PRH could be delivered through an "A&E Local".
The NHS trust that runs the hospitals said the enhanced urgent care model at PRH will be staffed by "highly skilled senior health professionals".
Hospital chiefs say the majority of people who currently attend the county’s A&E departments require "urgent" and not emergency care, and about two thirds of those who currently access A&E services at PRH would still get the care they needed at that site.
Speaking in December, SaTH said that the plans would "deliver benefits for the entire population".
A spokesman said: “As set out in the public consultation, we are proposing that A&E services will be consolidated at RSH, with a 24/7 urgent care model at PRH that will offer an extensive range of services and care staffed by highly skilled senior health professionals.
“The creation of a new dedicated emergency care centre, where specialist doctors treat the most serious cases, will deliver benefits for the entire population and help us to address the issues we currently face in this area. The precise range of urgent care services to be offered at PRH will be determined as we develop our more detailed plans, but based on initial analysis, we would expect that around two thirds of patients who currently access A&E services at this hospital would continue to receive the urgent care they require at PRH under the proposed plans."