Key year ahead for Shropshire's long-awaited hospital reorganisation plans

The coming 12 months will see two major milestones in plans for Royal Shrewsbury Hospital (RSH) and Princess Royal Hospital (PRH) in Telford – both managed by Shrewsbury & Telford Hospital NHS Trust (SaTH).

The £312m hospitals transformation process (HTP), previously known as ‘Future Fit’ is closer than ever to being realised, and officials at the trust say they are focussed on the next stage in making them a reality.

It is a key project for staff at the trust, which has been in special measures since 2018, and has some of the worst A&E delays in the country. The proposal passed a major hurdle earlier this year when the government approved the Strategic Outline Case for the plan – and is backed by all of the county’s MPs.

The trust is currently working on the next key phase of the project, the outline business case, expected to be submitted in Easter and reviewed by the government in the summer.

The third phase, the full business could be signed off by the end of 2023, with work potentially beginning in 2024, which would mark major progress for a project that dates back years, and has been beset by repeated delays.

It comes as the wider NHS is under its greatest pressure ever, from GPs to ambulance services, along with issues in community care.

The focus of the proposals is making the Telford site the base of planned care, and the Shrewsbury site the centre of emergency care.

Nigel Lee, director of strategy at the trust and the director leading the HTP plan, said that change is vital, and the ambition is to create “two thriving hospital sites”.

He said: “We know we cannot continue as we are because it is not helping us and it is not helping our patients.

“The underlying thing is about creating a more clinically sustainable site of acute services for the population and it is very much about looking at improving care for all our residents across Shropshire, Telford & Wrekin, and parts of Powys. We are absolutely focussed on delivering two thriving hospital sites.”

Dr Ed Rysdale, an emergency medicine consultant at the trust, said the proposals were centred on making sure the trust’s patients receive the best care possible. He said: “People say we are downgrading care, we are not, we are improving care. As clinicians we would not be doing anything that does not improve care for our patients. It is all about providing the best care we can for all our patients.”

Mr Lee said that the plans would help reduce waiting lists and cancellations for planned operations through the key planned care focus at PRH, with improved emergency medicine at RSH. He also pointed to the plans for urgent care sites at both sites – both of which would be available 24 hours a day.

Dr Rysdale said that focusing specialties on individual sites is key to bringing and retaining quality staff – and providing treatment for which patients currently have to travel out of the county.

He said: “At the moment for example with emergency medicine you can pretty much work in any hospital because there are vacancies around the country and what puts people off is split site services. Other places such as Stoke or Wolverhampton are more attractive because the services are on one site.”

He said that the improved services would also be key in attracting and keeping trainees, adding: “These are the consultants of the future. Having trainees come through this system they are more likely to want to stay with us.”

The view was echoed by Mr Lee who said: “With workforce challenges meaning we are not creating a clinically sustainable set of services, which mean for a number of key areas it is not then attractive to join because staff want to join a thriving team, they can see it is a great place to work, where they can deliver the care they want.”

Dr Rysdale said that while the plan would not solve all the health care struggles in the county – with community care discharge remaining a key issue in freeing up vital space at hospitals – it would help cut ambulance waits and lift some of the major pressure seen in recent months.

He said: “Currently the pressure in our emergency department is as pressured as I have ever known it. They are as bad as I can remember and the waits in our department are getting longer than I remember – and I worked before the four hour target came in. It is very, very hard for our nursing staff, who are spending many hours looking after patients in A&E. They are providing effectively in-patient medical care that would normally be delivered on a ward, but because patients are in A&E for a long time they are delivering it there.

“That puts a lot of strain on our nursing staff because they want to be doing emergency medicine, that is what their job is. We don’t want the patient waits we are having – to work out who comes in next, and it is a difficult decision at times.

“For me it is the most difficult part of the job, the ambulance waits outside. The big thing that will make a big difference is if we have a patient who needs to transfer to Stoke, or to Shrewsbury from Telford, or from Shrewsbury to Telford, we may well be waiting hours for an ambulance because they are stuck outside or we can’t get one, and that is a real strain on the team. That will all go with HTP because all services will be on one site.”