Shrewsbury & Telford Hospital NHS Trust (SaTH) – which manages Royal Shrewsbury Hospital (RSH) and Princess Royal Hospital (PRH) in Telford, has published updated details of its proposals for the 'Future Fit' re-organisation.
The trust's 'Strategic Outline Case' (SOC) for the controversial plans was approved by the government and the NHS last month.
The SOC, which sets out options for how the reorganisation will work, and what services will be based where, has now been made public for the first time.
The document confirms a Shropshire Star report from January, that health bosses had wanted to proceed with a plan that cost more than £500m – well over the £312m allocated by the government.
The SOC includes three options – but two have been discounted over cost, with the preferred option described as the 'do minimum' choice of what can be completed for the £312m available.
The 'do minimum' choice includes all the major and controversial elements of the Future Fit plan – having RSH as the county's sole 24-hour A&E, and PRH as the centre for planned care, but drops a number of elements of the "wider Future Fit ambitions".
The SOC explains that rises in costs since 2016, when the plan was first set out, mean that £312m will now only pay for the 'core clinical model'.
It states: "Due to inflation in build costs and additional mandatory build requirements (including Net Zero and single room requirements), £312m would now only enable the core clinical model to be delivered and would not allow other elements of the previous scope to be included."
The core elements would see A&E, critical care, and women & children's services moved to RSH, with planned care at PRH.
Both hospitals will have urgent care centres 24 hours a day – through an 'A&E Local' model at PRH.
It will also see ongoing medical wards and rehabilitation wards at PRH, as well as the expansion of pathology and pharmacy services.
A number of elements included in the more expensive options – costing £481m and £534m respectively – will now not go ahead until funding can be found.
They include further new bed capacity that complies with current standards and repurposing the ward block at RSH to increase the space available for education and training.
They would develop day case chemotherapy to Macmillan Quality Environment Mark standards, and upgrade planned services, both on the PRH site, and upgrade existing theatres – reducing risks associated with the trust's buildings.
Other plans were to upgrade outpatient facilities on both sites, as well as ward accommodation at PRH, along with developing an integrated multi-partner health and wellbeing hub on the PRH site.
The SOC says that the trust would expect to have the work on the core elements completed by December 2026, if the business case is approved - another stage yet to be passed.
The SOC outlines how the current hospitals set up is failing patients and staff, describing a "pressing need" to tackle the issues.
It states: "The current clinical service configuration does not meet the needs of patients. There are two inadequately sized emergency departments, split site delivery of key clinical services (including critical care), insufficient physical capacity (particularly affecting elective services), mixing of planned and unplanned care pathways, and poor clinical adjacencies.
"There is a pressing need to tackle these issues, which has only increased in the three years since we made a strong public commitment to address the problems by reconfiguring services.
"Covid-19 has further highlighted the need to reconfigure, and the Care Quality Commission (CQC) have also highlighted the adverse impact that our current service configuration is having on the quality and safety of our services.
"If we cannot make changes, there is an increasing risk to the staffing, quality and continuity of core clinical services at both sites."
Louise Barnett, Chief Executive of The Shrewsbury and Telford Hospital NHS Trust which runs both acute hospitals, has welcomed the approval of the SOC, and said that progress on the plans is "vital" to improve health for people across Shropshire and Mid Wales.
She said: “The Hospitals Transformation Programme aims to improve both the quality of patient care and the sustainability of the services that we provide to our communities.
“We simply cannot continue with the current service configuration because it will not be able to meet the future needs of our population and gives rise to significant workforce issues.
“Approval of the SOC has enabled us to take a major and exciting step forward and we are already working on the next stage, involving the development of an Outline Business Case which will set out the future plans in more detail.”
Simon Whitehouse, Chief Executive Officer for NHS Shropshire, Telford and Wrekin, said: “The Hospitals Transformation Programme is a key part of our overarching plans to transform health and care services across Shropshire, Telford & Wrekin and mid Wales. We remain committed to achieving the ambitions of the Future Fit consultation so that we can improve quality, safety, experience and outcomes for local people.
“The £10million of funding announced recently to create an elective surgical hub at the Princess Royal Hospital is also fantastic news. This development fully aligns with the Hospitals Transformation Programme.”